%0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e51517 %T Exploration of Reproductive Health Apps’ Data Privacy Policies and the Risks Posed to Users: Qualitative Content Analysis %A Zadushlivy,Nina %A Biviji,Rizwana %A Williams,Karmen S %+ Department of Health Policy and Management, Graduate School of Public Health and Health Policy, City University of New York, 55 W. 125th Street, New York, NY, 10027, United States, 1 918 816 0915, Karmen.Williams@sph.cuny.edu %K data privacy policy %K reproductive health apps %K Transparency, Health Content, Excellent Technical Content, Security/Privacy, Usability, Subjective %K THESIS %K THESIS evaluation %K women’s health %K menstrual health %K mobile health %K mHealth %K menstruating persons’ health %K mobile phone %D 2025 %7 5.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Mobile health apps often require the collection of identifiable information. Subsequently, this places users at significant risk of privacy breaches when the data are misused or not adequately stored and secured. These issues are especially concerning for users of reproductive health apps in the United States as protection of sensitive user information is affected by shifting governmental regulations such as the overruling of Roe v Wade and varying state-level abortion laws. Limited studies have analyzed the data privacy policies of these apps and considered the safety issues associated with a lack of user transparency and protection. Objective: This study aimed to evaluate popular reproductive health apps, assess their individual privacy policies, analyze federal and state data privacy laws governing these apps in the United States and the European Union (EU), and recommend best practices for users and app developers to ensure user data safety. Methods: In total, 4 popular reproductive health apps—Clue, Flo, Period Tracker by GP Apps, and Stardust—as identified from multiple web sources were selected through convenience sampling. This selection ensured equal representation of apps based in the United States and the EU, facilitating a comparative analysis of data safety practices under differing privacy laws. A qualitative content analysis of the apps and a review of the literature on data use policies, governmental data privacy regulations, and best practices for mobile app data privacy were conducted between January 2023 and July 2023. The apps were downloaded and systematically evaluated using the Transparency, Health Content, Excellent Technical Content, Security/Privacy, Usability, Subjective (THESIS) evaluation tool to assess their privacy and security practices. Results: The overall privacy and security scores for the EU-based apps, Clue and Flo, were both 3.5 of 5. In contrast, the US-based apps, Period Tracker by GP Apps and Stardust, received scores of 2 and 4.5, respectively. Major concerns regarding privacy and data security primarily involved the apps’ use of IP address tracking and the involvement of third parties for advertising and marketing purposes, as well as the potential misuse of data. Conclusions: Currently, user expectations for data privacy in reproductive health apps are not being met. Despite stricter privacy policies, particularly with state-specific adaptations, apps must be transparent about data storage and third-party sharing even if just for marketing or analytical purposes. Given the sensitivity of reproductive health data and recent state restrictions on abortion, apps should minimize data collection, exceed encryption and anonymization standards, and reduce IP address tracking to better protect users. %M 40053713 %R 10.2196/51517 %U https://www.jmir.org/2025/1/e51517 %U https://doi.org/10.2196/51517 %U http://www.ncbi.nlm.nih.gov/pubmed/40053713 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e65859 %T A Digital Pornography Education Prototype Co-Designed With Young People: Formative Evaluation %A Turvey,Jake %A Raggatt,Michelle %A Wright,Cassandra J C %A Davis,Angela C %A Temple-Smith,Meredith J %A Lim,Megan S C %K pornography %K education %K website %K prototyping %K evaluation %K sexual health %K sexual wellbeing %K pornography literacy %K young people %K youth %K adolescents %K The Gist %K sexual education %K Australia %K efficacy %K digital health %K co-design %D 2025 %7 4.3.2025 %9 %J JMIR Form Res %G English %X Background: Interventions to help young people make sense of sex and relationships in the context of widely available pornography are becoming increasingly supported in school settings. However, young people who experience disruptions to their education often have less access to such programs. Digital platforms may offer a more accessible method to deliver tailored sexual health and pornography literacy to young people who are disengaged from mainstream schooling, or who experience other types of structural disadvantage. Objective: This study aimed to describe the formative evaluation of “The Gist” a co-designed online sexual health education and pornography literacy prototype designed to meet the sexual health information needs of structurally marginalized young people in Australia. Methods: We conducted iterative workshops with 33 young people aged between 15 and 24 years recruited from an alternative education school in Melbourne, Australia. Through interactive activities, participants evaluated the overall prototype design, including its usability, desirability, inclusiveness, and potential for impact. Results: Participants reported The Gist to be easy to use (17/20, 85%) and safe (19/23, 83%), with “hot” branding (25/30, 83%). However, perceived content relevance was dependent on the participants’ existing level of sexual health knowledge and experience, with only 31% (7/23) agreeing that “The Gist feels like it was made for me.” The interactive learning activities such as the debunked (myth-busting) and quiz features were among the most used and well-liked on The Gist platform. Low unprompted engagement with the prototype outside of facilitated workshop settings also confirmed previous researcher postulations that The Gist as a standalone digital platform is unlikely to meet the needs of this population group. Further design refinements are needed to improve user experience, including more interactive activities and visual information in place of heavily text-based features. Conclusions: This study provides important insights into the design and sexual health information needs of structurally marginalized young people. Further research is needed to assess the overall efficacy of The Gist prototype, as well as its ability to positively influence young people’s sexual attitudes, beliefs, and behaviors. Future iterations should consider hybrid or face-to-face delivery models to better capture student engagement. %R 10.2196/65859 %U https://formative.jmir.org/2025/1/e65859 %U https://doi.org/10.2196/65859 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e63309 %T Exploring the Use of Digital Educational Tools for Sexual and Reproductive Health in Sub-Saharan Africa: Systematic Review %A Abdul Hamid Alhassan,Ramatu Hajia %A Haggerty,Catherine L %A Fapohunda,Abimbola %A Affan,Nabeeha Jabir %A Anto-Ocrah,Martina %+ Department of Medicine, Division of General Internal Medicine, University of Pittsburgh School of Medicine, 230 McKee Place, Pittsburgh, PA, 15213, United States, 1 000 000 0000, maa509@pitt.edu %K digital health %K adolescents %K Africa %K sexual health %K reproductive health %K human-centered design %D 2025 %7 26.2.2025 %9 Review %J JMIR Public Health Surveill %G English %X Background: Adolescents, particularly those in Sub-Saharan Africa, experience major challenges in getting accurate and comprehensive sexual and reproductive health (SRH) information because of sociocultural norms, stigma, and limited SRH educational resources. Digital educational tools, leveraging the widespread use of mobile phones and internet connectivity, present a promising avenue to overcome these barriers and enhance SRH education among adolescents in Sub-Saharan Africa. Objective: We conducted a systematic review to describe (1) the geographic and demographic distributions (designated objectives 1a and 1b, respectively, given their interrelatedness) and (2) the types and relevant impacts of digital educational tools (objective 2). Methods: We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, using databases, such as Ovid-MEDLINE, Google Scholar, PubMed, and ERIC, to conduct literature searches. The selection criteria focused on studies that specifically addressed digital educational tools used to assess or deliver SRH education, their implementation, and their effectiveness among the adolescent population in Sub-Saharan Africa. We used the JBI critical appraisal tools for the quality assessment of papers included in the review. Results: The review identified 22 studies across Sub-Saharan Africa that met the inclusion criteria. The 22 studies spanned populations in West, Central, East, and South Africa, with an emphasis on youth and adolescents aged 10-24 years, reflecting the critical importance of reaching these age groups with effective, accessible, and engaging health education (objectives 1a and 1b). There was a diverse range of digital tools used, including social media platforms, mobile apps, and gamified learning experiences, for a broad age range of adolescent youth. These methods were generally successful in engaging adolescents by providing them with accessible and relevant SRH information (objective 2). However, challenges, such as the digital divide, the cultural sensitivity of the material, and the necessity for a thorough examination of the long-term influence of these tools on behavior modification, were noted. Conclusions: Digital educational tools provide great potential to improve SRH education among adolescents in Sub-Saharan Africa. These technologies can help enhance relevant health outcomes and accessibility by delivering information that is easy to understand, interesting, and tailored to their needs. Future research should focus on addressing the identified challenges, including bridging the digital divide, ensuring cultural and contextual relevance of content, and assessing the long-term impact of digital SRH education on adolescent behavior and health outcomes. Policymakers and educators are encouraged to integrate digital tools into SRH educational strategies that target adolescents in order to improve the SRH of this age group and contribute to improving public health in Sub-Saharan Africa. %M 40009849 %R 10.2196/63309 %U https://publichealth.jmir.org/2025/1/e63309 %U https://doi.org/10.2196/63309 %U http://www.ncbi.nlm.nih.gov/pubmed/40009849 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 8 %N %P e60315 %T Simulation of Contraceptive Access for Adolescents and Young Adults Using a Pharmacist-Staffed e-Platform: Development, Usability, and Pilot Testing Study %A Knowles,Kayla %A Lee,Susan %A Yapalater,Sophia %A Taylor,Maria %A Akers,Aletha Y %A Wood,Sarah %A Dowshen,Nadia %+ PolicyLab, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, United States, 1 267 425 1449, knowlesk1@chop.edu %K adolescent %K contraception %K telemedicine %K user-centered design %K young adult %K reproductive %K design %K usability %K experience %K mHealth %K mobile health %K app %K youth %K teenager %K drug %K pharmacology %K pharmacotherapy %K pharmaceutics %K medication %K pharmacy %K digital health %K platform %K access %D 2025 %7 19.2.2025 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Offering contraceptive methods at pharmacies without a prescription is an innovative solution to reduce the incidence of unintended pregnancies among adolescents and young adults (AYA). Pharmacy-prescribed contraception may increase the convenience, simplicity, and affordability of contraceptives. Objective: The aim of this study was to develop, pilot test, and evaluate the acceptability and feasibility of a telemedicine electronic platform app simulating pharmacist prescribing of contraceptives to AYA as well as assess agreement between pharmacist-simulated contraceptive approvals and contraception as prescribed in routine clinic visits. Methods: This study was conducted in two phases: (1) development and usability testing of a prototype app to simulate pharmacists prescribing contraceptives to AYA and (2) pilot testing the app in a simulation for AYA requesting contraception from a pharmacist with pharmacist review and request approval or rejection. Eligibility criteria in both phases included the following: assigned female sex at birth, age 15-21 years, seeking contraceptive services at an academic adolescent medicine clinic, prior history of or intention to have penile-vaginal intercourse in the next 12 months, smartphone ownership, and English language proficiency. Phase 1 (usability) involved a video-recorded “think aloud” interview to share feedback and technical issues while using the app prototype on a smartphone and the completion of sociodemographic, sexual history, and perception of the prototype surveys to further develop the app. Phase 2 (pilot) participants completed phase 1 surveys, tested the updated app in a simulation, and shared their experiences in an audio-recorded interview. Descriptive analyses were conducted for quantitative survey data, and thematic analyses were used for interview transcripts. Results: Of the 22 participants, 10 completed usability testing, with a mean age of 16.9 (SD 1.97) years, and 12 completed pilot testing, with a mean age of 18.25 (SD 1.48) years. Three issues with the prototype were identified during “think aloud” interviews: challenges in comprehension of medical language, prototype glitches, and graphic design suggestions for engagement. Usability testing guided the frontend and backend creation of the platform. Overall, participants agreed or strongly agreed that using an app to receive contraceptives would make it easier for teens to access (n=19, 86%) and make contraceptive use less stigmatizing (n=19, 86%). In addition, participants agreed that receiving contraception prescriptions from a pharmacist without a clinic visit would be safe (n=18, 82%), convenient (n=19, 86%), acceptable (n=18, 82%), and easy (n=18, 82%). Pharmacists and medical providers had 100% agreement on the prescribed contraceptive method for pilot participants. Conclusions: AYA found contraceptive prescription by a pharmacist via an app to be highly acceptable and provided critical feedback to improve the design and delivery of the app. Additionally, pharmacist contraceptive approvals and contraception as prescribed in routine clinic visits were identical. %M 39970429 %R 10.2196/60315 %U https://pediatrics.jmir.org/2025/1/e60315 %U https://doi.org/10.2196/60315 %U http://www.ncbi.nlm.nih.gov/pubmed/39970429 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e55275 %T Evaluating Reaction Videos of Young People Watching Edutainment Media (MTV Shuga): Qualitative Observational Study %A Baker,Venetia %A Mulwa,Sarah %A Khanyile,David %A Arnold,Georgia %A Cousens,Simon %A Cawood,Cherie %A Birdthistle,Isolde %+ Faculty of Epidemiology and Population Health, The London School of Hygiene and Tropical Medicine, Keppel St, London, WC1E 7HT, United Kingdom, 44 020 7636 8636, venetia.baker1@lshtm.ac.uk %K mass media %K edutainment %K adolescents %K sexual health %K HIV prevention %K participatory research %D 2025 %7 31.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Mass media campaigns, particularly edutainment, are critical in disseminating sexual health information to young people. However, there is limited understanding of the authentic viewing experience or how viewing contexts influence engagement with media campaigns. Reaction videos, a popular format in web-based culture in which users film themselves reacting to television shows, can be adapted as a research method for immediate and unfiltered insights into young people’s engagement with edutainment media. Objective: We explored how physical and social context influences young people’s engagement with MTV Shuga, a dramatic television series based on sexual health and relationships among individuals aged 15 to 25 years. We trialed reaction videos as a novel research method to investigate how young people in South Africa experience the show, including sexual health themes and messages, in their viewing environments. Methods: In Eastern Cape, in 2020, purposively selected participants aged 18 to 24 years of an evaluation study were invited to take part in further research to video record themselves watching MTV Shuga episodes with their COVID-19 social bubble. To guide the analysis of the visual and audio data, we created a framework to examine the physical setting, group composition, social dynamics, coinciding activities, and viewers’ spoken and unspoken reactions to the show. We identified patterns within and across groups to generate themes about the nature and role of viewing contexts. We also reflected on the utility of the method and analytical framework. Results: In total, 8 participants recorded themselves watching MTV Shuga episodes in family or friendship groups. Viewings occurred around a laptop in the home (living room or bedroom) and outside (garden or vehicle). In same-age groups, viewers appeared relaxed, engaging with the content through discussion, comments, empathy, and laughter. Intergenerational groups experienced discomfort, with older relatives’ presence causing embarrassment and younger siblings’ distractions interrupting the engagement. Scenes featuring physical intimacy prompted some viewers to hide their eyes or leave the room. While some would prefer watching MTV Shuga alone to avoid the self-consciousness experienced in group settings, others valued the social experience and the lively discussions it spurred. This illustrates varied preferences for consuming edutainment and the factors influencing these preferences. Conclusions: The use of reaction videos for research captured real-time verbal and nonverbal reactions, physical environments, and social dynamics that other methods cannot easily measure. They revealed how group composition, dynamics, settings, and storylines can maximize engagement with MTV Shuga to enhance HIV prevention education. The presence of parents and the camera may alter young people’s behavior, limiting the authenticity of their viewing experience. Still, reaction videos offer a unique opportunity to understand audience engagement with media interventions and promote participatory digital research with young people. %M 39889281 %R 10.2196/55275 %U https://formative.jmir.org/2025/1/e55275 %U https://doi.org/10.2196/55275 %U http://www.ncbi.nlm.nih.gov/pubmed/39889281 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e60398 %T Sexual and Gender Minority Adolescents’ Preferences for HIV Pre-Exposure Prophylaxis Social Marketing Campaigns: Qualitative Preimplementation Study %A Macapagal,Kathryn %A Zapata,Juan Pablo %A Ma,Junye %A Gordon,Jacob D %A Owens,Christopher %A Valadez-Tapia,Silvia %A Cummings,Peter %A Walter,Nathan %A Pickett,Jim %+ Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, 625 N Michigan Ave, Suite 1400, Chicago, IL, 60611, United States, 1 312 503 3605, kathryn.macapagal@northwestern.edu %K social marketing campaigns %K sexual and gender minority %K adolescent %K HIV %K pre-exposure prophylaxis %K PrEP %K human-centered design %K implementation science %K dissemination %D 2025 %7 17.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Sexual and gender minority (SGM) adolescents in the United States are disproportionately affected by HIV. Pre-exposure prophylaxis (PrEP) is a highly effective biomedical HIV prevention method, but its awareness and uptake among SGM adolescents are low. There are no adolescent-centered PrEP social marketing campaigns in the United States that have the potential to increase awareness and interest in PrEP. Objective: To address this gap, this qualitative study aims to examine SGM adolescents’ needs and preferences regarding adolescent-centered PrEP social marketing campaigns. Methods: SGM adolescents from Chicago and its surrounding areas participated in web-based asynchronous focus groups from February to May 2021. Questions elicited their preferences for content, design, and delivery of SGM adolescent–centered PrEP campaigns. We used rapid qualitative data analysis and organized the findings around key components of social marketing, known as the 4 Ps: product, price, place, and promotion. Results: Participants (N=56) were aged 14 to 19 years (mean 18.16, SD 1.22 y), and 64% (36/56) of them identified as a racial or ethnic minority. Among the 56 participants, 70% (n=39) were aware of PrEP; however, 95% (n=53) did not know that PrEP could be prescribed to those aged under 18 years. Adolescents expressed a need for PrEP campaign messaging that provides simple, accurate, and easily accessible information (eg, what is PrEP, for whom PrEP is indicated, and where and how to access PrEP). For product and price, SGM adolescents wanted a campaign to address barriers to, costs of, and how to access PrEP and desired to know about other adolescents’ PrEP experiences to improve campaign relatability. For place and promotion, participants preferred digital campaigns on social media to reduce the possibility of embarrassment and stigma and increase the accessibility of health content. Conclusions: These findings lay the groundwork for designing adolescent-centered educational PrEP campaigns that prioritize both user preferences in PrEP marketing design and strategies to overcome common barriers to PrEP awareness. %R 10.2196/60398 %U https://formative.jmir.org/2025/1/e60398 %U https://doi.org/10.2196/60398 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e57399 %T Suspected Mpox Symptoms and Testing in Men Who Have Sex With Men in the United States: Cross-Sectional Study %A Atkins,Kaitlyn %A Carpino,Thomas %A Rao,Amrita %A Sanchez,Travis %A Edwards,O Winslow %A Hannah,Marissa %A Sullivan,Patrick S %A Ogale,Yasmin P %A Abara,Winston E %A Delaney,Kevin P %A Baral,Stefan D %K mpox %K emerging infectious diseases %K men who have sex with men %K sexual health %K testing %K monkeypox %K epidemic %K MSM %K United States %K rural %K cross-sectional study %K gay %K bisexual %K symptomology %K sociodemographic %K online sample %K self-efficacy %K rash %K fever %K HIV %K HIV prevention %K GBMSM %K Black and Hispanic %K LGBTQ %K Latino %K public health %K surveillance %K sores %D 2025 %7 16.1.2025 %9 %J JMIR Public Health Surveill %G English %X Background: The 2022 mpox outbreak in the United States disproportionately affected gay, bisexual, and other men who have sex with men (GBMSM). Uptake of mpox testing may be related to symptomology, sociodemographic characteristics, and behavioral characteristics. Objective: This study aimed to describe suspected mpox symptoms and testing uptake among a sample of GBMSM recruited via the internet in the United States in August 2022. Methods: We conducted a rapid internet-based mpox survey from August 5 to 15, 2022, among cisgender men 15 years and older who had previously participated in the 2021 American Men’s Internet Survey. We estimated the prevalence of suspected mpox symptoms (fever or rash or sores with unknown cause in the last 3 mo) and uptake of mpox testing. We calculated adjusted prevalence ratios (aPRs) and 95% CIs for associations between participant characteristics and suspected mpox symptoms and summarized characteristics of GBMSM reporting mpox testing. Among symptomatic GBMSM who did not receive mpox testing, we described testing self-efficacy, barriers, and facilitators. Results: Of 824 GBMSM, 126 (15.3%) reported at least 1 mpox symptom in the last 3 months; 58/126 (46%) with rash or sores, 57 (45.2%) with fever, and 11 (8.7%) with both. Increased prevalence of suspected mpox symptoms was associated with condomless anal sex (CAS; aPR 1.53, 95% CI 1.06‐2.20). Mpox testing was reported by 9/824 GBMSM (1%), including 5 with symptoms. Most GBMSM reporting mpox testing were non-Hispanic White men (7/9 vs 1 Black and 1 Hispanic or Latino man), and all 9 lived in urban areas. Most reported having an sexually transmitted infections test (8/9), 2 or more partners (8/9), CAS (7/9), and group sex (6/9) in the last 3 months. Of those tested, 3 reported living with HIV and all were on treatment, whereas the remaining 6 men without HIV reported current pre-exposure prophylaxis (PrEP) use. Of symptomatic GBMSM who did not report mpox testing, 47/105 (44.8%) had low mpox testing self-efficacy. Among those with low self-efficacy, the most common barriers to testing were not knowing where to get tested (40/47, 85.1%) and difficulty getting appointments (23/47, 48.9%). Among those with high testing self-efficacy (58/105, 55.2%), the most common facilitators to testing were knowing where to test (52/58, 89.7%), convenient site hours (40/58, 69%), and low-cost testing (38/58, 65.5%). Conclusions: While all GBMSM who reported testing for mpox were linked to HIV treatment or PrEP, those with symptoms but no mpox testing reported fewer such links. This suggests targeted outreach is needed to reduce structural barriers to mpox services among GBMSM in rural areas, Black and Hispanic or Latino GBMSM, and GBMSM living with HIV. Sustaining and scaling community-tailored messaging to promote testing and vaccination represent critical interventions for mpox control among GBMSM in the United States. %R 10.2196/57399 %U https://publichealth.jmir.org/2025/1/e57399 %U https://doi.org/10.2196/57399 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 13 %N %P e58912 %T Pervasive Games for Sexual Health Promotion: Scoping Literature Review %A Rubio,Claudio %A Besoain,Felipe %+ Department of Interactive Visualization and Virtual Reality, Faculty of Engineering, University of Talca, 2 norte #685, Talca, 3460000, Chile, 56 2201687 ext 2687, fbesoain@utalca.cl %K serious games %K promotion %K ubiquitous technologies %K healthy behaviors %K HIV %K sexually transmitted infection %K STI %K scoping review %K mobile phone %D 2025 %7 15.1.2025 %9 Review %J JMIR Serious Games %G English %X Background: Serious games play a fundamental role in promoting safe sexual behaviors. This medium has great potential for promoting healthy behaviors that prevent potential risk factors, such as sexually transmitted infections, and promote adherence to sexual health treatments, such as antiretroviral therapy. The ubiquity of mobile devices enhances access to such tools, increasing the effectiveness of video games as agents of change. Objective: In this scoping review, we aimed to (1) identify the extent to which pervasive games have been used in the field of sexual health, (2) determine the theories used in the design and evaluation of pervasive games for sexual health, (3) identify the methods used to evaluate pervasive games for sexual health, and (4) explore the reported benefits of using pervasive games for sexual health. Methods: Following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) methodology, we conducted a comprehensive literature search in the Web of Science, Scopus, IEEE Xplore, and ACM databases for articles published between January 1, 2000, and August 4, 2024. Included articles were published in English between 2000 and 2024 and involved the design, implementation, or evaluation of a ubiquitous video game focused on promoting safe sexual behaviors, with qualitative and/or quantitative results based on theory-based techniques and ubiquitous technologies. Review articles, conference papers, or books without available data or quantitative or qualitative results were excluded. Results: We screened 521 of 612 articles (85.1%) after removing duplicates. After the title and abstract review, 51 (9.8%) articles were assessed for eligibility, and 30 (5.8%) articles meeting the criteria were studied and evaluated in depth. The results suggested that the use of pervasive video games has a positive impact on promoting safe sexual behaviors. This is enhanced by the effectiveness of theory-based techniques and the use of mobile technologies as developmental factors that drive the gaming experience. The results indicated that this domain is a growing field that should not be ignored. Conclusions: The literature showed that pervasive video games have been effective in promoting safe sexual behaviors. Substantial growth has been seen in scientific community interest in researching this domain; nevertheless, there is still much to work on. In this context, we advocate for the standardization of design, implementation, and experimentation as essential phases in creating video game experiences. These 3 fundamental aspects are critical in the development of video game–based studies to ensure the reproducibility of experiments. %M 39813670 %R 10.2196/58912 %U https://games.jmir.org/2025/1/e58912 %U https://doi.org/10.2196/58912 %U http://www.ncbi.nlm.nih.gov/pubmed/39813670 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e57619 %T Studying the Digital Intervention Engagement–Mediated Relationship Between Intrapersonal Measures and Pre-Exposure Prophylaxis Adherence in Sexual and Gender Minority Youth: Secondary Analysis of a Randomized Controlled Trial %A Williams,Michael P %A Manjourides,Justin %A Smith,Louisa H %A Rainer,Crissi B %A Hightow-Weidman,Lisa B %A Haley,Danielle F %+ Bouve College of Health Sciences, Northeastern University, 30 Leon St, Boston, MA, 02115, United States, 1 617 373 3323, mpw144@gmail.com %K engagement %K pre-exposure prophylaxis %K PrEP %K digital health intervention %K adherence %K men who have sex with men %K sexual orientation %K gender minority %K youth %K adolescent %K teenager %K HIV %K randomized controlled trial %K mental health %K sociodemographic %K logistic regression %K health information %K health behavior %K sexual health %D 2025 %7 13.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Improving adherence to pre-exposure prophylaxis (PrEP) via digital health interventions (DHIs) for young sexual and gender minority men who have sex with men (YSGMMSM) is promising for reducing the HIV burden. Measuring and achieving effective engagement (sufficient to solicit PrEP adherence) in YSGMMSM is challenging. Objective: This study is a secondary analysis of the primary efficacy randomized controlled trial (RCT) of Prepared, Protected, Empowered (P3), a digital PrEP adherence intervention that used causal mediation to quantify whether and to what extent intrapersonal behavioral, mental health, and sociodemographic measures were related to effective engagement for PrEP adherence in YSGMMSM. Methods: In May 2019, 264 YSGMMSM were recruited for the primary RCT via social media, community sites, and clinics from 9 study sites across the United States. For this secondary analysis, 140 participants were eligible (retained at follow-up, received DHI condition in primary RCT, and completed trial data). Participants earned US currency for daily use of P3 and lost US currency for nonuse. Dollars accrued at the 3-month follow-up were used to measure engagement. PrEP nonadherence was defined as blood serum concentrations of tenofovir-diphosphate and emtricitabine-triphosphate that correlated with ≤4 doses weekly at the 3-month follow-up. Logistic regression was used to estimate the total effect of baseline intrapersonal measures on PrEP nonadherence, represented as odds ratios (ORs) with a null value of 1. The total OR for each intrapersonal measure was decomposed into direct and indirect effects. Results: For every US $1 earned above the mean (US $96, SD US $35.1), participants had 2% (OR 0.98, 95% CI 0.97-0.99) lower odds of PrEP nonadherence. Frequently using phone apps to track health information was associated with a 71% (OR 0.29, 95% CI 0.06-0.96) lower odds of PrEP nonadherence. This was overwhelmingly a direct effect, not mediated by engagement, with a percentage mediated (PM) of 1%. Non-Hispanic White participants had 83% lower odds of PrEP nonadherence (OR 0.17, 95% CI 0.05-0.48) and had a direct effect (PM=4%). Participants with depressive symptoms and anxiety symptoms had 3.4 (OR 3.42, 95% CI 0.95-12) and 3.5 (OR 3.51, 95% CI 1.06-11.55) times higher odds of PrEP nonadherence, respectively. Anxious symptoms largely operated through P3 engagement (PM=51%). Conclusions: P3 engagement (dollars accrued) was strongly related to lower odds of PrEP nonadherence. Intrapersonal measures operating through P3 engagement (indirect effect, eg, anxious symptoms) suggest possible pathways to improve PrEP adherence DHI efficacy in YSGMMSM via effective engagement. Conversely, the direct effects observed in this study may reflect existing structural disparity (eg, race and ethnicity) or behavioral dispositions toward technology (eg, tracking health via phone apps). Evaluating effective engagement in DHIs with causal mediation approaches provides a clarifying and mechanistic view of how DHIs impact health behavior. Trial Registration: ClinicalTrials.gov; NCT03320512; https://clinicaltrials.gov/study/NCT03320512 %M 39804696 %R 10.2196/57619 %U https://www.jmir.org/2025/1/e57619 %U https://doi.org/10.2196/57619 %U http://www.ncbi.nlm.nih.gov/pubmed/39804696 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52651 %T Promoting Comprehensive Sexuality Education in Pakistan Using a Cocreated Social Media Intervention: Development and Pilot Testing Study %A Ahmed,Furqan %A Ahmad,Ghufran %A Eisinger,Katharina %A Khan,Muhammad Asad %A Brand,Tilman %+ Department of Prevention and Evaluation, Leibniz Institute of Prevention Research and Epidemiology-BIPS, Achterstraße 30, Bremen, 28359, Germany, 49 (0)421 21856913, ahmedf@leibniz-bips.de %K digital health interventions %K sexuality education %K social media %K influencer marketing %K community readiness %D 2024 %7 20.12.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Comprehensive sexuality education (CSE) is a curriculum-based approach to learning and teaching about sexuality that focuses on the cognitive, emotional, physical, and social domains. The United Nations Educational, Scientific, and Cultural Organization (UNESCO) CSE guideline emphasizes gender issues and is firmly rooted in a human rights–based approach to sexuality. A recent cross-sectional community readiness assessment in Islamabad, Pakistan, found that the community is at the denial or resistant stage when it comes to implementing school-based sexuality education. The reluctance was attributed to a lack of understanding and widespread misconceptions about CSE. Objective: This study aims to use the cocreation process to develop, pilot, and evaluate an intervention based on community readiness level to respond to community resistance by introducing CSE content, its anticipated benefits, and addressing prevalent misconceptions through awareness and promotion content for digital social media platforms. Methods: For the development of the intervention (audio-video content), focus group discussion sessions with key stakeholders were held. Two videos were created in partnership with social media influencers and subsequently shared on Facebook, YouTube, and Instagram. A comprehensive process and performance evaluation of the videos and intervention development phase was conducted to evaluate audience exposure, reach, engagement, demographics, retention, and in-depth insights. The videos were uploaded to social media platforms in June and July 2021, and the data used to assess their performance was obtained in February 2022. Results: With a total reach (number of people who have contact with the videos) of 432,457 and 735,563 for the first and second videos, respectively, on all social media platforms, we concluded that social media platforms provide an opportunity to communicate, promote, and engage with important stakeholders to raise awareness and obtain support for CSE. According to the findings, the public is responsive to CSE promotion content developed for social media platforms, with a total engagement (the number of people who participate in creating, sharing, and using the content) of 11,578. The findings revealed that male viewers predominated across all social media platforms. Punjab province had the largest audience share on Instagram (51.9% for the first video, 52.7% for the second) and Facebook (44.3% for the first video and 48.4% for the second). YouTube had the highest audience retention, with viewers watching an average of 151 seconds (45%) of the first video and 163 seconds (38%) of the second. With a net sentiment score of 0.83 (minimum=−3, maximum=5), end-user participation was also positive, and audience feedback highlighted the reasons for positive and negative criticism. Conclusions: To promote sexuality education in Pakistan, it is vital to overcome opposition through sensitizing the society, and digital social media platforms offer a unique, though underused, chance to do so through reliable influencer marketing. %M 39705696 %R 10.2196/52651 %U https://formative.jmir.org/2024/1/e52651 %U https://doi.org/10.2196/52651 %U http://www.ncbi.nlm.nih.gov/pubmed/39705696 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e60692 %T Cocreating First Steps, a Toolkit to Improve Adolescent Sexual and Reproductive Health Services: Qualitative Human-Centered Design Study With Hispanic and Black Adolescent Mothers in New York City %A Gerchow,Lauren %A Lanier,Yzette %A Fayard,Anne-Laure %A Squires,Allison %+ Rory Meyers College of Nursing, New York University, 433 1st Ave, 6th Floor, New York, NY, 10010, United States, 1 212 998 5300, lmg490@nyu.edu %K adolescent %K reproductive health %K sexual health %K cocreation %K co-design %K human-centered design %D 2024 %7 19.11.