Browsing by Subject "Adolescent health"

Contraceptive prevalence in Haiti remains low despite extensive foreign aid targeted at improving family planning. [1] Earlier studies have found that peer-informed learning have been successful in promoting sexual and reproductive health. [2-5] This pilot project was implemented as a three-month, community-based, educational intervention to assess the impact of peer education in increasing contraceptive knowledge among women in Fondwa, Haiti. Research investigators conducted contraceptive information trainings to pre-identified female leaders of existing women’s groups in Fondwa, who were recruited as peer educators (n=4). Later, these female leaders shared the knowledge from the training with the test participants in the women’s group (n=23) through an information session. Structured surveys measuring knowledge of contraceptives were conducted with all participants before the intervention began, at the end of the intervention, and four weeks after the intervention. The surveys measured general contraceptive knowledge, knowledge about eight selected types of modern contraceptives and contraceptive preferences and attitudes. Only test participants showed significant improvement in their general contraceptive knowledge score (p<0.001), but both test participants and peer educators showed significant improvement in overall knowledge scores for identifying the types and uses of modern contraceptive methods. Assessment for knowledge retention remained significantly higher four weeks after the intervention than prior to the intervention. Therefore, a one-time, three-hour peer-based educational intervention using existing social structures is effective, and might be valuable in a population with minimal access to education and little to no knowledge about contraceptives.

The human papillomavirus (HPV) is a causative factor for many genital and oral cancers in the U.S. HPV-associated cancer are preventable through vaccination. The HPV vaccine is routinely administered to adolescents’ ages 11 to 12 to prevent HPV infection before sexual debut. However, HPV vaccination rates among adolescents are low, with approximately half of U.S. adolescents completing the vaccine series. In 2016, the number of required doses for vaccine completion were reduced to two doses for adolescents ages 11 to 14. Despite this reduction, the HPV vaccine remains a multi-dose series, requiring adolescents to return to the clinic to complete the series. Social determinants of health across several socioecological levels may play a role in vaccine completion among adolescents.

The purpose of this dissertation was to explore and describe determinants of HPV vaccine completion among adolescents. A systematic literature was conducted using a socioecological approach to explore barriers and facilitators to HPV vaccine initiation and completion among U.S. adolescents (Chapter 2). Chapter 3 highlights the quantitative findings from this study that examined the individual- and community-level determinants of health for adolescent HPV vaccine completion within a 14-month period. Chapter 4 details the convergent mixed-method findings from this study which integrated qualitative interviews and quantitative electronic health record data to examine the influence of individual-, relationship-, and community-level determinants of HPV vaccine completion within 14 months, and to describe barriers and facilitators to vaccine completion among parents and adolescents, ages 11 to 14 years. Findings across from these three chapters are synthesized in Chapter 5 and implications for future research and practice are discussed.

Individual-, relationship-, and community-level determinants are associated with HPV vaccine completion among adolescents ages 11 to 14 years and serve as barriers to completing the vaccine series. Barriers across levels interacted with one another, highlighting that multi-level influences play a role in adolescent HPV vaccine completion. Future research designing multi-level interventions for parents, adolescents, and healthcare providers are needed to reduce barriers to HPV vaccine completion. Reducing these barriers may improve HPV vaccine completion rates among adolescents thereby decreasing their risks for HPV-associated cancers in the future.

Problem: Gay, bisexual, and queer (GBQ) adolescent males are disproportionately affected by negative sexual health outcomes compared to their heterosexual counterparts. Their sex education needs are not sufficiently addressed in the home and the larger ecological systems. The omission of their sex education needs at a time when they are forming a sexual identity during adolescence compels GBQ males to seek information in unsupervised settings. Evidence-based interventions aimed at ensuring positive sexual health outcomes through sex communication cannot be carried out with these youth as research on how parents and GBQ males discuss sex in the home has been largely uninvestigated.

Methods: This naturalistic qualitative study focused on the interpretive reports of 15- to 20-year-old GBQ males’ discussions about sex-related topics with their parents. From a purposive sample of 30 male adolescents who self-identified as GBQ, participants who could recall at least one conversation about sex with their parents were recruited for one-time interviews and card sorts. This strategy revealed, using Bronfenbrenners’ Bioecological Theory, their perceptions about sex communication in the context of their reciprocal relationship and the ecological systems that GBQ males and their parents navigate.

Results: Parents received poor ratings as sex educators, were generally viewed as not confident in their communication approach, and lacked knowledge about issues pertinent to GBQ sons. Nevertheless, participants viewed parents as their preferred source of sex information and recognized multiple functions of sex communication. The value placed by GBQ youth on sex communication underscores their desire to ensure an uninterrupted parent-child relationship in spite of their GBQ sexual orientation. For GBQ children, inclusive sex communication is a proxy for parental acceptance.

Results show that the timing, prompts, teaching aids, and setting of sex communication for this population are similar to what has been reported with heterosexual samples. However, most GBQ sons rarely had inclusive guidance about sex and sexuality that matched their attraction, behavior, and identities. Furthermore, the assumption of heterosexuality resulted in the early awareness of being different from their peers which led them to covertly search for sex information. The combination of assumed heterosexuality and their early reliance on themselves for applicable information is a missed parental opportunity to positively impact the health of GBQ sons. More importantly, due to the powerful reach of new media, there is a critical period of maximum receptiveness that has been identified which makes inclusive sex communication paramount in the pre-sexual stage for this population. Our findings also indicate that there are plenty of opportunities for systemic improvements to meet this population’s sexual education needs.