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The purpose was to assess COVID-19 beliefs and attitudes and examine COVID-19-related changes in sexual behavior of men who have sex with men during 3 time periods: April-July 2020 (T1), August-December 2020 (T2), January-May 2021 (T3).Data were analyzed from 157 men who have sex with men in Ohio recruited to participate in a longitudinal multisite network study of syphilis epidemiology in 3 US cities: Columbus, Ohio; Baltimore, Maryland; and Chicago, Illinois. In April 2020, a COVID-19 module was appended to existing baseline and follow-up surveys to assess beliefs, attitudes, and changes in sexual behavior. Sample characteristics were summarized. Correlations between demographic variables (age, racial identity) and COVID-19 outcomes were examined.In response to COVID-19 social distancing restrictions and self-reported anxiety, some men limited sexual activity at T1, but the majority (n = 105 [67%]) continued to engage in sex. The number of men engaging in sex increased over time (T2: n = 124 [79%]; T3: n = 121 [77%]). At T1, men not in a relationship more frequently reported having less sex compared with prepandemic (n = 39 [57%]). By T3, men in a relationship more frequently reported less sex (n = 32 [54%]). Increased anxiety about sex and condom use was positively correlated with identifying as a man of color (P0.001). Most of the sample reported either starting or increasing online sexual activity during each time period.Future efforts to target sexual health during a pandemic or other health emergencies should prioritize men of color and address the unique perspective of both single and partnered men.

The objective was to review sexual and gender minority (SGM) health research studies to gain an understanding of how the community-based participatory research (CBPR) framework has been operationalized.We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to conduct a review of all SGM health research studies published in the past 10 years that cited a CBPR approach (PROSPERO Registration No. CRD42016036608). CINAHL, PubMed, and PsycINFO databases were systematically searched in October 2020. Dimensions of community involvement (e.g., shared decision-making; flexibility to community needs and priorities) and the strength of evidence for each dimension were rated using guidance from the Agency of Healthcare Research and Quality.The 48 eligible articles identified reported a range of 0-11 (out of 13) community elements. Seven studies reported zero elements. Qualitative studies (Adhering to the CBPR framework is challenging. The benefits of striving toward its principles, however, can move us toward transformative and sustainable social change within SGM communities.

The consistently high rate of sexually transmitted infections among people 18–24 years old warrants novel strategies promoting condom use among large segments of this population. Ample opportunity exits to employ such strategies in university settings. This study evaluated a sex-positive, home-practice intervention designed to promote condom use among university undergraduates engaging in penile–vaginal intercourse (PVI). A sample of 29 opposite-sex undergraduate couples, engaging in PVI, was recruited from a large university. After teaching couples about condom use, a health educator helped couples select condoms/lubricants from options comprising various sizes, fits, shapes, textures, and other features. A 30-day ‘homework assignment’ was made to use these products while reducing condom use errors/problems and enhancing sexual pleasure. A repeated measures design, with a six-month observation period, was used to evaluate the program. Over the six-month period, the mean frequency of condomless PVI decreased from 26.4 to 3.9 times ( P

Objective Single-visit intrauterine device (IUD) insertion protocols are recommended. We assessed the availability of single-visit IUD insertions, and whether access to these services varies by age, race or parity. Study design Using audit study methodology, we called a random sample of 396 obstetrician-gynecology practices in Ohio while posing as a potential client seeking an IUD insertion appointment. Callers used eight standardized scripts and noted justifications for protocols offered by clinic staff. Practices were randomized to follow a balanced 3×2 factorial design, whereby practices were assigned to one of two conditions: (1) age (18 vs. 30 years of age); (2) race (white vs. black); and (3) parity. Multivariable logistic regression was used to control for clinics rural vs. urban location while considering the effects of these variables on service provision. Results Almost all (95%) of the practices called offered IUD placement, of which 92% required multiple appointments for IUD insertion. Although access to single-visit IUD services did not vary by age or race, we found that parity was associated with clinics’ willingness to schedule a single-visit insertion visit (OR = 3.84, 95% CI = 1.23, 12.04). The most frequent justification provided by clinic staff for their multiple-appointment protocol was the need to verify insurance coverage or order the device directly through the patient’s insurance company. Conclusion Ohio patients seeking IUD placement must typically make more than one clinic visit. Implications Efforts are needed to reassure Ohio clinics that IUDs are routinely covered by insurers and to increase access to same-day IUD placement for women in Ohio, as the requirement to attend multiple clinics appointments to obtain a desired contraceptive may pose an insurmountable barrier to care for those with the fewest resources.