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Adolescent voices are frequently excluded from sexual and reproductive health (SRH) research. Despite progressive policies and access to SRH care, adolescents in New York City who live in neighborhoods with high poverty and those who identify as Black or Hispanic experience poor SRH outcomes, including high rates of unplanned pregnancies and sexually transmitted infections. Objective: This qualitative study aims to guide Black and Hispanic adolescent mothers in identifying problem areas in SRH care and cocreate health service recommendations with input from health care stakeholders to address those problems and improve SRH experiences. Methods: Through ethnographic interview methods, adolescent mothers in New York City shared their experiences from before pregnancy through parenting and identified problem areas in adolescent SRH services and education. Data were analyzed inductively and using situational analysis. Adolescent participants attended 2 cocreation workshops. In the first workshop, they confirmed interview findings, set priorities, and created rough prototypes. Following the first workshop, health care providers were interviewed to inform refinement of the rough prototypes. Adolescents further developed prototypes in the second cocreation workshop and named the resulting toolkit. Results: A total of 16 adolescent mothers participated in 47 interviews, and 10 (63%) participants attended at least 1 cocreation workshop. They highlighted deficiencies in sexual health education and emphasized the roles of health care providers and parents, rather than schools, in improving it. Adolescent participants designed recommendations for adolescents and health care providers to support quality conversations between adolescents, parents, and health care providers and created a preappointment checklist to help young patients initiate conversations with health care providers. Young participants stressed that sex education should address topics beyond sexually transmitted infections and pregnancy, such as emotional health and relationships. They created guidelines for health care providers outlining communication strategies to provide respectful, unbiased care and contraceptive counseling that encourages adolescent autonomy. Participants shared specific suggestions for how to support young parents respectfully. Health care stakeholders recommended adding information on confidential care; supporting lesbian, gay, bisexual, transgender, and queer youth; and focusing on improving communication between health care providers and patients rather than creating educational materials. In the second workshop, adolescent participants revised the prototypes based on feedback from health care stakeholders and named the toolkit of recommendations First Steps. Conclusions: This study highlighted the important roles that parents and health care workers play in adolescent sexual health education. Cocreated toolkits offer a practical approach for health care providers to engage adolescents and their parents in meaningful, adolescent-centered conversations that can promote health, safety, and well-being. %M 39560978 %R 10.2196/60692 %U https://pediatrics.jmir.org/2024/1/e60692 %U https://doi.org/10.2196/60692 %U http://www.ncbi.nlm.nih.gov/pubmed/39560978 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58873 %T The Effect of Interventions Based on the Information-Motivation-Behavioral Skills Model on the Human Papillomavirus Vaccination Rate Among 11-13-Year-Old Girls in Central and Western China: Protocol for a Randomized Controlled Trial %A Jing,Shu %A Wu,Yijin %A Dai,Zhenwei %A Tang,Shenglan %A Su,Xiaoyou %A Qiao,Youlin %+ School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, No 9 Dong Dan San Tiao, Dongcheng District, Beijing, 100730, China, 86 65105830, suxiaoyou@hotmail.com %K human papillomavirus %K HPV %K HPV vaccine %K vaccine hesitancy %K information-motivation-behavioral skills model %K HPV vaccination rate %K randomized controlled trial %K vaccination rate %K China %D 2024 %7 19.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Persistent infection of high-risk human papillomavirus (HPV) can lead to cervical intraepithelial neoplasia, cervical cancer, and even death. HPV vaccination for girls aged 9-14 years can effectively prevent the occurrence of cervical cancer. Some Chinese provinces and cities have launched free HPV vaccination programs for school-age girls; however, due to the lack of supportive government policies, the high price and supply shortage of HPV vaccines, and vaccine hesitancy, some parents refuse to vaccinate their daughters. Objective: This protocol reports the design of a randomized controlled trial (RCT) aiming to explore the efficacy of a digital HPV vaccination education intervention based on the information-motivation-behavioral skills (IMB) model in improving the HPV vaccination rate among 11-13-year-old girls in central and western China. Methods: A multicenter intervention study based on an online applet will be conducted in December 2024, and about 750 eligible parents of 11-13-year-old girls will be assigned in a 1:1 ratio to an intervention group receiving 7-day digital HPV vaccination education based on the IMB model or a control group using non-HPV publicity materials. Free HPV vaccination pilot projects will be carried out among this population by our research team in central and western China (some parents might refuse to vaccinate their daughters). All participants will be asked to complete online questionnaires at baseline; postintervention; and 1 week, 1 month, and 3 months after the intervention. Results: The primary outcome of this study will be receipt of the first HPV vaccination within 3 months. Data will be analyzed based on an intention-to-treat approach, and Stata 16.0 will be used for statistical analysis. Conclusions: This study aims to improve the HPV vaccination rate among 11-13-year-old girls and will examine the impact of a digital HPV vaccination education intervention based on the IMB model. The findings of this study may offer promising intervention measures for HPV vaccine hesitancy in low-health-resource areas in the future. Trial Registration: Chinese Clinical Trial Registry, ChiCTR2300067402; https://tinyurl.com/v5zt4hc9 International Registered Report Identifier (IRRID): PRR1-10.2196/58873 %M 39560975 %R 10.2196/58873 %U https://www.researchprotocols.org/2024/1/e58873 %U https://doi.org/10.2196/58873 %U http://www.ncbi.nlm.nih.gov/pubmed/39560975 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e63211 %T Awareness and Uptake of HIV Preexposure Prophylaxis and Postexposure Prophylaxis Among College Students With Sexual Experiences: Institutional-Based Cross-Sectional Study %A Xu,Junfang %A Xu,Ke %A Juma,Omar %A Zhang,Xingliang %A Lian,Zhujun %K HIV %K preexposure prophylaxis %K postexposure prophylaxis %K college students %K China %D 2024 %7 6.11.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Evidence has shown that HIV prevalence among young people, especially college students, has increased disproportionately. Preexposure prophylaxis (PrEP) and postexposure prophylaxis (PEP) are two of the most effective ways to prevent HIV, which are vital for college students with sexual experiences who have sexual risks. Objective: To provide evidence for effective intervention to reduce the risk of HIV infection among young students, this study aimed to analyze the awareness and uptake of HIV PrEP and PEP among college students with sexual experiences. Methods: An institutional-based cross-sectional study design was used to collect data through an electronic questionnaire from college students in 5 colleges located in Zhejiang Province. A total of 21,962 college students were investigated, of which 2605 students with sexual experiences were included in the data analysis with the following information collected: sociodemographic characteristics, awareness and uptake of HIV PrEP and PEP, sexual behaviors, and HIV tests. Binary logistic regression analysis was used to explore the factors on seeking PrEP and PEP. Results: The average age of college students with sexual experiences was 21.25 (SD 2.75) years. Overall, 61.4% (n=1600) of the participants were aware of PrEP, and 53.0% (n=1380) of them were aware of PEP. Moreover, 5.6% (n=146) of them have sought PrEP or/and PEP, and 89.1% (n=2321) have not sought PrEP or PEP. College students who had more than 6 sexual partners, have always had unprotected sex, have subjective perceived risk behavior, and undergo HIV testing were more likely to seek PrEP or/and PEP. The main ways for the participants to learn PrEP and PEP were through school clubs, the internet, and the Centers for Disease Control and Prevention. Moreover, senior students and those who had not undergone an HIV test had a lower likelihood of seeking PrEP and PEP. College students who did not have risky sexual behaviors (odds ratio 0.468, P=.004) and homosexual students (odds ratio 0.318, P=.03) were more likely not to seek PEP. Conclusions: College students with sexual experiences rarely seek PrEP and PEP, with a relatively low awareness of PrEP and PEP. It is very important to increase the knowledge and uptake of PrEP and PEP by educational and behavioral interventions among young students at risk for HIV infection. %R 10.2196/63211 %U https://publichealth.jmir.org/2024/1/e63211 %U https://doi.org/10.2196/63211 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e52557 %T Feasibility of Sexual Health and Contraceptive Web Services for Adolescents and Young Adults: Retrospective Study of a Pilot Program on Reunion Island %A Reynaud,Danielle %A Bouscaren,Nicolas %A Cartron,Emmanuelle %A Marimoutou,Catherine %K sexual health %K adolescent %K young adults %K web application %K contraception prescription %K contraception %K teleconsultation %K telemedicine %K youth %K usage %K e-consultation %K web based %D 2024 %7 1.11.2024 %9 %J JMIR Pediatr Parent %G English %X Background: Sexual health indicators for adolescents and young adults (AYAs) aged between 13 and 25 years are particularly poor on Reunion Island. Access to accurate information as well as sexual health and contraceptive services are vital to maintaining sexual well-being. Teleconsultations offer a promising approach to addressing the sexual health and contraceptive needs of AYAs who are more susceptible to engaging in unprotected sexual intercourse. However, the literature on digital sexual health services for this demographic group is limited. Objective: This study aims to describe the feasibility of a pilot sexual health and contraceptive teleconsultation web service used by AYAs on Reunion Island. Methods: A descriptive, retrospective study was conducted at the Reunion Island University Hospital Center using a convenient sample. Eligible participants were informed about the program through various communication channels, including seminars for health care professionals, radio broadcasts, posters, flyers, press articles, videos, and social media posts. AYAs accessed a web-based platform named SEXTUOZE from December 15, 2021, to September 30, 2022, that offered sexual health information and teleconsultations. Data collected included participant and teleconsultation characteristics, patient satisfaction, and the quality of completeness of medical records. Results: A total of 22 teleconsultations were scheduled and 7 were completed, all via synchronous video communication (duration: median 35 min). Overall, 4731 sessions were generated on the SEXTUOZE website. Reasons cited for accessing the web services were to seek sexual health advice (8/22, 36%), receive an initial birth control prescription (12/22, 55%), and inquire about condom prescriptions (2/22, 9%). Conclusions: While teleconsultation use for sexual health was initially low, it rose toward the end of the study period. Considering all elements of the implementation theory, future research should design interventions that not only are more operative and tailored but also ensure their adoption and sustainability in various health contexts. %R 10.2196/52557 %U https://pediatrics.jmir.org/2024/1/e52557 %U https://doi.org/10.2196/52557 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e59087 %T eHealth Communication Intervention to Promote Human Papillomavirus Vaccination Among Middle-School Girls: Development and Usability Study %A Kim,Youlim %A Lee,Hyeonkyeong %A Park,Jeongok %A Kim,Yong-Chan %A Kim,Dong Hee %A Lee,Young-Me %+ College of Nursing, Mo-Im Kim Nursing Research Institute, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2228 3373, hlee39@yuhs.ac %K cervical cancer %K human papillomavirus %K vaccines %K health communication %K chatbot %K artificial intelligence %K adolescent %K mobile phone %D 2024 %7 28.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: As the age of initiating sexual intercourse has gradually decreased among South Korean adolescents, earlier vaccination of adolescents for human papillomavirus (HPV) is necessary before their exposure to HPV. Health communication includes “cues to action” that lead to preventive health behaviors, and recently, social networking services, which operate with fewer time and space constraints, have been used in various studies as a form of eHealth communication. Objective: This study aims to investigate the feasibility and usability of an eHealth communication intervention for HPV vaccination in middle-school girls aimed at the girls and their mothers. Methods: The eHealth communication intervention for HPV vaccination was developed using a 6-step intervention mapping process: needs assessments, setting program outcomes, selection of a theory-based method and practical strategies, development of the intervention, implementation plan, and testing the validity of the intervention. Results: A review of 10 studies identified effective health communication messages, delivery methods, and theories for HPV vaccination among adolescents. Barriers including low knowledge, perceived threat, and the inconvenience of taking 2 doses of the vaccine were identified through focus groups, suggesting a need for youth-friendly and easy-to-understand information for adolescents delivered via mobile phones. The expected outcomes and the performance objectives are specifically tailored to reflect the vaccination intention. Behavior change techniques were applied using trusted sources and a health belief model. Health messages delivered through a KakaoTalk chatbot improved awareness and self-efficacy. Quality control was ensured with the use of a log system. The experts’ chatbot usability average score was 80.13 (SD 8.15) and the average score of girls was 84.06 (SD 7.61). Conclusions: Future studies need to verify the effectiveness of health communication strategies in promoting HPV vaccination and the effectiveness of scientific intervention using a chatbot as a delivery method for the intervention. %M 39466304 %R 10.2196/59087 %U https://formative.jmir.org/2024/1/e59087 %U https://doi.org/10.2196/59087 %U http://www.ncbi.nlm.nih.gov/pubmed/39466304 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55815 %T A Digital Sexual Health Intervention for Urban Adolescent and Young Adult Male Emergency Department Patients: User-Centered Design Approach %A Chernick,Lauren S. %A Bugaighis,Mona %A Daylor,Victoria %A Hochster,Daniel %A Rosen,Evan %A Schnall,Rebecca %A Stockwell,Melissa S %A Bell,David L. %+ Columbia University Irving Medical Center, 3959 Broadway, New York, NY, United States, 1 2123059825, lc2243@cumc.columbia.edu %K sexual health %K adolescent health %K sex education %K emergency medicine %K health planning %K sexual behavior %K SMS text messaging %K mHealth %K mobile app %K condom use %K user-centered design %D 2024 %7 4.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Adolescents and young adults frequently present to the emergency department (ED) for medical care and continue to have many unmet sexual health needs. Digital interventions show promise to improve adolescent and young adult sexual health; yet, few interventions focus on male ED patients, despite their infrequent use of contraceptives and rising rates of sexually transmitted infections. Objective: This paper describes the design and development of Dr. Eric (Emergency Room Interventions to Improve Care), a digital app focused on promoting condom use among sexually active adolescent and young adult male ED patients. Methods: This study followed 4 phases of app development, which were based on user-centered design and the software development lifecycle. In phase 1, define, we explored our target population and target health problem (infrequent condom use among male ED patients) by collecting key stakeholder input and conducting in-depth interviews with male patients and urban ED medical providers. In phase 2, discover, we partnered with a digital product agency to explore user experience and digital strategy. In phase 3, design, we refined Dr. Eric’s content, a 5-part sexual health educational module and a 10-week SMS text messaging program that focuses on condom use and partner communication about effective contraceptives. We conducted semistructured interviews with male adolescent and young adults to gather feedback on the app and perform usability testing, editing the app after each interview. We also interviewed informatics experts to assess the usability of a high-fidelity prototype. Interviews were recorded and analyzed via descriptive thematic analysis; informatic expert feedback was categorized by Nielsen’s heuristic principles. In phase 4, develop, we created the technical architecture and built a responsive web app. These findings were gathered leading to the final version of the digital Dr. Eric program. Results: Using data and key stakeholder input from phases 1 and 2, we iteratively created the Dr. Eric prototype for implementation in the ED setting. Interviews with 8 adolescent and young adult male ED patients suggested that users preferred (1) straightforward information, (2) a clear vision of the purpose of Dr. Eric, (3) open-ended opportunities to explore family planning goals, (4) detailed birth control method information, and (5) games presenting novel information with rewards. Five usability experts provided heuristic feedback aiming to improve the ease of use of the app. These findings led to the final version of Dr. Eric. Conclusions: Following these mobile health development phases, we created a digital sexual health mobile health intervention incorporating the principles of user experience and interface design. Dr. Eric needs further evaluation to assess its efficacy in increasing condom use among adolescent and young adult male ED patients. Researchers can use this framework to form future digital health ED-based digital interventions. %M 39365657 %R 10.2196/55815 %U https://formative.jmir.org/2024/1/e55815 %U https://doi.org/10.2196/55815 %U http://www.ncbi.nlm.nih.gov/pubmed/39365657 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e60021 %T Investigation of Mother-to-Child Transmission of Hepatitis B in Yinchuan, China: Cross-Sectional Survey Study %A Gu,Jie %A Xu,Yiyuan %A Yuan,Jiao %A Chen,Yuxiang %A Luo,Jingxia %A Guo,Cui %A Zhang,Guanbin %+ Department of Laboratory Medicine, Fujian Medical University, 1 Xuefu North Road, University Town, Minhou County, Fuzhou, 350122, China, 86 13811332083, gbzhang@capitalbio.com %K hepatitis B virus %K mother-to-child transmission %K antiviral therapy %K immunization failure %K cord blood %D 2024 %7 4.9.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Hepatitis B poses a significant global public health challenge, with mother-to-child transmission (MTCT) being the primary method of hepatitis B virus (HBV) transmission. The prevalence of HBV infection in China is the highest in Asia, and it carries the greatest burden globally. Objective: This study aims to critically evaluate the existing local strategies for preventing MTCT and the proposed potential enhancements by analyzing the prevalence of hepatitis B among pregnant women and their neonates in Yinchuan. Methods: From January 2017 to December 2021, 37,557 prenatal screening records were collected. Among them, 947 pregnant women who tested positive for hepatitis B surface antigen (HBsAg) near delivery and their 960 neonates were included in an HBV-exposed group, while 29 pregnant women who tested negative and their 30 neonates were included in an HBV-nonexposed group. HBV markers in maternal peripheral blood and neonatal cord blood were analyzed using the least absolute shrinkage and selection operator (LASSO) regression, logistic regression, chi-square test, t-test, and U-test. Additionally, to further evaluate the diagnostic value of HBsAg positivity in cord blood, we conducted an additional follow-up study on 103 infants who tested positive for HBsAg in their cord blood. Results: The prevalence of HBV among pregnant women was 2.5% (947/37,557), with a declining trend every year (χ²4=19.7; P=.001). From 2018 to 2020, only 33.0% (35/106) of eligible pregnant women received antiviral medication treatment. Using LASSO regression to screen risk factors correlated with HBsAg positivity in cord blood (when log [λ] reached a minimum value of –5.02), 5 variables with nonzero coefficients were selected, including maternal hepatitis B e-antigen (HBeAg) status, maternal hepatitis B core antibody (HBcAb) status, maternal HBV DNA load, delivery method, and neonatal birth weight. Through univariate and multivariate logistic regression, delivery by cesarean section (adjusted odds ratio [aOR] 0.52, 95% CI 0.31-0.87), maternal HBeAg positivity (aOR 2.05, 95% CI 1.27-3.33), low maternal viral load (aOR 2.69, 95% CI 1.33-5.46), and high maternal viral load (aOR 2.69, 95% CI 1.32-5.51) were found to be strongly associated with cord blood HBsAg positivity. In the additional follow-up study, 61 infants successfully completed the follow-up, and only 2 were found to be infected with HBV. The mothers of both these infants had detectable HBV DNA levels and should have received standard antiviral therapy. The results of the hepatitis B surface antibody (HBsAb) positivity rate and titer test indicated a gradual decline in the immunity of vaccinated infants as the interval after vaccination increased. Conclusions: The clinical relevance of HBV marker detection in cord blood is restricted within the current prevention measures for MTCT. There is an emphasis on the significance of public education regarding hepatitis B and the reinforcement of postnatal follow-up for the prevention of MTCT. %M 39230944 %R 10.2196/60021 %U https://publichealth.jmir.org/2024/1/e60021 %U https://doi.org/10.2196/60021 %U http://www.ncbi.nlm.nih.gov/pubmed/39230944 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e58009 %T Integrating Sexual and Reproductive Health Equity Into Public Health Goals and Metrics: Comparative Analysis of Healthy People 2030’s Approach and a Person-Centered Approach to Contraceptive Access Using Population-Based Data %A Gomez,Anu Manchikanti %A Reed,Reiley Diane %A Bennett,Ariana H %A Kavanaugh,Megan %+ School of Social Welfare, University of California, Berkeley, 120 Haviland Hall MC 7400, Berkeley, CA, 94720-7400, United States, 1 510 642 0722, anugomez@berkeley.edu %K contraception %K public health objectives %K public health metrics %K person-centeredness %K sexual and reproductive health equity %D 2024 %7 20.8.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The Healthy People initiative is a national effort to lay out public health goals in the United States every decade. In its latest iteration, Healthy People 2030, key goals related to contraception focus on increasing the use of effective birth control (contraceptive methods classified as most or moderately effective for pregnancy prevention) among women at risk of unintended pregnancy. This narrow focus is misaligned with sexual and reproductive health equity, which recognizes that individuals’ self-defined contraceptive needs are critical for monitoring contraceptive access and designing policy and programmatic strategies to increase access. Objective: We aimed to compare 2 population-level metrics of contraceptive access: a conventional metric, use of contraceptive methods considered most or moderately effective for pregnancy prevention among those considered at risk of unintended pregnancy (approximating the Healthy People 2030 approach), and a person-centered metric, use of preferred contraceptive method among current and prospective contraceptive users. Methods: We used nationally representative data collected in 2022 to construct the 2 metrics of contraceptive access; the overall sample included individuals assigned female at birth not using female sterilization or otherwise infecund and who were not pregnant or trying to become pregnant (unweighted N=2760; population estimate: 43.9 million). We conducted a comparative analysis to examine the convergence and divergence of the metrics by examining whether individuals met the inclusion criteria for the denominators of both metrics, neither metric, only the conventional metric, or only the person-centered metric. Results: Comparing the 2 approaches to measuring contraceptive access, we found that 79% of respondents were either included in or excluded from both metrics (reflecting that the metrics converged when individuals were treated the same by both). The remaining 21% represented divergence in the metrics, with an estimated 5.7 million individuals who did not want to use contraception included only in the conventional metric denominator and an estimated 3.5 million individuals who were using or wanted to use contraception but had never had penile-vaginal sex included only in the person-centered metric denominator. Among those included only in the conventional metric, 100% were content nonusers—individuals who were not using contraception, nor did they want to. Among those included only in the person-centered metric, 68% were currently using contraception. Despite their current or desired contraceptive use, these individuals were excluded from the conventional metric because they had never had penile-vaginal sex. Conclusions: Our analysis highlights that a frequently used metric of contraceptive access misses the needs of millions of people by simultaneously including content nonusers and excluding those who are using or want to use contraception who have never had sex. Documenting and quantifying the gap between current approaches to assessing contraceptive access and more person-centered ones helps clearly identify where programmatic and policy efforts should focus going forward. %M 39163117 %R 10.2196/58009 %U https://publichealth.jmir.org/2024/1/e58009 %U https://doi.org/10.2196/58009 %U http://www.ncbi.nlm.nih.gov/pubmed/39163117 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48371 %T Exploring the Use of Customized Links to Improve Electronic Engagement With Sexual and Reproductive Health Care Among Young African American Male Individuals: Web-Based Survey Study %A Arena,Sandy %A Adams,Mackenzie %A Burns,Jade %+ School of Nursing, University of Michigan, 400 N Ingalls, Room 3175, Ann Arbor, MI, 48109, United States, 1 734 936 5311, saarena@umich.edu %K African American %K engagement %K men’s health %K recruit %K recruitment %K reproductive health %K sexual behavior %K sexual health behavior %K sexual health %K sexual transmission %K sexually transmitted %K social media %K STIs %K young adult %K young adults %D 2024 %7 24.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Research has shown that heterosexual African American male individuals aged 18-24 years have a higher prevalence of sexually transmitted infections (STIs) and are more likely to engage in risky sexual behavior. There is a critical need to promote sexual reproductive health (SRH) services among this population, especially in urban settings. Young African American male individuals use social media platforms to access health information, showcasing the potential of social media and web-based links as tools to leverage electronic engagement with this population to promote SRH care. Objective: This study aims to explore electronic engagement with young African American male individuals in discussions about SRH care. This paper focuses on the recruitment and social media marketing methods used to recruit young, heterosexual African American male individuals aged 18-24 years for the Stay Safe Project, a larger study that aims to promote SRH services among this population in Detroit, Michigan. We investigate the use of TinyURL, a URL shortener and customized tool, and culturally informed social media marketing strategies to promote electronic engagement within this population. Methods: Participants were recruited between December 2021 and February 2022 through various modes, including email listserves, Mailchimp, the UMHealthResearch website, X (formerly Twitter), Facebook, and Instagram. Images and vector graphics of African American male individuals were used to create social media advertisements that directed participants to click on a TinyURL that led to a recruitment survey for the study. Results: TinyURL metrics were used to monitor demographic and user data, analyzing the top countries, browsers, operating systems, and devices of individuals who engaged with the customized TinyURL links and the total human and unique clicks from various social media platforms. Mailchimp was the most successful platform for electronic engagement with human and unique clicks on the custom TinyURL link, followed by Instagram and Facebook. In contrast, X, traditional email, and research recruiting websites had the least engagement among our population. Success was determined based on the type of user and follower for each platform, whether gained in the community through sign-ups or promoted at peak user time and embedded and spotlighted on nontraditional media (eg, social media sites, blogs, and podcasts) for the user. Low engagement (eg, traditional email) from the target population, limited visibility, and fewer followers contributed to decreased engagement. Conclusions: This study provides insight into leveraging customized, shortened URLs, TinyURL metrics, and social media platforms to improve electronic engagement with young African American male individuals seeking information and resources about SRH care. The results of this study have been used to develop a pilot intervention for this population that will contribute to strategies for encouraging sexual well-being, clinic use, and appropriate linkage to SRH care services among young, heterosexual African American male individuals. %M 38656772 %R 10.2196/48371 %U https://formative.jmir.org/2024/1/e48371 %U https://doi.org/10.2196/48371 %U http://www.ncbi.nlm.nih.gov/pubmed/38656772 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52695 %T Nurse-Led Brief Intervention for Enhancing Safe Sex Practice Among Emerging Adults in Hong Kong Using Instant Messaging: Feasibility Study %A Pak,Sharon Hoi Lam %A Wang,Man Ping %A Teitelman,Anne M %A Wong,Janet Yuen Ha %A Fong,Daniel Yee Tak %A Choi,Edmond Pui Hang %+ School of Nursing and Health Studies, Hong Kong Metropolitan University, 11/F, 1 Sheung Shing Street, Homantin, Kowloon, Hong Kong, China (Hong Kong), 852 39702988, jyhwong@hkmu.edu.hk %K condom use %K emerging adults %K HIV prevention %K IM intervention %K mHealth %K nurse-led intervention %K safer sex practice %K sexual health %K sexually transmitted infections %K text-messaging %D 2024 %7 20.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The incidence of sexually transmitted infections has been increasing throughout the world. Additionally, substantial changes in emerging adults’ attitudes toward sex and the popularization of premarital sex could further affect the diagnosis and treatment of sexually transmitted infections. With the high acceptability and effectiveness of instant messaging (IM) interventions for health promotion, there is potential for such interventions to improve condom use knowledge and promote safer sex practice. Objective: The study evaluates the feasibility of a nurse-led IM intervention to promote safer sex practices in emerging adults. Methods: A 30-minute adaptive IM intervention and a 5-day booster dose of daily messages after 2 weeks through WhatsApp (Meta Platforms, Inc) were conducted with emerging adults in local universities in Hong Kong aged between 18 and 29 years with previous sexual experience. A questionnaire was distributed 1 week after the intervention that measured the consistency in condom use, the change in condom use knowledge and attitudes, and the acceptability of the intervention. The feasibility of the intervention was assessed by Bowen’s feasibility framework. Results: A total of 20 participants completed the intervention and questionnaire. Results showed (1) high satisfaction level (mean satisfaction score: 9.10/10), (2) high demand of the intervention (retention rate: 95%), (3) smooth implementation of the intervention, (4) high practicality (13/20, 65% of the participants viewed IM to be an effective means of intervention), (5) potential integration of the intervention, and (6) significant mean increase in condom use knowledge and attitudes (mean increase 9.05; t19=3.727; 95% CI 3.97-14.13; P=.001). Conclusions: The IM intervention was feasible, acceptable, and had potential impacts on improving safer sex practices. These findings will support the future development of IM interventions in the arena of sexual health promotion. %M 38506897 %R 10.2196/52695 %U https://formative.jmir.org/2024/1/e52695 %U https://doi.org/10.2196/52695 %U http://www.ncbi.nlm.nih.gov/pubmed/38506897 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e47216 %T Efficacy of a Digital Health Preventive Intervention for Adolescents With HIV or Sexually Transmitted Infections and Substance Use Disorder: Protocol for a Randomized Controlled Trial %A Cordova,David %A Bauermeister,José A %A Warner,Sydni %A , %A Wells,Patricia %A MacLeod,Jennifer %A Neilands,Torsten B %A Mendoza Lua,Frania %A Delva,Jorge %A Fessler,Kathryn Bondy %A Smith Jr,Versell %A Khreizat,Sarah %A Boyer,Cherrie %+ School of Social Work, University of Michigan, 1080 South University Avenue, Ann Arbor, MI, 48109, United States, 1 734 763 6201, cordovad@umich.edu %K youth %K mHealth %K HIV %K STI %K illicit drugs %K primary care %K prevention %K public health %K USA %K teens %K drugs %K drug use %K sex %K racial minority %K risk behavior %K engagement %K tool %K substance use disorder %D 2024 %7 19.2.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: HIV or sexually transmitted infections remain a significant public health concern in the United States, with adolescents affected disproportionately. Adolescents engage in HIV/STI risk behaviors, including drug use and condomless sex, which increase the risk for HIV/STIs. At-risk adolescents, many of whom are racial minorities, experience HIV/STI disparities. Although at-risk adolescents are disproportionately affected by HIV/STI risk behaviors and infections and although the Centers for Disease Control and Prevention recommends routine HIV/STI testing for adolescents, relatively few adolescents report having ever been tested for HIV/STI. With expected increases in health clinic visits as a result of the Affordable Care Act combined with technological advances, health clinics and mobile health (mHealth), including apps, provide innovative contexts and tools to engage at-risk adolescents in HIV/STI prevention programs. Yet, there is a dearth of efficacious mHealth interventions in health clinics to prevent and reduce both condomless sex and drug use and increase HIV/STI testing for at-risk adolescents. Objective: To address this gap in knowledge, we developed a theory-driven, culturally congruent mHealth intervention (hereon referred to as S4E [Storytelling 4 Empowerment]) that has demonstrated feasibility and acceptability in a clinical setting. The next step is to examine the preliminary efficacy of S4E on adolescent HIV/STI testing and risk behaviors. This goal will be accomplished by 2 aims: the first aim is to develop a cross-platform and universal version of S4E. The cross-platform and universal version of S4E will be compatible with both iOS and Android operating systems and multiple mobile devices, aimed at providing adolescents with ongoing access to the intervention once they leave the clinic, and the second aim is to evaluate the preliminary efficacy of S4E, relative to usual care control condition, in preventing or reducing drug use and condomless sex and increasing HIV/STI testing in a clinical sample of at-risk adolescents aged 14-21 years living in Southeast Michigan. Methods: In this study, 100 adolescents recruited from a youth-centered community health clinic will be randomized via blocked randomization with random sequences of block sizes to one of the 2 conditions: S4E mHealth intervention or usual care. Theory-driven and culturally congruent, S4E is an mHealth adaptation of face-to-face storytelling for empowerment, which is registered with the Substance Abuse and Mental Health Services Administration's National Registry of Evidence-Based Programs and Practices. Results: This paper describes the protocol of our study. The recruitment began on May 1, 2018. This study was registered on December 11, 2017, in ClinicalTrials.gov. All participants have been recruited. Data analysis will be complete by the end of March 2024, with study findings available by December 2024. Conclusions: This study has the potential to improve public health by preventing HIV/STI and substance use disorders. Trial Registration: ClinicalTrials.gov NCT03368456; https://clinicaltrials.gov/study/NCT03368456 International Registered Report Identifier (IRRID): DERR1-10.2196/47216 %M 38373025 %R 10.2196/47216 %U https://www.researchprotocols.org/2024/1/e47216 %U https://doi.org/10.2196/47216 %U http://www.ncbi.nlm.nih.gov/pubmed/38373025 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e51278 %T Determinants of Adolescent Sexual and Reproductive Health in Sub-Saharan Africa: Protocol for an Umbrella Review %A Ghadirian,Mona Ziba %A Omer,Khalid %A Cockcroft,Anne %+ Department of Family Medicine, McGill University, 5858 chemin de la Côte-des-Neiges, Montreal, QC, H3S 1Z1, Canada, 1 514 398 7375, mona.ghadirian@mcgill.ca %K adolescents %K youth %K sexual health %K reproductive health %K sexually transmitted infections %K pregnancy %K sub-Saharan Africa %D 2023 %7 17.11.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Adolescents are a large proportion of the population in sub-Saharan Africa and face multiple risks to their health and well-being. Prior systematic reviews have focused on specific adolescent sexual and reproductive health outcomes such as teen pregnancies, HIV/AIDS, and sexually transmitted diseases. A comprehensive synthesis of the influential factors that shape different aspects of adolescent sexual and reproductive health can inform health policy and program development for this important segment of the population. Objective: This paper presents the protocol for an umbrella review that aims to synthesize the existing knowledge in the literature on the associations among individual, family, and societal factors and sexual and reproductive health outcomes among adolescents in sub-Saharan Africa. Methods: We will include systematic reviews that identify factors associated with sexual and reproductive health outcomes among adolescents, 10-19 years of age, in sub-Saharan Africa. Reviews can include quantitative and qualitative primary studies with or without meta-analysis. Academic and gray literature searches will identify reviews from PubMed, Scopus, CINAHL, Cochrane Database of Systematic Reviews, ProQuest, Google, and Google Scholar. Two reviewers (MZG and KO) will independently carry out title, abstract, and full text screening, assess methodological quality, and extract data. We will assess the methodological quality of the included studies using the Joanna Briggs Institute standard forms. The review will present findings in narrative form and in tables and will follow PRISMA (the Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting guidelines. Results: A preliminary search in April 2023 found 1351 articles to be screened. Conclusions: This umbrella review will permit a comprehensive and high-level understanding of the various factors that influence adolescent sexual and reproductive health in sub-Saharan Africa. