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Objectives Gay and bisexual men may feel discomfort discussing sensitive topics such as sexual behaviors and substance use with their health providers, which may prevent them from receiving important health information. This study investigates whether patients’ perceptions of their provider’s sexual orientation predicts patient-provider discussions of sexual and general health topics, and whether this relationship is moderated by patients’ disclosure of sexual orientation to providers. Methods Data were collected online from a sample of 576 gay and bisexual men living in the USA, aged 18–26. Adjusted risk ratios were estimated by using modified Poisson regression with robust error variance. Results Participants who believed their providers were gay or bisexual were more likely to have discussed sexual health topics, but not general health topics; simple slopes analyses revealed that this effect was stronger among those who had not disclosed to their providers. Disclosure was also consistently associated with increased likelihood of discussing almost all topics. Conclusions Findings highlight differences in communication based on disclosure and perceived sexual orientation of provider, suggesting the need to further explore how these differences influence young gay and bisexual men’s health. Practice implications Dyads may be more likely to discuss sexual health topics when patients believe their providers are sexual minorities themselves. In addition, patient-provider dyads may be likelier to discuss various health topics when providers are aware of patients’ sexual minority statuses.

Over a decade has passed since the first human papillomavirus (HPV) vaccine was introduced. These vaccines have received unequivocal backing from the scientific and medical communities, yet continue to be debated in the media and within the general public. The current review is an updated examination that the authors made five years ago on some of the key sociocultural and behavioral issues associated with HPV vaccine uptake and acceptability, given the changing HPV vaccine policies and beliefs worldwide. We explore current worldwide HPV vaccination rates, outline HPV vaccine policies, and revisit critical issues associated with HPV vaccine uptake including: risk compensation, perceptions of vaccine safety and efficacy, age of vaccination, and healthcare provider (HCP) recommendation and communication. While public scrutiny of the vaccine has not subsided, empirical evidence supporting its safety and efficacy beyond preventing cervical cancer has amassed. There are conclusive findings showing no link that vaccinated individuals engage in riskier sexual behaviors as a result of being immunized (risk compensation) both at the individual and at the policy level. Finally, HCP recommendation continues to be a central factor in HPV vaccine uptake. Studies have illuminated how HCP practices and communication enhance uptake and alleviate misperceptions about HPV vaccination. Strategies such as bundling vaccinations, allowing nurses to vaccinate via "standing orders," and diversifying vaccination settings (e.g., pharmacies) may be effective steps to increase rates. The successes of HPV vaccination outweigh the controversy, but as the incidence of HPV-related cancers rises, it is imperative that future research on HPV vaccine acceptability continues to identify effective and targeted strategies to inform HPV vaccination programs and improve HPV coverage rates worldwide.

Many men who have sex with men (MSM) do not disclose their same sex behaviors to healthcare providers (HCPs). We used a series of logistic regression models to explore a conceptual framework that first identified predictors of disclosure to HCPs among young MSM (YMSM), and subsequently examined young men's disclosure of male-male sexual behaviors to HCPs as a mediator between sociodemographic and behavioral factors and three distinct health outcomes [HIV testing, sexually transmitted infection (STI) testing, and human papillomavirus (HPV) vaccination]. We determined the predictors of disclosure to HCPs among YMSM and examined the relationship between disclosure and the receipt of appropriate healthcare services. Data were collected online through a US national sample of 1750 YMSM (ages 18-29 years) using a social and sexual networking website for MSM. Sexual history, STI/HIV screening history, sexual health, and patient-provider communication were analyzed in the logistic regression models. Participants were predominantly white (75.2%) and gay/homosexual (76.7%) with at least some college education (82.7%). Young men's disclosure of male-male sexual behaviors to HCPs was associated with the receipt of all healthcare outcomes in our model. Disclosure was a stronger mediator in HPV vaccination than in HIV and STI testing. Disclosure to non-HCP friends and family, HCP visit in the past year, and previous STI diagnosis were the strongest predictors of disclosure. Young men's disclosure of male-male sexual behaviors to HCPs is integral to the receipt of appropriate healthcare services among YMSM. HPV vaccination is more dependent on provider-level interaction with patients than HIV/STI testing.

Objective Human papillomavirus (HPV) vaccine uptake in many countries has been sub-optimal. We examine several issues associated with non-vaccination that have received particular attention, including fears about sexual risk compensation, concerns about vaccine safety, inadequate vaccination recommendations by health care providers (HCPs), and distrust due to the perceived “newness” of HPV vaccines. Methods Selective review of behavioral and social science literature on HPV vaccine attitudes and uptake. Results There is no evidence of post-vaccination sexual risk compensation, HPV vaccines are quite safe, and they can no longer be considered “new”. Nonetheless, research findings point to these issues and, most importantly, to the failure of HCPs to adequately recommend HPV vaccine as major drivers of non-vaccination. Conclusion Most fears related to HPV vaccine are more related to myth than reality. In the absence of major health policy initiatives, such as those implemented in Canada, the U.K., and Australia, a multi-level, multi-faceted approach will be required to achieve high rates of HPV vaccination. It will be essential to focus on the education of HCPs regarding indications for HPV vaccination and approaches to communicating most effectively with parents and patients about the safety and benefits of vaccination and the risks associated with non-vaccination.