Background As part of an ongoing sexual network study, we assessed the impact of COVID-19 on sexual behavior of men who have sex with men (MSM). Methods The Columbus, Ohio arm of the multi-site Network Epidemiology of Syphilis Transmission (NEST) study is following 241 MSM over two years. Participants attend quarterly visits with behavioral surveys and HIV/STI testing. In April 2020, we implemented an additional survey to measure the impact of COVID-19 on sexual behavior. Our analysis compared participants’ reported sexual behavior during two periods: April-July 2020 (T1) and August-December 2020 (T2). Results Of the 200 participants who completed at least one COVID-19 survey in either time period, 10 (5%) self-reported a previous COVID-19 diagnosis. We compared behaviors reported by 174 respondents who submitted surveys in both time periods. During T1, about half (46%) said they felt more anxious about sex since COVID-19; anxiety was similar during T2 (43%). Many reported engaging in online sexual activities, though we saw no meaningful differences by time period for starting or increasing chatting on hookup apps (T1=30%, T2=30%), sexting (T1=30%, T2=25%), or video chat sex (T1=16%, T2=14%). Watching pornography was reported more often in T1 than T2 (53% vs. 42%). Nearly a third of respondents (30%) in T1 reported that they were not having sex; this decreased to 17% in T2. Compared to pre-pandemic behavior, in T1 a majority of participants (74%) said they were less likely to have sex with a new partner, compared to 61% during T2. Conclusion During COVID-19, nearly half of MSM reported feeling more anxious about sex, and many turned to online activities in lieu of in-person sex. However, when comparing the early months of the pandemic to later months of 2020, more participants are resuming in-person sex, and willingness to have sex with new partners also rose.

Background In preparation for a prospective network study of men who have sex with men (MSM), we conducted a mixed-methods pilot study to examine feasibility and acceptability of several study components, including recruitment, data collection, and compensation. Methods We conducted in-depth interviews (IDIs) with eight providers serving MSM and five focus group discussions (FGDs) with 34 MSM from four target MSM populations: young Black men, HIV-positive men, HIV-negative men on pre-exposure prophylaxis (PrEP), and men not engaged in medical care. We also conducted a 4-week pilot of a smartphone app for ecological momentary assessment (EMA) with 20 MSM (ongoing). EMA surveys were employed to capture daily data on anal and oral sex, consumption of alcohol and drugs, use of hook-up and social networking apps, and other behaviors. We used a brief exit survey to assess EMA app acceptability. Results A major theme identified during IDIs and FGDs was the importance of developing trust and maintaining confidentiality during proposed respondent driven sampling (RDS) recruitment activities. A second FGD theme emphasized the importance of compensating participants appropriately for RDS and other study activities. All EMA participants reported being “completely comfortable” reporting their sexual behavior through the app. Most (67%) preferred the app to in-person interviews. Several participants identified technical issues with the app, including not receiving push notifications and spontaneous app closure. Conclusion IDIs and FGDs confirmed that developing trust and protecting participant confidentiality are critical for successful RDS recruitment. FGDs showed that MSM value their contributions to research and desire commensurate compensation. The EMA app was acceptable, despite technological challenges. It is feasible to use EMA to capture sexual behavior in this population. This mixed-methods pilot allowed for adjustments to the planned network study, including changes in compensation type and amount, troubleshooting technical issues, and modifications to the EMA survey. Disclosure No significant relationships.