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42023394512; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=394512 International Registered Report Identifier (IRRID): DERR1-10.2196/51278 %M 37976499 %R 10.2196/51278 %U https://www.researchprotocols.org/2023/1/e51278 %U https://doi.org/10.2196/51278 %U http://www.ncbi.nlm.nih.gov/pubmed/37976499 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e49962 %T Adolescents and Young Adults Evaluating a Website for Affective-Sexual Information and Education: Multicenter Cross-Sectional Study %A Montero-Pons,Laura %A Rodríguez-Martín,Dolors %A Esquinas,Cristina %A García-Sierra,Rosa %A Manresa-Domínguez,Josep Maria %A Reyes-Lacalle,Azahara %A Cabedo-Ferreiro,Rosa %A Vicente-Hernández,MªMercedes %A Gómez Masvidal,Míriam %A Toran-Monserrat,Pere %A Falguera-Puig,Gemma %+ Sexual and Reproductive Healthcare Santa Coloma de Gramenet, Primary Care Management Metropolitana Nord, Catalan Institute of Health, 49, 53 Major St, Santa Coloma de Gramenet, 08921, Spain, 34 936 932 736, lmontero.ics@gencat.cat %K sex education %K adolescent %K young adult %K internet %K cross-sectional studies %K program evaluation %K gender mainstreaming %D 2023 %7 26.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Today’s young people have long been demanding a paradigm shift in the emotional and sexual education they receive. While for them, affective-sexual and gender diversity is already a reality, the sexual and reproductive health professionals they encounter lack sufficient training. The digital devices and affective-sexual education websites aimed at today’s young people must also be thoroughly evaluated. The website Sexe Joves is a website on sexuality by the Department of Health of the Government of Catalonia (Spain). It is designed for people aged 14 to 25 years. It currently needs to undergo a process of evaluation. Affective-sexual education aimed at young people must stem from their participation and the whole range of sexual and gender diversity in order to reach the entire population equally. Objective: The aim of this study was to evaluate the website Sexe Joves as a source of affective-sexual health information, education, and communication for young people. It takes into account sex, gender identity, sexual orientation, socioeconomic status, and location within Catalonia (urban, semiurban, and rural areas). Methods: This was an observational, descriptive, and cross-sectional study that forms part of a larger mixed methods study. An ad hoc questionnaire was used to collect data. In total, 1830 participants were included. The study was carried out simultaneously in all the territorial administrations of Catalonia. Results: Almost 30% of the sample obtained were young people who experience affective-sexual and gender diversity. Of those surveyed, only 14.2% (n=260) said they were familiar with the website and of these, 6.5% said they used it (n=114). The website content rated most indispensable was on sexual abuse, harassment, and violence, followed by sexually transmitted infections; 70.5% (n=1200) reported that they visit pornographic websites. Conclusions: The results of this study will contribute to the design of new strategies for the website Sexe Joves, a public health resource, in order to improve affective sexual education for young people. International Registered Report Identifier (IRRID): RR2-10.3390/ijerph192416586 %M 37883153 %R 10.2196/49962 %U https://www.jmir.org/2023/1/e49962 %U https://doi.org/10.2196/49962 %U http://www.ncbi.nlm.nih.gov/pubmed/37883153 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e48968 %T Effectiveness of a Theory-Based Digital Animated Video Intervention to Reduce Intention and Willingness to Sext Among Diploma Students: Cluster Randomized Controlled Trial %A Mansor,Norain %A Ahmad,Norliza %A Md Said,Salmiah %A Tan,Kit-Aun %A Sutan,Rosnah %+ Department of Community Health, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, UPM Serdang, Serdang, 43400, Malaysia, 60 192710577, lizaahmad@upm.edu.my %K sexting %K randomized controlled trial %K YouTube %K intention %K willingness %K young adult %K Malaysia, diploma students %K digital content %K digital health intervention %K attrition rate %K primary outcome %K sexual risk %K sexual health %K WhatsApp %D 2023 %7 20.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Sexting refers to the exchange of sexually explicit digital content in the form of texts, photos, or videos. In recent years, sexting has become a public health concern. Surveys in Malaysia show a high prevalence of young adults engaged in sexting. Given that sexting is associated with sexual risk behavior, cyberbullying, and mental health issues, this behavior needs intervention to alleviate the resulting public health burden. However, there is a scarcity of theory-based intervention programs on the prevention of intention and willingness to sext among young adults. Objective: This study aimed to develop and implement a sexting intervention module guided by the prototype willingness model (PWM), delivered using web-based animated video, and evaluate its effectiveness among diploma students from a public higher educational institution. The primary outcomes were intention and willingness to sext, while the secondary outcomes were knowledge, attitude, perceived norms, and prototype perceptions of sexting. Methods: This 2-armed, parallel, single-blinded cluster randomized controlled trial was conducted in a public higher educational institution in the state of Melaka, Malaysia. Diploma students from 12 programs were randomly allocated into intervention and control groups. Both groups answered a self-administered web-based questionnaire assessing the outcomes at the baseline. The intervention group received a newly developed intervention module based on the PWM in the form of 5 animated videos posted on a private YouTube platform, while the control group was put on the waitlist. The intervention group was encouraged to discuss any issues raised with the researchers via WhatsApp private chat after viewing the videos. All participants were observed immediately and 3 months postintervention. Data analysis was performed with SPSS (version 26; IBM Corp). A generalized linear mixed model was used to determine the effectiveness of the intervention. Results: There were a total of 300 participants with an attrition rate of 8.3% (n=25). After adjusting for age, sex, relationship status, and the amount of time spent on the web, there were significant differences in the intention to sext (β=–.12; P=.002; Cohen d=0.23), willingness to sext (β=–.16; P<.001; Cohen d=0.40), knowledge (β=.12; P<.001; Cohen d=0.39), attitude (β=–.11; P=.001; Cohen d=0.31), perceived norms (β=–.06; P=.04; Cohen d=0.18), and prototype perceptions (β=–.11; P<.001; Cohen d=0.35) between the intervention and control groups over 3 months. Conclusions: In this study, the sexting intervention module using the PWM that was delivered via web-based animated videos was effective in reducing intention and willingness to sext as well as in improving knowledge of sexting, attitudes, perceived norms, and prototype perceptions. Therefore, relevant agencies involved in the promotion of sexual and reproductive health among young adults in Malaysia can consider the implementation of this module. Trial Registration: Thai Clinical Trial Registry TCTR20201010002; https://www.thaiclinicaltrials.org/show/TCTR20201002001 %M 37862090 %R 10.2196/48968 %U https://www.jmir.org/2023/1/e48968 %U https://doi.org/10.2196/48968 %U http://www.ncbi.nlm.nih.gov/pubmed/37862090 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e45236 %T Prevalence and Trends of Sexual Behaviors Among Young Adolescents Aged 12 Years to 15 Years in Low and Middle-Income Countries: Population-Based Study %A Jing,Zhengyue %A Li,Jie %A Wang,Yi %A Zhou,Chengchao %+ Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, Jinan, 250012, China, 86 053188381567, zhouchengchao@sdu.edu.cn %K risky sexual behaviors %K early sexual intercourse %K multiple sexual partners %K condom use %K young adolescents %K low and middle-income countries %D 2023 %7 7.6.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Risky sexual behaviors remain significant public health challenges among adolescents. Nearly 90% of adolescents live in low and middle-income countries (LMICs), but few studies have used standardized methodology to monitor the prevalence and trends of sexual behaviors among adolescents in LMICs. Objective: This study aimed to assess the prevalence of sexual behaviors (ever had sexual intercourse, multiple sexual partners, and condom use) among adolescents aged 12 years to 15 years as well as the trends in prevalence between 2003 and 2017. Methods: For this population-based study, we used recent data from the Global School-based Student Health Survey conducted in 69 LMICs from 2003 to 2017 to assess the recent prevalence of sexual behaviors by using complex analysis and a random effects meta-analyses method. Using the chi-square trend test, we also assessed the trends in the prevalence of sexual behaviors in 17 countries that had conducted ≥1 round of surveys from 2003 to 2017. Results: We included 145,277 adolescents aged 12 years to 15 years (64,719/145,277, 44.5% boys) from the 69 LMICs that had conducted ≥1 survey and 80,646 adolescents aged 12 years to 15 years (34,725/80,646, 43.1% boys) from the 17 LMICs that had conducted ≥1 round of surveys. The recent global prevalence of ever had sexual intercourse was 6.9% (95% CI 6.2%-7.6%) and was higher among boys (10.0%, 95% CI 9.1%-11.1%) than girls (4.2%, 95% CI 3.7%-4.7%) and among those aged 14 years to 15 years (8.5%, 95% CI 7.7%-9.3%) than those aged 12 years to 13 years (4%, 95% CI 3.4%-4.7%). Among adolescents who had ever had sex, the recent global prevalence of having multiple sexual partners was 52% (95% CI 50.4%-53.6%) and was higher among boys (58%, 95% CI 56.1%-59.9%) than girls (41.4%, 95% CI 38.9%-43.9%) and among those aged 14 years to 15 years (53.5%, 95% CI 51.6%-55.4%) than those aged 12 years to 13 years (49.7%, 95% CI 45.9%-53.5%). Among adolescents who had ever had sex, the recent global prevalence of condom use was 58.1% (95% CI 56.2%-59.9%) and was higher among girls (59.2%, 95% CI 56.4%-61.9%) than boys (57.7%, 95% CI 55.7%-59.7%) and among those aged 14 years to 15 years (59.9%, 95% CI 58.0%-61.8%) than those aged 12 years to 13 years (51.6%, 95% CI 47.5%-55.7%). Between the earliest and latest surveys, the overall prevalence of ever had sexual intercourse (3.1% decrease) and condom use (2.0% decrease) showed downward trends. The overall prevalence of having multiple sexual partners increased by 2.6%. Conclusions: We provide evidence and important implication for policymakers to develop targeted policy support systems to prevent and reduce risky sexual behaviors among young adolescents in LMICs with a high prevalence of risky sexual behaviors. %M 37285196 %R 10.2196/45236 %U https://publichealth.jmir.org/2023/1/e45236 %U https://doi.org/10.2196/45236 %U http://www.ncbi.nlm.nih.gov/pubmed/37285196 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e43653 %T Findings From the Step Up, Test Up Study of an Electronic Screening and Brief Intervention for Alcohol Misuse in Adolescents and Young Adults Presenting for HIV Testing: Randomized Controlled Efficacy Trial %A Karnik,Niranjan S %A Kuhns,Lisa M %A Hotton,Anna L %A Del Vecchio,Natascha %A McNulty,Moira %A Schneider,John %A Donenberg,Geri %A Keglovitz Baker,Kristin %A Diskin,Rose %A Muldoon,Abigail %A Rivera,Juan %A Summersett Williams,Faith %A Garofalo,Robert %+ Institute for Juvenile Research, Department of Psychiatry, University of Illinois Chicago, 1747 West Roosevelt Road, Chicago, IL, 60608, United States, 1 3122730185, nkarnik@uic.edu %K HIV prevention %K men who have sex with men %K transgender women %K alcohol intervention %K HIV %K gay %K homosexual %K MSM %K alcohol %K youth %K screening %K sexual behavior %K sexual behavior %K sexual risk %K risky %K pre-exposure prophylaxis %K prophylaxis %K prevention %K efficacy %K adolescent %K young adult %K testing %K risk %D 2023 %7 29.3.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Substance use, particularly binge drinking of alcohol and noninjection substance use, is associated with increased risk for HIV infection among youth, but structured substance use screening and brief intervention are not often provided as part of HIV risk reduction. Objective: The purpose of the study was to test the efficacy of a fully automated electronic screening and brief intervention, called Step Up, Test Up, to reduce alcohol misuse among adolescents and young adults presenting for HIV testing. Secondary objectives were reduction in sexual risk and uptake of pre-exposure prophylaxis (PrEP) for HIV prevention. Methods: Youth aged 16 years to 25 years who presented for HIV testing at community-based locations were recruited for study participation. Those who screened at moderate to high risk on the Alcohol Use Disorders Identification Test were randomized (1:1) to either an electronic brief intervention or a time-attention control. The primary outcome was change in alcohol use at 1, 3, 6, and 12-month follow-ups. Negative binomial and log binomial regression analyses with generalized estimating equations were conducted to evaluate the intervention efficacy. Results: Among a sample of 329 youth, there were no significant differences in alcohol use outcomes between conditions over time or at the 1, 3, 6, or 12-month time points. In terms of secondary outcomes, there was evidence of reduction in condomless insertive anal sex under the influence of alcohol and drugs at 12 months compared with 3 months in the intervention versus the attention control condition (incidence rate ratio=0.15, 95% CI 0.05-0.44); however, there were no other significant differences in sexual risk and no difference in PrEP engagement. Conclusions: We found no effect of electronic brief intervention to reduce alcohol use and some effect on sexual risk among youth aged 16 years to 25 years who present for HIV testing. Trial Registration: ClinicalTrials.gov number NCT02703116; https://clinicaltrials.gov/ct2/show/NCT02703116 International Registered Report Identifier (IRRID): RR2-10.1186/s12889-020-8154-6 %M 36989027 %R 10.2196/43653 %U https://mental.jmir.org/2023/1/e43653 %U https://doi.org/10.2196/43653 %U http://www.ncbi.nlm.nih.gov/pubmed/36989027 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 11 %P e39207 %T A Trans Youth of Color Study to Measure Health and Wellness: Protocol for a Longitudinal Observation Study %A Calvetti,Sam %A Rusow,Joshua A %A Lewis,Jacqueline %A Martinez,Amarah %A Slay,Lindsay %A Bray,Bethany C %A Goldbach,Jeremy T %A Kipke,Michele D %+ The Brown School, Washington University in St Louis, One Brookings Drive, MSC 1196-0257-03, St Louis, MO, 63130, United States, 1 323 283 7503, rusow@wustl.edu %K AIDS virus %K HIV %K cohort study %K gender minority %K transgender youth %D 2022 %7 7.11.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Growing research on transgender youth is accounting for the variety of ways in which young people define their genders and sexualities. Because of this growing representation, more research is needed to understand how intersectional identities and stigma affect risk for HIV acquisition along the HIV care continuum and engagement in mental and physical health care. Little is known about accessibility to HIV-related prevention services of nonbinary and transmasculine youth, and further understanding of the impacts on transfeminine people—those who have historically faced the highest prevalence of HIV positivity—is crucial. Objective: The overarching aims of the Trans Youth of Color Study are to conduct longitudinal research with a cohort of transgender minority youth (TGMY), explore factors that aid in the prevention of new HIV infection and transmission, and reduce HIV- and AIDS-related disparities by focusing on successful engagement in care. Findings from this research will be used to inform the development of new interventions designed to engage TGMY in the HIV prevention and care continua. Methods: Longitudinal research (baseline and follow-up assessments every 6 months for 3 waves of data collection) followed a cohort (N=108) of transgender youth of color recruited in Los Angeles, California, United States. Participants were recruited using multiple community-informed strategies, such as from local venues, social media, and participant referral. In addition to self-report surveys, urine was collected to assess recent use of illicit drugs, and blood, rectal, and throat swabs were collected to test for current sexually transmitted infection and HIV infection. Additional blood and plasma samples (10 mL for 4 aliquots and 1 pellet) were collected and stored for future research. Results: Participants in the Trans Youth of Color Study were recruited between May 25, 2018, and December 7, 2018. Baseline and longitudinal data are being analyzed as of August 2022. Conclusions: The findings from this research will inform adaptations to existing evidence-based HIV prevention interventions and help to guide new interventions designed to engage TGMY, especially those who are Black, Indigenous, or people of color, in the HIV prevention and care continua. International Registered Report Identifier (IRRID): DERR1-10.2196/39207 %M 36342757 %R 10.2196/39207 %U https://www.researchprotocols.org/2022/11/e39207 %U https://doi.org/10.2196/39207 %U http://www.ncbi.nlm.nih.gov/pubmed/36342757 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e33826 %T Promoting Adolescent Sexual and Reproductive Health in North America Using Free Mobile Apps: Environmental Scan %A Benoit,James Russell Andrew %A Louie-Poon,Samantha %A Kauser,Samar %A Meherali,Salima %+ Faculty of Nursing, University of Alberta, 5-147 Edmonton Clinic Health Academy, 11405 87 Ave NW, Edmonton, AB, T6E1S1, Canada, 1 780 777 1864, jrbenoit@ualberta.ca %K mHealth %K mobile health %K adolescent %K sexual and reproductive health %K environmental scan %K mobile app %K sexual health %K reproductive health %K health %K sexual %K reproductive %K MARS %K Mobile App Rating Scale %K digital health %K adolescents %D 2022 %7 4.10.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Neglecting adolescents’ sexual and reproductive health (SRH) can affect multiple domains of development. Promoting healthy adolescent SRH is increasingly done using mobile phone apps. Providing SRH information via mobile phones can positively influence SRH outcomes including improving knowledge, reducing sexual risk behavior, and increasing the use of health services. A systematic approach to establishing and evaluating the quality of adolescent SRH mobile apps is urgently needed to rigorously evaluate whether they are a viable and effective strategy for reaching adolescents and improving adolescent SRH knowledge and behaviors in particular. Objective: This study aimed to conduct an environmental scan to produce an inventory of adolescent SRH–specific mobile apps with descriptions of their purpose, structure, operations, and quality of evidence. Methods: We used a literature review to develop 15 search terms for adolescent SRH–related apps in the Canadian and US Apple and Google app stores. After generating the search results, inclusion and exclusion criteria were applied. Using the remaining apps, we built an evidence table of app information, and app reviewers assessed each included app using the Mobile App Rating Scale. App assessments were then used to highlight trends between apps and identify gaps in app quality. Results: In total, 2761 apps were identified by our searches, of which 1515 were duplicates. Of the 1246 remaining apps, 15 met the criteria for further assessment. Across all subdomains, on a scale of 1-5, the mean app score was 3.4/5. The Functionality subdomain had the highest mean score of 4.1/5, whereas the Engagement subdomain had the lowest score of 2.9/5. The top 4 apps were Tia: Female Health Advisor (4.7/5), Under the Stethoscope (4.2/5), Condom Credit Card (4.1/5), and Shnet (3.7/5). Conclusions: This environmental scan aimed to provide a comprehensive overview of the mobile apps developed to promote adolescent SRH knowledge and outcomes. Of the 15 mobile apps available to provide information related to adolescent SRH, few provided comprehensive, reliable, and evidence-based SRH information. Areas of strength included the apps’ gestural design, performance, ease of use, and navigation. Areas of weakness included app goals, evidence base, and app customization options. These results can be used to conduct future studies evaluating the use and efficacy of mobile apps on health knowledge and behaviors and promote adolescent SRH. %M 36194450 %R 10.2196/33826 %U https://pediatrics.jmir.org/2022/4/e33826 %U https://doi.org/10.2196/33826 %U http://www.ncbi.nlm.nih.gov/pubmed/36194450 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 9 %P e30372 %T Effectiveness of Cash Transfer Delivered Along With Combination HIV Prevention Interventions in Reducing the Risky Sexual Behavior of Adolescent Girls and Young Women in Tanzania: Cluster Randomized Controlled Trial %A Kuringe,Evodius %A Christensen,Alice %A Materu,Jacqueline %A Drake,Mary %A Majani,Esther %A Casalini,Caterina %A Mjungu,Deusdedit %A Mbita,Gaspar %A Kalage,Esther %A Komba,Albert %A Nyato,Daniel %A Nnko,Soori %A Shao,Amani %A Changalucha,John %A Wambura,Mwita %+ Department of Sexual and Reproductive Health, National Institute for Medical Research, Isamilo Road, Box 1462, Mwanza, 33104, United Republic of Tanzania, 255 0282500399, evokur@gmail.com %K adolescent %K female %K HIV infections/epidemiology %K HIV infections/prevention and control %K herpes simplex virus type 2 %K incidence %K motivation %K Tanzania %D 2022 %7 19.9.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Poverty and social inequality exacerbate HIV risk among adolescent girls and young women (AGYW) in sub-Saharan Africa. Cash transfers can influence the structural determinants of health, thereby reducing HIV risk. Objective: This study assessed the effectiveness of cash transfer delivered along with combination HIV prevention (CHP) interventions in reducing the risky sexual behavior of AGYW in Tanzania. The incidence of herpes simplex virus type 2 (HSV-2) infection was used as a proxy for sexual risk behavior. Methods: A cluster randomized controlled trial was conducted in 15 matched pairs of communities (1:1 intervention to control) across 3 strata (urban, rural high-risk, and rural low-risk populations) of the Shinyanga Region, Tanzania. The target population was out-of-school AGYW aged 15-23 years who had completed 10-hour sessions of social and behavior change communication. Eligible communities were randomly assigned to receive CHP along with cash transfer quarterly (intervention group) or solely CHP interventions (control group) with no masking. Study recruitment and baseline survey were conducted between October 30, 2017 and December 1, 2017. Participants completed an audio computer-assisted self-interview, HIV counselling and testing, and HSV-2 testing at baseline and during follow-up visits at 6, 12, and 18 months after the baseline survey. A Cox proportional hazards model with random effects specified at the level of clusters (shared frailty) adjusted for matching pairs and other baseline imbalances was fitted to assess the effects of cash transfer on the incidence of HSV-2 infection (primary outcome). Secondary outcomes included HIV prevalence at follow-up, self-reported intergenerational sex, and self-reported compensated sex. All secondary outcomes were measured at each study visit. Results: Of the 3026 AGYW enrolled in the trial (1482 in the intervention and 1544 in the control), 2720 AGYW (1373 in the intervention and 1347 in the control) were included in the final analysis. Overall, HSV-2 incidence was not significantly different at all follow-up points between the study arms in the adjusted analysis (hazard ratio 0.96, 95% CI 0.67-1.38; P=.83). However, HSV-2 incidence was significantly lower in the rural low-risk populations who received the cash transfer intervention (hazard ratio 0.45, 95% CI 0.29-0.71; P=.001), adjusted for potential confounders. Conclusions: Although this trial showed no significant impact of the cash transfer intervention on HSV-2 incidence among AGYW overall, the intervention significantly reduced HSV-2 incidence among AGYW in rural low-risk communities. Factors such as lesser poverty and more asset ownership in urban and rural high-risk communities may have undermined the impact of cash transfer. Trial Registration: ClinicalTrials.gov NCT03597243; https://clinicaltrials.gov/show/NCT03597243 %M 36121686 %R 10.2196/30372 %U https://publichealth.jmir.org/2022/9/e30372 %U https://doi.org/10.2196/30372 %U http://www.ncbi.nlm.nih.gov/pubmed/36121686 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 7 %P e32286 %T Strategies to Identify and Reach Young Women Who Sell Sex With HIV Prevention and Care Services: Lessons Learnt From the Implementation of DREAMS Services in Two Cities in Zimbabwe %A Chabata,Sungai T %A Makandwa,Rumbidzo %A Hensen,Bernadette %A Mushati,Phillis %A Chiyaka,Tarisai %A Musemburi,Sithembile %A Busza,Joanna %A Floyd,Sian %A Birdthistle,Isolde %A Hargreaves,James R %A Cowan,Frances M %+ Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), 4 Bath Road, Belgravia, Harare, Zimbabwe, 263 773577686, sungaichabata@gmail.com %K respondent-driven sampling %K peer outreach %K female sex worker %K young women who sell sex %K HIV prevention %K Zimbabwe %K sub-Saharan Africa %D 2022 %7 27.7.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Young women who sell sex (YWSS), are underserved by available HIV prevention and care services. The Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) Partnership aimed to reduce the risk of HIV acquisition among vulnerable populations of adolescent girls and young women, including YWSS, in 10 sub-Saharan African countries. We describe 2 methods, respondent-driven sampling (RDS) and peer outreach, used to refer YWSS for DREAMS services in Zimbabwe, and compare the characteristics and engagement of YWSS referred to these services by each method. We hypothesized that RDS would identify YWSS at higher risk of HIV and those who were less engaged with HIV prevention and care services than peer outreach. Objective: We aimed to compare respondent-driven sampling and peer outreach in recruiting and referring high-risk populations for HIV prevention and care services. Methods: We used RDS, a sampling method designed to reach a representative sample of the network of key populations, and peer outreach, a programmatic approach to identify, reach, and refer YWSS for DREAMS between April and July 2017, and January 2017 and July 2018, respectively, in 2 cities in Zimbabwe. For RDS, we conducted detailed mapping to understand sex work typology and geography, and then purposively selected 10 “seed” participants in each city to initiate RDS. For peer outreach, we initiated recruitment through 18 trained and age-matched peer educators using youth-tailored community mobilization. We described the characteristics and service engagement of YWSS who accessed DREAMS services by each referral approach and assessed the association of these characteristics with referral approach using the chi-square test. Analysis was performed with and without restricting the period when RDS took place. We estimated the relative incremental costs of recruiting YWSS using each strategy for referral to DREAMS services. Results: Overall, 5386 and 1204 YWSS were referred for DREAMS services through peer outreach and RDS, respectively. YWSS referred through RDS were more likely to access DREAMS services compared to YWSS referred through peer outreach (501/1204, 41.6% vs 930/5386, 17.3%; P<.001). Regardless of referral approach, YWSS who accessed DREAMS had similar education levels, and a similar proportion tested HIV negative and reported not using a condom at the last sex act. A higher proportion of YWSS accessing DREAMS through RDS were aged 18-19 years (167/501, 33.3% vs 243/930, 26.1%; P=.004) and more likely to be aware of their HIV status (395/501, 78.8% vs 396/930, 42.6%; P<.001) compared to those accessing DREAMS services through peer outreach. The incremental cost per young woman who sells sex recruited was US $7.46 for peer outreach and US $52.81 for RDS. Conclusions: Peer outreach and RDS approaches can reach and refer high-risk but different groups of YWSS for HIV services, and using both approaches will likely improve reach. International Registered Report Identifier (IRRID): RR2-10.1186/s12889-018-5085-6 %M 35896024 %R 10.2196/32286 %U https://publichealth.jmir.org/2022/7/e32286 %U https://doi.org/10.2196/32286 %U http://www.ncbi.nlm.nih.gov/pubmed/35896024 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 7 %P e30944 %T HIV and Sexually Transmitted Infection Testing Among Substance-Using Sexual and Gender Minority Adolescents and Young Adults: Baseline Survey of a Randomized Controlled Trial %A Parker,Jayelin N %A Choi,Seul Ki %A Bauermeister,Jose A %A Bonar,Erin E %A Carrico,Adam W %A Stephenson,Rob %+ Center for Sexuality and Health Disparities, University of Michigan, 400 N Ingalls, Room 3340, Ann Arbor, MI, 48109, United States, 1 7347644646, jayelinp@umich.edu %K testing %K substance use %K sexual minority %K social determinants %D 2022 %7 1.7.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Gay, bisexual, and other men who have sex with men and transgender individuals are more heavily affected by HIV and other sexually transmitted infections (STIs) than their cisgender, heterosexual peers. In addition, sexual and gender minorities who use substances are often at a further increased risk of HIV and other STIs. Increasing testing for HIV and other STIs allows this hardly reached population to receive early intervention, prevention, and education. Objective: We explored HIV and STI testing patterns among 414 sexual and gender minority adolescents and young adults aged 15 to 29 years who self-reported substance use and lived in southeastern Michigan. Methods: We analyzed data from the baseline survey of a 4-arm randomized controlled trial that aimed to examine the efficacy of a brief substance use intervention for creating gains in engagement in HIV prevention. We fit multinomial logistic regression models to 2 categorical HIV and STI testing variables (lifetime and previous 12 months) based on self-reports of testing (never, STIs only, HIV only, or both). In addition, we compared HIV and STI testing behaviors across demographic characteristics, structural factors, psychosocial barriers, substance use, and sexual behaviors. Results: Our findings showed that 35.5% (147/414) of adolescents and young adults reported not being tested for either HIV or STIs in the previous year, and less than half (168/414, 40.6%) of the sample achieved the Centers for Disease Control and Prevention recommendation of HIV and STI testing once per year. We observed HIV and STI testing disparities across sociodemographic (eg, sexual identity, education, and income) and health (eg, substance use) correlates. Specifically, cisgender gay men who have sex with men were more likely to report being tested for HIV compared with bisexual men and transgender individuals, who were more likely to be tested for STIs. Conclusions: This study illustrates the results of an HIV prevention intervention in southeastern Michigan showing the need for HIV prevention interventions that leverage structural factors, psychosocial barriers, and substance use as key drivers to achieve HIV and STI testing rates to meet the Centers for Disease Control and Prevention guidelines. Trial Registration: ClinicalTrials.gov NCT02945436; http://clinicaltrials.gov/ct2/show/NCT02945436 International Registered Report Identifier (IRRID): RR2-10.2196/resprot.9414 %M 35776441 %R 10.2196/30944 %U https://publichealth.jmir.org/2022/7/e30944 %U https://doi.org/10.2196/30944 %U http://www.ncbi.nlm.nih.gov/pubmed/35776441 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 6 %P e32718 %T User- and Message-Level Correlates of Endorsement and Engagement for HIV-Related Messages on Twitter: Cross-sectional Study %A Oh,Jimin %A Bonett,Stephen %A Kranzler,Elissa C %A Saconi,Bruno %A Stevens,Robin %+ School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, 19104, United States, 1 515 231 9890, stepdo@nursing.upenn.edu %K HIV prevention %K social media %K public health %K young adults %K LASSO %K HIV %K Twitter %K digital health %D 2022 %7 17.6.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Youth and young adults continue to experience high rates of HIV and are also frequent users of social media. Social media platforms such as Twitter can bolster efforts to promote HIV prevention for these individuals, and while HIV-related messages exist on Twitter, little is known about the impact or reach of these messages for this population. Objective: This study aims to address this gap in the literature by identifying user and message characteristics that are associated with tweet endorsement (favorited) and engagement (retweeted) among youth and young men (aged 13-24 years). Methods: In a secondary analysis of data from a study of HIV-related messages posted by young men on Twitter, we used model selection techniques to examine user and tweet-level factors associated with tweet endorsement and engagement. Results: Tweets from personal user accounts garnered greater endorsement and engagement than tweets from institutional users (aOR 3.27, 95% CI 2.75-3.89; P<.001). High follower count was associated with increased endorsement and engagement (aOR 1.05, 95% CI 1.04-1.06; P<.001); tweets that discussed STIs garnered lower endorsement and engagement (aOR 0.59, 95% CI 0.47-1.74; P<.001). Conclusions: Findings suggest practitioners should partner with youth to design and disseminate HIV prevention messages on social media, incorporate content that resonates with youth audiences, and work to challenge stigma and foster social norms conducive to open conversation about sex, sexuality, and health. %M 35713945 %R 10.2196/32718 %U https://publichealth.jmir.org/2022/6/e32718 %U https://doi.org/10.2196/32718 %U http://www.ncbi.nlm.nih.gov/pubmed/35713945 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e32416 %T Acceptability and Feasibility of Peer-to-Peer Text Messaging Among Adolescents to Increase Clinic Visits and Sexually Transmitted Infection Testing: Interrupted Times-Series Analysis %A Lightfoot,Marguerita %A Jackson-Morgan,Joi %A Pollack,Lance %A Bennett,Ayanna %+ Division of Prevention Science, Department of Medicine, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, 94143, United States, 1 415 502 4320, lightfom@ohsu.edu %K HIV prevention %K STI prevention %K adolescents %K youth %K text messaging %K SMS %K peer-to-peer intervention %K HIV %K STI %K HIV testing %D 2022 %7 9.6.2022 %9 Short Paper %J JMIR Form Res %G English %X Background: Adolescents are disproportionately affected by sexually transmitted infections (STIs), including HIV. Many youths with asymptomatic STI or related symptoms do not seek treatment and may not be screened if accessing the health care system for other reasons. Objective: We examined intervention completion and changes in the number of new patients, the number of STI or HIV tests, and the sexual risk profile of patients over time to determine the feasibility and acceptability of a peer-driven text messaging strategy to connect youth to STI and HIV services. Methods: The intervention enlisted consecutive patients at an adolescent medicine clinic to send a text message to 5 peers they believed were sexually active and lived in the clinic’s service area. The intervention was evaluated using an interrupted time-series design in which baseline clinic service levels were documented during a 35-week lead-in period, followed by a 20-week intervention implementation period, and a 16-week period of continued clinic observation. Clinic and patient data were obtained through chart abstraction from intake forms that occurred during the entire study period. Analyses conducted in 2015 used a generalized linear mixed model. Results: Of the 153 patients approached to participate, 100 agreed to send SMS text messages. Most (n=55, 55%) reported no concerns with sending the text message. No adverse events or negative outcomes were reported. Adolescent STI testing, positive test results, and reported risk behavior increased post intervention, although this was not statistically significant, likely because of the small sample size. Conclusions: Given low youth uptake of health care services, and STI/HIV screening, in particular, new strategies are needed to address access barriers. Common approaches for reaching youth are resource-intensive and often miss those not connected to school or community programs. The peer-based text messaging strategy showed promise for both increasing the number of youths accessing health services and finding youths engaging in sexual risk behaviors and most in need of sexual health screening and services. %M 35686737 %R 10.2196/32416 %U https://formative.jmir.org/2022/6/e32416 %U https://doi.org/10.2196/32416 %U http://www.ncbi.nlm.nih.gov/pubmed/35686737 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 2 %P e33207 %T Using Video Games to Improve the Sexual Health of Young People Aged 15 to 25 Years: Rapid Review %A Franco Vega,Ignacio %A Eleftheriou,Anastasia %A Graham,Cynthia %+ Department of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, University Road, Room 44/3073, Southampton, SO17 1BJ, United Kingdom, 44 023 8059 3091, c.a.graham@soton.ac.uk %K sex education %K serious games %K sexually transmitted infections %K rapid review %K mobile phone %D 2022 %7 19.5.2022 %9 Review %J JMIR Serious Games %G English %X Background: Sexually transmitted infections and unintended pregnancies among young people remain public health concerns in many countries. To date, interventions that address these concerns have had limited success. Serious games are increasingly being used as educational tools in health and professional public education. Although acknowledged as having great potential, few studies have evaluated the use of serious games in sexual health education among young people, and to date, there have been no published reviews of these studies. Objective: This study aims to assess the effects of video game–based sexual health interventions for risky sexual behavior in young people aged between 15 and 25 years. Methods: A rapid review of randomized controlled trials and quasi–randomized controlled trials was performed. The search included the following bibliographic databases: Cochrane Central Register of Controlled Trials, Embase, MEDLINE, PsycINFO, and Scopus. A total of 2 reviewers independently screened 50% (35/70) of the retrieved articles during the full-text screening phase. Results: From a total of 459 identified citations, after removing duplicates, 327 (71.2%) articles were deemed eligible for title and abstract screening. Of the 327 articles, 70 (21.4%) full texts were screened, from which 10 (3.1%) articles (evaluating 11 different games) were included in the review. The findings highlighted the considerable diversity in video game–based interventions and assessed sexual health outcomes. Although there were some promising findings in outcome studies using game-based interventions, the results across studies were mixed. Conclusions: Although game interventions for sexual health have been in existence for almost three decades, relatively few studies have evaluated them, and the results of previous outcome studies have been mixed. Moreover, there is little clarity regarding which specific elements of a game facilitate positive outcomes. We provide recommendations for future researchers developing video game–based interventions to improve sexual health in young people. %M 35587873 %R 10.2196/33207 %U https://games.jmir.org/2022/2/e33207 %U https://doi.org/10.2196/33207 %U http://www.ncbi.nlm.nih.gov/pubmed/35587873 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 4 %P e31233 %T An Unstructured Supplementary Service Data–Based mHealth App Providing On-Demand Sexual Reproductive Health Information for Adolescents in Kibra, Kenya: Randomized Controlled Trial %A Macharia,Paul %A Pérez-Navarro,Antoni %A Sambai,Betsy %A Inwani,Irene %A Kinuthia,John %A Nduati,Ruth %A Carrion,Carme %+ Universitat Oberta de Catalunya, Rambla del Poblenou, 156, Barcelona, 08018, Spain, 34 619963691, paulmachariah@gmail.com %K adolescents %K sexual reproductive health %K mobile phones %K randomized controlled trial %D 2022 %7 15.4.