Browsing by Subject "Sexually transmitted infections"
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Item Open Access Exploring Multilevel Factors associated with Dual-Method Contraceptive use among Adolescent and Young Adult Women(2024) Holt, Lauren MarieSexually transmitted infections (STIs) continue to rise in the US, and adolescent and young adult women (AYAW) between ages 18 and 24 have some of the highest STI rates in the country. Further, AYAW who use prescribed contraceptives (commonly referred to as birth control) are less likely to use condoms and more likely to be diagnosed with an STI than non-prescribed contraceptive users. The purpose of this dissertation is to understand multilevel factors contributing to condom use decision-making and STI risk perception analysis among AYAW who use prescribed contraceptives. Data was using qualitative research methods in two separate studies. In one study, a grounded theory approach was used to explain the processes associated with STI risk perception and dual-method contraceptive decision-making. In a separate study, sex education policy experts in Texas were interviewed to identify barriers and facilitators to implementing comprehensive sex education at a local level. Additionally, legal and ethical issues in conducting sexual health research with AYAW were explored. The findings suggest that dual-method contraceptive decision-making is a complex process that is influenced by individual, relationship, community, and societal factors. Instead of having conversations about STIs, AYAW are making assumptions about the STI status of their partners based on partner and relationship factors and are deferring to their partners for dual-method contraceptive decision-making. Additionally, societal, community, and relationship factors influence how AYAW perceive STIs in comparison to pregnancy. To increase STI risk perception and dual-method contraceptive use a multilevel holistic approach is recommended.
Item Open Access Social Determinants of HPV Vaccine Completion among Adolescents(2020) Mansfield, Lisa NicoleThe 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.