Tumor profiling (TP) is primarily used to identify driver mutations within a tumor for treatment purposes, but it may also identify germline mutations. Current involvement of cancer genetic counselors (GCs) in the TP process is not clear. Members of the National Society of Genetic Counselors Cancer Special Interest Group were invited to participate in a confidential, web-based survey to characterize current practices and attitudes related to the use of TP. Of 105 useable responses, 86.7% of GCs reported their institutions were using TP, although only 6.7% did this routinely. Although 63.7% reported personal involvement in the process, largely with result interpretation and follow-up germline testing, 69.7% reported seeing fewer than 5 patients for this reason and 97.9% desired further education on this topic. Work and regional setting were not predictors of involvement with TP; however, GCs in the academic setting were less aware of who obtains consent (p = 0.001). GCs reported they were not often utilized as a resource regarding TP. Overall, GCs believed TP is beneficial in identifying hereditary cancer syndromes, although most reported finding a germline mutation in

While adults are assumed to have the capacity to consent to medical research, and young children to have no capacity, adolescents’ capacity to consent is not well described. Adapting the MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR), we describe adolescents’ capacity to consent to medical research and factors influencing that capacity. Our pilot study included a community-based sample of 30 adolescents, 14 to 21 years of age, who completed the MacCAT-CR after undergoing a simulated informed consent process. We found that adolescents’ capacity to consent to research was associated with age, health literacy, and family affluence. These findings suggest that investigators and institutional review boards should be aware that factors other than age may influence capacity to consent, and, for modifiable factors, such as health literacy, consent processes for medical research with adolescents can be modified.