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Adolescents transitioning from childhood to adulthood need to be equipped with sexual reproductive health (SRH) knowledge, skills, attitudes, and values that empower them. Accessible, reliable, appropriate, and friendly information can be provided through mobile phone–based health interventions. Objective: This study aims to investigate the effectiveness and impact of an Unstructured Supplementary Service Data (USSD)–based app in increasing adolescents’ knowledge about contraceptives, gender-based stereotypes, sexually transmitted infections (STIs), abstinence, and perceived vulnerability, and helping adolescents make informed decisions about their SRH. Methods: A randomized controlled trial (RCT) methodology was applied to investigate the potential of a USSD-based app for providing on-demand SRH information. To be eligible, adolescents aged 15 to 19 years residing in Kibra, Kenya, had to have access to a phone and be available for the 3-month follow-up visit. Participants were randomly assigned to the intervention (n=146) and control (n=154) groups using sequentially numbered, opaque, sealed envelopes. The primary outcome was improved SRH knowledge. The secondary outcome was improved decision-making on SRH. The outcomes were measured using validated tools on adolescent SRH and user perceptions during the follow-up visit. A paired sample t test was used to compare the changes in knowledge scores in both groups. The control group did not receive any SRH information. Results: During the RCT, 54.9% (62/109) of adolescents used the USSD-based app at least once. The mean age by randomization group was 17.3 (SD 1.23) years for the control group and 17.3 (SD 1.12) years for the intervention group. There was a statistically significant difference in the total knowledge scores in the intervention group (mean 10.770, SD 2.012) compared with the control group (mean 10.170, SD 2.412) conditions (t179=2.197; P=.03). There was a significant difference in abstinence (P=.01) and contraceptive use (P=.06). Of the individuals who used the app, all participants felt the information received could improve decision-making regarding SRH. Information on STIs was of particular interest, with 27% (20/62) of the adolescents seeking information in this area, of whom 55% (11/20) were female. In relation to improved decision-making, 21.6% (29/134) of responses showed the adolescents were able to identify STIs and were likely to seek treatment; 51.7% (15/29) of these were female. Ease of use was the most important feature of the app for 28.3% (54/191) of the responses. Conclusions: Adolescents require accurate and up-to-date SRH information to guide their decision-making and improve health outcomes. As adolescents already use mobile phones in their day-to-day lives, apps provide an ideal platform for this information. A USSD-based app could be an appropriate tool for increasing SRH knowledge among adolescents in low-resource settings. Adolescents in the study valued the information provided because it helped them identify SRH topics on which they needed more information. Trial Registration: Pan African Clinical Trial Registry PACTR202204774993198; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=22623 %M 35436230 %R 10.2196/31233 %U https://mhealth.jmir.org/2022/4/e31233 %U https://doi.org/10.2196/31233 %U http://www.ncbi.nlm.nih.gov/pubmed/35436230 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 4 %P e27792 %T Support for Texting-Based Condom Negotiation Among Forcibly Displaced Adolescents in the Slums of Kampala, Uganda: Cross-sectional Validation of the Condom Use Negotiated Experiences Through Technology Scale %A Okumu,Moses %A Logie,Carmen H %A Ansong,David %A Mwima,Simon %A Hakiza,Robert %A Newman,Peter A %+ School of Social Work, University of Illinois, Urbana-Champaign, 1010 W Nevada St, Urbana, IL, 61801, United States, 1 217 333 2213, okumu@illinois.edu %K condom negotiation %K sexting %K refugee and displaced adolescents %K digital sexual communication %K HIV prevention %K gender %D 2022 %7 6.4.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Promoting sexual health among forcibly displaced adolescents is a global public health priority. Digital sexual communication strategies (eg, sexting) may increase adolescents’ confidence in discussing sexual health issues and negotiating condom use. However, limited evidence exists describing validated measures for text-based condom negotiation in the literature. Objective: This study helps fill this gap by adapting and examining the psychometric properties of a condom use experience through technology (condom use negotiated experiences through technology [CuNET]) scale. Methods: Using peer network sampling, 242 forcibly displaced adolescents (aged 16-19 years) living in Kampala’s slums were recruited for participation between January and March 2018. A subscale (embarrassment to negotiate condom use) of the Multidimensional Condom Attitudes Scale was adapted to incorporate sexting, yielding CuNET. Participants were randomly assigned to calibration and validation subsamples to conduct exploratory and confirmatory factor analyses to establish and validate the scale. CuNET measured participants’ support levels for texting-based condom negotiation via sexting based on gender, and multivariable logistic regression was used to explore its associations with sexual health outcomes (recent consistent condom use, access to sexual and reproductive health services, and lifetime sexually transmitted infection testing). Results: The one-factor CuNET with the validation sample was valid (χ24=5.3; P=.26; root mean square error of approximation=0.05, 90% CI 0.00-0.16; comparative fit index=0.99; Tucker-Lewis index=0.99; standardized root mean square residual=0.006), and reliability (Cronbach α=.98). Adolescent girls showed significantly lower levels of support for using sexting to negotiate condom use (mean 13.60, SE 0.70 vs mean 21.48, SE 1.23; P=.001). In multivariable analyses, a 1-point increase in the CuNET score was associated with increased odds of recent consistent condom use (adjusted odds ratio [aOR] 1.73, 95% CI 1.24-2.41) but not with access to sexual and reproductive health services (aOR 1.51, 95% CI 0.99-2.30) or lifetime sexually transmitted infection testing (aOR 0.90, 95% CI 0.64-1.26). Conclusions: The unidimensional CuNET scale is valid and reliable for forcibly displaced adolescents living in slums in Kampala, gender-sensitive, and relevant for predicting consistent condom use among urban displaced and refugee adolescents. Further development of this scale will enable a better understanding of how adolescents use digital tools for condom negotiation. %M 35384852 %R 10.2196/27792 %U https://publichealth.jmir.org/2022/4/e27792 %U https://doi.org/10.2196/27792 %U http://www.ncbi.nlm.nih.gov/pubmed/35384852 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e36060 %T Impact-Oriented Dialogue for Culturally Safe Adolescent Sexual and Reproductive Health in Bauchi State, Nigeria: Protocol for a Codesigned Pragmatic Cluster Randomized Controlled Trial %A Cockcroft,Anne %A Omer,Khalid %A Gidado,Yagana %A Mohammed,Rilwanu %A Belaid,Loubna %A Ansari,Umaira %A Mitchell,Claudia %A Andersson,Neil %+ Community Information for Empowerment and Transparency-Participatory Research at McGill, Department of Family Medicine, McGill University, 5858 Côte-des-Neiges, Suite 300, Montreal, QC, H3S 1Z1, Canada, 1 450 626 8432, anne.cockcroft@mcgill.ca %K adolescents %K sexual and reproductive health %K participatory research %K mixed methods research %K dialogic intervention %K co-design %K cultural safety %K Nigeria %D 2022 %7 15.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Adolescents (10-19 years) are a big segment of the Nigerian population, and they face serious risks to their health and well-being. Maternal mortality is very high in Nigeria, and rates of pregnancy and maternal deaths are high among female adolescents. Rates of HIV infection are rising among adolescents, gender violence and sexual abuse are common, and knowledge about sexual and reproductive health risks is low. Adolescent sexual and reproductive health (ASRH) indicators are worse in the north of the country. Objective: In Bauchi State, northern Nigeria, the project will document the nature and extent of ASRH outcomes and risks, discuss the findings and codesign solutions with local stakeholders, and measure the short-term impact of the discussions and proposed solutions. Methods: The participatory research project is a sequential mixed-methods codesign of a pragmatic cluster randomized controlled trial. Focus groups of local stakeholders (female and male adolescents, parents, traditional and religious leaders, service providers, and planners) will identify local priority ASRH concerns. The same stakeholder groups will map their knowledge of factors causing these concerns using the fuzzy cognitive mapping (FCM) technique. Findings from the maps and a scoping review will inform the contextualization of survey instruments to collect information about ASRH from female and male adolescents and parents in households and from local service providers. The survey will take place in 60 Bauchi communities. Adolescents will cocreate materials to share the findings from the maps and survey. In 30 communities, randomly allocated, the project will engage adolescents and other stakeholders in households, communities, and services to discuss the evidence and to design and implement culturally acceptable actions to improve ASRH. A follow-up survey in communities with and without the intervention will measure the short-term impact of these discussions and actions. We will also evaluate the intervention process and use narrative techniques to assess its impact qualitatively. Results: Focus groups to explore ASRH concerns of stakeholders began in October 2021. Baseline data collection in the household survey is expected to take place in mid-2022. The study was approved by the Bauchi State Health Research Ethics Committee, approval number NREC/03/11/19B/2021/03 (March 1, 2021), and by the Faculty of Medicine and Health Sciences Institutional Review Board McGill University (September 13, 2021). Conclusions: Evidence about factors related to ASRH outcomes in Nigeria and implementation and testing of a dialogic intervention to improve these outcomes will fill a gap in the literature. The project will document and test the effectiveness of a participatory approach to ASRH intervention research. Trial Registration: ISRCTN Registry ISRCTN18295275; https://www.isrctn.com/ISRCTN18295275 International Registered Report Identifier (IRRID): DERR1-10.2196/36060 %M 35289762 %R 10.2196/36060 %U https://www.researchprotocols.org/2022/3/e36060 %U https://doi.org/10.2196/36060 %U http://www.ncbi.nlm.nih.gov/pubmed/35289762 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e35117 %T The Efficacy of a Smartphone Game to Prevent HIV Among Young Africans: Protocol for a Randomized Controlled Trial in the Context of COVID-19 %A Mudhune,Victor %A Sabben,Gaëlle %A Ondenge,Ken %A Mbeda,Calvin %A Morales,Marissa %A Lyles,Robert H %A Arego,Judith %A Ndivo,Richard %A Bednarczyk,Robert A %A Komro,Kelli %A Winskell,Kate %+ Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, United States, 1 404 7275286, swinske@emory.edu %K HIV %K young Africans %K adolescent %K Kenya %K serious game %K game for health %K randomized controlled trial %K mHealth %K prevention %K smartphone %K teenager %K young adult %K Africa %K gaming %K COVID-19 %K efficacy %D 2022 %7 3.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Adolescents contribute slightly less than one-third of all new HIV infections in sub-Saharan Africa. There is a need for more effective intervention approaches to help young adolescents safely navigate through adolescence and into adulthood. We are assessing the efficacy of Tumaini, a smartphone game designed to prevent HIV among young Africans. Against the background of COVID-19, meaningful alteration of the research protocol was necessary to ensure successful implementation and retention of the study participants in ongoing research. Objective: The objective of our protocol is to determine (1) if Tumaini delays sexual debut and increases condom use at first sex and (2) whether it influences behavioral mediators of early and unprotected sex. Methods: Participants were recruited from Kisumu County in Western Kenya. This study is a 2-arm, individual-randomized controlled trial that enrolled 1004 adolescents aged between 12 years and 15 years. The intervention arm participants are playing Tumaini, while the control arm is provided with Brainilis, a commercially available control game. The study period will last 45 months. At baseline, participants in both arms completed a baseline survey and biological testing for HIV and herpes simplex virus, type 2 (HSV-2); participants will have annual game play periods in years 1-3. They will also complete a total of 12 follow-up surveys. At endline, repeat biological testing will be conducted. Protocol adaptations were necessitated by the COVID-19 pandemic and implemented in accordance with local public health guidelines. Results: Participants were enrolled between October 2020 and November 2020. We plan to complete study procedures in September 2024. The enrolled participant sample was 50.1% (499/996) female and had a mean age of 14.0 (SD 0.6) years. Conclusions: This ongoing research demonstrates that, with appropriate revisions to planned protocol activities guided by the need to maintain study integrity, protect both study participants and staff, and adhere to institutional review board and local health authority guidelines, human subject research is possible in the context of a global pandemic. If the trial demonstrates efficacy, Tumaini would provide an alternative, remote means of delivering age-appropriate education to adolescents on safer sex, HIV prevention, and effective life skills on a highly scalable, low-cost, and culturally adaptable platform. Trial Registration: ClinicalTrials.gov NCT04437667; https://clinicaltrials.gov/ct2/show/NCT04437667 International Registered Report Identifier (IRRID): DERR1-10.2196/35117 %M 35030090 %R 10.2196/35117 %U https://www.researchprotocols.org/2022/3/e35117 %U https://doi.org/10.2196/35117 %U http://www.ncbi.nlm.nih.gov/pubmed/35030090 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e30526 %T An Evidence Map on Serious Games in Preventing Sexually Transmitted Infections Among Adolescents: Systematic Review About Outcome Categories Investigated in Primary Studies %A Ilskens,Karina %A Wrona,Kamil J %A Dockweiler,Christoph %A Fischer,Florian %+ School of Public Health, Bielefeld University, Universitätsstr. 25, Bielefeld, 33615, Germany, 49 5211065160, kamil.wrona@uni-bielefeld.de %K serious games %K entertainment education %K STI %K STD %K sexual health %K effect %K impact %K sexually transmitted infections %K adolescents %K adolescent sexual health %D 2022 %7 2.2.2022 %9 Review %J JMIR Serious Games %G English %X Background: Sexually transmitted infections (STIs) represent a global health risk. Adolescents are at increased risk of infection for several reasons such as lack of knowledge, risky sexual behaviors, and lack of behavioral sills (eg, to negotiate safer sex). Given the fact that adolescents often use digital media and that serious games are considered to have the potential to change knowledge, attitudes and behavior, serious games represent an opportunity for the prevention of STIs. Objective: The aim of this systematic review was to identify and systematically summarize the dimensions that have been investigated in primary studies on serious games targeting STI prevention among adolescents. Methods: A systematic review was conducted in PubMed and Web of Science. Studies published from 2009 to 2021 were included that assessed the effectiveness of serious games on adolescent sexual health. A total of 18 studies met the inclusion criteria and were categorized according to dimensions of effectiveness and user experience. Results: Various dimensions of effectiveness and aspects of user experience were investigated in the primary studies. In total, 9 dimensions of effectiveness were observed: sexual behavior, behavioral intentions, knowledge, attitudes and beliefs, self-efficacy and personal limitations, character traits and future orientation, environmental and individual risk factors, risk perception and risk assessment, as well as normative beliefs and (social) norms. Furthermore, several dimensions related to user experience were investigated in primary studies, that is, motivation, acceptability, trustworthiness, comprehensibility, handling and control, perceived effectiveness, as well as satisfaction. Conclusions: This review provides an overview of serious games interventions that are vastly different in approach, content, and even platform. In previous studies, knowledge has already been comprehensively assessed, and a positive influence of serious games on knowledge about sexual topics is evident. The results clearly show that adolescents’ sexual knowledge has been increased by the serious games interventions. However, methodological and content differences in the surveys make it difficult to draw conclusions about the effectiveness related to changes in attitudes and behavior. %M 35107438 %R 10.2196/30526 %U https://games.jmir.org/2022/1/e30526 %U https://doi.org/10.2196/30526 %U http://www.ncbi.nlm.nih.gov/pubmed/35107438 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e30360 %T Feasibility, Acceptability, and Design of a Mobile Ecological Momentary Assessment for High-Risk Men Who Have Sex With Men in Hanoi, Vietnam: Qualitative Study %A Trang,Kathy %A Le,Lam X %A Brown,Carolyn A %A To,Margaret Q %A Sullivan,Patrick S %A Jovanovic,Tanja %A Worthman,Carol M %A Giang,Le Minh %+ Global TIES for Children, New York University, 627 Broadway, New York City, NY, 10012, United States, 1 212 998 1212, kathytrang.kt@gmail.com %K men who have sex with men %K HIV %K mental disorder %K ecological momentary assessment %K mobile phone %K mHealth %K sexual minorities %K pilot projects %D 2022 %7 27.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Men who have sex with men (MSM) are at a disproportionate risk for HIV infection and common mental disorders worldwide. In the context of HIV, common mental disorders are important and are frequent drivers of suboptimal prevention and treatment outcomes. Mobile ecological momentary assessments (EMAs), or the repeated sampling of people’s behaviors and psychological states in their daily lives using mobile phones, can clarify the triggers and HIV-related sequelae of depressive-anxious symptoms and contribute toward the design of ecological momentary interventions (EMIs) that cater to the contextually varying needs of individuals to optimize prevention and treatment outcomes. Objective: This study aims to characterize the feasibility and acceptability of mobile EMA among high-risk MSM in Hanoi, Vietnam. It aims to evaluate the perceived relevance, usability, and concerns of this group with regard to the content and delivery of mobile EMA and the potential of leveraging such platforms in the future to deliver EMIs. Methods: Between January and April 2018, a total of 46 participants were recruited. The participants completed 6 to 8 mobile EMA surveys daily for 7 days. Surveys occurred once upon waking, 4 to 6 times throughout the day, and once before sleeping. All surveys queried participants’ perceived safety, social interactions, psychological state, and mental health symptoms. The morning survey further queried on sleep and medication use within the past 24 hours, whereas the night survey queried on sexual activity and substance use and allowed participants to share an audio recording of a stressful experience they had that day. At the end of the week, participants were interviewed about their experiences with using the app. Results: Participants completed an average of 21.7 (SD 12.7) prompts over the 7-day period. Excluding nonresponders, the average compliance rate was 61.8% (SD 26.6%). A thematic analysis of qualitative interviews suggested an overall positive reception of the app and 5 recurring themes, which were centered on the relevance of psychological and behavioral items to daily experiences (eg, mental health symptoms and audio recording), benefits of using the app (eg, increased self-understanding), worries and concerns (eg, privacy), usability (eg, confusion about the interface), and recommendations for future design (eg, integrating more open-ended questions). Conclusions: Mobile EMA is feasible and acceptable among young MSM in Vietnam; however, more research is needed to adapt EMA protocols to this context and enhance compliance. Most participants eagerly provided information about their mental health status and daily activities. As several participants looked toward the app for further mental health and psychosocial support, EMIs have the potential to reduce HIV and mental health comorbidity among MSM. %M 35084340 %R 10.2196/30360 %U https://formative.jmir.org/2022/1/e30360 %U https://doi.org/10.2196/30360 %U http://www.ncbi.nlm.nih.gov/pubmed/35084340 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 1 %P e32400 %T Evaluation of an AIDS Educational Mobile Game (AIDS Fighter · Health Defense) for Young Students to Improve AIDS-Related Knowledge, Stigma, and Attitude Linked to High-Risk Behaviors in China: Randomized Controlled Trial %A Tang,Jian %A Zheng,Yu %A Zhang,Daiying %A Yu,Xingli %A Ren,Jianlan %A Li,Mei %A Luo,Yue %A Tian,Min %A Chen,Yanhua %+ Department of Nursing, The Affiliated Hospital of Southwest Medical University, 25 Taiping Street, Jiangyang District, Luzhou, 646000, China, 86 18982765016, chen_yanhua25@163.com %K young students %K AIDS education %K educational game %K game-based intervention %K serious games %K public health %K HIV %K AIDS epidemic %K stigma %K health defense %K health knowledge %K digital health %K digital health intervention %D 2022 %7 24.1.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: The AIDS epidemic among young students is serious, and effective preventive interventions are urgently needed. Game-based intervention has become an innovative way to change healthy behaviors, and we have developed an AIDS educational game called AIDS Fighter · Health Defense. Objective: In this study, we tested the effect of AIDS Fighter · Health Defense on young students in improving AIDS-related knowledge, stigma, and attitude related to high-risk behaviors in Southwest China. Methods: A randomized controlled trial was conducted from September 14 to 27, 2020. In total, 96 students from 2 classes in a middle school were selected by stratified cluster sampling in Luzhou City, Southwest China. The students were randomly divided into the intervention group (n=50, 52%) and the control group (n=46, 48%). The intervention group played the AIDS educational game AIDS Fighter · Health Defense; the control group learned AIDS-related knowledge through independent learning on the QQ chat group. An AIDS-related knowledge questionnaire, a stigma scale, and an attitude questionnaire on AIDS-related high-risk behaviors were used to measure the effect of the AIDS educational game via face-to-face interviews. The user experience of the game was assessed using the Educational Game User Experience Evaluation Scale. The difference was statistically significant at P≤.05. Results: After the intervention, the AIDS knowledge awareness rate (X̅ [SD], %) of the intervention and control groups were 70.09 (SD 11.58) and 57.49 (SD 16.58), with t=4.282 and P<.001. The stigma scores of the 2 groups were 2.44 (SD 0.57) and 2.48 (SD 0.47), with t=0.373 and P=0.71. The positive rate (X̅ [SD], %) of attitudes of high-risk AIDS behaviors of the 2 groups were 82.00 (SD 23.44) and 79.62 (SD 17.94), with t=0.555 and P=0.58. The mean percentage of the game evaluation was 54.73% as excellent, 31.45% as good, 13.09% as medium, and 0.73% as poor. Conclusions: AIDS Fighter · Health Defense could increase AIDS-related knowledge among young students, but the effect of the game in reducing AIDS-related stigma and improving the attitudes of high-risk AIDS behaviors was not seen. Long-term effects and large-scale studies are needed to assess the efficacy of game-based intervention. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000038230; https://trialsearch.who.int/Trial2.aspx?TrialID=ChiCTR2000038230 %M 34870603 %R 10.2196/32400 %U https://games.jmir.org/2022/1/e32400 %U https://doi.org/10.2196/32400 %U http://www.ncbi.nlm.nih.gov/pubmed/34870603 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e35593 %T A Mindfulness-Based Intervention to Alleviate Stress From Discrimination Among Young Sexual and Gender Minorities of Color: Protocol for a Pilot Optimization Trial %A Cook,Stephanie H %A Wood,Erica P %A Mirin,Nicholas %A Bandel,Michelle %A Delorme,Maxline %A Gad,Laila %A Jayakar,Olive %A Mustafa,Zainab %A Tatar,Raquel %A Javdani,Shabnam %A Godfrey,Erin %+ Department of Social and Behavioral Sciences, School of Global Public Health, New York University, 708 Broadway, 7th Floor, New York, NY, 10003, United States, 1 212 992 5635, sc5810@nyu.edu %K sexual and gender minorities %K racial/ethnic minorities %K mindfulness %K mobile phone %D 2022 %7 14.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Young sexual and gender minorities (SGMs) of color may face unique experiences of discrimination based on their intersectional positions (eg, discrimination based on both racial or ethnic identity and sexual identity). Emerging evidence suggests that mindfulness practices may reduce stress from discrimination and improve overall well-being among young SGM. Moreover, the omnipresence of smartphone access among racial or ethnic and sexual minority communities provides a method through which to administer mindfulness-based interventions among young SGMs of color. Objective: This paper outlines the protocol of the Optimizing a Daily Mindfulness Intervention to Reduce Stress from Discrimination among Young Sexual and Gender Minorities of Color (REDUCE) study, a pilot optimization trial of a smartphone-based mindfulness intervention that was developed in conjunction with the Healthy Minds Program (HMP) with the aim of reducing stress from discrimination among young SGMs. Methods: In total, 80 young (ages 18-29 years) SGMs of color will be enrolled in the study. The HMP is a self-guided meditation practice, and participants will be randomized to either a control condition or an intervention that uses a neuroscience-based approach to mindfulness. We will use the multiphase optimization strategy to assess which combination of mindfulness interventions is the most effective at reducing stress from discrimination among young SGMs of color. A combination of mindfulness-based meditation intervention components will be examined, comprising mindfulness-based practices of awareness, connection, and purpose. Awareness refers to the practice of self-awareness, which reduces the mind’s ability to be distracted and instead be present in the moment. Connection refers to the practice of connection with oneself and others and emphasizes on empathy and compassion with oneself and others. Purpose encourages goal-making in accordance with one’s values and management of behavior in accordance with these goals. In addition, we will assess the feasibility and acceptability of the HMP application among young SGMs of color. Results: The REDUCE study was approved by the Institutional Review Board of New York University, and recruitment and enrollment began in the winter of 2021. We expect to complete enrollment by the summer of 2022. The results will be disseminated via social media, journal articles, abstracts, or presentations, as well as to participants, who will be given the opportunity to provide feedback to the researchers. Conclusions: This optimization trial is designed to test the efficacy, feasibility, and acceptability of implementing an application-based, mindfulness-based intervention to reduce stress from discrimination and improve well-being among young SGMs of color. Evidence from this study will assist in the creation of a sustainable, culturally relevant mobile app–based mindfulness intervention to reduce stress from discrimination among young SGMs of color. Trial Registration: Clinicaltrials.gov NCT05131360; https://clinicaltrials.gov/ct2/show/NCT05131360 International Registered Report Identifier (IRRID): DERR1-10.2196/35593 %M 34928237 %R 10.2196/35593 %U https://www.researchprotocols.org/2022/1/e35593 %U https://doi.org/10.2196/35593 %U http://www.ncbi.nlm.nih.gov/pubmed/34928237 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e31381 %T Educators' Perspectives on Integrating Technology Into Sexual Health Education: Implementation Study %A Decker,Martha J %A Harrison,Salish %A Price,Melisa %A Gutmann-Gonzalez,Abigail %A Yarger,Jennifer %A Tenney,Rachel %+ Department of Epidemiology and Biostatistics, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 550 16th Street, Second Floor, San Francisco, CA, 94158, United States, 1 (415) 476 3095, Mara.Decker@ucsf.edu %K adolescent %K sex education %K technology %K mobile app %K implementation %K California %K health educator %D 2022 %7 12.1.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: In the last decade, the use of technology-based sexual health education has increased. Multiple studies have shown the feasibility of technology-based interventions, while a subset has also shown efficacy in improving youths’ sexual health outcomes such as increased condom use and knowledge. However, little is known about health educators’ experiences in integrating technology to augment sexual health curricula. Objective: The purpose of this study was to assess the perceptions and experiences of health educators regarding the incorporation of technology into a sexual health education program designed for underserved youth in Fresno County, California, and to identify facilitators and challenges to incorporating technology into the in-person curriculum. Methods: This implementation study used data collected as part of a cluster randomized controlled trial to evaluate In the Know (ITK), an in-person sexual health education curriculum that includes technology-based content, such as a resource locator, videos, and games, which can be accessed through a mobile app or website. Data from implementation logs from each cohort (n=51) and annual interviews (n=8) with health educators were analyzed to assess the health educators’ experiences using the technology and adaptations made during the implementation. Results: The health educators reported that technological issues affected implementation to some degree: 87% of the time in the first year, which decreased to 47% in the third year as health educators’ familiarity with the app increased and functionality improved. Technology issues were also more common in non–school settings. Successes and challenges in 3 domains emerged: managing technology, usability of the ITK app, and youth engagement. The health educators generally had positive comments about the app and youth engagement with the technology-based content and activities; however, they also noted certain barriers to adolescents’ use of the mobile app including limited data storage and battery life on mobile phones. Conclusions: Health educators require training and support to optimize technology as a resource for engaging with youth and providing sensitive information. Although technology is often presented as a solution to reach underserved populations, educational programs should consider the technological needs and limitations of the participants, educators, and settings. International Registered Report Identifier (IRRID): RR2-10.2196/18060 %M 35019842 %R 10.2196/31381 %U https://humanfactors.jmir.org/2022/1/e31381 %U https://doi.org/10.2196/31381 %U http://www.ncbi.nlm.nih.gov/pubmed/35019842 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e29969 %T An Artificial Intelligence Chatbot for Young People’s Sexual and Reproductive Health in India (SnehAI): Instrumental Case Study %A Wang,Hua %A Gupta,Sneha %A Singhal,Arvind %A Muttreja,Poonam %A Singh,Sanghamitra %A Sharma,Poorva %A Piterova,Alice %+ Department of Communication, University at Buffalo, The State University of New York, 359 Baldy Hall, Buffalo, NY, 14260, United States, 1 7166451501, hwang23@buffalo.edu %K artificial intelligence %K chatbot %K Facebook %K affordance %K sex education %K sexual and reproductive health %K contraception %K case study %K young people %K India %K transmedia %K mobile apps %K mobile health %K technology design %K user engagement %K digital health %K mobile phone %D 2022 %7 3.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Leveraging artificial intelligence (AI)–driven apps for health education and promotion can help in the accomplishment of several United Nations sustainable development goals. SnehAI, developed by the Population Foundation of India, is the first Hinglish (Hindi + English) AI chatbot, deliberately designed for social and behavioral changes in India. It provides a private, nonjudgmental, and safe space to spur conversations about taboo topics (such as safe sex and family planning) and offers accurate, relatable, and trustworthy information and resources. Objective: This study aims to use the Gibson theory of affordances to examine SnehAI and offer scholarly guidance on how AI chatbots can be used to educate adolescents and young adults, promote sexual and reproductive health, and advocate for the health entitlements of women and girls in India. Methods: We adopted an instrumental case study approach that allowed us to explore SnehAI from the perspectives of technology design, program implementation, and user engagement. We also used a mix of qualitative insights and quantitative analytics data to triangulate our findings. Results: SnehAI demonstrated strong evidence across fifteen functional affordances: accessibility, multimodality, nonlinearity, compellability, queriosity, editability, visibility, interactivity, customizability, trackability, scalability, glocalizability, inclusivity, connectivity, and actionability. SnehAI also effectively engaged its users, especially young men, with 8.2 million messages exchanged across a 5-month period. Almost half of the incoming user messages were texts of deeply personal questions and concerns about sexual and reproductive health, as well as allied topics. Overall, SnehAI successfully presented itself as a trusted friend and mentor; the curated content was both entertaining and educational, and the natural language processing system worked effectively to personalize the chatbot response and optimize user experience. Conclusions: SnehAI represents an innovative, engaging, and educational intervention that enables vulnerable and hard-to-reach population groups to talk and learn about sensitive and important issues. SnehAI is a powerful testimonial of the vital potential that lies in AI technologies for social good. %M 34982034 %R 10.2196/29969 %U https://www.jmir.org/2022/1/e29969 %U https://doi.org/10.2196/29969 %U http://www.ncbi.nlm.nih.gov/pubmed/34982034 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e23874 %T Formative Study of Mobile Phone Use for Family Planning Among Young People in Sierra Leone: Global Systematic Survey %A Chukwu,Emeka %A Gilroy,Sonia %A Addaquay,Kojo %A Jones,Nki Nafisa %A Karimu,Victor Gbadia %A Garg,Lalit %A Dickson,Kim Eva %+ Department of Computer Information System, Faculty of Information and Communications Technology (ICT), University of Malta, Msida, MSD 2080, Malta, 356 99330888, nnaemeka_ec@hotmail.com %K young people %K short message service %K SMS %K chatbot %K text message %K interactive voice response %K IVR %K WhatsApp %K Facebook %K family planning %K contraceptives %K Sierra Leone %D 2021 %7 12.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Teenage pregnancy remains high with low contraceptive prevalence among adolescents (aged 15-19 years) in Sierra Leone. Stakeholders leverage multiple strategies to address the challenge. Mobile technology is pervasive and presents an opportunity to reach young people with critical sexual reproductive health and family planning messages. Objective: The objectives of this research study are to understand how mobile health (mHealth) is used for family planning, understand phone use habits among young people in Sierra Leone, and recommend strategies for mobile-enabled dissemination of family planning information at scale. Methods: This formative research study was conducted using a systematic literature review and focus group discussions (FGDs). The literature survey assessed similar but existing interventions through a systematic search of 6 scholarly databases. Cross-sections of young people of both sexes and their support groups were engaged in 9 FGDs in an urban and a rural district in Sierra Leone. The FGD data were qualitatively analyzed using MAXQDA software (VERBI Software GmbH) to determine appropriate technology channels, content, and format for different user segments. Results: Our systematic search results were categorized using Grading of Recommended Assessment and Evaluation (GRADE) into communication channels, audiovisual messaging format, purpose of the intervention, and message direction. The majority of reviewed articles report on SMS-based interventions. At the same time, most intervention purposes are for awareness and as helpful resources. Our survey did not find documented use of custom mHealth apps for family planning information dissemination. From the FGDs, more young people in Sierra Leone own basic mobile phones than those that have feature capablilities or are smartphone. Young people with smartphones use them mostly for WhatsApp and Facebook. Young people widely subscribe to the social media–only internet bundle, with the cost ranging from 1000 leones (US $0.11) to 1500 leones (US $0.16) daily. Pupils in both districts top-up their voice call and SMS credit every day between 1000 leones (US $0.11) and 5000 leones (US $0.52). Conclusions: mHealth has facilitated family planning information dissemination for demand creation around the world. Despite the widespread use of social and new media, SMS is the scalable channel to reach literate and semiliterate young people. We have cataloged mHealth for contraceptive research to show SMS followed by call center as widely used channels. Jingles are popular for audiovisual message formats, mostly delivered as either push or pull only message directions (not both). Interactive voice response and automated calls are best suited to reach nonliterate young people at scale. %M 34766908 %R 10.2196/23874 %U https://formative.jmir.org/2021/11/e23874 %U https://doi.org/10.2196/23874 %U http://www.ncbi.nlm.nih.gov/pubmed/34766908 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e19614 %T Gamifying Sexual Education for Adolescents in a Low-Tech Setting: Quasi-Experimental Design Study %A Haruna,Hussein %A Okoye,Kingsley %A Zainuddin,Zamzami %A Hu,Xiao %A Chu,Samuel %A Hosseini,Samira %+ Writing Lab, Institute for the Future of Education, Tecnologico de Monterrey, Avenida Eugenio Garza Sada 2501 Sur, Monterrey, 64849, Mexico, 52 18134162370, harunahussein@gmail.com %K gamified instruction %K serious gaming %K gamification %K educational innovation %K teenage students %K digital generation %K e-learning %K low-tech setting %D 2021 %7 12.10.