Center for Innovative Public Health Research

This study aimed to understand how adolescent adoption of behaviors protective against different health risks relate to each other, as well as the role family and friends might play in the adoption of protective behaviors. We used data from adolescents (N = 1,803; age 13-17 years) who were recruited between April 2022 and June 2023 for the QuaranTeen Health study, an online, longitudinal survey assessing the impact of the COVID-19 pandemic on adolescent sexual health. We used data from the baseline questionnaire to calculate weighted correlations between friend and family norms about masking and vaccination and adolescents' COVID-19 protective behaviors, defined as 1) participant masking in the past two weeks and 2) receiving at least one COVID-19 vaccination shot. We used weighted logistic regression models to estimate associations between COVID-19-protective behaviors and sexual health-protective behaviors (i.e., condom use and hormonal contraception use at the most recent sex). We found that increased friend and family norms for COVID-19-protective behaviors were associated with participant masking (friends: ρ = .40, p < .01; family: ρ = .34, p < .01) and vaccine uptake (friends: ρ = .40, p < .01; family: ρ = .56, p < .01). Both behaviors were positively associated with condom use (masking: OR = 1.63, 95% CI = [1.05, 2.52]; vaccination: OR = 2.20, 95% CI = [1.32, 3.69]). Neither was associated with hormonal contraception use. Our findings suggest that family and friend norms for health-protective behaviors appear to be associated with health-protective behaviors among adolescents, at least when examining COVID-19-protective behaviors. Integrating friend and family norms may increase the effectiveness of future sexual health interventions designed to increase sexual health-protective behaviors among adolescents.

The purpose of this study was to conduct formative research to inform the development of an app, that would simultaneously engage youth and adults, to prevent dating and sexual violence (DSV) and alcohol use (AU).Participants (N = 56) were high school students, parents/guardians, and professionals (e.g., school personnel) from across the United States who participated in online focus groups. Overall, participants had positive perceptions of the utility, helpfulness, and effectiveness of an app to prevent DSV and AU among high school students. Participants provided in depth information about both the content (e.g., local rates of DSV and AU) and features (e.g., skills-based, inclusion of incentives, help button) that the app should include.These preliminary data suggest that future research to develop and pilot an app for both youth and adults to prevent DSV and AU among high school students is warranted.

Gender minority adults experience higher rates of sexual violence (SV) than cisgender adults. How this disparity extends to youths, including perpetration rates, is unknown. To compare rates of experience and perpetration of SV by gender identity and investigate characteristics associated with odds of perpetration within gender identity categories. This cross-sectional study used baseline data from a national online longitudinal survey collected in 2018 to 2020. Eligible participants were youths ages 14 to 16 years who read English and had internet access. Data were analyzed in November 2021 and March 2022. Youth characteristics included stressors associated with being marginalized (eg, internalized transphobia), general stressors (eg, trauma not associated with experiencing SV), other marginalized statuses (eg, identifying as a girl), factors associated with protection (eg, social support), environmental characteristics (eg, community violence exposure), and risk factors associated with SV (eg, consumption of violent pornography). Self-reported rates of experiencing and perpetrating SV, defined as sexual assault, rape, attempted rape, and coercive sex, among cisgender, transgender, and nonbinary youths. Among 4193 youths in the sample (mean [SD] age, 14.8 [0.7] years), 3282 participants (78.3%) were cisgender, 329 participants (7.9%) were transgender, and 582 participants (13.9%) were nonbinary. The odds of SV perpetration were not statistically significantly different for transgender boys and girls (odds ratio [OR], 0.90; 95% CI, 0.57-1.41; P = .64) or nonbinary youths (OR, 0.78; 95% CI, 0.54-1.12; P = .18) compared with cisgender boys and girls. By contrast, transgender boys and girls (OR, 2.31; 95% CI, 1.83-2.91; P < .001) and nonbinary youths (OR, 2.37; 95% CI, 1.98-2.83; P < .001) were more than 2-fold as likely as cisgender boys and girls to report experiencing SV. Aggressive behavior was associated with higher odds of SV perpetration for transgender boys and girls (adjusted OR [aOR], 1.87; 95% CI, 0.75-4.65; P = .18) and nonbinary youths (aOR, 1.61; 95% CI, 0.78-3.32; P = .20). Indications of hostile masculinity were associated with higher odds of SV perpetration among cisgender youths (ie, positive attitudes for boys to engage in rape behaviors: aOR per unit increase in score, 1.15; 95% CI, 1.07-1.25; P < .001; sexual dominance: aOR per unit increase in score, 1.03; 95% CI, 1.01-1.04; P < .001) but not among transgender or nonbinary youths. These findings may suggest an important foundation for the development of inclusive, research-based SV prevention programs and methods for incorporating gender identity effectively into SV research.