The developmental period of emerging adulthood is considered a critical time for those with type 1 diabetes (Peters & Lafell, 2011; Weissberg-Benchell, Wolpert, & Anderson, 2007), and this period is known for poor diabetes outcomes (Wysocki, Hough, Ward, & Green, 1992). Emerging adulthood is marked by increasing freedom (Arnett, 2000) and by numerous transitional events such as leaving the parental home or attending college (Arnett, 2000; Furstenberg, Rumbaut, & Settersten, 2005). This transitional period is proposed to be challenging relative to potential indicators of success or difficulties reflected in diabetes outcomes (Hanna, 2011). Indeed, the diabetes outcome of glycemic control declines during this period (Bryden et al., 2001; Insabella, Grey, Knafl, & Tamborlane, 2007) and is linked to diabetes management (Hood, Peterson, Rohan, & Drotar, 2009). Studies have confirmed that diabetes management is important to target when trying to maintain glycemic control during challenging transitions known to disrupt diabetes care routines (Balfe, 2009; Ramchandani et al., 2000). Diabetes management is proposed to be associated with impulse control in the emerging adulthood framework guiding this study (Hanna, 2011). Impulse control is the ability to delay gratification to achieve goals (Casey, Getz, & Galvan, 2008), the inhibitory control element of executive functioning (Garner, 2009), and particularly important developmentally during emerging adulthood (Steinberg, 2008). This developmental cognitive process is associated with biological changes in the prefrontal cortex, which is immature into the mid to late 20 s (Casey et al., 2008). Developmental changes occur in the balance between impulsivity and impulse control during the transition from adolescence into young adulthood (Steinberg, 2007). Impulsivity, the tendency to put greater emphasis on rewards related to immediate outcomes, occurs due to motivated reward-seeking in the absence of impulse control, the ability to value a delayed, potentially larger reward (Monterosso & Ainslie, 1999; Solnick, Kannenberg, Eckerman, & Waller, 1980). Impulsivity implies heightened reactivity to proximal cues, which may compete with behaviors relative to outcomes that may seem equivocal and distal (Steinberg, 2007; Steinberg et al., 2008). For example, in the case of diabetes management, an emerging adult enrolled in college might be distracted by proximal cues related to a social event and forget about checking his or her blood glucose level, which is needed for the distal outcome of glycemic control. Support for the importance of this developmental process to health behaviors is documented in the general youth literature indicating that less self-control is associated with behaviors that risk one’s health (Patock-Peckham, Cheong, Balhorn, & Nagoshi, 2001; Piquero, Gibson, & Tibbetts, 2002; Steinberg, 2008; Tangney, Baumeister, Boone, 2004). Further, executive functioning has been reported to be associated with diabetes management among youth with type 1 diabetes (McNally, Rohan, Pendley, Delemater, & Droter, 2010; Graziano et al., 2011), supporting the importance of cognitive functioning for youth with diabetes. However, impulse control has garnered less attention for its relationship with diabetes management. Diabetes management is also proposed to be associated with diabetes-specific self-efficacy in this emerging adulthood framework (Hanna, 2011). Self-efficacy is one’s perceived confidence in one’s abilities to perform specific behaviors (Bandura, 1997), in this case, diabetes management. This individual characteristic is assumed to be especially salient for these autonomous youth (Hanna, 2011) who have great freedom (Arnett, 2000) and primary responsibility for diabetes care (Hanna et al., 2011). Indeed, diabetes self-efficacy is well-known to be associated with diabetes management among youth with diabetes (Berg et al., 2011; Helgeson, Honcharuk, Becker, Escobar, & Siminerio, 2011; Iannotti et al., 2006; Johnston-Brooks, Lewis, & Garg, 2002; Ott, Greening, Palardy, Holderby, & DeBell, 2000; Stewart et al., 2003). In addition, diabetes self-efficacy is considered an important variable to target in interventions to improve management (Iannotti et al., 2006) and may be particularly important for youth in this developmental period. Impulse control, a neurocognitive developmental process (Steinberg et al., 2008), may be a challenging factor on which to intervene; however, diabetes management may be amenable to interventions through self-efficacy, a learned behavior (Bandura, 1977). From a social cognitive perspective, diabetes-specific self-efficacy may represent a mechanism to “balance” the demands of diabetes management and the enhanced sensation-seeking and impulsivity associated with the transition from adolescence to adulthood. For example, when emerging adults with lower impulse control are introduced to a new situation with novel proximal cues, they may be especially challenged in their diabetes management. This, in turn, may lead them to develop poor diabetes-specific self-efficacy and negatively impact their diabetes management. On the other hand, youth with high self-control may have had greater success in managing diabetes in the past and developed greater confidence in their skills, which serve them well in managing diabetes in novel (for them) social situations such as a fraternity party. This suggests a model in which diabetes-related self-efficacy mediates the relationship between impulse control and diabetes management. Although no studies have been conducted looking specifically at relationships among impulse control, diabetes-specific self-efficacy, and diabetes management behavior, there is evidence suggesting such an inter-relationship in other youth behaviors. For example, self-efficacy has been found to fully mediate the relationship between impulsivity and marijuana use among youth, with higher levels of self-efficacy reducing the association of impulsivity to marijuana use (Hayaki et al., 2011). Because there is little research in the diabetes area on the relationships among developmental cognitive processes, specifically impulse control, diabetes self-efficacy, and diabetes management, this is an exploratory study. The purposes of this study were to (a) examine the relationship between impulse control and diabetes management and (b) test diabetes-specific self-efficacy as a mediator of this relationship. A better understanding of these relationships may inform diabetes management interventions around diabetes-specific self-efficacy and impulse control, salient for youth during this developmental period.

BACKGROUND The natural history of Neisseria gonorrhoeae (GC) infections is largely unknown. The objective of the current study was to use sequential weekly vaginal samples and molecular techniques to describe the natural history of incident gonorrhea infections in adolescent women. METHODS A cohort of 387 adolescent women aged 14 to 17 were enrolled from urban, primary care clinics and followed longitudinally for a period of up to 8 years. Weekly vaginal swabs and daily diaries were provided during 12-week periods biannually, beginning and ending with a clinic visit, where all identified infections were treated. For this study, specimens and data from 16 women who became infected with GC during a weekly sampling period were analyzed. RESULTS GC organism load was highly variable between subjects. The number of organisms did not significantly differ across the first 6 weeks of infection (P = 0.59). Organism load did not differ among women with a previously documented GC infection at week 1 (P = 0.43) or across the first 6 weeks of infection (P = 0.67). The association of concurrent chlamydial infection on gonorrhea organism load was borderline significant over the first 6 weeks of infection (P = 0.06). CONCLUSIONS Individual shedding patterns varied widely, and GC organism load did not decline in women for at least several weeks and were not associated with genitourinary symptoms. Chlamydia coinfection is associated with higher GC organism loads, potentially increasing chances of transmission. This study utilized a standardized quantification technique to assess GC organism load.

The purpose of this study was to assess the associations between sexual compulsivity and the sexual behaviors of college women. Data were collected from 170 college women through an Internet-based cross-sectional survey. Measures included recent and lifetime sexual history, intentions to have sex during an upcoming special event on campus, and the Sexual Compulsivity Scale. Women who were higher in sexual compulsivity had more lifetime sexual partners, were more likely to engage in sex with partners outside of a relationship, and were more likely to report intentions to engage in sexual behavior with non-relationship partners.