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Sexual education has become increasingly important as unhealthy sexual practices and subsequent health risks become more prevalent during adolescence. Traditional sex education teaching methodologies are limiting for digital natives exposed to various digital technologies. Harnessing the power of technology applications attractive to the younger generation may be a useful approach for teaching sex education. Objective: The aim of this study was to improve sexual health knowledge and understanding of the problems associated with unhealthy sexual practices and address sexual and reproductive health challenges experienced in a low-tech setting. Methods: A participatory design approach was used to develop the digital gamified methodology. A sample of 120 secondary school students aged 11-15 were randomly assigned to either experimental or control group for each of the 3 teaching approaches: (1) gamified instruction (actual serious games [SG] in teaching); (2) gamification (GM; making nongames, such as game-like learning); and (3) traditional teaching (TT) methods. Results: The SG and GM approaches were more effective than TT methods in teaching sexual health education. Specifically, the average scores across groups demonstrated an increase of mean scores from the pre- to posttest (25.10 [SD 5.50] versus 75.86 [SD 13.16]; t119=41.252; P<.001 [2 tailed]). Analysis of variance indicated no significant differences across groups for pretest scores (F2,117=1.048, P=.35). Significant differences across groups were evident in the posttest scores. Students in the SG and GM groups had higher average scores than the TT group (F2,117=83.98; P<.001). Students reported increased learning motivation, attitude, know-how, and participation in learning (P<.001) when using SG and GM approaches. Conclusions: Digital health technologies (particularly teaching and learning through gamified instruction and other novel approaches) may improve sexual health education. These findings may also be applied by practitioners in health care settings and by researchers wishing to further the development of sex education. %M 34636739 %R 10.2196/19614 %U https://games.jmir.org/2021/4/e19614 %U https://doi.org/10.2196/19614 %U http://www.ncbi.nlm.nih.gov/pubmed/34636739 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e31185 %T A Technology-Based Training Tool for a Health Promotion and Sex Education Program for Justice-Involved Youth: Development and Usability Study %A Snow-Hill,Nyssa L %A Donenberg,Geri %A Feil,Edward G %A Smith,David R %A Floyd,Brenikki R %A Leve,Craig %+ Center for Dissemination and Implementation Science, Department of Medicine, University of Illinois at Chicago, 818 South Wolcott Avenue, MC 579 Box #7, SRH 6th Floor, Chicago, IL, 60612, United States, 1 312 413 2712, nyssa@uic.edu %K health education %K sexual behavior %K juvenile delinquency %K feasibility studies %K evidence-based practice %K adolescent health services %K inservice training %K implementation science %K organizational innovation %K technology %K risk reduction behavior %K mobile phone %K health technology %K health promotion %K sexual health %D 2021 %7 30.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Justice-involved youth are especially vulnerable to mental health distress, substance misuse, and risky sexual activity, amplifying the need for evidence-based programs (EBPs). Yet, uptake of EBPs in the justice system is challenging because staff training is costly in time and effort. Hence, justice-involved youth experience increasing health disparities despite the availability of EBPs. Objective: To counter these challenges, this study develops and pilot-tests a prototype of a technology-based training tool that teaches juvenile justice staff to deliver a uniquely tailored EBP for justice-involved youth—PHAT (Preventing HIV/AIDS Among Teens) Life. PHAT Life is a comprehensive sex education, mental health, and substance use EBP collaboratively designed and tested with guidance from key stakeholders and community members. The training tool addresses implementation barriers that impede uptake and sustainment of EBPs, including staff training and support and implementation costs. Methods: Staff (n=11) from two juvenile justice settings pilot-tested the technology-based training tool, which included five modules. Participants completed measures of HIV and sexually transmitted infection (STI) knowledge, sex education confidence, and implementation outcomes such as training satisfaction, adoption, implementation, acceptability, appropriateness, and sustainability. PHAT Life trainers assessed fidelity through two activity role plays participants submitted upon completing the training modules. Results: Participants demonstrated increases in HIV and STI knowledge (t10=3.07; P=.01), and were very satisfied (mean 4.42, SD 0.36) with the training tool and the PHAT Life curriculum. They believed that the training tool and curriculum could be adopted, implemented, and sustained within their settings as an appropriate and acceptable intervention and training. Conclusions: Overall, the results from this pilot test demonstrate feasibility and support continuing efforts toward completing the training tool and evaluating it within a fully powered randomized controlled trial. Ultimately, this study will provide a scalable option for disseminating an EBP and offers a more cost-effective and sustainable way to train staff in an EBP. %M 34591028 %R 10.2196/31185 %U https://formative.jmir.org/2021/9/e31185 %U https://doi.org/10.2196/31185 %U http://www.ncbi.nlm.nih.gov/pubmed/34591028 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e25782 %T Investigating Viewership of Season 3 of “13 Reasons Why” and the Mental Wellness of Adolescents: Partially Randomized Preference Trial %A Uhls,Yalda T %A Felt,Laurel %A Wartella,Ellen %A Sanders,Andrew %+ University of California, Los Angeles, Franz Hall, Los Angeles, CA, 90095, United States, 1 3102101244, yaldatuhls@gmail.com %K media %K adolescence %K mental health %K narrative %K 13 Reasons Why %K conversation %K television %K depression %K sexual assault %D 2021 %7 15.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: A conflicting body of research suggests that additional investigation is needed to understand how globally watched television shows featuring social and mental health issues, such as 13 Reasons Why, might affect adolescents’ mental wellness. Objective: This study aims to investigate adolescents’ viewership of the third season of the Netflix drama 13 Reasons Why (13RW-3) and their engagement with show-related content, paying special attention to mental health outcomes and conversational partners. Methods: A panel-based research platform operated by the National Opinion Research Center at the University of Chicago recruited 157 adolescents aged 13 to 17 years from its nationally representative pool of participants. Participants answered questions about how they discussed and learned about social and mental health issues portrayed in 13RW-3 (eg, masculine role pressure and sexual assault) and questions about mental wellness (eg, mental health self-efficacy and depression). After the participants completed the survey (T1), they were directed to either watch 13RW-3 as it aired for the first time (intervention group) or not watch 13RW-3 (control group). Approximately one month later (T2), all the participants were asked to complete the postsurvey. Additional survey questions about conversational partners, information seeking because of watching the show, and use of show-related content were included in the intervention postsurvey. Results: Our sample (N=157) was 52.2% (n=82) female and 54.8% (n=86) White, with a mean age of 14.99 (SD 1.4) years. At T2, viewers of 13RW-3 spoke about suicide significantly more frequently than nonviewers (P=.007). From T1 to T2, viewers increasingly discussed issues explored by 13RW-3 (P=.002), especially suicide, mental health, and bullying. Adolescent viewers were most likely to speak with friends, and parents were the second most commonly named. Two variables emerged as consistent moderators of conversational choices—having depressive symptoms and being impacted by sexual assault. There was no association between conversational frequency and information seeking around social and mental health issues, and neither mental health self-efficacy scores nor masculine role pressure scores significantly differed between viewers and nonviewers at T2. Conclusions: Viewing 13RW-3, a globally watched television show featuring social and mental health issues, led to adolescent conversations and information searches about topics explored by the show. Depressive symptoms and the impact of sexual assault moderated several relationships, guiding participants toward engaging with certain issues and seeking out specific conversational partners. As 13RW-3’s stories drove conversations—and story-driven conversations can raise awareness, reduce stigma, shift attitudes, normalize certain behaviors, and strengthen supportive relationships—potential wellness implications for television shows featuring social and mental health issues are considerable. %M 34524097 %R 10.2196/25782 %U https://mental.jmir.org/2021/9/e25782 %U https://doi.org/10.2196/25782 %U http://www.ncbi.nlm.nih.gov/pubmed/34524097 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e30499 %T Promoting Adolescent Healthy Relationships (The About Us Program): Protocol for a Randomized Clinical Trial %A Anderson,Pamela %A Coyle,Karin %A Guinosso,Stephanie %A Ferrand,John L %A Owora,Arthur %A Houghton,Rebecca F %A Walsh-Buhi,Eric %+ Department of Applied Health Science, School of Public Health, Indiana University, 1025 E. 7th Street, Room 116, Bloomington, IN, 47405, United States, 1 8128554867, erwals@iu.edu %K adolescents %K youth %K teens %K healthy relationships %K unintended pregnancy %K teen pregnancy %K sexually transmitted infections %K sexually transmitted diseases %K sexual health education %K school-based health center %K randomized controlled trial %D 2021 %7 1.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Romantic relationships play a critical role in adolescent development, and by middle adolescence, most young people have been involved in at least one romantic relationship, a context in which most sexual interactions occur. Research suggests adolescents lack positive models and skills related to building healthy relationships. Objective: This project aims to test the impact of an innovative healthy relationships intervention, called About Us, implemented in school-based health centers (SBHCs) in California in a randomized controlled trial. Methods: About Us is being tested using a 7-site, 2-group, parallel randomized controlled trial with a treatment versus control allocation ratio of 3:2 to assess the impact of the intervention relative to the standard of care among adolescents aged 14 to 18 years. Adolescents with active parental consent provide study assent at each of the 3 survey time points: baseline, 3 months postintervention, and 9 months postintervention. A stratified randomization procedure was used to ensure balance in key covariates and screening criteria across intervention groups. Through benchmark intent-to-treat analyses, we will examine the primary outcome of this study—the impact of About Us relative to the standard of care 9 months following the end of the intervention on the prevalence of vaginal or anal sex without condoms in the past 3 months. The secondary outcomes are four-fold: what is the impact of About Us relative to the standard of care 3 and 9 months following the end of the intervention, on (1) the prevalence of abstinence from vaginal or anal sex in the past 3 months, (2) composite scores of relationship communication and positive conflict resolution among participants involved in a relationship at baseline, (3) the prevalence of SBHC service use or information receipt in the past 3 months, and (4) composite scores of condom use intentions and attitudes regarding condoms and other birth control? Additionally, as part of our sensitivity analyses, two additional analyses will be implemented: modified intent-to-treat and complete case analysis. Results: This project (ClinicalTrials.gov #NCT03736876) was funded in 2016 through the Family Youth Services Bureau as part of the Personal Responsibility Education Innovative Strategies program. Baseline data collection took place between February 2018 and March 2020, yielding a total of 5 cohorts and 533 study participants: 316 assigned to treatment and 217 assigned to control. Ongoing follow-up data collection continued through May 2021. Conclusions: About Us draws on developmental science to create a contextually and developmentally relevant program that addresses motivation and emotional influences in sexual decision-making. The intervention was designed for implementation within SBHCs, an understudied venue for relationship and sexual health promotion interventions. Unfortunately, COVID-19 pandemic restrictions led to school closures, interrupting ongoing programming, and in-person follow-up data collection, which has affected study attrition. Trial Registration: ClinicalTrials.gov NCT03736876; https://clinicaltrials.gov/ct2/show/NCT03736876 International Registered Report Identifier (IRRID): DERR1-10.2196/30499 %M 34468330 %R 10.2196/30499 %U https://www.researchprotocols.org/2021/9/e30499 %U https://doi.org/10.2196/30499 %U http://www.ncbi.nlm.nih.gov/pubmed/34468330 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e30271 %T Online Public Attention Toward Premature Ejaculation in Mainland China: Infodemiology Study Using the Baidu Index %A Wei,Shanzun %A Ma,Ming %A Wen,Xi %A Wu,Changjing %A Zhu,Guonian %A Zhou,Xiangfu %+ Department of Urology, The Third Affiliated Hospital, Sun Yat-Sen University, 600 Tianhe Rd, Guangzhou, 510630, China, 86 18227624438, 182119319@QQ.com %K premature ejaculation %K Baidu Index %K infodemiology %K public interest %K patients’ concern %K sexuality %K sexual dysfunction %D 2021 %7 26.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Premature ejaculation (PE) is one of the most described psychosocial stress and sexual complaints worldwide. Previous investigations have focused predominantly on the prospective identification of cases that meet researchers’ specific criteria. The genuine demand from patients with regard to information on PE and related issues may thus be neglected. Objective: This study aims to examine the online search trend and user demand related to PE on a national and regional scale using the dominant major search engine in mainland China. Methods: The Baidu Index was queried using the PE-related terms for the period of January 2011 to December 2020. The search volume for each term was recorded to analyze the search trend and demographic distributions. For user interest, the demand and trend data were collected and analyzed. Results: Of the 36 available PE search keywords, 4 PE searching topics were identified. The Baidu Search Index for each PE topic varied from 46.30% (86,840,487/187,558,154) to 6.40% (12,009,307/187,558,154). The annual percent change (APC) for the complaint topic was 48.80% (P<.001) for 2011 to 2014 and –16.82% (P<.001) for 2014 to 2020. The APC for the inquiry topic was 16.21% (P=.41) for 2011 to 2014 and –11.00% (P<.001) for 2014 to 2020. For the prognosis topic, the annual APC was 11.18% (P<.001) for 2011 to 2017 and –19.86% (P<.001) for 2017 to 2020. For the treatment topic, the annual APC was 14.04% (P<.001) for 2011 to 2016 and –38.83% (P<.001) for 2016 to 2020. The age distribution of those searching for topics related to PE showed that the population aged 20 to 40 years comprised nearly 70% of the total search inquiries (second was 17.95% in the age group younger than 19 years). People from East China made over 50% of the total search queries. Conclusions: The fluctuating online popularity of PE searches reflects the real-time population demands. It may help medical professionals better understand population interest, population concerns, regional variations, and gender differences on a nationwide scale and make disease-specific health care policies. The internet search data could be more reliable when the insufficient and lagging registry data are completed. %M 34435970 %R 10.2196/30271 %U https://www.jmir.org/2021/8/e30271 %U https://doi.org/10.2196/30271 %U http://www.ncbi.nlm.nih.gov/pubmed/34435970 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 6 %P e29792 %T A Digital Gaming Intervention to Improve HIV Testing for Adolescents and Young Adults: Protocol for Development and a Pilot Randomized Controlled Trial %A Castel,Amanda D %A Wilbourn,Brittany %A Trexler,Connie %A D'Angelo,Lawrence D %A Greenberg,Daniel %+ Department of Epidemiology, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW, Suite 500, Washington, DC, 20052, United States, 1 2029944392, blewis1@gwu.edu %K HIV testing %K pre-exposure prophylaxis (PrEP) %K youth %K mobile phone %D 2021 %7 14.6.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Two strategies of the US Ending the HIV Epidemic initiative are early diagnosis of infections via widespread testing and prevention of new infections using pre-exposure prophylaxis (PrEP). These strategies are particularly important for adolescents and young adults (AYAs) who are disproportionately affected by HIV, particularly if they identify as Black and/or lesbian, gay, bisexual, transgender, queer or questioning, and others (LGBTQ+). This study will develop and test an interactive life-simulation game in which players can enact real-life behaviors and receive their HIV risk profile to improve HIV testing and PrEP access among AYAs aged 13-24 years in Washington, DC. Objective: This mixed methods study aims to determine the acceptability of an interactive, enhanced life-simulation game prototype among AYAs, conduct a pilot test of the gaming intervention among a small cohort of AYAs to ensure game usability and acceptability, and evaluate the efficacy of the game in a randomized controlled study with AYAs at risk for HIV in Washington, DC. Methods: This research protocol will be conducted in 3 phases. A formative phase will involve surveys and focus groups (n=64) with AYAs living in the DC area. These focus groups will allow researchers to understand youth preferences for game enhancement. The second phase will consist of a pilot test (n=10) of the gaming intervention. This pilot test will allow researchers to modify the game based on formative results and test the planned recruitment and data collection strategy with intended end users. The third phase will consist of a randomized controlled study among 300 AYAs to examine the efficacy of the life-simulation game compared with app-based HIV educational materials on HIV and PrEP in changing HIV testing, knowledge, risk behaviors, and PrEP access. Participants will have unlimited access to either the life-simulation game or the educational app for 3 months from the time of enrollment. Study assessments will occur at enrollment and at 1, 3, and 6 months post enrollment via e-surveys. At 6 months, a subset of intervention participants (n=25) will participate in in-depth exit interviews regarding their experience being in the study. Results: Institutional review board approval was received on February 5, 2020. This project is currently recruiting participants for the formative phase. Conclusions: This interactive life-simulation intervention aims to increase HIV testing and PrEP access among AYAs in the DC area. In this intervention, players can enact real-life behaviors and receive their HIV risk profile to promote HIV testing and PrEP seeking. Such an intervention has great potential to improve knowledge of HIV and PrEP among AYAs, increase motivation and self-efficacy related to HIV testing and PrEP use, and decrease individual and structural barriers that often preclude engagement in HIV prevention services. Trial Registration: ClinicalTrials.gov NCT04917575; https://clinicaltrials.gov/ct2/show/NCT04917575 International Registered Report Identifier (IRRID): PRR1-10.2196/29792 %M 34185022 %R 10.2196/29792 %U https://www.researchprotocols.org/2021/6/e29792 %U https://doi.org/10.2196/29792 %U http://www.ncbi.nlm.nih.gov/pubmed/34185022 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 2 %P e19114 %T Efficacy of a Web-Based Intervention (Smart Choices 4 Teens) for Facilitating Parent-Adolescent Communication About Relationships and Sexuality: Randomized Controlled Trial %A Bourdeau,Beth %A Miller,Brenda A %A Byrnes,Hilary F %A Woodall,W Gill %A Buller,David B %A Grube,Joel W %+ Division of Prevention Science, University of California San Francisco, 550 16th Street, 3rd Floor, San Francisco, CA, 94143, United States, 1 4155021000, Beth.Bourdeau@ucsf.edu %K adolescent %K sexual behavior %K parenting %K intervention %K randomized controlled trial %K mobile phone %D 2021 %7 15.6.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: There is a need for interventions that promote healthy decision making among adolescents and leverage the ongoing impact of parental relationships through older adolescence and young adulthood. These interventions should maximize adolescent engagement and be easily accessible to families in terms of cost, duration, and logistics related to participation. Objective: This study aims to test the efficacy of the healthy relationships and sexual decision-making component of a web-based intervention for older adolescents and their parents, ascertain whether the efficacy varies by gender, and assess its efficacy over time. Methods: A randomized controlled trial was conducted for the web-based, self-paced intervention Smart Choices 4 Teens from 2014 to 2015. Families (N=411) with adolescents aged 16-17 years were randomly assigned to the intervention or control condition. Surveys assessing aspects of sexual communication were administered at baseline and at 6, 12, and 18 months. Generalized estimating equations were used to determine the impact of exposure to the relationships component of the intervention on sexual communication by parents, as reported by adolescents. Results: Less than half (88/206, 42.7%) of the intervention group participated in the third and final intervention component, which was focused on relationships and sexual decision making. Participation in the relationships component increased the frequency of parental sexual communication and increased the number of dating rules after accounting for other significant adolescent characteristics. The impact of the intervention varied little by gender, although it did demonstrate an impact on communication reports over the follow-up survey administrations. Conclusions: Smart Choices 4 Teens demonstrated efficacy in increasing the frequency of sexual communication between parents and adolescents in the long term. Trial Registration: ClinicalTrials.gov NCT03521115; https://clinicaltrials.gov/ct2/show/NCT03521115 %M 34128818 %R 10.2196/19114 %U https://pediatrics.jmir.org/2021/2/e19114 %U https://doi.org/10.2196/19114 %U http://www.ncbi.nlm.nih.gov/pubmed/34128818 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e24937 %T Multicultural Adaptation of Mighty Girls for Widespread Dissemination: Pilot Study, App Development and Usability Testing, and Gauging Parent Support With Focus Groups %A Norris,Anne E %A Thalasinos,Roxana Delcampo %A Hecht,Michael L %+ REAL Prevention, LLC, 817 Kingsbridge Dr, Oviedo, FL, 32765, United States, 1 4074161727, anne@real-prevention.com %K implementation science %K mobile apps %K peer influence %K early intervention %K adolescent health %D 2021 %7 2.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Taking evidence-based interventions to scale is a challenge for prevention science. Mighty Girls is an evidence-based sexual health intervention program that combines classroom sessions with novel, cutting-edge technology (digital puppetry). The program was developed for 7th grade Latinas, but US school and community demographics rarely allow interventions targeting a single ethnic group. Additionally, digital puppetry is costly to scale up, and parent disapproval often prevents successful dissemination of adolescent sexual health programs. Intervening steps along the scaling-up pathway are needed to adapt the program prior to scaling up for dissemination. Objective: The aims of this study were to create a multicultural adaptation of the Mighty Girls program using a mobile app that is less costly to disseminate and is acceptable to parents of 7th grade girls. Methods: This study used a three-phase process to adapt Mighty Girls into Mighty Teens. All phases used purposive (nonprobability) sampling of low-income, multicultural, urban metropolitan groups (7th grade girls and their parents) within central Florida. Phase 1 involved two videotaped implementations of a multicultural adaptation of the classroom sessions, one involving focus groups (N=14) and the other serving as a single-group pretest-posttest pilot study (N=23). Phase 2 involved development of a narrative cell phone app prototype, which was subjected to usability testing (N=25). App usability and engagement were assessed qualitatively (observation, focus group, open-ended questions) and quantitatively. Phase 3 used focus groups to assess parent support for the program (N=6). Qualitative data were analyzed using descriptive content analysis. Quantitative data were analyzed using descriptive statistics and paired t tests. Results: Qualitative findings supported classroom sessions being multicultural, and identified simple changes to improve engagement and learning. Quantitative findings from the second classroom session implementation pilot study indicated a significant pre-post difference in intention to delay sexual intercourse (P=.04). App usability and appeal were supported by a System Usability Scale score of 76 (exceeding 68 per the industry standard) and 83% (20/24) of participants agreeing they would recommend the app to friends. Parents (mothers) expressed only positive regard for program goals, and classroom session and app activities. Conclusions: This study adapted Mighty Girls into an engaging, easier-to-disseminate, multicultural program, termed Mighty Teens, that uses a narrative-generating app to support behavior change, and is likely to be accepted by parents of 7th grade girls. This study also provides evidence of the preliminary effectiveness of Mighty Teens classroom sessions. The sampling method and sample size were appropriate for adaptation, but research involving a more representative US sample is needed to confirm multicultural fit, parent receptivity, and program effectiveness. Study implications include integrating app use throughout the classroom sessions to build narrative-generating skills across the program and increasing the number of narratives produced, which should in turn increase the program’s behavior change potency. %M 34076578 %R 10.2196/24937 %U https://formative.jmir.org/2021/6/e24937 %U https://doi.org/10.2196/24937 %U http://www.ncbi.nlm.nih.gov/pubmed/34076578 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e24303 %T Sexual Health Influencer Distribution of HIV/Syphilis Self-Tests Among Men Who Have Sex With Men in China: Secondary Analysis to Inform Community-Based Interventions %A Yang,Nancy %A Wu,Dan %A Zhou,Yi %A Huang,Shanzi %A He,Xi %A Tucker,Joseph %A Li,Xiaofeng %A Smith,Kumi M %A Jiang,Xiaohui %A Wang,Yehua %A Huang,Wenting %A Fu,Hongyun %A Bao,Huanyu %A Jiang,Hongbo %A Dai,Wencan %A Tang,Weiming %+ Dermatology Hospital of Southern Medical University, No 2 Lujing Road, Yuexiu District, Guangzhou, 510091, China, 86 15920567132, weiming_tang@med.unc.edu %K sexual health influencer %K men who have sex with men %K HIV %K syphilis %K self-test %K sexual health %K influencer %K social network %K peers %D 2021 %7 1.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Social network–based strategies can expand HIV/syphilis self-tests among men who have sex with men (MSM). Sexual health influencers are individuals who are particularly capable of spreading information about HIV and other sexually transmitted infections (STIs) within their social networks. However, it remains unknown whether a sexual health influencer can encourage their peers to self-test for HIV/syphilis. Objective: The aims of this study were to examine the impact of MSM sexual health influencers on improving HIV/syphilis self-test uptake within their social networks compared to that of nonsexual health influencers. Methods: In Zhuhai, China, men 16 years or older, born biologically male, who reported ever having had sex with a man, and applying for HIV/syphilis self-tests were enrolled online as indexes and encouraged to distribute self-tests to individuals (alters) in their social network. Indexes scoring >3 on a sexual health influencer scale were considered to be sexual health influencers (Cronbach α=.87). The primary outcome was the mean number of alters encouraged to test per index for sexual health influencers compared with the number encouraged by noninfluencers. Results: Participants included 371 indexes and 278 alters. Among indexes, 77 (20.8%) were sexual health influencers and 294 (79.2%) were noninfluencers. On average, each sexual health influencer successfully encouraged 1.66 alters to self-test compared to 0.51 alters encouraged by each noninfluencer (adjusted rate ratio 2.07, 95% CI 1.59-2.69). More sexual health influencers disclosed their sexual orientation (80.5% vs 67.3%, P=.02) and were community-based organization volunteers (18.2% vs 2.7%, P<.001) than noninfluencers. More alters of sexual health influencers came from a rural area (45.5% vs 23.8%, P<.001), had below-college education (57.7% vs 37.1%, P<.001), and had multiple casual male sexual partners in the past 6 months (25.2% vs 11.9%, P<.001). Conclusions: Being a sexual health influencer was associated with encouraging more alters with less testing access to self-test for HIV/syphilis. Sexual health influencers can be engaged as seeds to expand HIV/syphilis testing coverage. %M 34061035 %R 10.2196/24303 %U https://www.jmir.org/2021/6/e24303 %U https://doi.org/10.2196/24303 %U http://www.ncbi.nlm.nih.gov/pubmed/34061035 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e21082 %T Geosocial Networking Dating App Usage and Risky Sexual Behavior in Young Adults Attending a Music Festival: Cross-sectional Questionnaire Study %A Garga,Shirali %A Thomas,Meryl %A Bhatia,Ashneet %A Sullivan,Aidan %A John-Leader,Franklin %A Pit,Sabrina %+ University Centre for Rural Health, Western Sydney University, 62 Uralba Street, Lismore, 2480, Australia, 61 429455720, S.Pit@westernsydney.edu.au %K sexual health %K mobile apps %K young adults %K music festival %D 2021 %7 15.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the prevalent use of geosocial networking dating apps (GNDAs), there is limited research on their impact on sexual health outcomes among young music festivals attendees. Objective: This study aims to explore the use of GNDAs and risky sexual behaviors of young adults attending a music festival. Methods: The music festival attendees (N=862) completed a cross-sectional questionnaire study encompassing demographics, dating app use, and risky sexual behaviors in the past year. Associations between these variables were estimated using bivariate and multivariate logistic regression analyses. Results: Of the respondents, 51.9% (448/862) had used GNDAs in the previous year. Compared with people who had 1 partner, people who had 2-5 sexual partners in the previous year had almost 7 times the odds of using dating apps (odds ratio [OR] 6.581, 95% CI 4.643-9.328) and those who had more than 5 partners had 14 times the odds of using dating apps (OR 14.294, 95% CI 8.92-22.906). Condom users were more likely to be app users (P<.001), as were those who relied on emergency Plan B (P=.002), but people using hormonal contraception were less likely to use dating apps (P=.004). After adjusting for sexual orientation and relationship status, those having casual sex had 3.096 (95% CI 2.225-4.307; P<.001) times the odds of using dating apps and those having multiple sexual partners had 3.943 (95% CI 2.782-5.588; P<.001) times the odds of using dating apps. Similarly, after adjusting for sexual orientation, relationship status, and number of sexual partners, people who had no discussions before having sex about sexually transmitted infections (STIs) or boundaries were more likely to use dating apps (OR 1.755, 95% CI 1.232-2.500; P=.002). Those who perceived the risk of having sex without contraception to be very high had 2.486 (95% CI 2.213-5.096; P=.01) times the odds of using dating apps than those who perceived no risk. Compared with those who perceived no risk, people who thought that the risk of having multiple sexual partners was low to high had 1.871 (95% CI 1.024-3.418; P=.04) times the odds of using dating apps. A significant number of app users (389/440, 88.4%) indicated that GNDAs should promote safe sex. Conclusions: This study identified that festival goers engaging in certain high-risk sexual behaviors, including casual sex, having multiple sexual partners, and having sex without discussion about STI status and boundaries, are more likely to use dating apps. Festival goers who perceived sex without any form of contraception, having sex while drunk, and having multiple sexual partners as risky were more likely to be app users. Policy makers and GNDA developers should acknowledge the vulnerability of their users to adverse sexual health outcomes and use GNDAs as a platform to promote risk-reduction practices. %M 33856354 %R 10.2196/21082 %U https://www.jmir.org/2021/4/e21082 %U https://doi.org/10.2196/21082 %U http://www.ncbi.nlm.nih.gov/pubmed/33856354 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e22564 %T An Interactive Web-Based Sexual Health Literacy Program for Safe Sex Practice for Female Chinese University Students: Multicenter Randomized Controlled Trial %A Wong,Janet Yuen-Ha %A Zhang,Wen %A Wu,Yongda %A Choi,Edmond Pui Hang %A Lo,Herman Hay Ming %A Wong,Wendy %A Chio,Jasmine Hin Man %A Tam,Hau Lin Cherry %A Ngai,Fei Wan %A Tarrant,Marie %A Wang,Man Ping %A Ngan,Hextan Yuen-Sheung %A Fong,Daniel Yee-Tak %+ School of Nursing, University of Hong Kong, Pokfulam, Hong Kong SAR, Hong Kong, 852 39176645, dytfong@hku.hk %K sexual health %K eHealth %K women's health %K sex education %K health literacy %D 2021 %7 12.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Sexual health concerns among young adults worldwide help to motivate preventative practices against sexually transmitted infections. To foster better sexual health, sexual health literacy must be enhanced. Little research has been conducted on the impact of gender power dynamics on sexual health, such as sexual coercion, even though the prevalence of sexual coercion remains high in China. Objective: This study describes the development and systematic evaluation of a web-based sexual health literacy intervention called “Smart Girlfriend” for female Chinese university students. Methods: A multicenter randomized controlled trial was conducted with 781 female university students at 5 universities with dormitories in Hong Kong. Inclusion criteria were used to select unmarried, female, Chinese university students who were ≥18 years old and had not received a sexual health intervention in the past 12 months. Participants were randomly assigned to 2 groups: one group received an interactive web-based sexual health literacy intervention and the other group received a single webpage of online information about condom use. The intervention content was based on the Health Belief Model and the Continuum of Conflict and Control theory. The primary outcome was self-reported consistency of condom use with every partner at 3-month and 6-month follow-up assessments, analyzed using zero/one inflated beta (ZOIB) regression. The secondary outcome was an appraisal of the knowledge, attitudes, norms, and self-efficacy of condom use using the 25-item Multidimensional Condom Attitudes Scale (MCAS). The intention to treat was applied in analyses. Results: Of 1503 individuals that were screened, 781 (52%) were randomized into 2 groups. The retention rates at the 3-month and 6-month follow-ups were 92% and 91%, respectively. Most participants were born locally (536/746, 72%), and 18% (134/746) self-reported as a sexual minority. ZOIB results regarding the consistency of condom use were not significant [model 1: odds ratio (OR) 2.25 with a 95% credible interval (CrI) of 0.84-6.36; model 2: OR 8.03 (95% CrI 0.22-330.31); model 3: OR 1.21 (95% CrI 0.78-1.86)]. Consistency in the intervention group was 5% higher (95% CI −1.90 to 11.63) than the control group at the 3-month follow-up, and 1% higher (95% CI −5.81 to 8·02) at the 6-month follow-up. MCAS scores at the 3-month follow-up were significantly higher in the intervention group (mean 122.51, SD 15.97) than the control group (mean 119.86, SD 15.85; P=.02). Conclusions: An interactive web-based sexual health literacy program did not significantly increase the consistency of condom use compared to a single webpage of condom use information; however, it did temporarily improve knowledge, attitudes, norms, and self-efficacy regarding condom use. Future revisions of this intervention should be personalized and delivered with a proactive approach. Trial Registration: ClinicalTrials.gov NCT03695679; https://clinicaltrials.gov/ct2/show/NCT03695679 %M 33709941 %R 10.2196/22564 %U https://www.jmir.org/2021/3/e22564 %U https://doi.org/10.2196/22564 %U http://www.ncbi.nlm.nih.gov/pubmed/33709941 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e20898 %T Peer-to-Peer Sharing of Social Media Messages on Sexual Health in a School-Based Intervention: Opportunities and Challenges Identified in the STASH Feasibility Trial %A Hirvonen,Maija %A Purcell,Carrie %A Elliott,Lawrie %A Bailey,Julia V %A Simpson,Sharon Anne %A McDaid,Lisa %A Moore,Laurence %A Mitchell,Kirstin Rebecca %A , %+ MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Berkeley Square, 99 Berkeley St, Glasgow, G3 7HR, United Kingdom, 44 1413537500, kirstin.mitchell@glasgow.ac.uk %K social media %K sexual health %K sex education %K peer education %K process evaluation %K school %K feasibility studies %K adolescent %K social networking %D 2021 %7 16.