LGBTQ+ young people experience disproportionate rates have unwanted pregnancy and STIs, due to a lack of preventive systems that meet their needs. Specifically, sexual health education in the United States ignores, erases, or simply does not speak to the lives and needs of LGBTQ+ young people. Through funding provided by the Office of Adolescent Health, Planned Parenthood of the Great Northwest and the Hawaiian Islands is implementing and evaluating IN•clued: Inclusive Healthcare—Youth and Providers Empowered. The IN•clued program, based in the Health Belief Model, consists of a three-hour in-person workshop about sexual risk prevention, self-efficacy in reproductive healthcare settings, and how to access sexual health services. This is part of a cluster randomized controlled trial in which evaluators randomly assign each cohort of youth enrolled to receive the IN•clued intervention or the control condition, a benign intervention. The program has been conducted in nine states across the country. A total of 48 youth groups were randomized (24 program and 24 control) with 475 youth (268 program and 207 control). In the combined sample, 78% are white, 98% LGBTQ+, 35% receive free or reduced lunch, 62% come from two parent households, and the average age is 16. Preliminary analysis of year one differences in outcomes between the program and control youth, using three-month follow-up data, shows a statistically significant positive difference in knowledge of sexual risks, confidence talking to healthcare providers, and engaging in recent risky sex. These outcomes will be updated prior to the conference.

background: Adolescent use of alcohol, tobacco, and other drugs (ATOD) is a common experience in the US. Additionally, first sexual intercourse typically begins at 16 years of age. The impact sexual orientation has on ATOD use and sexual behavior is not well documented. As such, the purpose of this study was to assess these relationships among students. methods: Data was derived from the 2015 YRBS (n=15,624). This study is conducted every odd year, and is a representative sample of high school students in the US. Logistic regression was used to estimate the association between sexual orientation (straight vs bisexual) and sexual behaviors with interaction terms by ATOD use. results: There were significant interaction for sex before age 13 and tried cigarettes, alcohol, cocaine, inhalant, current cigarette use, and binge drinking with greater odds among bisexuals. Also, there were significant interaction for sex with 4 or more people and tried cigarettes, alcohol, current cigarette use, and binge drinking with greater odds among bisexuals. Lastly, it was found that there were significant interaction for condom use and tried marijuana, cocaine, inhalants, and binge drinking with greater odds among bisexuals. conclusions: This study found significant interaction between ATOD and sexual behaviors with bisexual youths at higher risks. These youth may need more emotional and social support as they begin to understand their sexuality. It may be important for individuals working with GLBT youth to more intensely target their efforts in providing bisexual youth opportunities to learn and engage in healthy stress management techniques.

Background: Public health framing around contraception for young women tends to value efficacy at preventing pregnancy over other features. This focus can overlook the diverse reasons why some young women choose lower-efficacy methods, including emergency contraception (EC), condoms and withdrawal, even when higher-efficacy methods are available.

Methods: We conducted a mixed-methods study with young women (ages 15-29) seeking EC at Bay Area clinics. On surveys, respondents (N=211) reported contraceptive attitudes on Likert-type scales. We compared attitudes across method types and used multivariable regression models to examine factors associated with attitudes (e.g., pregnancy intentions, prior healthcare experiences, mental health). We conducted and thematically analyzed in-depth interviews (N=22) to further understand motivations for choosing lower-efficacy methods.

Results: Nearly all women surveyed (95%) reported past use of contraception, including condoms (58%), hormonal methods (55%), EC (36%), and withdrawal (27%). In multivariable models, desire to avoid pregnancy was associated with more positive attitudes about hormonal methods (p=.004) and more negative attitudes about withdrawal (p=.017). Positive prior healthcare experience was associated with positive attitudes about EC (p=.013) and hormonal methods (p=.026). We found no association between mental health and contraceptive attitudes. In interviews, respondents described values that drive their decision to use lower-efficacy methods, including: preference for spontaneity, emphasis on being “natural,” flexibility over permanence, and past method experience.

Conclusions: Young women make contraceptive decisions based on preferences and values that include, but are not limited to, efficacy. Sexual health providers and programs should incorporate person-centered approaches and that recognize young women’s diverse contraceptive needs.