In 2012, Jackson, Mississippi, had the third highest incidence rate of human immunodeficiency virus (HIV) among young Black men who have sex with men (MSM). The goal of this qualitative study (the initial phase of an HIV prevention clinical trial) was to explore how cultural norms regarding antihomosexual attitudes interfere with the safe sex practices and relationship norms of young Black MSM in Mississippi.Nine focus groups (N = 54) were conducted with young Black MSM aged 18-29. Participants were recruited through medical providers at local sexually transmitted infection clinics and through community organizers at local LGBT outreach programs. The data were analyzed through the use of grounded theory, multiple coders for consistency and intercoder reliability, and a qualitative data analysis software.Three major themes were identified during the analysis: (1) resiliency and condom use, (2) inconsistent condom use among closeted young Black MSM, and (3) intimate partner violence (IPV) among closeted young Black MSM. Black MSM in Mississippi continue to be highly stigmatized within their social networks (i.e., families, sexual partners, and community).The findings suggest that cultural and community norms regarding antihomosexual attitudes may be a barrier to the practices of safe sex and a contributing factor to IPV among young Black MSM. There is a need for tailored interventions that address these cultural norms and establish social and community support for young Black MSM in Mississippi.

Condom negotiation among young Black men who have sex with men in the Southern United States was explored using the theory of reasoned action. Fifty-four (18- to 29-year-old) males participated in nine focus group interviews. Discussions elicited condom use and negotiation attitudes, beliefs and social norms. Positive personal attitudes (respect of self, personal health concerns) and high negotiation self-efficacy was emphasized. Conversely, social norms revealed non-prioritized condom use behavior. Divergence between individual and community indicates theoretical models targeting sexual communication must address external factors (social, economic, political context), which intersects with individual intentions, attitudes to influence HIV prevalence in this community.

This study was undertaken in two locations in Trinidad Sea Lots and Point Fortin between November and December 2007. Participants were women aged 16-24. The study uses the PEER (participatory ethnographic evaluation and research) method to generate in-depth narrative data and provide an authentic insider view of the realities of the target group. The FoQus on Segmentation strategy was used to gain programmer input into the study design identify potential determinants of condom use and explore factors that will be used to develop a concept for promoting condom use with outside partners. PSI/Caribbean will use the results to develop interpersonal communication activities and a media campaign directed at the target group. Initially the study set out to understand transactional cross-generational relationships identified as a major risk factor among the target group. The data revealed that within the target population sexual relationships and financial benefits are intimately linked within all relationships. Despite the differences in economic context between Sea Lots and Point Fortin in all interview narratives sex and money are inextricable. An over-riding feature of the interviews is that sex is commoditised as part of the norm of relationships. Sex without financial gain is perceived within the target group as aberrant and certainly not normative. The data made clear that defining some relationships as transactional and some as not is not meaningful in the context of the target group. The study has therefore focussed on understanding how patterns of concurrent relationships are managed and maintained.

This study explores beliefs held by young African American men newly diagnosed with a sexually transmitted infection (STI), regarding condom use. Recruited from a publicly funded STI clinic, participants were African American men (18–29 years of age) who reported using a condom in the past 3 months for penile–vaginal intercourse. Through face-to-face qualitative interviews, 20 men shared their perceptions of condom use with female partners. Findings suggest that condom use among high-risk African American men may best be understood as part of the complex relational dynamics associated with having multiple partnerships. Given the high seroprevalence of STIs in their communities and sexual networks, men also describe the tensions related to sexual pleasure and the fear associated with non-condom use.