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: There is a strong interest in the use of social media to spread positive sexual health messages through social networks of young people. However, research suggests that this potential may be limited by a reluctance to be visibly associated with sexual health content on the web or social media and by the lack of trust in the veracity of peer sources. Objective: The aim of this study was to investigate opportunities and challenges of using social media to facilitate peer-to-peer sharing of sexual health messages within the context of STASH (Sexually Transmitted Infections and Sexual Health), a secondary school-based and peer-led sexual health intervention. Methods: Following training, and as a part of their role, student-nominated peer supporters (aged 14-16 years) invited school friends to trainer-monitored, private Facebook groups. Peer supporters posted curated educational sex and relationship content within these groups. Data came from a feasibility study of the STASH intervention in 6 UK schools. To understand student experiences of the social media component, we used data from 11 semistructured paired and group interviews with peer supporters and their friends (collectively termed students; n=42, aged 14-16 years), a web-based postintervention questionnaire administered to peer supporters (n=88), and baseline and follow-up questionnaires administered to students in the intervention year group (n=680 and n=603, respectively). We carried out a thematic analysis of qualitative data and a descriptive analysis of quantitative data. Results: Message sharing by peer supporters was hindered by variable engagement with Facebook. The trainer-monitored and private Facebook groups were acceptable to student members (peer supporters and their friends) and reassuring to peer supporters but led to engagement that ran parallel to—rather than embedded in—their routine social media use. The offline context of a school-based intervention helped legitimate and augment Facebook posts; however, even where friends were receptive to STASH messages, they did not necessarily engage visibly on social media. Preferences for content design varied; however, humor, color, and text brevity were important. Preferences for social media versus offline message sharing varied. Conclusions: Invitation-only social media groups formed around peer supporters’ existing friendship networks hold potential for diffusing messages in peer-based sexual health interventions. Ideally, interactive opportunities should not be limited to single social media platforms and should run alongside offline conversations. There are tensions between offering young people autonomy to engage flexibly and authentically and the need for adult oversight of activities for information accuracy and safeguarding. %M 33591287 %R 10.2196/20898 %U http://www.jmir.org/2021/2/e20898/ %U https://doi.org/10.2196/20898 %U http://www.ncbi.nlm.nih.gov/pubmed/33591287 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e25062 %T An Asynchronous, Mobile Text-Based Platform (XatJove Anoia) for Providing Health Services to Teenagers: Protocol for a Quasiexperimental Study %A Sauch Valmaña,Glòria %A Vidal-Alaball,Josep %A Garcia Furió,Victoria %A Testoni,Giorgia %A Espelt,Albert %A Exposito,Katarin %A Saigí-Rubió,Francesc %A Carré,Núria %A Sanz,Ikuska %A Vicens,Victor %+ Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Carrer Pica d'Estats, 36, Sant Fruitós de Bages, 08272, Spain, 34 6930040, jvidal.cc.ics@gencat.cat %K mHealth %K telehealth %K teenager %K health promotion and sexual health %K health promotion %K sexual health %D 2021 %7 3.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Due to the COVID-19 pandemic, it is more essential than ever to implement protective measures in primary care centers to ensure patients’ safety. This protocol describes a quasiexperimental study on the use of a mobile chat platform as a clinical consultation tool for adolescents and primary health care physicians. Objective: The purpose of the quasiexperimental study is to demonstrate that the use of mobile phones and messaging apps increases the number of health consultations. The study will be performed as part of the Health and School program in the Anoia region. Methods: The quasiexperimental study will compare the number of face-to-face consultations to the number of consultations conducted on XatJove Anoia, as part of the Health in Schools program in the Anoia region. The study will involve the use of a new communication platform (ie, XatJove Anoia) for health care professionals and adolescents, and data on the number of face-to-face consultations will be collected as part of the same program in another region. Data will be collected from secondary schools during the academic year 2020-2021. Statistical analyses will be performed on the data that users will enter in the registration form. These data will be collected by means of a questionnaire, which will be submitted once the questionnaire is closed. The questionnaire will consist of multiple-choice questions, which will allow numerical values to be assigned to various responses in order to carry out statistical analyses. Results: The study is projected to start at the beginning of November 2020 and finish in June 2021, which is when data analysis is expected to start. Conclusions: The results of the quasiexperimental study may assist in the development and planning of school health programs. Trial Registration: ClinicalTrials.gov NCT04562350; https://clinicaltrials.gov/ct2/show/NCT04562350. International Registered Report Identifier (IRRID): PRR1-10.2196/25062 %M 33533729 %R 10.2196/25062 %U https://www.researchprotocols.org/2021/2/e25062 %U https://doi.org/10.2196/25062 %U http://www.ncbi.nlm.nih.gov/pubmed/33533729 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e17837 %T The Promise and Peril of Mobile Phones for Youth in Rural Uganda: Multimethod Study of Implications for Health and HIV %A Kreniske,Philip %A Basmajian,Alyssa %A Nakyanjo,Neema %A Ddaaki,William %A Isabirye,Dauda %A Ssekyewa,Charles %A Nakubulwa,Rosette %A Hirsch,Jennifer S %A Deisher,Andrea %A Nalugoda,Fred %A Chang,Larry W %A Santelli,John S %+ HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute and Columbia University, 722 West 168th Street, New York, NY, New York, United States, 1 646 774 6947, pk2361@columbia.edu %K adolescence %K youth %K mobile phones %K cell phones %K mobility %K HIV %K East Africa %D 2021 %7 2.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In East Africa, where landlines are used by 1% of the population and access to the internet is limited, owning a cell phone is rapidly becoming essential for acquiring information and resources. Our analysis illuminates the perils and potential promise of mobile phones with implications for future interventions to promote the health of adolescents and young adults (AYAs) and to prevent HIV infection. Objective: The aim of this study is to describe the current state of AYAs’ phone use in the region and trace out the implications for mobile health interventions. Methods: We identified 2 trading centers that were representative of southern Uganda in terms of key demographics, proportion of cell phone ownership, and community HIV prevalence. We stratified the sample of potential informants by age group (15-19 years and 20-24 years), gender, and phone ownership and randomly sampled 31 key informant interview participants within these categories. In addition, we conducted 24 ethnographic participant observations among AYAs in the communities of study. Results: AYA frequently reported barriers to using their phones, such as difficulty accessing electricity. Nearly all AYAs used mobile phones to participate in the local economy and communicate with sexual partners. Phone use was frequently a point of contention between sexual partners, with many AYAs reporting that their sexual partners associated phone use with infidelity. Few AYAs reported using their phones for health-related purposes, with most getting health information in person from health workers. However, most AYAs reported an instance when they used their phone in an emergency, with childbirth-related emergencies being the most common. Finally, most AYAs reported that they would like to use their phones for health purposes and specifically stated that they would like to use their mobile phones to access current HIV prevention information. Conclusions: This study demonstrates how mobile phones are related to income-generating practices in the region and communication with sexual partners but not access to health and HIV information. Our analysis offers some explanation for our previous study, which suggested an association between mobile phone ownership, having multiple sexual partners, and HIV risk. Mobile phones have untapped potential to serve as tools for health promotion and HIV prevention. %M 33528375 %R 10.2196/17837 %U https://www.jmir.org/2021/2/e17837 %U https://doi.org/10.2196/17837 %U http://www.ncbi.nlm.nih.gov/pubmed/33528375 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e26192 %T Mobile Health–Supported HIV Self-Testing Strategy Among Urban Refugee and Displaced Youth in Kampala, Uganda: Protocol for a Cluster Randomized Trial (Tushirikiane, Supporting Each Other) %A Logie,Carmen %A Okumu,Moses %A Hakiza,Robert %A Kibuuka Musoke,Daniel %A Berry,Isha %A Mwima,Simon %A Kyambadde,Peter %A Kiera,Uwase Mimy %A Loutet,Miranda %A Neema,Stella %A Newby,Katie %A McNamee,Clara %A Baral,Stefan D %A Lester,Richard %A Musinguzi,Joshua %A Mbuagbaw,Lawrence %+ Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, , Canada, 1 (416) 978 6314, carmen.logie@utoronto.ca %K adolescents and youth %K implementation research %K HIV testing %K mobile health %K refugee %K Uganda %D 2021 %7 2.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: HIV is the leading cause of mortality among youth in sub-Saharan Africa. Uganda hosts over 1.43 million refugees, and more than 83,000 live in Kampala, largely in informal settlements. There is limited information about HIV testing uptake and preferences among urban refugee and displaced youth. HIV self-testing is a promising method for increasing testing uptake. Further, mobile health (mHealth) interventions have been effective in increasing HIV testing uptake and could be particularly useful among youth. Objective: This study aims to evaluate the feasibility and effectiveness of two HIV self-testing implementation strategies (HIV self-testing intervention alone and HIV self-testing combined with an mHealth intervention) in comparison with the HIV testing standard of care in terms of HIV testing outcomes among refugee/displaced youth aged 16 to 24 years in Kampala, Uganda. Methods: A three-arm cluster randomized controlled trial will be implemented across five informal settlements grouped into three sites, based on proximity, and randomization will be performed with a 1:1:1 method. Approximately 450 adolescents (150 per cluster) will be enrolled and followed for 12 months. Data will be collected at the following three time points: baseline enrollment, 8 months after enrollment, and 12 months after enrollment. Primary outcomes (HIV testing frequency, HIV status knowledge, linkage to confirmatory testing, and linkage to HIV care) and secondary outcomes (depression, condom use efficacy, consistent condom use, sexual relationship power, HIV stigma, and adolescent sexual and reproductive health stigma) will be evaluated. Results: The study has been conducted in accordance with CONSORT (Consolidated Standards of Reporting Trials) guidelines. The study has received ethical approval from the University of Toronto (June 14, 2019), Mildmay Uganda (November 11, 2019), and the Uganda National Council for Science and Technology (August 3, 2020). The Tushirikiane trial launched in February 2020, recruiting a total of 452 participants. Data collection was paused for 8 months due to COVID-19. Data collection for wave 2 resumed in November 2020, and as of December 10, 2020, a total of 295 participants have been followed-up. The third, and final, wave of data collection will be conducted between February and March 2021. Conclusions: This study will contribute to the knowledge of differentiated HIV testing implementation strategies for urban refugee and displaced youth living in informal settlements. We will share the findings in peer-reviewed manuscripts and conference presentations. Trial Registration: ClinicalTrials.gov NCT04504097; https://clinicaltrials.gov/ct2/show/NCT04504097. International Registered Report Identifier (IRRID): DERR1-10.2196/26192 %M 33528378 %R 10.2196/26192 %U https://www.researchprotocols.org/2021/2/e26192 %U https://doi.org/10.2196/26192 %U http://www.ncbi.nlm.nih.gov/pubmed/33528378 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 1 %P e23088 %T A Web-Based Game for Young Adolescents to Improve Parental Communication and Prevent Unintended Pregnancy and Sexually Transmitted Infections (The Secret of Seven Stones): Development and Feasibility Study %A Shegog,Ross %A Armistead,Laura %A Markham,Christine %A Dube,Sara %A Song,Hsing-Yi %A Chaudhary,Pooja %A Spencer,Angela %A Peskin,Melissa %A Santa Maria,Diane %A Wilkerson,J Michael %A Addy,Robert %A Tortolero Emery,Susan %A McLaughlin,Jeffery %+ Department of Health Promotion and Behavioral Sciences, School of Public Health, University of Texas Health Science Center Houston, 7000 Fannin St, Suite 2668, Houston, TX, 77006, United States, 1 17135009677, Ross.Shegog@uth.tmc.edu %K serious game %K intervention mapping %K sexual health %K adolescents %K sexually transmitted infections %K teenage pregnancy %K parent, communication %K intergenerational %K mobile phone %D 2021 %7 27.1.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: Early adolescent unintended pregnancy and sexually transmitted infection prevention are significant public health challenges in the United States. Parental influence can help adolescents make responsible and informed sexual health decisions toward delayed sexual debut; yet parents often feel ill equipped to communicate about sex-related topics. Intergenerational games offer a potential strategy to provide life skills training to young adolescents (aged 11-14 years) while engaging them and their parents in communication about sexual health. Objective: This study aims to describe the development of a web-based online sexual health intergenerational adventure game, the Secret of Seven Stones (SSS), using an intervention mapping (IM) approach for developing theory- and evidence-based interventions. Methods: We followed the IM development steps to describe a theoretical and empirical model for young adolescent sexual health behavior, define target behaviors and change objectives, identify theory-based methods and practical applications to inform design and function, develop and test a prototype of 2 game levels to assess feasibility before developing the complete 18-level game, draft an implementation plan that includes a commercial dissemination strategy, and draft an evaluation plan including a study design for a randomized controlled trial efficacy trial of SSS. Results: SSS comprised an adventure game for young adolescent skills training delivered via a desktop computer, a text-based notification system to provide progress updates for parents and cues to initiate dialogue with their 11- to 14-year-old child, and a website for parent skills training and progress monitoring. Formative prototype testing demonstrated feasibility for in-home use and positive usability ratings. Conclusions: The SSS intergenerational game provides a unique addition to the limited cadre of home-based programs that facilitate parent involvement in influencing young adolescent behaviors and reducing adolescent sexual risk taking. The IM framework provided a logical and thorough approach to development and testing, attentive to the need for theoretical and empirical foundations in serious games for health. %M 33502323 %R 10.2196/23088 %U http://games.jmir.org/2021/1/e23088/ %U https://doi.org/10.2196/23088 %U http://www.ncbi.nlm.nih.gov/pubmed/33502323 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e19109 %T Young People’s Experiences Using an On-Demand Mobile Health Sexual and Reproductive Health Text Message Intervention in Kenya: Qualitative Study %A Mwaisaka,Jefferson %A Gonsalves,Lianne %A Thiongo,Mary %A Waithaka,Michael %A Sidha,Hellen %A Alfred,Otieno %A Mukiira,Carol %A Gichangi,Peter %+ International Centre for Reproductive Health, Kenya, Tom Mboya Street, Mombasa, Kenya, 254 723 206 132, jeffmwaisaka@gmail.com %K mHealth %K mobile phones %K sexual and reproductive health %K Kenya %D 2021 %7 15.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Digital health usability assessments can help explain how well mobile health (mHealth) apps targeting young people with sexual and reproductive health (SRH) information performed and whether the intended purpose was achieved. However, few digital health assessments have been conducted to evaluate young people’s perceptions regarding mHealth system interactions and content relevance on a wide range of SRH topics. In addition, the majority of randomized controlled trials (RCTs) have focused on push messaging platforms; therefore, the mHealth field lacks sufficient RCTs investigating on-demand mHealth SRH platforms. Objective: The objective of this study was to explore young people’s experiences using an on-demand SRH mHealth platform in Kenya. Methods: We used qualitative data related to the usability of an mHealth platform, Adolescent/Youth Reproductive Mobile Access and Delivery Initiatives for Love and Life Outcome (ARMADILLO), collected at the end of the intervention period. A total of 30 in-depth interviews (IDIs) were held with the intervention participants (15 women and 15 men) to elicit their experiences, opinions, and perspectives on the design and content of the ARMADILLO platform. The study participants were randomly selected from a list of intervention arm participants to participate in the IDIs. The interviews were later transcribed verbatim, translated into English, and coded and analyzed thematically using NVivo version 12 software (QSR International). Results: Respondents reported varied user experiences and levels of satisfaction, ranging from ease of use by the majority of the respondents to systematic frustrations that prevented some participants from progressing to other stages. Interesting features of the mHealth platform included the immediate response participants received when requesting messages, weekly remunerated quizzes, and perceived ability of educative and informative content and messages to change behaviors. Proposed enhancements to the platform included revising some concepts and words for easy understanding and increasing the interactivity of the platform, whereby young people could seek clarity when they came across difficult terms or had additional questions about the information they received. Conclusions: The importance of understanding the range of health literacy and technological variations when dealing with young people cannot be overemphasized. Young people, as mHealth end users, must be considered throughout intervention development to achieve optimum functionality. In addition, young people targeted with mHealth SRH interventions must be sensitized to the interactions on mHealth platforms or any other digital health apps if implemented in a nonresearch setting for optimal use by the targeted audience. %M 33448930 %R 10.2196/19109 %U http://mhealth.jmir.org/2021/1/e19109/ %U https://doi.org/10.2196/19109 %U http://www.ncbi.nlm.nih.gov/pubmed/33448930 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e20158 %T Effectiveness, Acceptability, and Feasibility of Digital Health Interventions for LGBTIQ+ Young People: Systematic Review %A Gilbey,Dylan %A Morgan,Helen %A Lin,Ashleigh %A Perry,Yael %+ Telethon Kids Institute, 15 Hospital Avenue, Perth , Australia, 61 63191195, Dylan.Gilbey@telethonkids.org.au %K systematic review %K mental health %K physical health %K sexual health %K youth %K sexuality %K gender %K mobile phones %D 2020 %7 3.12.2020 %9 Review %J J Med Internet Res %G English %X Background: Young people (aged 12-25 years) with diverse sexuality, gender, or bodily characteristics, such as those who identify as lesbian, gay, bisexual, transgender, intersex, or queer (LGBTIQ+), are at substantially greater risk of a range of mental, physical, and sexual health difficulties compared with their peers. Digital health interventions have been identified as a potential way to reduce these health disparities. Objective: This review aims to summarize the characteristics of existing evidence-based digital health interventions for LGBTIQ+ young people and to describe the evidence for their effectiveness, acceptability, and feasibility. Methods: A systematic literature search was conducted using internet databases and gray literature sources, and the results were screened for inclusion. The included studies were synthesized qualitatively. Results: The search identified 38 studies of 24 unique interventions seeking to address mental, physical, or sexual health–related concerns in LGBTIQ+ young people. Substantially more evidence-based interventions existed for gay and bisexual men than for any other population group, and there were more interventions related to risk reduction of sexually transmitted infections than to any other health concern. There was some evidence for the effectiveness, feasibility, and acceptability of these interventions overall; however, the quality of evidence is often lacking. Conclusions: There is sufficient evidence to suggest that targeted digital health interventions are an important focus for future research aimed at addressing health difficulties in LGBTIQ+ young people. Additional digital health interventions are needed for a wider range of health difficulties, particularly in terms of mental and physical health concerns, as well as more targeted interventions for same gender–attracted women, trans and gender-diverse people, and people with intersex variations. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020128164; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=128164 %M 33270039 %R 10.2196/20158 %U https://www.jmir.org/2020/12/e20158 %U https://doi.org/10.2196/20158 %U http://www.ncbi.nlm.nih.gov/pubmed/33270039 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e18650 %T Expert Opinions on Web-Based Peer Education Interventions for Youth Sexual Health Promotion: Qualitative Study %A Martin,Philippe %A Alberti,Corinne %A Gottot,Serge %A Bourmaud,Aurelie %A de La Rochebrochard,Elise %+ Institut National de la Santé Et de la Recherche Médicale (INSERM), Epidémiologie clinique et évaluation économique appliquées aux populations vulnérables (ECEVE), Université de Paris, 10 Avenue de Verdun, Paris, 75010, France, 33 676606491, philippe.martin@inserm.fr %K youth %K health promotion %K internet %K sexual health %K peer education %D 2020 %7 24.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Participatory education, in the form of peer education, may be an effective way to promote youth sexual health. With the advent of the internet, web-based interventions have potential as an attractive new tool for sexual health promotion by peers. Objective: The aim of this study was to evaluate professional experts’ opinions on the perspectives for web-based participatory interventions to promote sexual health by peers and among young people. Methods: Semistructured interviews were carried out with 20 experts (stakeholders in direct contact with young people, researchers, and institutional actors) specializing in sexual health, health promotion, peer education, youth, internet, and social media. After coding with N’Vivo, data were subjected to qualitative thematic analysis. Results: The majority of experts (18/20, 90%) found this kind of intervention to be attractive, but highlighted the necessary conditions, risks, and limitations attached to developing an acceptable peer intervention on the internet for sexual health promotion among young people. Five main themes were identified: (1) an internet intervention; (2) sexual health; (3) internet skills, and uses and the need for moderation; (4) multifaceted peers; and (5) minority peers. In the absence of youth interest for institutional messages, the experts highlighted the attractive participatory features of web-based interventions and the need for geolocalized resources. However, they also warned of the limitations associated with the possibility of integrating peers into education: peers should not be mere messengers, and should remain peers so as not to be outsiders to the target group. Experts highlighted concrete proposals to design an online participatory peer intervention, including the process of peer implication, online features in the intervention, and key points for conception and evaluation. Conclusions: The experts agreed that web-based participatory interventions for youth sexual health promotion must be tailored to needs, uses, and preferences. This type of action requires youth involvement framed in an inclusive and holistic sexual health approach. Peer education can be implemented via the internet, but the design of the intervention also requires not being overly institutional in nature. Involving young people in their own education in an interactive, safe online space has the potential to develop their empowerment and to foster long-term positive behaviors, especially in the area of sexual health. %M 33231552 %R 10.2196/18650 %U http://www.jmir.org/2020/11/e18650/ %U https://doi.org/10.2196/18650 %U http://www.ncbi.nlm.nih.gov/pubmed/33231552 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 11 %P e16517 %T Patient Perception of Mobile Phone Apps for the Care and Prevention of Sexually Transmitted Diseases: Cross-Sectional Study %A Jakob,Lena %A Steeb,Theresa %A Fiocco,Zeno %A Pumnea,Teodora %A Jakob,Sophia Nomi %A Wessely,Anja %A Rothenberger,Christoph Clemens %A Brinker,Titus Josef %A French,Lars Einar %A Berking,Carola %A Heppt,Markus Vincent %+ Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Ulmenweg 18, Erlangen, 91054, Germany, 49 913185 ext 45810, markus.heppt@uk-erlangen.de %K sexually transmitted diseases %K sexually transmitted infection %K mobile phone apps %K health apps %D 2020 %7 10.11.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In the emerging era of digitalization and electronic health, various health-related apps have been launched, including apps for sexually transmitted diseases. Until now, little has been known about how patients perceive the value of such apps. Objective: To investigate patient’s attitudes and awareness toward sexually transmitted disease–related apps in an outpatient sexually transmitted disease clinic setting. Methods: A cross-sectional study was conducted at a dermatovenereological outpatient unit between April and July 2019. Patients completed a self-administered questionnaire on their perceptions of the popularity and usefulness of sexually transmitted disease–related apps. Descriptive analysis was performed with expression of categorical variables as frequencies and percentages. For continuous variables, the median, range, and interquartile range were indicated. Contingency tables and chi-square tests were used to investigate associations between sociodemographic data and items of the questionnaire. Results: A total of 226 patients were surveyed (heterosexual: 137/193, 71.0%; homosexual: 44/193, 22.8%; bisexual: 12/193, 6.2%); 11.9% (27/225) had previously used health-related apps. Nearly half of the patients (97/214, 45.3%) specifically considered sexually transmitted disease–related apps useful, 47.8% (100/209) voted that they could supplement or support the consultation of a physician. Interestingly, only 35.1% (74/211) preferred a printed patient brochure on sexually transmitted diseases over downloading and using an app, but 64.0% (134/209) would download a sexually transmitted disease–related app recommended by their physician. General information regarding sexually transmitted diseases (93/167, 55.7%), evaluation of skin diseases based on photos or videos (78/167, 53.3%), information on the prevention of sexually transmitted diseases (76/167, 45.5%), mediation of nearby contact points or test sites (74/167, 44.3%), anonymous medical advice (69/167, 41.3%), and calculation of the risk of having a sexually transmitted disease (63/167, 37.3%) were rated as the most important features. Men were more likely than women to find sexually transmitted disease–related apps useful in general (P=.04; χ2=6.28) and to pay for such apps (P=.01; χ2=9.19). Patients aged <40 years would rather download an app recommended by their physician (P=.03; χ2=7.23), whereas patients aged >40 years preferred reading a patient brochure on sexually transmitted diseases (P=.02; χ2=8.14). Conclusions: This study demonstrated high general interest in the use of sexually transmitted disease–related apps in this sample of dermatovenereological outpatients. In particular, young age and male sex were significantly associated with a positive perception, underlining the high potential of apps in the prevention and early recognition of sexually transmitted diseases in this group. Future studies are warranted to validate these findings in other populations. %M 33170133 %R 10.2196/16517 %U https://mhealth.jmir.org/2020/11/e16517 %U https://doi.org/10.2196/16517 %U http://www.ncbi.nlm.nih.gov/pubmed/33170133 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e21454 %T African American Emerging Adult Perspectives on Unintended Pregnancy and Meeting Their Needs With Mobile Technology: Mixed Methods Qualitative Study %A Ingram,Lucy Annang %A Stafford,Crystal %A McCollum,Quentin %A Isreal,McKenzie %+ Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Room 503G, Columbia, SC, 29202, United States, 1 803 777 4389, lannang@sc.edu %K unintended pregnancy %K emerging adult %K African American %K mobile technology %K pregnancy %K teenage years %K health promotion %K mobile %K sexual health %D 2020 %7 21.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: In the United States, a disproportionate number of unintended pregnancies occur among African Americans, particularly those in their later teenage years and early 20s. Mobile technology is becoming more ubiquitous as a method for health promotion; however, relatively little research has been done with this population to determine their perspectives about unintended pregnancy, the potential of successfully using mobile technology to prevent unintended pregnancy, and the content of such programs. Objective: The purpose of this study was to obtain the perspectives of African American emerging adults about unintended pregnancy and the use of mobile technology to reduce unintended pregnancy rates. Methods: Focus groups and interviews were conducted with 83 African Americans, aged 18-21 years. Data were analyzed using an open coding process. Emergent codes were then added as needed, and themes and subthemes were identified. Results: Participants cited the social environment and lack of education as primary reasons for disproportionate rates of unintended pregnancy. They noted that unintended pregnancy is an important issue and that they desire more sexual health information. They enthusiastically supported mobile technology as a means to communicate unintended pregnancy prevention programming and offered many suggestions for program content, look, and feel. Conclusions: Young and emerging adult African Americans want and need sexual health resources, and a mobile-based platform could be widely accepted and address needs to lower disproportionate rates of unintended pregnancy. An essential next step is to use these findings to inform the development of a mobile-based unintended pregnancy prevention and sexual health program prototype to determine feasibility. %M 33084591 %R 10.2196/21454 %U http://mhealth.jmir.org/2020/10/e21454/ %U https://doi.org/10.2196/21454 %U http://www.ncbi.nlm.nih.gov/pubmed/33084591 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e19459 %T African American Adolescents and Young Adults, New Media, and Sexual Health: Scoping Review %A Teadt,Sierra %A Burns,Jade C %A Montgomery,Tiffany M %A Darbes,Lynae %+ School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, United States, 1 2692547062, steadt@umich.edu %K African American %K adolescent %K young adult %K technology %K safe sex %K sexually transmitted infections %K sexual behavior %K new media %K social media %K internet %D 2020 %7 5.10.2020 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Rates of sexually transmitted infections and unintended pregnancies are disproportionately high among African American adolescents and young adults (AYA). New media platforms such as social networking sites, microblogs, online video sites, and mobile phone applications may be a promising approach in promoting safe sex and preventing sexually transmitted infections. Objective: The purpose of this scoping review was to address promising approaches in new media that may serve as valuable tools in health promotion, prevention, education, and intervention development aimed at African American AYA. Methods: An electronic search was conducted using Google Scholar, Scopus, Cumulative Index to Nursing and Allied Health (CINHAL), and PubMed online databases. Concept blocks and MeSH terminology were used to identify articles around African American youth and new media. Results: The search yielded 1169 articles, and 16 publications met the criteria. Studies from the review found themes in new media that included feasibility, changing attitudes, and improving knowledge related to sexual health behavior among youth of color. Conclusions: New media is a promising and feasible platform for improving the sexual health of African American AYA. Further research is suggested to better understand the benefits of new media as a sexual health promotion tool among this specific population. %M 33016890 %R 10.2196/19459 %U https://mhealth.jmir.org/2020/10/e19459 %U https://doi.org/10.2196/19459 %U http://www.ncbi.nlm.nih.gov/pubmed/33016890 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 9 %P e18784 %T Pre-Exposure Prophylaxis Integration Into Family Planning Services at Title X Clinics in the Southeastern United States: Protocol for a Mixed Methods Hybrid Type I Effectiveness Implementation Study (Phase 2 ATN 155) %A Sheth,Anandi N %A Hussen,Sophia A %A Escoffery,Cam %A Haddad,Lisa B %A Powell,Leah %A Brown,Nakita %A Filipowicz,Teresa R %A McCumber,Micah %A Sanchez,Maria %A Renshaw,Laura %A Psioda,Matthew A %A Sales,Jessica M %+ Department of Medicine, Division of Infectious Diseases, School of Medicine, Emory University, 341 Ponce de Leon Ave, Atlanta, GA, 30308, United States, 1 404 616 6240, ansheth@emory.edu %K HIV %K pre-exposure prophylaxis %K implementation science %K family planning services %D 2020 %7 25.9.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Adolescent and young adult women (AYAW), particularly racial and ethnic minorities, in the Southern United States are disproportionately affected by HIV. Pre-exposure prophylaxis (PrEP) is an effective, scalable, individual-controlled HIV prevention strategy that is grossly underutilized among women of all ages and requires innovative delivery approaches to optimize its benefit. Anchoring PrEP delivery to family planning (FP) services that AYAW already trust, access routinely, and deem useful for their sexual health may offer an ideal opportunity to reach women at risk for HIV and to enhance their PrEP uptake and adherence. However, PrEP has not been widely integrated into FP services, including Title X–funded FP clinics that provide safety net sources of care for AYAW. To overcome potential implementation challenges for AYAW, Title X clinics in the Southern United States are uniquely positioned to be focal sites for conceptually informed and thoroughly evaluated PrEP implementation science studies. Objective: The objective of this study is two-fold: to evaluate multilevel factors associated with the level of PrEP adoption and implementation (eg, PrEP screening, counseling, and prescription) within and across 3 FP clinics and to evaluate PrEP uptake, persistence, and adherence among female patients in these clinics over a 6-month follow-up period. Methods: Phase 2 of Planning4PrEP (Adolescent Medicine Trials Network for HIV/AIDS Interventions 155) is a mixed methods hybrid type 1 effectiveness implementation study to be conducted in three clinics in Metro Atlanta, Georgia, United States. Guided by the Exploration, Preparation, Implementation, and Sustainment framework, this study will prepare clinics for PrEP integration via clinic-wide trainings and technical assistance and will develop clinic-specific PrEP implementation plans. We will monitor and evaluate PrEP implementation as well as female patient PrEP uptake, persistence, and adherence over a 6-month follow-up period. Results: Phase 2 of Planning4PrEP research activities began in February 2018 and are ongoing. Qualitative data analysis is scheduled to begin in Fall 2020. Conclusions: This study seeks to evaluate factors associated with the level of PrEP adoption and implementation (eg, PrEP screening, counseling, and prescription) within and across 3 FP clinics following training and implementation planning and to evaluate PrEP uptake, persistence, and adherence among female patients over a 6-month follow-up period. This will guide future strategies to support PrEP integration in Title X–funded clinics across the Southern United States. Trial Registration: ClinicalTrials.gov NCT04097834; https://clinicaltrials.gov/ct2/show/NCT04097834 International Registered Report Identifier (IRRID): DERR1-10.2196/18784 %M 32975528 %R 10.2196/18784 %U http://www.researchprotocols.org/2020/9/e18784/ %U https://doi.org/10.2196/18784 %U http://www.ncbi.nlm.nih.gov/pubmed/32975528 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 8 %P e14816 %T Bahamas National Implementation Project: Proposal for Sustainability of an Evidence-based HIV Prevention Intervention in a School Setting %A Wang,Bo %A Deveaux,Lynette %A Lunn,Sonja %A Dinaj-Koci,Veronica %A Ghosh,Samiran %A Li,Xiaoming %A Marshall,Sharon %A Rolle,Glenda %A Forbes,Nikkiah %A Stanton,Bonita %+ Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, 368 Plantation Street, Albert Sherman Center, Worcester, MA, United States, 1 774 455 4672, bo.wang@umassmed.edu %K adolescent %K HIV prevention %K implementation %K sustainability %K evidence-based intervention %D 2020 %7 21.8.2020 %9 Proposal %J JMIR Res Protoc %G English %X Background: Sustained implementation of school-based prevention programs is low. Effective strategies are needed to enhance both high-level implementation fidelity and sustainability of prevention programs. Objective: This proposed study aims to determine if the provision of either biweekly monitoring and feedback and site-based assistance and mentorship or both to at-risk and moderate-performing teachers with monitoring through an enhanced decision-making platform by the Ministry of Education (MOE) and Ministry of Health (MOH) based on the real-time implementation data will increase national implementation fidelity and result in sustained implementation over time. Methods: This study will target government schools including 200 grade 6 teachers in 80 primary schools and 100 junior/middle high school teachers (and their classes) on 12 Bahamian islands. Teacher and school coordinator training will be conducted by the MOE in year 1, followed by an optimization trial among teachers in the capital island. Informed by these results, an implementation intervention will be conducted to train using different levels of educational intensity all at-risk and moderate-performing teachers. Subsequently selected training and implementation strategies will be evaluated for the national implementation of Focus on Youth in the Caribbean and Caribbean Informed Parents and Children Together in years 2 to 5. Results: It is hypothesized that a more intensive training and supervision program for at-risk and moderate-performing teachers will enhance their implementation fidelity to the average level of the high-performing group (85%), an HIV prevention program delivered at the national level can be implemented with fidelity in grade 6 and sustained over time (monitored annually), and student outcomes will continue to be highly correlated with implementation fidelity and be sustained over time (assessed annually through grade 9). The proposed study is funded by the National Institute of Child Health and Human Development from August 1, 2018, through May 31, 2023. Conclusions: The study will explore several theory-driven implementation strategies to increase sustained teacher implementation fidelity and thereby increase the general public health impact of evidence-based interventions. The proposed project has potential to make significant contributions to advancing school-based HIV prevention research and implementation science and serve as a global model for the Fast Track strategy. International Registered Report Identifier (IRRID): PRR1-10.2196/14816 %M 32821065 %R 10.2196/14816 %U http://www.researchprotocols.org/2020/8/e14816/ %U https://doi.org/10.2196/14816 %U http://www.ncbi.nlm.nih.gov/pubmed/32821065 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 8 %P e17191 %T Two-Way Text Messaging to Support Self-Care and Delivery of an Online Sexual Health Service: Mixed Methods Evaluation %A Shanks,Sarah %A Morelli,Alessandra %A Ardines,Elena %A Holdsworth,Gillian %A Baraitser,Paula %+ SH:24, 35a Westminster Bridge Road, London, SE1 7JB, United Kingdom, 1 02076202250, sshanks@nhs.net %K SMS %K text message %K digital health %K sexual health %K self-care %K mobile phone %D 2020 %7 20.8.