Among men who have sex with men (MSM), sexual compulsivity has been associated with higher frequencies of sexual behaviors that may increase risk for transmission of HIV and other sexually transmitted infections (STI). In a Midwestern region where social and community resources for MSM are relatively diffuse, the patterns of partner-seeking and sexual behavior, and their relations to sexual compulsivity, may be different than findings from most other assessments of men in large urban areas. Using a community-based participatory approach (CBPR) and a cross-sectional survey, quantitative data were collected between November 2006 and January 2007 from 504 men related to sexual compulsivity, sexual partner-seeking, and sexual behavior. We sought to explore sexual behaviors in venues where men reported meeting sexual partners, based on their level of compulsivity. Venues that could be characterized as "sexualized" were better predictors of higher sexual compulsivity scores among men than those that are "social" in nature. Men who were higher in compulsivity reported patterns of saturating sexualized venues in order to find sexual partners. Given the unique patterns of sexual partner-seeking in this area, interventions to decrease sexual risk-taking should take into account that men who have a higher propensity for sexual compulsivity are visiting multiple venues, and prevention messages need to be tailored to be consistent across these contexts. In addition, these may need to be differentially designed based on the specific environment in which they are to be delivered.

BACKGROUND Men who have sex with men (MSM) are disproportionately affected by human papillomavirus (HPV)-related outcomes and would benefit from HPV vaccination in adolescence. We assessed HPV vaccine attitudes, uptake, and barriers in this high-risk young MSM (YMSM) population. METHODS An online US sample of 1457 YMSM aged 18 to 26 years were recruited in December 2011 to examine HPV vaccine acceptability and uptake. The online survey included sociodemographics, HPV vaccine attitudes, acceptability, HPV vaccination status, health care use, and HPV knowledge. RESULTS Despite high use of health care in the past year (86%) and high acceptability (87.8/100) for free HPV vaccine, only 6.8% had received one or more vaccine doses. In addition, only 4% of unvaccinated men had been offered the vaccine by their health care provider (HCP). In a multivariate regression of unvaccinated men, increased vaccine acceptability was associated with an HCP recommendation, worry about getting infected with HPV, and being tested for a sexually transmitted disease in the past year, whereas safety concerns, lower perceived risk of infection, and shame associated with HPV infection/disease were associated with decreased vaccine acceptability. Through logistic regression, vaccine uptake was associated with being tested for a sexually transmitted disease in the past year, disclosure of being gay or bisexual to a doctor, and greater HPV knowledge. CONCLUSIONS Health care providers need to use routine points of contact with YMSM patients to vaccinate against HPV. These data indicated missed opportunities to vaccinate YMSM who are open to HPV vaccination. In the future, HCPs of YMSM should be careful to avoid missed opportunities to vaccinate.

Introduction In the U.S., HPV vaccination of adolescent males remains low, despite the recommendation for routine vaccination. Although research has highlighted that health care provider (HCP) recommendation is very influential in HPV vaccine uptake, research on this topic in the male population is lacking. Accordingly, we used a qualitative approach to identify HCP knowledge, attitudes, and behaviors regarding adolescent male HPV vaccination, one year, after routine vaccination of adolescent males was recommended. Method A total of 20 U.S. pediatric HCPs participated in 20–30 min interviews about knowledge, attitudes, and practices regarding male HPV vaccination. Interviews were audio-recorded, transcribed and, analyzed using inductive content analysis. Results The providers had been in practice for 1–35 years, 75% were female, and 75% were White. Opinions on HPV vaccination were shaped by knowledge/perception of the risks and benefits of vaccination. Although all providers frequently offered HPV vaccine to male patients, the strength and content of the offer varied greatly. Vaccination opinions determined what issues were emphasized in the vaccine offer (e.g., stressing herd immunity, discussing prevention of genital warts), while adolescent age influenced if and how they pitched their vaccine offer (e.g., HPV as a STI). Most providers agreed with the ACIP recommendations, however, several expressed that providers’ preexisting opinions might remain unchanged despite the recommendations. Consistent with the literature on determinants of HPV vaccination, providers believed that their own recommendation was a major factor in a family's decision to vaccinate. Barriers to vaccination included the “newness” and sexual nature of the vaccine, lack of insurance coverage, and the vaccine not being mandated. Conclusions Providers’ opinions about, and approaches to offering, HPV vaccination to males were highly variable. Interventions designed to improve male HPV vaccination should focus on helping providers to routinely recommend the vaccine to all of their eligible patients, both males and females.