Little is known about the characteristics and context of adolescent relationship abuse victimization across youth of different sexual and gender minority identities. This study sought to examine this in a national sample of 14-15-year-old youth. The sample comprised 3296 youth who reported having been in a relationship, of which 36% (n = 1197) were exclusively cisgender heterosexual; 41% (n = 1, 349) cisgender sexual minority; and 23% (n = 750) gender minority, the majority of whom were also sexual minority. More than half of all youth who had been in a relationship, dated or hooked up with someone had experienced some form of adolescent relationship abuse victimization. Gender minority youth, in particular transgender boys and non-binary youth assigned female at birth, were more likely to be victims of multiple types of adolescent relationship abuse compared to cisgender youth. Perpetrator gender varied for sexual and gender minorities and was more homogenous for cisgender heterosexual youth. Several factors were associated with adolescent relationship abuse for all youth, although alcohol use, and parental trust and communication emerged as particularly important for sexual and gender minority youth. Overall, findings address multiple gaps in the literature and contribute to the understanding of adolescent relationship abuse across different sexual and gender identities.

IntroductionUganda, like most Sub-Saharan African countries, has comprehensive HIV prevention campaigns, yet programs tailored to young adults are completely lacking.MethodsIn 2016, 202 18–22 year olds were recruited from across Uganda via Facebook to take part in online, 3 day, asynchronous focus groups (FGs). The aim of the FGs was to understand sexual health decision making to inform HIV prevention content development. The study sample was purposefully balanced on age, district, educational attainment, employment status, and income. Eight FGs were conducted; participants were stratified by sex and sexual behaviour in the past 12 months.ResultsYong adults who were abstinent said they were making this choice because they treasured virginity; and wanted to stay STD-free and avoid pregnancies. There were drawbacks, particularly for women who said that their boyfriends may leave if they did not have sex. Peer pressure and feeling excluded from those who were having sex were also disadvantages. Ugandan young adults talked about the cultural norm of having multiple partners, both for financial gain and social status. Using condoms was universally noted as the right thing to do. At the same time, sexually active youth voiced several barriers to condom use, including: being allergic to rubber, fear of getting cancer with frequent use, and embarrassment.When asked about how confident they were in negotiating condoms, sexually experienced women voiced a range or responses from ‘I can’t at all’ to ‘sometimes’ to ‘always’.Refusing sex was possible: If a woman did not want to have sex, respondents said she could blame it on her period and if a man did not want to have sex, he could say he was ‘tired’. That said, all agreed that the refusal of sex in a relationship could be met with consequences (e.g., distrust by one’s partner, an end to the relationship).ConclusionSeveral important challenges that Uganda young adults faces in making healthy sexual decisions were voiced. These issues need to be directly addressed in HIV prevention programs tailored to this age group.