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Digital health care is increasingly used to improve health service accessibility and reduce costs. Remote health care requires a significant self-management role for service users, and this generates information provision and support needs that should be reflected in service planning. SMS text messaging offers a convenient and low-cost method of communication and is increasingly used across digital health care services to provide remote support. Objective: The aim of this study was to quantify the number of messages generated through user interaction with a two-way SMS text messaging support service within an online sexual health service and to thematically explore the content of the messages and type of support required to facilitate self-management. Methods: The content of all SMS text messages received by an online sexual health service was analyzed from April 4, 2018, to July 5, 2018. Messages were classified as being either administrative or clinical in nature and service or user initiated. For those messages that were both clinical and user initiated, a qualitative thematic analysis was completed to fully describe the content of the interactions. Results: A total of 267 actionable messages were generated per 1000 orders requested through the service. Of the 8562 messages, 5447 (63.62%) messages were administrative and 3115 (36.38%) were clinical. Overall, 4306 of the 8562 messages (50.29%) responded to service-generated queries reflecting the public health and clinical responsibilities of an online provider, and 4256 (49.71%) were user-generated queries, demonstrating a willingness by users to proactively engage with a two-way SMS text messaging support service. Of the 3115 clinical messages, 968 (31.08%) clinical messages were user initiated and shared personal and complex clinical information, including requests for help with the self-testing process and personalized clinical advice relating to symptoms and treatment. Conclusions: This study demonstrates the willingness of users of an online sexual health service to engage with two-way SMS text messaging and provides insight into the quantity and nature of the support required to facilitate service delivery and self-care. Further work is required to understand the range of clinical problems that can be managed within this medium. %M 32815820 %R 10.2196/17191 %U http://mhealth.jmir.org/2020/8/e17191/ %U https://doi.org/10.2196/17191 %U http://www.ncbi.nlm.nih.gov/pubmed/32815820 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e16725 %T Meeting Kids Where They Are At–A Substance Use and Sexual Risk Prevention Program via Telemedicine for African American Girls: Usability and Acceptability Study %A Lopez,Cristina %A Gilmore,Amanda K %A Moreland,Angela %A Danielson,Carla Kmett %A Acierno,Ron %+ Medical University of South Carolina, 99 Jonathan Lucas Street, MSC 161, Charleston, SC, 29425, United States, 1 8438761034, lopezcm@musc.edu %K adolescents %K substance use %K sexual risk reduction %K telehealth %K prevention programs %K mobile phone %D 2020 %7 11.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Rural African American youth lack access to drug and sexual risk–taking prevention programs available in more urban areas. Recent data indicate that rural youth now use substances at higher rates and at younger ages than their urban peers. Objective: This study aims to evaluate the initial usability and acceptability of a low-cost, technology-based approach to delivering effective, culturally tailored, integrated substance use disorder (SUD) and HIV risk behavior prevention programs to African American female youth to inform the use of this intervention via telemedicine for rural youth. Methods: Effective SUD prevention strategies and emotion regulation skills were integrated into an existing evidence-based HIV risk reduction program culturally tailored for African American female adolescents—Sisters Informing, Healing, Living, and Empowering (SIHLE)—and delivered to 39 African American female youth via group telehealth. The evaluation of the resulting program, 12-session SIHLEplus, was completed by 27 girls who also completed self-report measures that assessed sexual risk behaviors (eg, number of partners and age of sex initiation), substance use, exposure to traumatic events, and emotion regulation. Results: The descriptive and qualitative results of the pilot study demonstrate the initial usability and acceptability of delivering evidence-based prevention successfully via telehealth to help address health disparities in this vulnerable population. Conclusions: Although more research is needed, the findings from this study suggest that SIHLEplus has demonstrated initial usability and acceptability. %M 32780022 %R 10.2196/16725 %U http://www.jmir.org/2020/8/e16725/ %U https://doi.org/10.2196/16725 %U http://www.ncbi.nlm.nih.gov/pubmed/32780022 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 8 %P e18060 %T Evaluating the Effectiveness of an Intervention Integrating Technology and In-Person Sexual Health Education for Adolescents (In the Know): Protocol for a Cluster Randomized Controlled Trial %A Decker,Martha J. %A Gutmann-Gonzalez,Abigail %A Price,Melisa %A Romero,Julio %A Sheoran,Bhupendra %A Yarger,Jennifer %+ Department of Epidemiology and Biostatistics, Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, 3333 California Street, Suite 265, San Francisco, CA, 94118, United States, 1 4154763375, mara.decker@ucsf.edu %K adolescents %K sexual health %K sex education %K technology %K randomized controlled trial %K United States %K mobile app %K mobile phone %D 2020 %7 7.8.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Access to a smartphone is nearly universal among American adolescents, and most of them have used the internet to seek health information. Integrating digital technologies into health program delivery may expand opportunities for youth to receive important health information, yet there are few rigorous studies assessing the effectiveness of this type of intervention. Objective: The purpose of this study is to assess the effectiveness of In the Know (ITK), a program integrating in-person and technology-based sexual health education for underserved adolescents. Methods: Youth were engaged in the development of the intervention, including the design of the digital technology and the curriculum content. The intervention focuses on 3 main areas: sexual health and contraceptive use, healthy relationships, and educational and career success. It includes an in-person, classroom component, along with a web-based component to complement and reinforce key content. A cluster randomized controlled trial is in progress among adolescents aged 13-19 years living in Fresno County, California. It is designed to examine the differences in self-reported health and behavioral outcomes among youth in the intervention and control groups at 3 and 9 months. Primary outcomes are condom and contraceptive use or no sex in the past 3 months and use of any clinical health services in the past 3 months. Secondary outcomes include the number of sexual partners in the past 3 months and knowledge of local clinical sexual health services. We will use mixed-effects linear and logistic regression models to assess differences between the intervention and control groups. Results: Trial enrollment began in October 2017 and ended in March 2020 with a total of 1260 participants. The mean age of the participants is 15.73 (SD 1.83) years, and 69.98% (867/1239) of the participants report being Hispanic or Latino. Study results will be available in 2021. Conclusions: ITK has the potential to improve contraceptive and clinic use among underserved youth. This trial will inform future youth-focused health interventions that are considering incorporating technology. International Registered Report Identifier (IRRID): DERR1-10.2196/18060 %M 32763885 %R 10.2196/18060 %U https://www.researchprotocols.org/2020/8/e18060 %U https://doi.org/10.2196/18060 %U http://www.ncbi.nlm.nih.gov/pubmed/32763885 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e15378 %T Participatory Interventions for Sexual Health Promotion for Adolescents and Young Adults on the Internet: Systematic Review %A Martin,Philippe %A Cousin,Lorraine %A Gottot,Serge %A Bourmaud,Aurelie %A de La Rochebrochard,Elise %A Alberti,Corinne %+ Université de Paris, ECEVE, INSERM, 10 Avenue de Verdun, Paris, 75010, France, 33 676606491, philippe.martin@inserm.fr %K sexual health %K health promotion %K internet %K participatory interventions %K adolescents and young adults %K methods %D 2020 %7 31.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The World Health Organization recommends the development of participatory sexuality education. In health promotion, web-based participatory interventions have great potential in view of the internet’s popularity among young people. Objective: The aim of this review is to describe existing published studies on online participatory intervention methods used to promote the sexual health of adolescents and young adults. Methods: We conducted a systematic review based on international scientific and grey literature. We used the PubMed search engine and Aurore database for the search. Articles were included if they reported studies on participatory intervention, included the theme of sexual health, were conducted on the internet (website, social media, online gaming system), targeted populations aged between 10 and 24 years, and had design, implementation, and evaluation methods available. We analyzed the intervention content, study implementation, and evaluation methods for all selected articles. Results: A total of 60 articles were included, which described 37 interventions; several articles were published about the same intervention. Process results were published in many articles (n=40), in contrast to effectiveness results (n=23). Many of the 37 interventions were developed on websites (n=20). The second most used medium is online social networks (n=13), with Facebook dominating this group (n=8). Online peer interaction is the most common participatory component promoted by interventions (n=23), followed by interaction with a professional (n=16). Another participatory component is game-type activity (n=10). Videos were broadcast for more than half of the interventions (n=20). In total, 43% (n=16) of the interventions were based on a theoretical model, with many using the Information-Motivation-Behavioral Skills model (n=7). Less than half of the interventions have been evaluated for effectiveness (n=17), while one-third (n=12) reported plans to do so and one-fifth (n=8) did not indicate any plan for effectiveness evaluation. The randomized controlled trial is the most widely used study design (n=16). Among the outcomes (evaluated or planned for evaluation), sexual behaviors are the most evaluated (n=14), followed by condom use (n=11), and sexual health knowledge (n=8). Conclusions: Participatory online interventions for young people’s sexual health have shown their feasibility, practical interest, and attractiveness, but their effectiveness has not yet been sufficiently evaluated. Online peer interaction, the major participatory component, is not sufficiently conceptualized and defined as a determinant of change or theoretical model component. One potential development would be to build a conceptual model integrating online peer interaction and support as a component. %M 32735217 %R 10.2196/15378 %U http://www.jmir.org/2020/7/e15378/ %U https://doi.org/10.2196/15378 %U http://www.ncbi.nlm.nih.gov/pubmed/32735217 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e13686 %T Maternal Parenting Electronic Diary in the Context of a Home Visit Intervention for Adolescent Mothers in an Urban Deprived Area of São Paulo, Brazil: Randomized Controlled Trial %A Fatori,Daniel %A Argeu,Adriana %A Brentani,Helena %A Chiesa,Anna %A Fracolli,Lislaine %A Matijasevich,Alicia %A Miguel,Euripedes C %A Polanczyk,Guilherme %+ Department of Psychiatry, University of Sao Paulo Medical School, 785 R Dr Ovídio Pires de Campos, Sao Paulo, Brazil, 55 11961626183, daniel.fatori@gmail.com %K mHealth %K early childhood development %K maternal care %K randomized clinical trial %K daily diary %K ambulatory assessment %D 2020 %7 28.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Pregnancy during adolescence is prevalent in low- and middle-income countries (LMICs), which is associated with various adverse outcomes that can be prevented with home visiting programs. However, testing these interventions in LMICs can be challenging due to limited resources. The use of electronic data collection via smartphones can be an alternative and ideal low-cost method to measure outcomes in an environment with adverse conditions. Objective: Our study had two objectives: to test the efficacy of a nurse home visiting intervention on maternal parenting and well-being measured by an electronic daily diary (eDiary), and to investigate the compliance rate of the eDiary measurement method. Methods: We conducted a randomized controlled trial to test the efficacy of Primeiros Laços, a nurse home visiting program, for adolescent mothers living in an urban deprived area of São Paulo, Brazil. A total of 169 pregnant adolescents were assessed for eligibility criteria, 80 of whom were included and randomized to the intervention (n=40) and control group (care as usual, n=40). Primeiros Laços is a home visiting intervention delivered by trained nurses tailored to first-time pregnant adolescents and their children, starting during the first 16 weeks of pregnancy until the child reaches 24 months of age. Participants were assessed by blind interviewers at 8-16 weeks of pregnancy (baseline), 30 weeks of pregnancy, and when the child was 3, 6, and 12 months of age. At 18 months, participants were assessed regarding maternal parenting and parental well-being using a 7-consecutive-day eDiary. The smartphone app was programmed to notify participants every day at 9:00 PM over a period of seven days. Results: We were able to contact 57/80 (71%) participants (29 from the intervention group and 28 from the control group) when the child was 18 months of age. Forty-eight of the 57 participants (84%) completed at least one day of the eDiary protocol. The daily compliance rate ranged from 49% to 70%. Our analyses showed a significant effect of the intervention on parental well-being (B=0.32, 95% CI [0.06, 0.58], P=.02) and the maternal parenting behavior of the mother telling a story or singing to the child (odds ratio=2.33, 95% CI [1.20, 4.50], P=.01).Our analyses showed a significant effect of the intervention on parental well-being (B=0.32, P=.02) and the maternal parenting behavior of the mother telling a story or singing to the child (odds ratio=2.33, P=.01). Conclusions: The Primeiros Laços intervention improved maternal parenting and parental well-being, demonstrating its promise for low-income adolescent mothers. The compliance rate of the eDiary assessment showed that it was generally accepted by adolescent mothers with limited resources. Future studies can implement ambulatory assessment in LMICs via smartphones to measure mother and child behaviors. Trial Registration: ClinicalTrials.gov NCT02807818; https://clinicaltrials.gov/ct2/show/NCT02807818 %M 32720906 %R 10.2196/13686 %U https://mhealth.jmir.org/2020/7/e13686 %U https://doi.org/10.2196/13686 %U http://www.ncbi.nlm.nih.gov/pubmed/32720906 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e14242 %T Inferring Sexually Transmitted Infection Risk From Attractiveness in Online Dating Among Adolescents and Young Adults: Exploratory Study %A Krishnamurti,Tamar %A Davis,Alexander L %A Fischhoff,Baruch %+ Division of General Internal Medicine, University of Pittsburgh, 200 Meyran Avenue, Parkvale Building Suite 200, Pittsburgh, PA, 15213, United States, 1 412 692 4855, tamark@pitt.edu %K risk perception %K heuristics %K sexually transmitted infections %K online dating %K dating apps %K adolescents %K sexual health %K attractiveness %K halo effect %D 2020 %7 9.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Sexually transmitted infection (STI) rates are on the rise among adolescents and young adults in the United States. With the popularity of online dating, adolescents and young adults must increasingly rely on limited cues to make initial judgments about potential sexual partners, including judgments about STI risk. Objective: This study aimed to assess whether in the context of online dating, an attractiveness heuristic would be used for STI risk assessment. We hypothesized that consistent with research on halo effects, decision makers would judge more attractive people to be less likely to have STIs. Methods: In a survey experiment, we asked participants to determine which individual in each of 20 sets of paired photographs was enrolled in a personals website for people with publicly disclosed STIs. Results: Despite financial incentives for accuracy and high levels of self-confidence in their judgments, participants performed no better than chance at identifying individuals with self-reported STIs. Contrary to our hypothesis, however, more attractive people were judged as being more likely to have an STI. This relationship appears to be mediated by inferences regarding the target individual’s sexual behavior, with more attractive individuals considered to have more partners. Conclusions: On showing adolescents and young adults photographs offering no diagnostic information about STIs, they appeared to use attractiveness as a cue for sexual risk, which was mediated by the belief that attractive individuals have more sexual opportunities. Health care providers may wish to address this heuristic process among their adolescent patients in discussions about sexual health. %M 32442128 %R 10.2196/14242 %U https://www.jmir.org/2020/6/e14242 %U https://doi.org/10.2196/14242 %U http://www.ncbi.nlm.nih.gov/pubmed/32442128 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e15964 %T A Digital Pornography Literacy Resource Co-Designed With Vulnerable Young People: Development of "The Gist" %A Davis,Angela C %A Wright,Cassandra JC %A Murphy,Stacey %A Dietze,Paul %A Temple-Smith,Meredith J %A Hellard,Margaret E %A Lim,Megan SC %+ Burnet Institute, GPO Box 2284, Melbourne, 3181, Australia, 61 3 9282 2111, angela.davis@burnet.edu.au %K co-design %K pornography literacy %K sexual health %K sex education %D 2020 %7 1.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The impact of viewing pornography at a young age on the sexual health of subgroups of young people is an important public health issue. However, the topic is complex and extremely sensitive, and best practices for research and harm reduction are yet to be defined. Drawing on cross-disciplinary approaches, such as co-design, is one way to achieve a better understanding of the issue among vulnerable young people and to create needs-based and evidence-informed digital resources to promote pornography literacy. Objective: The objective of this study was to co-design a relevant, usable, and acceptable digital prototype to address the pornography literacy needs of vulnerable young people. Methods: In total, 17 young people aged between 14 and 23 years who were engaged in youth services programs or alternative education programs were recruited to participate in 4 co-design workshops with a multidisciplinary design team. Results: Although the participants could identify problems with pornography and critique its messages, they lacked the information to understand alternative healthy attitudes and behaviors. A digital resource that provides detailed and practical information about sex, sexual ethics, and relationships may help vulnerable young people to identify and contrast with any problematic messages they receive from both pornography and society. Embedding this information with pornography literacy messages may be a more effective way of addressing underlying attitudes. Acknowledging information-seeking patterns and leveraging user interaction patterns from commonly used digital platforms among users may enhance engagement with resources. Importantly, digital platforms are perceived among this group as a source of anonymous secondary information but would not be organically accessed among this group without face-to-face conversations as an access point. Conclusions: This paper highlights the potential for pornography literacy to be embedded within real and practical information about having sex, navigating sexuality, and healthy relationships. The study findings include important recommendations for the conceptualization of digital pornography literacy programs and opportunities for cross-disciplinary co-design research to address complex and emerging health issues. %M 32348268 %R 10.2196/15964 %U https://www.jmir.org/2020/6/e15964 %U https://doi.org/10.2196/15964 %U http://www.ncbi.nlm.nih.gov/pubmed/32348268 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e16702 %T Sexual Behaviors and Violence in Pornography: Systematic Review and Narrative Synthesis of Video Content Analyses %A Carrotte,Elise R %A Davis,Angela C %A Lim,Megan SC %+ Burnet Institute, 85 Commercial Rd, Melbourne, 3004, Australia, 61 0385062403, megan.lim@burnet.edu.au %K pornography %K content analysis %K sexual media %K sexual violence %K sexual behavior %D 2020 %7 14.5.2020 %9 Review %J J Med Internet Res %G English %X Background: Owing to increasing access to Web-based pornography and concerns about its impact on viewers, many researchers have attempted to systematically analyze the content of pornography. Objective: We aimed to systematically review the results of quantitative content analyses of video-based pornography and identify the degree to which the following behaviors are depicted: (1) sexual behaviors and themes, (2) condom use during sexual behaviors, and (3) aggression and violence. Methods: Inclusion criteria for article eligibility were (1) peer-reviewed publications, (2) articles in the English language, (3) articles describing a quantitative content analysis of video pornography, and (4) articles quantitatively examining at least one variable of interest. Results: A total of 23 studies met the eligibility criteria. Studies varied in scope and definitions of behavioral variables. Condom use was rare, although more commonly depicted in gay male pornography (36%-64% videos) compared with heterosexual pornography (2%-3% videos). Normative sexual behaviors were most frequently depicted in pornography samples (eg, vaginal intercourse in 48%-90% and fellatio in 52%-90% of heterosexual videos; fellatio in 66%-100% and anal intercourse in 70%-80% of gay male videos). Extreme acts of violence (1%-3% videos) and rape (0%-6% videos) were relatively rare. However, more subtle forms of aggression, such as spanking (5%-75% videos), were more common, and unequal sexual relations (eg, domination) were also common. Although estimates varied by study, dominating and violent behaviors were nearly always directed toward women. Conclusions: Condom nonuse and gender inequalities are common in pornography, which has implications for the development of healthy sexual relationships among pornography viewers. Higher quality research, including study replication and consistent methodological choices, is needed. %M 32406863 %R 10.2196/16702 %U https://www.jmir.org/2020/5/e16702 %U https://doi.org/10.2196/16702 %U http://www.ncbi.nlm.nih.gov/pubmed/32406863 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 1 %P e16254 %T Engaging African American Youth in the Development of a Serious Mobile Game for Sexual Health Education: Mixed Methods Study %A Patchen,Loral %A Ellis,Lindsey %A Ma,Tony Xuyen %A Ott,Corilyn %A Chang,Katie H K %A Araya,Brook %A Atreyapurapu,Sravanthi %A Alyusuf,Amal %A Gaines Lanzi,Robin %+ MedStar Washington Hospital Center, 110 Irving Street NW, Washington, DC, 20010, United States, 1 2028777128, loral.patchen@medstar.net %K sexual health %K sex education %K African Americans %K youth %K adolescents %K video games %K games, experimental %K community-based participatory research %K user-centered design %D 2020 %7 31.1.2020 %9 Original Paper %J JMIR Serious Games %G English %X Background: Although teen pregnancy rates decreased dramatically in the United States over the past decade, the rates of sexually transmitted infections (STIs) among adolescents and young adults increased. STI rates disproportionately affect African American youth and young adults. Innovative, accessible, and culturally relevant sexual health interventions are urgently needed. Objective: This study aimed to identify the optimal modality for a game-based sexual health intervention; develop the educational, entertainment, and technological aspects of the serious game; and demonstrate its usability and acceptance by the target population. Methods: This project was grounded in formative data collection with community-based participatory research principles and practices combined with a user-centered design and development approach. Sexually Active Adolescent–Focused Education (SAAFE) was developed using input and feedback from African American youths aged 15 to 21 years who participated in a youth advisory board and focus group discussions to inform the co-design and cocreation of the serious game. The process was highly iterative with multiple sessions for user input following design changes. It proceeded in 3 stages. Social cognitive theory and problem-solving theory were leveraged to provide evidence-based, trauma-informed education through a serious game. Usability testing assessed the quality of user experience with the prototype. Results: Across all 3 stages, a total of 86 self-identified African American males and females aged 15 to 21 years from the District of Columbia and Birmingham, Alabama, participated. Participants requested a dating simulation game. They wanted SAAFE to be customizable, realistic, entertaining, educational, modern, and experiential, linking consequences to their gameplay decisions. Usability testing resulted in an initial System Usability Survey score of 77.7, placing the game in the 82nd percentile and above average for usability. Conclusions: Initial results suggest that the SAAFE prototype is a promising intervention to engage African American youth in sexual health education using a role-playing game. If proven efficacious, the game has the potential to meet the need for sex education, counterbalance unhealthy portrayals of sex in popular media, and respond to the disparities in the STI epidemic. %M 32012041 %R 10.2196/16254 %U http://games.jmir.org/2020/1/e16254/ %U https://doi.org/10.2196/16254 %U http://www.ncbi.nlm.nih.gov/pubmed/32012041 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 1 %P e12917 %T Development of a Mobile Phone App to Promote Safe Sex Practice Among Youth in Stockholm, Sweden: Qualitative Study %A Nielsen,Anna %A Bågenholm,Aspasia %A De Costa,Ayesha %+ Karolinska Institutet, Department of Women's and Children's Health, Karolinska University Hospital, Stockholm, 17176, Sweden, 46 704078496, anna.nielsen.1@ki.se %K mHealth %K youth %K sexual health %K condoms %K Sweden %D 2020 %7 28.1.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Mobile health (mHealth) has been shown to be effective in increasing knowledge of sexual health among youth. To date, evaluations mostly refer to interventions delivered via computer, email, and text messages. The possibility of downloading apps on mobile devices has opened up opportunities to develop engaging interventions on safe sexual health promotion. To attract young users and have them engage with a sexual health app, it is important to involve youth in intervention development. Objective: This study aimed to obtain input from youth on the content of a mobile phone app intended to promote safe sex and increase condom use among youth in Stockholm. Methods: This study was conducted at the Youth Health Clinics (YHC) in Stockholm County, Sweden. A total of 15 individual in-depth interviews and 2 focus group discussions (with youth aged 18-23 years) were conducted at the YHC in Stockholm. Areas explored were: (1) youth perceptions of condom use (advantages and obstacles), (2) perceptions of mHealth to promote safe sexual practices, and (3) content development for a mobile phone app to promote safe sex. Results: The smartphone app was developed based on the categories that emerged from the data. With regard to content, youth requested sex education, including information on sexually transmitted infections. In addition, condom-specific information, including practical usage technique, advice on how to have the condom talk, and how to decrease shame related to condom use, was requested. Youth suggested different modes to deliver the content, including text messages, movie clips, and push notifications. It was suggested that the tone of the messages delivered should be fun, entertaining, and supportive. The inputs from youth influenced the development of the following sections of the app: Condom Obstacles and Solutions; Quiz; Games; Self-Refection; Challenges; Stories by Peers (stories from peers and information from a doctor); Condom Tips, Pep Talk, and Boosting; and Random Facts. Conclusions: It is important to use input from youth when developing a smartphone intervention since the success of the intervention largely depends on the level of engagement and usage by youth. Furthermore, if proven efficient in increasing condom use, it is important that the development, including content and mode, is thoroughly described so that the intervention can be replicated. Likewise, if proven inefficient, it is important to learn from mistakes to improve and adjust the intervention. The effect of this smartphone app on safe sexual practices among youth is being evaluated in a pragmatic randomized controlled trial in Stockholm (ISRCTN13212899) and will be reported separately. %M 32012038 %R 10.2196/12917 %U https://formative.jmir.org/2020/1/e12917 %U https://doi.org/10.2196/12917 %U http://www.ncbi.nlm.nih.gov/pubmed/32012038 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 8 %P e13005 %T Research and Implementation Lessons Learned From a Youth-Targeted Digital Health Randomized Controlled Trial (the ARMADILLO Study) %A Gonsalves,Lianne %A Njeri,Winnie Wangari %A Schroeder,Megan %A Mwaisaka,Jefferson %A Gichangi,Peter %+ Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, Geneva, , Switzerland, 41 795006554, gonsalvesl@who.int %K adolescent health %K sexual and reproductive health %K health communication %K mHealth %K Kenya %K intervention research %D 2019 %7 27.9.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Evidence is lacking on the efficacy of sexual and reproductive health (SRH) communication interventions for youth (aged 15-24 years), especially from low- and middle-income countries. Therefore, the World Health Organization initiated the Adolescent/Youth Reproductive Mobile Access and Delivery Initiative for Love and Life Outcomes (ARMADILLO) program, a free, menu-based, on-demand text message (SMS, short message service) platform providing validated SRH content developed in collaboration with young people. A randomized controlled trial (RCT) assessing the effect of the ARMADILLO intervention on SRH-related outcomes was implemented in Kwale County, Kenya. Objective: This paper describes the implementation challenges related to the RCT, observed during enrollment and the intervention period, and their implications for digital health researchers and program implementers. Methods: This was an open, three-armed RCT. Following completion of a baseline survey, participants were randomized into the ARMADILLO intervention (arm 1), a once-a-week contact SMS text message (arm 2), or usual care (arm 3, no intervention). The intervention period lasted seven weeks, after which participants completed an endline survey. Results: Two study team decisions had significant implications for the success of the trial’s enrollment and intervention implementation: a hands-off participant recruitment process and a design flaw in an initial language selection menu. As a result, three weeks after recruitment began, 660 participants had been randomized; however, 107 (53%) participants in arm 1 and 136 (62%) in arm 2 were “stuck” at the language menu. The research team called 231 of these nonengaging participants and successfully reached 136 to learn reasons for nonengagement. Thirty-two phone numbers were found to be either not linked to our participants (a wrong number) or not in their primary possession (a shared phone). Among eligible participants, 30 participants indicated that they had assumed the introductory message was a scam or spam. Twenty-seven participants were confused by some aspect of the system. Eleven were apathetic about engaging. Twenty-four nonengagers experienced some sort of technical issue. All participants eventually started their seven-week study period. Conclusions: The ARMADILLO study’s implementation challenges provide several lessons related to both researching and implementing client-side digital health interventions, including (1) have meticulous phone data collection protocols to reduce wrong numbers, (2) train participants on the digital intervention in efficacy assessments, and (3) recognize that client-side digital health interventions have analog discontinuation challenges. Implementation lessons were (1) determine whether an intervention requires phone ownership or phone access, (2) digital health campaigns need to establish a credible presence in a busy digital space, and (3) interest in a service can be sporadic or fleeting. Clinical Trial: International Standard Randomized Controlled Trial Number (ISRCTN): 85156148; http://www.isrctn. com/ISRCTN85156148 %M 31573939 %R 10.2196/13005 %U http://mhealth.jmir.org/2019/8/e13005/ %U https://doi.org/10.2196/13005 %U http://www.ncbi.nlm.nih.gov/pubmed/31573939 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 2 %N 2 %P e13936 %T Gender Perspectives on Social Norms Surrounding Teen Pregnancy: A Thematic Analysis of Social Media Data %A Barker,Kathryn M %A Subramanian,S V %A Selman,Robert %A Austin,S Bryn %+ Center on Gender Equity and Health, University of California San Diego, 9500 Gilman Drive #0507, La Jolla, CA, 92093-0507, United States, 1 8582460066, katebarker@ucsd.edu %K teenage childbearing %K teen pregnancy %K adolescent sexual behavior %K social media %K social norms %K gender %D 2019 %7 17.09.2019 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Social concern with teen pregnancy emerged in the 1970s, and today’s popular and professional health literature continues to draw on social norms that view teen pregnancy as a problem—for the teen mother, her baby, and society. It is unclear, however, how adolescents directly affected by teen pregnancy draw upon social norms against teen pregnancy in their own lives, whether the norms operate differently for girls and boys, and how these social norms affect pregnant or parenting adolescents. Objective: This research aims to examine whether and how US adolescents use, interpret, and experience social norms against teen pregnancy. Methods: Online ethnographic methods were used for the analysis of peer-to-peer exchanges from an online social network site designed for adolescents. Data were collected between March 2010 and February 2015 (n=1662). Thematic analysis was conducted using NVivo software. Results: American adolescents in this online platform draw on dominant social norms against teen pregnancy to provide rationales for why pregnancy in adolescence is wrong or should be avoided. Rationales range from potential socioeconomic harms to life-course rationales that view adolescence as a special, carefree period in life. Despite joint contributions from males and females to a pregnancy, it is primarily females who report pregnancy-related concerns, including experiences of bullying, social isolation, and fear. Conclusions: Peer exchange in this online forum indicates that American adolescents reproduce prevailing US social norms of viewing teen pregnancy as a social problem. These norms intersect with the norms of age, gender, and female sexuality. Female adolescents who transgress these norms experience bullying, shame, and stigma. Health professionals must ensure that strategies designed to prevent unintended adolescent pregnancy do not simultaneously create hardship and stigma in the lives of young women who are pregnant and parent their children. %M 31536963 %R 10.2196/13936 %U http://pediatrics.jmir.org/2019/2/e13936/ %U https://doi.org/10.2196/13936 %U http://www.ncbi.nlm.nih.gov/pubmed/31536963 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 9 %P e13837 %T The #MeToo Movement in the United States: Text Analysis of Early Twitter Conversations %A Modrek,Sepideh %A Chakalov,Bozhidar %+ Health Equity Institute, San Francisco State University, 1600 Hollaway Avenue HSS 386, San Francisco, CA, 94132, United States, 1 415 405 7556, smodrek@sfsu.edu %K social media %K sexual abuse %K sexual assault %K machine learning %K infodemiology %K infoveillance %D 2019 %7 03.09.