Purpose The use of self-report of human papillomavirus (HPV) vaccination status has several implications for clinical care and research. Reports of HPV vaccination history of adolescent girls (ages: 14–17 years) and their mothers were compared with medical chart data to assess the accuracy of HPV vaccine recall. Methods Adolescent girls (N = 74) and their mothers independently completed questionnaires regarding HPV vaccination history, which were compared with medical chart data to assess the accuracy of HPV vaccine recall. Results There were high levels of inaccuracy between actual HPV vaccination and self-report of vaccine receipt. Both mothers and daughters had poor recall of HPV vaccination, and were more likely to underestimate than overestimate the coverage. Girls who accurately reported their vaccination status were not more likely to have been sexually active in the past 2 months ( p = .75). Conclusions These findings have clinical and research implications, as self-report is relied on to assess young women's vaccination status in research settings or in the absence of medical records. These data address the still prevalent concern that HPV vaccination encourages adolescent sexual behavior. It is unlikely that sexual behaviors will change as a result of vaccination in the large percentage of girls who cannot recall being vaccinated.

Purpose The quadrivalent HPV vaccination was approved for use in males ages 9 to 26 in 2009 and recommended for routine administration in 2011. The purpose of this study was to uncover predictable commonalities amongst parents who chose to vaccinate their 11–17 year old sons against HPV. Methods We compiled data from a U.S. national sample of 779 parents with sons 11–17 years old using a web-based survey to gather information about behavioral and sociodemographic factors which predicted receipt of 1 or more HPV vaccine doses based on parental report. Predictors were first modeled individually for univariable associations. Significant predictors (p

Objective To explore alcohol involvement trajectories and associated factors during the year post-high school (HS) graduation among emerging adults with type 1 diabetes. Methods Youth (N = 181) self-reported alcohol use at baseline and every 3 months for 1 year post-HS graduation. Data were also collected on parent–youth conflict, diabetes self-efficacy, major life events, living and educational situations, diabetes management, marijuana use, cigarette smoking, and glycemic control. Trajectories of alcohol use were modeled using latent class growth analysis. Associations between trajectory class and specific salient variables were examined using analysis of variance, chi square, or generalized linear mixed model, as appropriate. Results Identified alcohol involvement trajectory classes were labeled as (1) consistent involvement group (n = 25, 13.8%) with stable, high use relative to other groups over the 12 months; (2) growing involvement group (n = 55, 30.4%) with increasing use throughout the 12 months; and (3) minimal involvement group (n = 101, 55.8%) with essentially no involvement until the ninth month. Those with minimal involvement had the best diabetes management and better diabetes self-efficacy than those with consistent involvement. In comparison with those minimally involved, those with growing involvement were more likely to live independently of parents; those consistently involved had more major life events; and both the growing and consistent involvement groups were more likely to have tried marijuana and cigarettes. Conclusions This sample of emerging adults with type 1 diabetes has three unique patterns of alcohol use during the first year after HS.

OBJECTIVE The purpose of this article was to identify the information parents and their adolescent sons deem important when making the decision to get vaccinated against human papillomavirus (HPV). METHOD Twenty-one adolescent males (ages 13 to 17), with no previous HPV vaccination, and their parents were recruited from adolescent primary care clinics serving low- to middle-income families in a large Midwestern city. Dyad members participated in separate semistructured interviews eliciting the information participants felt would increase vaccine uptake and series completion via media and clinic-based sources. Interviews were recorded, transcribed, and coded using inductive content analysis. RESULTS Overall, participants felt fear-based messages would be most effective for increasing vaccination uptake through commercials. When describing clinic messages, parents and sons felt the most important component was a recommendation for vaccination from the health care provider (HCP). Additionally, parents desired more information about the vaccine from the HCP than the sons, including cost, number of shots, and time since the approval of the vaccine for males. Compared with the clinic message, the commercial message was a vector for vaccine awareness, whereas the clinic message was a source of vaccine information. Vaccine initiation messages should provide vaccine information and come from an HCP, whereas completion messages should remind the patient why they initiated the vaccine and can come from any medical staff. CONCLUSIONS Family/individual-focused interventions should be tailored to message source, timing, and target audience. This information can be used to guide public health professionals in the development of interventions to increase vaccine uptake.

Routine administration of the quadrivalent human papillomavirus (HPV) vaccine has been recommended for 11-12-year-old males since 2011, but coverage remains low. In a U.S. national sample of parents of 11-17-year-old males (n=779), 78.6% of parents reported their sons had not received the HPV vaccine. The most common reason for non-vaccination (56.7%) was "My doctor or healthcare provider has not recommended it." Parents citing only logistical reasons for non-vaccination (e.g., lack of recommendation, access, or education, n=384) reported significantly higher vaccine acceptability than parents reporting a combination of attitudinal (e.g., concerns about vaccine safety or efficacy) and logistical barriers (n=92), while parents citing only attitudinal barriers (n=73) reported the lowest level of vaccine acceptability. In sum, many parents are willing but have not vaccinated sons due to logistical barriers, most commonly lack of healthcare provider recommendation. These findings have important implications for increasing HPV vaccination coverage among adolescent males.