IntroductionDespite what adolescent health practitioners may assume, multiple studies have found that lesbian, gay, and bisexual (LGB) girls are more likely than heterosexual girls to have unprotected penile-vaginal sex, engage in penile-anal sex, have multiple sexual partners, have high risk sexual partners, and to get pregnant. In the face of these disparities, it is unknown if LGB girls are getting tested for STIs.MethodsNinety-one 14–18 year old cisgender females who identified as sexual minority (i.e., had a sexual identity other than exclusively heterosexual) and lived in the United States were recruited through Facebook and surveyed online in July 2016.ResultsTwenty-nine percent of respondents estimated they lived in a lower than average income household. Seventy-five percent were White race; 11% were Hispanic ethnicity. Two in five respondents (42%) lived in a suburban area, one in four (27%) lived in an urban area, and just under one in three (30%) lived in a small town or rural area.LGB girls reported rates of lifetime STI testing (21%) similar to rates of HIV testing (19%). Four percent said they had ever tested positive for an STI; none reported a positive HIV test.Compared to 6% of LGB girls who have only had sex with girls, 30% of LGB girls who have only had sex with guys, and 46% of girls who have had sex with guys and girls have ever been tested for an STI (p=0.01).Although not statistically significant, LGB girls who did not use a condom at last penile-vaginal sex (62%) were more likely than those who did (35%) to have ever been tested for STIs (p=0.15).ConclusionIt may be that LGB girls who have male partners, either exclusively or while also having female partners, are aware of the STI risk that penile-vaginal sex may confer and are testing accordingly. The higher rates of STI testing in the face of lower condom use however, may suggest that some LGB teens who are having sex with guys are using testing instead of condoms as a form of STI prevention.

Guy2Guy (G2G) is the first comprehensive HIV prevention program developed for sexual minority males as young as 14 years old and is delivered nationally via text messaging. Here, we report the results of the pilot randomized control trial. G2G was tested against an attention-matched "healthy lifestyle" control (eg, self-esteem). Both programs lasted 5 weeks and delivered 5 to 10 text messages daily. A 1-week booster was delivered 6 weeks subsequently. Participants were cisgender males ages 14 to 18 years old who were gay, bisexual, and/or queer and had an unlimited text messaging plan. Youth were recruited across the United States via Facebook and enrolled by telephone from October 2014 to April 2015. Ninety-day postintervention outcomes were condomless sex acts (CSA) and abstinence and, secondarily, HIV testing. We also examined these outcomes at intervention end and stratified them by sexual experience. At 90 days postintervention, there were no significant differences in CSAs or abstinence noted. Among participants who were sexually active at baseline, intervention participants were significantly more likely to report getting an HIV test (adjusted odds ratio = 3.42, P = .001). They were also less likely than control youth to be abstinent (adjusted odds ratio = 0.48, P = .05). CSAs were significantly lower for those in the intervention versus control at intervention end (incident rate ratio = 0.39, P = .04), although significance was lost once age was added to the analysis (incident rate ratio = 0.58, P = .26). G2G appears promising in increasing adolescent HIV testing rates. Sex-positive intervention messages appear to have increased the participants' comfort with having sex (ie, less abstinence) while not increasing their potential for HIV transmission (ie, more CSAs). Additional content or features may be needed to invigorate condom use.

Although conventional implantable cardioverter-defibrillators (ICDs) have proved effective in the prevention of sudden cardiac death (SCD), they still appear to be limited by non-trivial acute and long-term complications. The recent advent of an entirely subcutaneous ICD (S-ICD) represents a further step in the evolution of defibrillation technology towards a less-invasive approach. This review highlights some historical and current issues concerning the S-ICD that may offer a viable therapeutic option in selected patients at high risk of SCD and in whom pacing is not required. After the CE Mark and US Food and Drug Administration (FDA) approvals, the S-ICD is being implanted worldwide with growing clinical data regarding its safety and efficacy (the EFFORTLESS Registry). The recently developed new generation of S-ICD (EMBLEM, Boston Scientific) demonstrates favourable features including a smaller device, longer longevity and remote-monitoring compatibility. Further innovations in the S-ICD system and potential integration with leadless pacing may play an important role in defibrillation therapy and prevention of SCD in the near future.