A focus group session, using the Theory of Planned Behavior to guide questions and discussion, was conducted at midpoint of a 12-month cooking skills program in a rural Appalachian food desert. The purpose of this qualitative study was to determine the attitudes, subjective norms and perceived behavioral control beliefs that influenced participation in these classes. Participants viewed the classes as opportunities for social interaction and to have new experiences. Subjective norms were influenced by family members and traditional cooking. Perceived behavioral control was influenced by the opportunity to try new foods without concern of food waste, acquisition of the knowledge to introduce healthy foods into family meals and enhanced food preparation skills. During the evaluation, a strong sense of participant appreciation of researcher presence was discovered. This unexpected positive component of the program will be promoted using motivational interviewing techniques to enhance adherence to healthy eating behaviors during and after cooking skills programs.

Background The aim of this study was to describe acceptance of and experiences utilising expedited partner therapy (EPT) among African-American girls recruited from short-term juvenile detention centres. Methods: Ninety-five detained African-American girls (aged 13–17 years) completed audio computer-assisted self-interviews (ACASI) and self-collected vaginal swab specimens assayed for chlamydia and gonorrhoea. EPT was offered to sexually transmissible infection (STI)-positive participants (n = 51); follow-up phone interviews assessed medication delivery to partners. Summary statistics described EPT acceptance frequency. Generalised estimating equations assessed correlates of acceptance. Nine semi-structured interviews elicited EPT experiences. Results: EPT was offered 69 times, accepted by 70% (n = 37) girls and provided to 68% (n = 36) of girls. Acceptance was significantly associated with sexual risk behaviours such as infrequent partner STI prevention discussion (OR = 3.2, 95% CI: 1.0,–10.1, P = 0.048) and ≥ 4 lifetime sex partners (OR = 3.3, 95% CI: 1.0–11.0, P = 0.048). Discontinued relationships were the most common barrier to EPT acceptance. Emergent interview themes included sense of responsibility, which appeared to motivate acceptance and help overcome identified discomfort with partner disclosure conversations. Conclusions: Future research is needed to determine EPT efficacy among African-American juvenile populations and feasibility of its use outside of research settings.

Objectives Objectives were to (1) explore perceived effectiveness of existing smoke-free print advertisements in rural communities and (2) generate message content, characteristics, and media delivery channels that resonate with residents. Design and Sample Qualitative methods design. Thirty-nine rural adults recruited by community partners. Measures Content analysis of findings from individuals in four focus groups who participated in general discussion and reviewed eight print ads related to secondhand smoke (SHS) and smoke-free policy. Results Six content themes were identified: smoking/SHS dangers, worker health, analogies, economic impact, rights, and nostalgia. Seven message characteristics were recognized: short/to the point, large enough to read, graphic images, poignant stories, statistics/charts/graphs, message sender, and messages targeting different groups. Four media delivery channels were considered most effective: local media, technology, billboard messages, and print materials. Conclusions Seeking input from key informants is essential to reaching rural residents. Use of analogies in media messaging is a distinct contribution to the literature on effective smoke-free campaigns. Other findings support previous studies of effective messaging and delivery channels. Further research is needed to examine effectiveness of themes related to message content in smoke-free ads and delivery strategies. Effective media messaging can lead to policy change in rural communities to reduce exposure to SHS.

This article is a revision of the previous edition article by S.C. Kalichman, volume 10, pp. 6880–6882, © 2001, Elsevier Ltd.

Lesbian, gay, and bisexual (LGB) people are affected by multiple health disparities and risk factors, including tobacco use. Few studies to date have examined tobacco use specifically in rural LGB populations, and none has investigated the intersections of identity, rural LGB culture, and tobacco. The purpose of this study was to explore the perspective of Appalachian LGB people regarding tobacco use. Methods . Nineteen LGB-identified Appalachian residents participated in audiotaped, semi-structured interviews. Two authors analyzed and coded transcripts through constant comparison, and determined themes through consensus. Results . Five themes emerged: the convergence of Appalachian and LGB identities, tacit awareness of LGB identity by others, culture and tobacco use, perceived associations with tobacco use, and health beliefs and health care. Conclusions . LGB Appalachians connect stress and culture to tobacco, but seem less aware that partial concealment of their identity might be a source of the stress that could influence their smoking.