Background:

Cases of sexually transmitted infections (STIs) are rising in college students at concerning rates despite efforts to improve sexual health promotion. Chlamydia and gonorrhea are especially prevalent in individuals between the ages of 15 and 24. Many college health promotion practices target female college students, excluding a large portion of the student population. Therefore, it is crucial that interventions are developed for males.

Methods:

This project utilized community-based participatory research on a college campus in the Northeast US. The research team consisted of four undergraduate male students, a university researcher, a graduate assistant, and staff from the Wellness Office. Data collection included surveys and focus groups exploring college men’s attitudes regarding sexual health behaviors.

Results:

Qualitative and quantitative data analysis revealed that the main motivator for condom use is pregnancy prevention and most do not use condoms if their female partner is on birth control. Results indicated low perceived susceptibility and severity towards contracting an STI so it is critical to encourage testing. The CBPR project team developed a theory-based peer education program based on the research results, which was implemented on campus. Preliminary process and outcome evaluation results show the program has potential to impact men’s perceived susceptibility of contracting STIs and be effective in increasing condom use and testing behaviors.

Conclusion:

Working with college male students, through a community-based participatory process on safer sex practices and condom use, revealed an important opportunity to include college males in the development and implementation of effective health promotion programs.

Objective: Describe the association between religion-informed sex decision-making on contraceptive use among university students.

Methods: Data from an online survey of students at a southeastern university were restricted to persons 18-29 years (N=593). Descriptive statistics, exact chi-square (χ²) tests, and measures of effect size (Cramer’s V: j) were used to assess the relationship between religion-informed sex decision-making (i.e. the extent to which religious/spiritual beliefs influence sex decision-making) and contraceptive use at last vaginal sex (long-acting reversible contraception (LARC), short-acting reversible contraception (SARC), condom, other).

Results: Students were female (74%), white (45%), non-Hispanic (84%), heterosexual (81%) and insured (80%). Median age was 20 years and 82% of students reported having had vaginal sex in the last 12 months. Students reported being religious (62%), spiritual (81%), or both (59%). Women’s use of LARC (p=0.004; φ=0.154) and condoms (p=0.045;φ=0.116) were significantly associated with religiosity, but not spirituality. Additionally, women who reported no or low religion-informed sex decision-making were more likely to report using LARC (p=0.049;φ=0.148), SARC (p=0.000;φ=0.258) and condoms (p=0.001;φ=0.214). Associations between contraception and religion-informed sex decision-making indicate medium to large effect sizes (0.15-0.25). Men’s report of contraceptive use was not influenced by religiosity or spirituality.

Conclusions: The majority of university students reported being religious, spiritual, or both. Religiosity and religion-informed sex decision-making were significantly associated with women’s contraceptive use, but not men’s. Providers should consider the importance of religion on university women’s contraceptive decision-making and employ patient-centered strategies to elicit this information when appropriate.

Introduction: New York City high school students who identify as lesbian, gay, bisexual, transgender, questioning and other identities on the spectrums of sexuality and gender (LGBTQ+) are more than three times as likely to experience a pregnancy compared to heterosexual and cisgender peers. NYC Department of Health and Mental Hygiene (DOHMH) designed and conducted a qualitative study to better understand LGBTQ+ teens’ experiences and needs in sexual health education in high school. Participants expressed that learned sexual health information was not applicable to their experiences. Inequitable access to information about sexual health co-exists with other trauma and stressors, such as family rejection, sexual abuse, and depression that disproportionately impact LGBTQ+ teens.

Approach: NYC DOHMH is uniquely positioned to amplify and act on the narratives of LGTBQ+ teens’ with respect to sexual health education. In partnership with other city agencies and community-based organizations, DOHMH has sought to alter sexual health education environments and content in schools, clinics, colleges, foster care agencies, and youth-serving organizations. Efforts include sharing LGBTQ+ teens’ experiences with providers, community leaders, parents, and school administrators and staff, as well as implementing adaptations in New York City Teens Connection (NYCTC) services which reach over 15,000 youth annually.

Conclusions: Amplifying and responding to the sexual health education needs of LGBTQ+ teens can lead to innovative solutions to address disparities in unintended teen pregnancies. With adaptations, sexual health education can be made more inclusive and supportive of LGBTQ+ teens in a variety of educational environments.