Vaccinations against sexually transmitted infections (STIs) are a critical strategy for preventing STIs, but are limited by their acceptance in the general population. This chapter discusses the acceptability of current and future vaccinations against STIs, including licensed vaccines for human papillomavirus (HPV) and hepatitis B (HBV), as well as potential vaccines for HIV and genital herpes. Despite a high level of documented acceptability, there continues to be a gap between intention to vaccinate and vaccine acceptance. Prophylactic STI vaccination will only reach its complete potential if it is widely accepted by parents of adolescents before they are sexually active. Social, behavioral, and attitudinal factors that have been associated with acceptance or acceptability are identified for parents, adolescents, and healthcare providers. Potential structural, public health, and clinical strategies that may be implemented to increase uptake of current and future STI vaccines are discussed.

Introduction Public health condom promotion efforts increasingly focus on the importance of sexual pleasure; however, little is known about sexual event‐specific factors that may increase or decrease perceptions of sexual pleasure when condoms are used. Aims To examine event‐level factors associated with ratings of sexual pleasure during condom‐protected vaginal intercourse. Methods Data were collected in 2008 from 1,875 men during a prospective daily diary study of sexual behavior and condom use. Sexual pleasure was assessed during condom‐protected vaginal intercourse considering situational, relational, intrapersonal, and behavioral predictors. Analyses were generalized estimating equation ordinal regression. Main Outcome Measures Event‐specific perceptions of sexual pleasure (three categories: not at all enjoyable to extremely enjoyable). Results Vaginal intercourse was reported on 29.8% (N = 8,876/29,714) of diary days; complete condom use was reported for 59.1% (5,249/8,876) of all vaginal intercourse events. This was confusing by using the word “all sexual events.” Higher sexual pleasure ratings during complete condom use were associated with older age, manual stimulation of one's genitals, receiving oral sex, and performing oral sex. Sexual pleasure ratings also increased in association with intercourse duration, intercourse intensity, ejaculation, erection perception, and condom comfort. Sexual pleasure ratings were lower with erection difficulty and partner discomfort during sex. Conclusions These data advance understanding of sexual pleasure during condom use, suggesting that sexual pleasure increases in conjunction with specific relational, physiological, and condom perceptions. These findings offer points upon which clinicians and health educators can engage men in an ongoing dialogue about augmenting sexual pleasure in the context of condom use. Hensel DJ, Stupiansky NW, Herbenick D, Dodge B, and Reece M. Sexual pleasure during condom‐protected vaginal sex among heterosexual men. J Sex Med 2012;9:1272–1276.

The present review describes the indications for vaccinating men with the quadrivalent human papillomavirus (HPV) vaccine, reports on the US rates of male vaccination, and reviews the recent research on acceptability of vaccinating men and research on the cost-effectiveness of adding men to existing female HPV immunization programs.Recent evidence shows that the quadrivalent HPV vaccine prevents several HPV-related diseases in men. However, despite the licensure of the vaccine in the USA for men 9 through 26 years of age, rates of male vaccination are very low. Research on acceptability, in general, indicates strong interest in vaccination among men, parents, and healthcare providers, though female vaccination is typically seen as a higher priority. Cost-effectiveness studies indicate that in the context of modest female vaccination rates and with the specification of a broad range of disease outcomes (e.g. genital warts, anogenital cancers, and oropharyngeal cancers), male vaccination can be quite cost-effective.Men are at high risk for HPV infection and can benefit from vaccination, but vaccination rates among men remain extremely low. More research needs to be done on the predictors of uptake of HPV vaccine among men and on the development of interventions to increase male vaccination.

Public health messaging encourages men who have sex with men (MSM) to be tested for sexually transmitted infections (STI) and HIV at least yearly, and more frequently depending on sexual behaviors. However, despite engaging in a range of sexual behaviors, many MSM do not participate in regular STI testing. The objective of this study was to understand factors associated with STI testing among a nonclinic-based population of men accessing an Internet-based social and sexual networking site. We asked 25,736 men to complete a comprehensive behavioral and health assessment after being recruited from an Internet site popular among men seeking social or sexual interactions with other men. Analyses were performed using multivariate logistic regression with effects significant at p 0.05. Two separate predictive models were assessed: STI diagnosis within the past 2 years and STI testing within the past year. Regarding previous STI diagnosis, men who used a condom some of the time or never during both insertive (odds ratio [OR] = 1.72) and receptive (OR = 1.41) anal sex were significantly more likely to have had an STI in the past 2 years. For STI testing, men who never used condoms during receptive anal sex were more likely to have had an STI test within the past year (OR = 1.31), but men who had a STI history were less likely to have been tested (O = 0.24). Public health efforts directed toward MSM should continue to emphasize screening for STI other than HIV, particularly among those men prioritized during condom promotion campaigns. In addition to the benefits of learning one's STI status, the STI screening and treatment environment itself may provide an important venue for encouraging a range of sexual health promoting behaviors.