In the United States, law enforcement and judicial systems and mental health professionals continue to struggle to deal with the rise in the number of juvenile sex offenders. The consequences of sex offending are substantial for victims, society, perpetrators, and their families, involving significant human (emotional and physical suffering) and financial costs. Adolescent sexual offending is a complex phenomenon that cannot be easily explained. Many theories have been proposed to explain why some children and teens sexually abuse others. However, to date there is no empirically derived and tested model to explain what motivates adolescents to perpetrate sexual crimes. This chapter provides an overview of biological, individual, familial, social, and behavioral characteristics of adolescents who have sexually offended. This chapter also reviews common approaches to treating and preventing recurrent sexually aggressive behavior in juveniles.

Objectives. We tested the efficacy of a brief intervention to promote correct and consistent use of condoms among Black male youths attending sexually transmitted infection (STI) clinics in 3 southern US cities. Methods. In 2010 to 2012, we screened (n = 1102) and enrolled (n = 702) youths aged 15 to 23 years who identified as Black and reported recent (past 2 months) sexual activity and randomized them to a private, brief, interactive intervention (n = 349) or an attention-equivalent control condition (n = 353). Assessments occurred at baseline and 2 and 6 months after the intervention. Results. At 6 months, with adjustment for age and pretest nonequivalence of the outcome variable, an estimated odds ratio (EOR) of 1.63 (95% confidence interval [CI] = 1.07, 2.49; P = .02) indicated efficacy for correct condom use. An adjusted generalized estimating equations model with both 2- and 6-month condom use variables produced an EOR of 1.49 (95% CI = 1.06, 2.08; P = .02). We did not observe significant effects on chlamydia and gonorrhea incidence. Conclusions. This brief intervention, delivered as part of STI clinical care, could help alleviate the disproportionate STI–HIV burden among young Black men.

Background The purpose of this study was to identify unmediated associations of early sexual debut (ESD) on the current safer sex practices of young Black men (YBM). Methods: A cross-sectional study of YBM (n = 697) attending clinics treating sexually transmissible diseases (STIs) in three cities was conducted. ESD was dichotomised at the age of 13 years and under. A series of regression models were used to test the moderating effects of ESD and perceived parental monitoring (PPM). A regression model also tested the effect of years of sexual experience (YSE) on sexual risk behaviours, while controlling for ESD. Results: Mean age of debut was 13.95 years. ESD results varied with significance for pregnancy (P

Background Media is a social determinant of HIV and sexually transmissible infection (STI) risk. However, limited empirical data have examined men’s media exposure and their sexual attitudes and behaviour towards women. Methods: Eighty heterosexual African-American men were assessed on their exposure to music videos, sexual attitudes and behaviour. They also were tested for STIs. Results: Findings indicated that men influenced by music videos reported more sexual adventurism, more condom barriers, more lifetime sexual partners, more condom request refusals, substance abuse and a history of incarceration. Conclusions: Further longitudinal research is needed to better understand this relationship and to address the role of media in HIV and STI prevention interventions.

Objective: To provide an updated review of condom migration as a means of highlighting methodological issues for future studies of this behavioural issue. Methods: Electronic searches of PubMed, MEDLINE and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were carried out in October 2010 and updated in January 2011 for English-language articles published from 1994 onward. Results:Evidence addressing condom migration from microbicides and vaccines is vastly underdeveloped, simply because these products are still experimental. In contrast, the more advanced evidence regarding male circumcision is hopeful because it suggests that migration may not be an overwhelming issue. Nonetheless, the entire body of empirical evidence on this question could be substantially expanded and improved. Conclusion: Until stronger evidence suggests that condom migration is unlikely, it is important to be mindful of the potential for condom migration to occur in response to biomedical interventions (circumcision, microbicides and vaccines).