Background: There are notable disparities by race/ethnicity in the sexual health of U.S. adolescents and young adults. The objective of this study was to examine change over time in racial-ethnic disparities in sexual risk behaviors among U.S. high school students.

Methods: Data were analyzed from six biennial cycles of the national Youth Risk Behavior Survey (2007‒2017), conducted among cross-sectional, nationally representative samples of 9th-12th grade students. Data were collected via self-administered questionnaires. Multivariable logistic regression models were used to test for linear trends by race/ethnicity (white, black, Hispanic) in: ever had sex, current sexual activity, having four or more lifetime sexual partners, and condomless sex. Interaction terms were included to test for differences in trends by race/ethnicity. Further, prevalence ratios and risk differences by race/ethnicity for each cycle were used to calculate average percent change in the estimates to determine if health disparities changed over time.

Results: During 2007‒2017, prevalences for ever had sex, current sexual activity, and having four or more lifetime sexual partners decreased across all racial-ethnic groups. For condomless sex, prevalences declined over time for black and white students, but not Hispanic students. Significant differences in trends by race/ethnicity were observed for all variables except condomless sex. Data suggest that racial-ethnic health disparities for sexual risk behaviors decreased over time, except for condomless sex.

Conclusions: Although the racial-ethnic gap in sexual risk behaviors may be shrinking for many behaviors, work is still needed to achieve health equity in risks associated with HIV/AIDS, sexually transmitted infections, and pregnancy.

Introduction

Most abstinence-only sexual education programs contain information that does not meet the developmental needs of adolescence through young adulthood.¹ Some of the outcomes that were envisaged for abstinence-only education such as delayed initiation of sexual activities and positive sexual behavior have not been met.²

Methods

This was a cross-sectional survey, among new college students attending two historically black universities in a southern state. The online survey was a 76-question fixed-choice and open-response which was administered in students’ classrooms. These surveys were completed on their mobile phones and other provided devices. We analyzed results using IBM SPSS 25.0.

Results

383 young adults were recruited for this study. About 26% of them received abstinence-only sexual education before college. Students who received abstinence-only sexual education said they have been having oral sex regularly (32.8%), anal sex (4.8%), and sexual intercourse (30.7%) within the past 6 months of college enrollment. This group was more likely to believe that pulling out is safe sex (OR: 1.05, CI: 0.38-2.87) and less likely to discuss sexual health matters with their parents at home (p<0.05).

Conclusions

Our results reveal that receipt of abstinence-only sexual education was not protective of freshmen from unsafe sexual behavior. Our results showed that sexual education is not being adequately supplemented in the home.

1. Stanger-Hall, K. F., & Hall, D. W. (2011). Abstinence-only education and teen pregnancy rates: why we need comprehensive sex education in the U.S. PloS one, 6(10), e24658.

2. Mathematica Policy Research (2007). Impacts of Four Title V, Section 510 Abstinence Education Programs.

HIV and other sexually transmitted infections disproportionately affect African American Youth ages 13-25. Gender role perceptions may influence condom attitudes and condom use self-efficacy, which are related to condom use and condom negotiation skills. This study seeks to investigate the influence of gender role perceptions on condom attitudes and condom self-efficacy.

African American teens (n=152) ages 14-18 were surveyed in this study. Gender roles were assessed with the Attitude towards Women Scale and the Gender Role Attitudes Scale. The condom measures included Condom Attitudes and Condom Self-Efficacy scales.

Correlation analyses demonstrated more positive attitudes towards women were associated with positive condom attitudes (r=.299, p=.001) and higher condom self-efficacy (r=.502, p=.000). More positive gender role attitudes were associated with higher scores on condom self-efficacy (r=.207, p=.024). Multivariate analyses found a significant difference when examining attitudes towards women and condom attitudes (p<.0001) and condom self-efficacy (p<.0001). Adolescents with more modern views towards women had more positive views on condom use and higher levels of self- efficacy. There was also a significant difference in condom attitudes (p=.018) by gender role attitudes, demonstrating that adolescents with more modern gender role perceptions scored higher on the Condom Use Attitudes scale.

Results of this study indicate a need for programs addressing perceptions on gender roles and views of women to foster positive condom attitudes and increase condom self-efficacy. Shifting the perceptions of individuals regarding gender roles and condom use attitudes and condom self-efficacy may positively influence condom use and condom negotiation skills.