Introduction Little is known about event‐level condom use errors during vaginal sex. Aims The aim of this article is to examine factors associated with complete condom use compared to forms of incomplete condom use, including delayed condom application and early condom removal, over a 30‐day period. Methods Data were collected in 2008 from 1,875 men during a prospective daily diary study of sexual behavior and condom use. Incomplete condom use was assessed during vaginal intercourse considering situational, relational, intrapersonal, and behavioral predictors. Analyses were generalized estimating equation multinomial logistic regression. Main Outcome Measures Condom use during vaginal sex: complete use, delayed application, early removal, and both delayed application/early removal. Results Of 29,714 diary reports, 30% (8,876) included vaginal intercourse. Analyses were conducted (in 2009) on 83.2% of these intercourse events (6,325), during which condoms were used and for which participants provided complete data. Incomplete condom use included penetration before applying condoms during 12% of events (749), removing condoms before intercourse ended during 3.1% (198), and both types of incomplete use during 2% (129) of events. Erection quality (less than typical erect penile length and circumference, less rigidity, and difficulty maintaining erection) was associated with greater odds of incomplete use, as was a participant's history of other recent incomplete use. Perceptions of condom comfort and recent previous complete use were protective factors against incomplete use. Conclusions Men's incomplete condom use is associated with recent condom use patterns, as well as with their physiological characteristics and perceptions of condoms during sexual intercourse. Event‐level analyses such as these help describe how incomplete condom use occurs among individuals incorporating condoms into their sexual activities. Hensel DJ, Stupiansky NW, Herbenick D, Dodge B, and Reece M. When condom use is not condom use: An event‐level analysis of condom use behaviors during vaginal intercourse. J Sex Med 2011;8:28–34.

It is widely believed that marijuana use and alcohol use directly intercede on successful condom use. However, measurement differences and inconsistent findings in past research remain unclear whether marijuana and alcohol work directly to influence condom behavior, or spuriously function through other factors that actually reflect an increased likelihood of vaginal sex. The current study prospectively disentangles the association of marijuana and alcohol use on condom behavior among adolescent women.Young women (N=387; 14-17 years) provided daily sexual diaries as part of a longitudinal cohort study (1999-2009) of sexual behavior and sexual relationships. To separate the effects of marijuana and alcohol use on vaginal sex from condom use (when vaginal sex occurs), we estimated a 3-category outcome variable (no vaginal sex, vaginal sex with a condom, vaginal sex without a condom), alternating no sex (Model 1) and sex without a condom (Model 2) as the referent categories. Generalized estimating equation multinomial logistic regression adjusted odds ratios for multiple sexual events from the same young woman over time.Subjects contributed 14,538 coital events; 30% of these events were condom-protected. Neither marijuana nor alcohol use was directly associated with lower condom use; the strongest effect of condom use (adjusted odds ratio) and nonuse was performance of these behaviors in the past week.This study finds no evidence of a relationship between marijuana or alcohol use and condom nonuse. Both condom use and nonuse were identified as consistent behavioral patterns, regardless of the effect of marijuana and alcohol use.

This study asked whether physicians would prioritize HPV vaccination on the basis of a young woman's relationship status and HPV history (i.e., abnormal Pap test, HPV infection or HPV-related disease). Eight hundred physicians identified as HPV vaccinators in a US claims database were surveyed. Prioritization was assessed on a 0-10 rating scale (from extremely low to extremely high priority). Physicians gave lower priority to vaccinating patients who were married or in a long-term monogamous relationship, with mean (SD) scores of 5.76 (2.82) and 6.80 (2.48), respectively, than for patients who were single and either dating or not dating, with mean (SD) scores of 9.8 (0.68) and 9.22 (1.61), respectively; p

Background: In the USA, the human papillomavirus (HPV) vaccine is currently licensed for 9–26-year-old females, but licensure for women over 26 years is being considered. The aim of the current study was to investigate the association of sociodemographic and health-related factors to HPV vaccine acceptability among adult women. Methods: The current study utilised a nationally representative sample of women (n = 1323) aged 27–55 living in the USA, with an oversampling of black and Latina women. A multiple item measure of HPV vaccine acceptability across varying cost and location-of-availability (clinic only v. any local pharmacy) conditions was the main outcome measure. General linear modelling was used to analyse the association of vaccine cost, location availability, and sociodemographic and health-related variables with vaccine acceptability. Results: Vaccine cost had the strongest association with acceptability [F (2, 1249) = 832.1; P

Objective: To assess relations between sexual compulsivity and a history of sexually transmitted infection (STI) diagnosis and testing among a community-based sample of men who have sex with men (MSM) in a mid-size urban area of the midwestern United States. Methods: Sexual health data were collected from 504 MSM in the metropolitan area of Indianapolis, Indiana, using a community-based participatory research approach. Sexual compulsivity scores were assessed using the Sexual Compulsivity Scale (SCS). Results: The reliability and construct validity of the SCS were determined to be high in the total study sample. Men who scored high on the SCS reported higher levels of sexual risk behaviour with both male and female partners and were significantly more likely to have been diagnosed with STI (including chlamydia, gonorrhoea, both hepatitis A and B, and syphilis) than other men. Men who scored high on the SCS were not more likely than other men to have been tested for STI, despite higher levels of sexual risk. Conclusions: The SCS may be useful as a supplemental instrument in public health programmes and healthcare settings that encourage men to assess their sexual behaviours and make decisions to pursue STI or HIV screening. For those already diagnosed with an STI, the SCS may help providers to identify the cognitive and affective components of sexual behaviours that increase the likelihood that an STI will be transmitted to a sexual partner.

Purpose: Individuals with type 1 Diabetes Mellitus (Tl OM) are at high risk for hypoglycemia (HG); HG while driving may result in serious accidents. Failure to perform self-blood glucose monitoring (SBGM) before driving and inadequate knowledge about preventive recommendations increases the risk of HG while driving, and is a particular concern for adolescents. The current study piloted an innovative computerbased driving game to increase awareness of risks and inform adolescents of current safety recommendations. Methods: Ninety-nine participants (14-16 years) with TlDM were recruited from adolescent diabetes clinics to participate in a game-based education program about HG. which included driving modules designed to simulate the effects of hypoglycemia on vehicle operator motor skills. Participants completed a short baseline (Tl) preand post-task questionnaire about HG which queried them on the areas of driving behaviors, HG history, driving history. SBGM habits, and self-efficacy regarding hypoglycemia awareness. A short follow-up questionnaire (T2) queried hypoglycemia knowledge and intention to engage in behaviors to reduce the chance of hypoglycemic episodes while driving. Paired sample t tests were used to assess changes in HG knowledge variables. Results: Almost all adolescents reported morning HG as the most frequent time of HG 62% (61/99) before breakfast and 31 % (31 /99) after breakfast, but before lunch. Only 59%(31/99) performed SBGM four or more times daily as recommended; 22% (22/99) tested twice daily or less. Almost a quarter (23%, 20/86) had an episode of severe HG in the past 3 months. Over half (53%, n = 52) of adolescents reported driving every day, 26%(n = 26)did notdrive,21% (n = 21) drove up to three times a week or less. Of those who drive, 41 % ( 30/73) either agreed or strongly agreed that they drive when their blood glucose is

Adult self-report of vaccination status has been demonstrated to be variably accurate for a number of different vaccines [1–6]. Generally, recall of vaccines has high sensitivity and reasonable specificity, but findings have differed depending on the type of vaccination and certain demographic characteristics. There is limited research on the accuracy of self-reported vaccination status in adolescents, and specifically regarding human papillomavirus (HPV) vaccination. Understanding HPV vaccination status has research and clinical implications. In many research studies, and some instances within clinical practice, self-reported vaccination status is relied on to obtain immunization history and inform the need for further vaccinations [5]. The current study used medical records and self-administered questionnaires to compare actual HPV vaccination status with self-reported and parent-reported receipt of HPV vaccine among adolescent girls in an urban setting.

Background Licensed for use in males in 2009, Human Papillomavirus (HPV) vaccination rates in adolescent males are extremely low. Literature on HPV vaccination focuses on females, adult males, or parents of adolescent males, without including adolescent males or the dynamics of the parent-son interaction that may influence vaccine decision-making. The purpose of this paper is to examine the decision-making process of parent-son dyads when deciding whether or not to get vaccinated against HPV. Methods Twenty-one adolescent males (ages 13–17), with no previous HPV vaccination, and their parents/guardians were recruited from adolescent primary care clinics serving low to middle income families in a large Midwestern city. Dyad members participated in separate semi-structured interviews assessing the relative role of the parent and son in the decision regarding HPV vaccination. Interviews were recorded, transcribed, and coded using inductive content analysis. Results Parents and sons focused on protection as a reason for vaccination; parents felt a need to protect their child, while sons wanted to protect their own health. Parents and sons commonly misinterpreted the information about the vaccine. Sons were concerned about an injection in the penis, while some parents and sons thought the vaccine would protect them against other sexually transmitted infections including Herpes, Gonorrhea, and HIV. Parents and sons recalled that the vaccine prevented genital warts rather than cancer. The vaccine decision-making process was rapid and dynamic, including an initial reaction to the recommendation for HPV vaccine, discussion between parent and son, and the final vaccine decision. Provider input was weighed in instances of initial disagreement. Many boys felt that this was the first health care decision that they had been involved in. Dyads which reported shared decision-making were more likely to openly communicate about sexual issues than those that agreed the son made the decision. Conclusion Parents and sons play an active role in the decision-making process, with an individual’s role being influenced by many factors. The results of this study may be used to guide the messages presented by clinicians when recommending the HPV vaccine, and future vaccine uptake interventions.