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: The #MeToo movement sparked an international debate on the sexual harassment, abuse, and assault and has taken many directions since its inception in October of 2017. Much of the early conversation took place on public social media sites such as Twitter, where the hashtag movement began. Objective: The aim of this study is to document, characterize, and quantify early public discourse and conversation of the #MeToo movement from Twitter data in the United States. We focus on posts with public first-person revelations of sexual assault/abuse and early life experiences of such events. Methods: We purchased full tweets and associated metadata from the Twitter Premium application programming interface between October 14 and 21, 2017 (ie, the first week of the movement). We examined the content of novel English language tweets with the phrase “MeToo” from within the United States (N=11,935). We used machine learning methods, least absolute shrinkage and selection operator regression, and support vector machine models to summarize and classify the content of individual tweets with revelations of sexual assault and abuse and early life experiences of sexual assault and abuse. Results: We found that the most predictive words created a vivid archetype of the revelations of sexual assault and abuse. We then estimated that in the first week of the movement, 11% of novel English language tweets with the words “MeToo” revealed details about the poster’s experience of sexual assault or abuse and 5.8% revealed early life experiences of such events. We examined the demographic composition of posters of sexual assault and abuse and found that white women aged 25-50 years were overrepresented in terms of their representation on Twitter. Furthermore, we found that the mass sharing of personal experiences of sexual assault and abuse had a large reach, where 6 to 34 million Twitter users may have seen such first-person revelations from someone they followed in the first week of the movement. Conclusions: These data illustrate that revelations shared went beyond acknowledgement of having experienced sexual harassment and often included vivid and traumatic descriptions of early life experiences of assault and abuse. These findings and methods underscore the value of content analysis, supported by novel machine learning methods, to improve our understanding of how widespread the revelations were, which likely amplified the spread and saliency of the #MeToo movement. %M 31482849 %R 10.2196/13837 %U https://www.jmir.org/2019/9/e13837/ %U https://doi.org/10.2196/13837 %U http://www.ncbi.nlm.nih.gov/pubmed/31482849 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e12824 %T A Health Education Website Developed to Meet Young People’s Information Needs About Web-Based Pornography and Sharing of Sexually Explicit Imagery (SCOPE): Usability Study %A Davis,Angela C %A Wright,Cassandra J C %A Temple-Smith,Meredith J %A Hellard,Margaret E %A Lim,Megan S C %+ Burnet Institute, 85 Commercial Rd, Melbourne, 3004, Australia, 61 385062403, megan.lim@burnet.edu.au %K adolescent %K pornography %K health promotion %K internet %K sex education %D 2019 %7 13.08.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Although we know that many young people watch online pornography and engage in sexting, there is limited literature examining their needs in relation to information on these highly sensitive and complex issues. Online resources exist; however, we can find no evidence of any of them having been formally tested for usability within the target population. Objective: This study aimed to test the usability of a resource about online pornography and sexting among young people. Methods: Semistructured interviews were conducted with 17 participants aged 15 to 29 years. Results: We found that the SCOPE resource was perceived as trustworthy and credible because of its evidence-based content, nonjudgmental tone, and balanced perspectives. Multimedia and video content enhanced the layout and usability of the resource; however, content relevance could be improved by targeting age and developmental stages. Participants identified resource sections such as Real Stories from young people as relevant and engaging. However, they raised issues with the translation of formative research findings relating to these stories into their final presentation. Conclusions: Our findings suggest that young people prefer online resources about complex issues, such as online pornography and sexting, if they are balanced in content and tone. Most importantly, in the context of responding to complex and sensitive issues such as these, co-design methods can ensure that young people are central to the development of resources and avoid gaps in translating research into practice. In the context of limited literature focusing on the usability of online resources about these topics, this paper provides important insights for public health practitioners working in this emerging space. %M 31411140 %R 10.2196/12824 %U http://formative.jmir.org/2019/3/e12824/ %U https://doi.org/10.2196/12824 %U http://www.ncbi.nlm.nih.gov/pubmed/31411140 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 8 %P e11165 %T Text-Messaging, Online Peer Support Group, and Coaching Strategies to Optimize the HIV Prevention Continuum for Youth: Protocol for a Randomized Controlled Trial %A Swendeman,Dallas %A Arnold,Elizabeth Mayfield %A Harris,Danielle %A Fournier,Jasmine %A Comulada,W Scott %A Reback,Cathy %A Koussa,Maryann %A Ocasio,Manuel %A Lee,Sung-Jae %A Kozina,Leslie %A Fernández,Maria Isabel %A Rotheram,Mary Jane %A , %+ University of California, Los Angeles, Department of Psychiatry & Biobehavioral Sciences, 10920 Wilshire Blvd, Suite 350, Los Angeles, CA, 90024, United States, 1 3107948128, dswendeman@mednet.ucla.edu %K adolescents %K HIV/AIDS %K mHealth %K homelessness %K MSM %K transgender %K prevention %D 2019 %7 09.08.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: America’s increasing HIV epidemic among youth suggests the need to identify novel strategies to leverage services and settings where youth at high risk (YAHR) for HIV can be engaged in prevention. Scalable, efficacious, and cost-effective strategies are needed, which support youth during developmental transitions when risks arise. Evidence-based behavioral interventions (EBIs) have typically relied on time-limited, scripted, and manualized protocols that were often delivered with low fidelity and lacked evidence for effectiveness. Objective: This study aims to examine efficacy, implementation, and cost-effectiveness of easily mountable and adaptable, technology-based behavioral interventions in the context of an enhanced standard of care and study assessments that implement the guidelines of Centers for Disease Control and Prevention (CDC) for routine, repeat HIV, and sexually transmitted infection (STI) testing for high-risk youth. Methods: Youth aged between 12 and 24 years (n=1500) are being recruited from community-based organizations and clinics serving gay, bisexual, and transgender youth, homeless youth, and postincarcerated youth, with eligibility algorithms weighting African American and Latino youth to reflect disparities in HIV incidence. At baseline and 4-month intervals over 24 months (12 months for lower-risk youth), interviewers monitor uptake of HIV prevention continuum steps (linkage to health care, use of pre- or postexposure prophylaxis, condoms, and prevention services) and secondary outcomes of substance use, mental health, and housing security. Assessments include rapid diagnostic tests for HIV, STIs, drugs, and alcohol. The study is powered to detect modest intervention effects among gay or bisexual male and transgender youth with 70% retention. Youth are randomized to 4 conditions: (1) enhanced standard of care of automated text-messaging and monitoring (AMM) and repeat HIV/STI testing assessment procedures (n=690); (2) online group peer support via private social media plus AMM (n=270); (3) coaching that is strengths-based, youth-centered, unscripted, based on common practice elements of EBI, available over 24 months, and delivered by near-peer paraprofessionals via text, phone, and in-person, plus AMM (n=270); and (4) online group peer support plus coaching and AMM (n=270). Results: The project was funded in September 2016 and enrollment began in May 2017. Enrollment will be completed between June and August 2019. Data analysis is currently underway, and the first results are expected to be submitted for publication in 2019. Conclusions: This hybrid implementation-effectiveness study examines alternative models for implementing the CDC guidelines for routine HIV/STI testing for YAHR of acquiring HIV and for delivering evidence-based behavioral intervention content in modular elements instead of scripted manuals and available over 24 months of follow-up, while also monitoring implementation, costs, and effectiveness. The greatest impacts are expected for coaching, whereas online group peer support is expected to have lower impact but may be more cost-effective. Trial Registration: ClinicalTrials.gov NCT03134833; https://clinicaltrials.gov/ct2/show/NCT03134833 (Archived by WebCite at http://www.webcitation.org/76el0Viw9) International Registered Report Identifier (IRRID): DERR1-10.2196/11165 %M 31400109 %R 10.2196/11165 %U https://www.researchprotocols.org/2019/8/e11165/ %U https://doi.org/10.2196/11165 %U http://www.ncbi.nlm.nih.gov/pubmed/31400109 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 7 %P e13220 %T Brief Motivational Interviewing Delivered by Clinician or Computer to Reduce Sexual Risk Behaviors in Adolescents: Acceptability Study %A Shafii,Taraneh %A Benson,Samantha K %A Morrison,Diane M %+ Division of Adolescent Medicine, Department of Pediatrics, University of Washington School of Medicine, CSB-200 PO Box 5371, Seattle, WA, 98145, United States, 1 206 987 2028, taraneh.shafii@seattlechildrens.org %K sexual health %K risk behaviors %K adolescent %K healthcare providers %K computer-assisted diagnosis %K teen health %K preventive care %D 2019 %7 10.7.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Clinicians are expected to screen their adolescent patients for an increasing number of health behaviors and intervene when they uncover risky behaviors, yet, the clinic time allotted to screen, intervene, and provide resources is insufficient. Brief motivational interviewing (MI) offers succinct behavior change counseling; however, for implementation, clinicians need training, skill, and time. Computerized screening and counseling adjuvants may help clinicians increase their scope of behavioral screening, especially with sensitive topics such as sexual health, and provide risk-reduction interventions without consuming provider time during visits. Objective: The objectives of this study were to (1) understand the extent to which health care providers use brief MI for sexual health discussions with adolescent patients and (2) assess the acceptability of incorporating a brief MI-based intervention to reduce sexual risk behaviors into their clinical practice delivered by either themselves or a computer. Methods: At a national medical conference, surveys were administered to clinicians who provide sexual health care to adolescents. They were asked about their current use of MI for sexual risk behavior discussions and their willingness to implement computerized sexual health screening and computerized sexual risk behavior interventions into their clinical practice. Results: The large majority (87.6%, 170/194) of clinicians already used MI with their patients with less than half (72/148, 48.6%) reporting they had been formally trained in MI. Despite all (195/195, 100.0%) clinicians feeling very or completely comfortable discussing sexual risk behaviors with their patients, the large majority (160/195, 82.1%) reported it would be useful, very useful, or extremely useful for a computerized program to do it all: screen their patients, generate risk profiles, and provide the risk-reduction counseling rather than doing it themselves. Conclusions: In this study, most clinicians used some form of brief MI or client-centered counseling when discussing sexual risk behaviors with adolescents and are very comfortable doing so. However, the large majority would prefer to implement computerized sexual health screening, risk assessment, and sexual risk behavior interventions into their clinical care of adolescents. %R 10.2196/13220 %U http://www.jmir.org/2019/7/e13220/ %U https://doi.org/10.2196/13220 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e12657 %T Feasibility of Using Short Message Service and In-Depth Interviews to Collect Data on Contraceptive Use Among Young, Unmarried, Sexually Active Men in Moshi, Tanzania, and Addis Ababa, Ethiopia: Mixed Methods Study With a Longitudinal Follow-Up %A Pima,Francis Maganga %A Oshosen,Martha %A Ngowi,Kennedy Michael %A Habte,Bruck Messele %A Maro,Eusebious %A Teffera,Belete Eshete %A Kisigo,Godfrey %A Swai,Iraseni Ufoo %A Msangi,Salim Semvua %A Ermias,Amha %A Mmbaga,Blandina T %A Both,Rosalijn %A Sumari-de Boer,Marion %+ Department of Clinical Trials, Kilimanjaro Clinical Research Institute, PO Box 2236, Moshi,, United Republic of Tanzania, 255 754331948, m.sumari@kcri.ac.tz %K SMS %K contraceptives %K sexual behavior %K feasibility %K young unmarried men %D 2019 %7 26.06.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Data on contraceptive needs and use among young unmarried men are limited. Conventional ways of data collection may lead to limited and unreliable information on contraceptive use due to sensitivity of the topic, as many young men feel ashamed to discuss their behavior of using contraceptives. As short message service (SMS) is anonymous and a commonly used means of communication, we believe that if deployed, it will create a promising user-friendly method of data collection. Objective: The objective was to investigate the feasibility of using SMS to collect data on sexually active, young, unmarried men’s sexual behavior and contraceptive preferences, practices, and needs in Addis Ababa, Ethiopia, and Moshi, Tanzania. Methods: We enrolled men aged 18-30 years who were students (in Ethiopia and Tanzania), taxi or local bus drivers/assistants (Ethiopia and Tanzania), Kilimanjaro porters (Tanzania), or construction workers (Ethiopia). Young men were interviewed using a topic list on contraceptive use. They were followed up for 6 months by sending fortnightly SMS texts with questions about contraceptive use. If the young men indicated that they needed contraceptives during the reporting period or were not satisfied with the method they used, they were invited for a follow-up interview. At the end of the study, we conducted exit interviews telephonically using a semistructured questionnaire to explore the feasibility, acceptability, and accuracy of using SMS to validate the study findings in both countries. Results: We enrolled 71 young unmarried men—35 in Tanzania and 36 in Ethiopia. In Moshi, 1908 messages were delivered to participants and 1119 SMS responses were obtained. In Ethiopia, however, only 525 messages were sent to participants and 248 replies were received. The question on dating a girl in the past weeks was asked 438 times in Tanzania and received 252 (58%) replies, of which 148 (59%) were “YES.” In Ethiopia, this question was asked 314 times and received 64 (20%) replies, of which 52 (81%) were “YES” (P=.02 for difference in replies between Tanzania and Ethiopia). In Tanzania, the question on contraceptive use was sent successfully 112 times and received 108 (96%) replies, of which 105 (94%) were “YES.” In Ethiopia, the question on contraceptive use was asked 17 times and received only 2 (11%) replies. Exit interviews in Tanzania showed that SMS was accepted as a means of data collection by 22 (88%) of the 25 interviewed participants. Conclusions: Despite network and individual challenges, the SMS system was found to be feasible in Moshi, but not in Addis Ababa. We recommend more research to scale up the method in different groups and regions. %M 31244476 %R 10.2196/12657 %U http://formative.jmir.org/2019/2/e12657/ %U https://doi.org/10.2196/12657 %U http://www.ncbi.nlm.nih.gov/pubmed/31244476 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 6 %N 6 %P e13338 %T Sexting, Web-Based Risks, and Safety in Two Representative National Samples of Young Australians: Prevalence, Perspectives, and Predictors %A Milton,Alyssa C %A Gill,Benjamin A %A Davenport,Tracey A %A Dowling,Mitchell %A Burns,Jane M %A Hickie,Ian B %+ Brain and Mind Centre, University of Sydney, 88 Mallet Street, Camperdown, 2050, Australia, 61 2 86276947, alyssa.milton@sydney.edu.au %K youth %K sexual behavior %K cyberbullying %K mental health %K internet %K safety %K risk %D 2019 %7 17.06.2019 %9 Original Paper %J JMIR Ment Health %G English %X Background: The rapid uptake of information and communication technology (ICT) over the past decade—particularly the smartphone—has coincided with large increases in sexting. All previous Australian studies examining the prevalence of sexting activities in young people have relied on convenience or self-selected samples. Concurrently, there have been recent calls to undertake more in-depth research on the relationship between mental health problems, suicidal thoughts and behaviors, and sexting. How sexters (including those who receive, send, and two-way sext) and nonsexters apply ICT safety skills warrants further research. Objective: This study aimed to extend the Australian sexting literature by measuring (1) changes in the frequency of young people’s sexting activities from 2012 to 2014; (2) young people’s beliefs about sexting; (3) association of demographics, mental health and well-being items, and internet use with sexting; and (4) the relationship between sexting and ICT safety skills. Methods: Computer-assisted telephone interviewing using random digit dialing was used in two Young and Well National Surveys conducted in 2012 and 2014. The participants included representative and random samples of 1400 young people aged 16 to 25 years. Results: From 2012 to 2014, two-way sexting (2012: 521/1369, 38.06%; 2014: 591/1400, 42.21%; P=.03) and receiving sexts (2012: 375/1369, 27.39%; 2014: 433/1400, 30.93%; P<.001) increased significantly, not sexting (2012: 438/1369, 31.99%; 2014: 356/1400, 25.43%; P<.001) reduced significantly, whereas sending sexts (2012: n=35/1369, 2.56%; 2014: n=20/1400, 1.43%; P>.05) did not significantly change. In addition, two-way sexting and sending sexts were found to be associated with demographics (male, second language, and being in a relationship), mental health and well-being items (suicidal thoughts and behaviors and body image concerns), and ICT risks (cyberbullying others and late-night internet use). Receiving sexts was significantly associated with demographics (being male and not living with parents or guardians) and ICT risks (being cyberbullied and late-night internet use). Contrary to nonsexters, Pearson correlations demonstrated that all sexting groups (two-way, sending, and receiving) had a negative relationship with endorsing the ICT safety items relating to being careful when using the Web and not giving out personal details. Conclusions: Our research demonstrates that most young Australians are sexting or exposed to sexting in some capacity. Sexting is associated with some negative health and well-being outcomes—specifically, sending sexts is linked to suicidal thoughts and behaviors, body image issues, and ICT safety risks, including cyberbullying and late-night internet use. Those who do sext are less likely to engage in many preventative ICT safety behaviors. How the community works in partnership with young people to address this needs to be a multifaceted approach, where sexting is positioned within a wider proactive conversation about gender, culture, psychosocial health, and respecting and caring for each other when on the Web. %M 31210139 %R 10.2196/13338 %U https://mental.jmir.org/2019/6/e13338/ %U https://doi.org/10.2196/13338 %U http://www.ncbi.nlm.nih.gov/pubmed/31210139 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 6 %P e12896 %T The Notijoves Project: Protocol for a Randomized Controlled Trial About New Communication Technologies and Gamification to Promote Partner Notification of Sexually Transmitted Infections Among Young People %A Carnicer-Pont,Dolors %A Loureiro-Varela,Eva %A Manresa,Josep Mª %A Martinez,Montse %A Avecilla,Àngels %A Montero-Pons,Laura %A Falguera-Puig,Gemma %+ Cancer Prevention and Control Programme, Catalan Institute of Oncology, Hospital Duran i Reynals, 199-203, Gran Via de L'Hospitalet, Avenue, L'Hospitalet de Llobregat, 08908, Spain, 34 93 260 73 57 ext 7339, dcarnicer@iconcologia.net %K mobile apps %K sexually transmitted infections %K partner notification %K youth %K games, experimental %K game theory %K randomized controlled trial %D 2019 %7 26.5.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: An increase in sexually transmitted infections (STIs) as well as an increase in the use of new information and communication technologies among young people in Catalonia is the inspiration behind the idea of designing a smartphone app to promote partner notification of STIs. Objective: The main objective of this study is to design a Web-based tool adapted to smartphones for partner notification of STIs among youth who are 16 to 24 years old. Additionally, the objective is to evaluate the Web-based tool’s role in increasing the patient referral partner notification. Methods: This is a multicenter randomized controlled trial with a proportional stratification of the sample by center and random allocation of participants to the 3 arms of the study (simple Web-based intervention, game Web-based intervention, and control). This study is being conducted by midwives, gynecologists, and physicians in the sexual and reproductive areas of the primary health care centers. Results: The primary outcome measure is the number and proportion of partner notifications. Additional outcome measures are the yield of early diagnosis and treatment of those exposed and infected, acceptability, barriers, and preferences for partner notification. Expected results include an increase in the yield of partner notification, early diagnosis and treatment among youth using Web-based interventions compared with those receiving the traditional advice to notify, and a description of sexual networks among those participating in the study. Conclusions: The Notijoves is expected to have a sustainable positive impact in the partner notification practice among youth and contribute to increasing the awareness of STI prevention. International Registered Report Identifier (IRRID): DERR1-10.2196/12896 %M 31199306 %R 10.2196/12896 %U https://www.researchprotocols.org/2019/6/e12896/ %U https://doi.org/10.2196/12896 %U http://www.ncbi.nlm.nih.gov/pubmed/31199306 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 6 %P e13462 %T An Affirmative Coping Skills Intervention to Improve the Mental and Sexual Health of Sexual and Gender Minority Youth (Project Youth AFFIRM): Protocol for an Implementation Study %A Craig,Shelley L %A McInroy,Lauren B %A Eaton,Andrew David %A Iacono,Gio %A Leung,Vivian WY %A Austin,Ashley %A Dobinson,Cheryl %+ Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor St W, Toronto, ON, M5S 1V4, Canada, 1 4169788847, shelley.craig@utoronto.ca %K sexual and gender minorities %K youth %K coping behavior %K pragmatic clinical trial %K cognitive behavioral therapy %K implementation science %D 2019 %7 06.06.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Sexual and gender minority youth (SGMY, aged 14-29 years) face increased risks to their well-being, including rejection by family, exclusion from society, depression, substance use, elevated suicidality, and harassment, when compared with their cisgender, heterosexual peers. These perils and a lack of targeted programs for SGMY exacerbate their risk for HIV and other sexually transmitted infections. Cognitive behavioral therapy (CBT) interventions support clients by generating alternative ways of interpreting their problems and beliefs about themselves. CBT, tailored to the experiences of SGMY, may help SGMY improve their mood and coping skills by teaching them how to identify, challenge, and change maladaptive thoughts, beliefs, and behaviors. Based on the promising results of a pilot study, a CBT-informed group intervention, AFFIRM, is being tested in a pragmatic trial to assess its implementation potential. Objective: The aim of this study is to scale-up implementation and delivery of AFFIRM, an 8-session manualized group coping skills intervention focused on reducing sexual risk behaviors and psychosocial distress among SGMY. Our secondary aim is to decrease sexual risk taking, poor mental health, and internalized homophobia and to increase levels of sexual self-efficacy and proactive coping among SGMY. Methods: SGMY are recruited via flyers at community agencies and organizations, as well as through Web-based advertising. Potential participants are assessed for suitability for the group intervention via Web-based screening and are allocated in a 2:1 fashion to the AFFIRM intervention or a wait-listed control in a stepped wedge wait-list crossover design. The intervention groups are hosted by collaborating community agency sites (CCASs; eg, community health centers and family health teams) across Ontario, Canada. Participants are assessed at prewait (if applicable), preintervention, postintervention, 6-month follow-up, and 12-month follow-up for sexual health self-efficacy and capacity, mental health indicators, internalized homophobia, stress appraisal, proactive and active coping, and hope. Web-based data collection occurs either independently or at CCASs using tablets. Participants in crisis are assessed using an established distress protocol. Results: Data collection is ongoing; the target sample is 300 participants. It is anticipated that data analyses will use effect size estimates, paired sample t tests, and repeated measures linear mixed modeling in SPSS to test for differences pre- and postintervention. Descriptive analyses will summarize data and profile all variables, including internal consistency estimates. Distributional assumptions and univariate and multivariate normality of variables will be assessed. Conclusions: AFFIRM is a potentially scalable intervention. Many existing community programs provide safe spaces for SGMY but do not provide skills-based training to deal with the increasingly complex lives of youth. This pragmatic trial could make a significant contribution to the field of intervention research by simultaneously moving AFFIRM into practice and evaluating its impact. International Registered Report Identifier (IRRID): DERR1-10.2196/13462 %M 31172957 %R 10.2196/13462 %U https://www.researchprotocols.org/2019/6/e13462/ %U https://doi.org/10.2196/13462 %U http://www.ncbi.nlm.nih.gov/pubmed/31172957 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 2 %N 1 %P e13158 %T Concerns of Female Adolescents About Menarche and First Sexual Intercourse: Mixed Methods Analysis of Social Media Questions %A Hodgson,Nikkie Saldivar %A Yom-Tov,Elad %A Strong,William F %A Flores,Priscilla L %A Ricoy,Giselle N %+ Microsoft Research, 13 Shenkar St, Herzeliya,, Israel, 972 747111359, eladyt@yahoo.com %K menarche %K sexual intercourse %K social media %K infodemiology %K infoveillance %D 2019 %7 04.06.2019 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Adolescents use social media for information on medical and social aspects of maturation. Objective: The aim of this study was to investigate the concerns and information needs of adolescents regarding menarche and first sexual intercourse. Methods: Questions about menarche or first sexual intercourse were obtained from Yahoo Answers, a community-based social media question-and-answer website. A total of 1226 questions were analyzed. We focused on 123 question pairs made by users who asked questions on both topics and reported their ages at each. Quantitative and qualitative analyses were performed on these question pairs. Results: Qualitative analysis identified uncertainty as a significant theme for both menarche and first intercourse. Quantitative analysis showed that uncertainty was expressed in 26% (13/50) of menarche questions and 14% (7/50) of intercourse questions. Lack of communication was expressed in 4% (2/50) of menarche questions, compared with 8% (4/50) of intercourse questions. Ages at menarche and at first sexual intercourse were correlated, with women reporting menarche at the age of 13 years or younger being 2.6 times more likely to experience first sexual intercourse before the age of 16 years (P<.001, chi-square test). Older age at menarche was associated with greater lack of communication with parents (analysis of variance, P=.002). Conclusions: The questions of adolescents on the topics of menarche and first sexual intercourse express anxiety and uncertainty and are associated with a lack of information and deficient communication with parents. The more normative and expected a behavior, the less these factors appear. Therefore, parents and educators should, to the extent possible, improve communication around these topics, especially when they occur at less typical ages. %M 31518326 %R 10.2196/13158 %U http://pediatrics.jmir.org/2019/1/e13158/ %U https://doi.org/10.2196/13158 %U http://www.ncbi.nlm.nih.gov/pubmed/31518326 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 5 %P e13049 %T A Smartphone Game to Prevent HIV Among Young Africans (Tumaini): Assessing Intervention and Study Acceptability Among Adolescents and Their Parents in a Randomized Controlled Trial %A Sabben,Gaëlle %A Mudhune,Victor %A Ondeng'e,Ken %A Odero,Isdorah %A Ndivo,Richard %A Akelo,Victor %A Winskell,Kate %+ Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, United States, 1 4046833103, gaelle.sabben@emory.edu %K HIV %K youth %K sub-Saharan Africa %K Kenya %K serious game %K narrative %K smartphone %K pilot study %K randomized controlled trial %K acceptability %D 2019 %7 21.05.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Young people aged 15 to 24 years account for one-third of new adult HIV infections. Controlling the HIV epidemic requires effective interventions targeted toward young people and their needs. Smartphone games offer a promising avenue for reaching this population with evidence-based HIV prevention interventions. It is crucial to the effectiveness of these interventions that they be acceptable and intrinsically motivating to adolescents as well as acceptable to their parents. Objective: Tumaini is a narrative-based smartphone game designed to help prevent HIV among young Africans aged 11 to 14 years by delaying first sex and increasing condom use at first sex. Following a 16-day feasibility study of Tumaini, we assessed the acceptability (1) of the intervention, where acceptability was operationalized as appeal, relevance, value, usability, and understandability, and (2) of this study and a planned future randomized controlled efficacy trial. Methods: During the randomized feasibility study (n=60) of Tumaini in western Kenya in spring 2017, 30 participants used the intervention on a study-provided smartphone. The app automatically logged participant interaction with the game in time-stamped log files. All 30 participants completed an Audio Computer-Assisted Self-Interview–based game experience survey, and 27 took part in 4 focus group discussions (FGDs) about the game’s appeal, relevance, value, usability, and understandability. Their parents (n=22) also participated in 4 FGDs about the acceptability of the intervention, of this study, and of a planned efficacy trial. Survey data were analyzed using SAS software (SAS Institute Inc); FGD transcripts were coded and analyzed in MAXQDA 12 (Verbi GmbH); and gameplay log files were analyzed using Microsoft Excel. Results: Adolescent participants’ survey responses indicated that Tumaini scored well with players on all indicators of acceptability (appeal, relevance, value, usability, and understandability). Focus group analyses aligned with these findings and emphasized a high degree of player engagement with the game, which was supported by log file analysis. Adolescent participants were eager for additional content, and parents were receptive to a longer study involving biomarkers, based on their positive experiences with this study. There is scope to improve communication with parents about their role in the intervention. As the game was tested in beta version, there is also scope to fine-tune some of the game mechanics to increase usability. Conclusions: This study shows the strong acceptability of an interactive smartphone-based game both to adolescents and their parents in western Kenya and that of the study methods used to pilot-test the intervention. It also suggests that longitudinal efficacy studies of this type of intervention, including those using biomarkers, have the potential to be acceptable among parents. Trial Registration: ClinicalTrials.gov NCT03054051; https://clinicaltrials.gov/ct2/show/NCT03054051 (Archived by WebCite at http://www.webcitation.org/70U2gCNtW) %M 31115348 %R 10.2196/13049 %U http://mhealth.jmir.org/2019/5/e13049/ %U https://doi.org/10.2196/13049 %U http://www.ncbi.nlm.nih.gov/pubmed/31115348 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 2 %P e10695 %T Google for Sexual Relationships: Mixed-Methods Study on Digital Flirting and Online Dating Among Adolescent Youth and Young Adults %A Lykens,James %A Pilloton,Molly %A Silva,Cara %A Schlamm,Emma %A Wilburn,Kate %A Pence,Emma %+ Center for Research and Education on Gender and Sexuality, San Francisco State University, 835 Market Street, 5th Floor, Suite 525, San Francisco, CA,, United States, 1 415 817 4520, james.lykens@etr.org %K youth %K sexual health %K online dating %K adolescent health %D 2019 %7 16.05.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: According to a 2015 report from the Pew Research Center, nearly 24% of teens go online almost constantly and 92% of teens are accessing the internet daily; consequently, a large part of adolescent romantic exploration has moved online, where young people are turning to the Web for romantic relationship-building and sexual experience. This digital change in romantic behaviors among youth has implications for public health and sexual health programs, but little is known about the ways in which young people use online spaces for sexual exploration. An examination of youth sexual health and relationships online and the implications for adolescent health programs has yet to be fully explored. Objective: Although studies have documented increasing rates of sexually transmitted infections and HIV among young people, many programs continue to neglect online spaces as avenues for understanding sexual exploration. Little is known about the online sexual health practices of young people, including digital flirting and online dating. This study explores the current behaviors and opinions of youth throughout online sexual exploration, relationship-building, and online dating, further providing insights into youth behavior for intervention opportunities. Methods: From January through December 2016, an exploratory study titled TECHsex used a mixed-methods approach to document information-seeking behaviors and sexual health building behaviors of youth online in the United States. Data from a national quantitative survey of 1500 youth and 12 qualitative focus groups (66 youth) were triangulated to understand the experiences and desires of young people as they navigate their sexual relationships through social media, online chatting, and online dating. Results: Young people are using the internet to begin sexual relationships with others, including dating, online flirting, and hooking up. Despite the fact that dating sites have explicit rules against minor use, under 18 youth are using these products regardless in order to make friends and begin romantic relationships, albeit at a lower rate than their older peers (19.0% [64/336] vs 37.8% [440/1163], respectively). Nearly 70% of youth who have used online dating sites met up with someone in person (44.78% [30/67] under 18 vs 74.0% [324/438] over 18). Focus group respondents provided further context into online sexual exploration; many learned of sex through pornography, online dating profiles, or through flirting on social media. Social media played an important role in vetting potential partners and beginning romantic relationships. Youth also reported using online dating and flirting despite fears of violence or catfishing, in which online profiles are used to deceive others. Conclusions: Youth are turning to online spaces to build sexual relationships, particularly in areas where access to peers is limited. Although online dating site use is somewhat high, more youth turn to social media for online dating. Sexual relationship-building included online flirting and online dating websites and/or apps. These findings have implications for future sexual health programs interested in improving the sexual health outcomes of young people. Researchers may be neglecting to include social media as potential sources of youth hookup culture and dating. We implore researchers and organizations to consider the relationships young people have with technology in order to more strategically use these platforms to create successful and youth-centered programs to improve sexual health outcomes. %M 31099335 %R 10.2196/10695 %U http://publichealth.jmir.org/2019/2/e10695/ %U https://doi.org/10.2196/10695 %U http://www.ncbi.nlm.nih.gov/pubmed/31099335 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 2 %P e11242 %T An Intervention to Increase Condom Use Among Users of Chlamydia Self-Sampling Websites (Wrapped): Intervention Mapping and Think-Aloud Study %A Newby,Katie %A Crutzen,Rik %A Brown,Katherine %A Bailey,Julia %A Saunders,John %A Szczepura,Ala %A Hunt,Jonny %A Alston,Tim %A Sadiq,S Tariq %A Das,Satyajit %+ Centre for Advances in Behavioural Science, Faculty of Health and Life Sciences, Coventry University, RC Building (4th Floor), Priory St, Coventry, CV1 5FB, United Kingdom, 44 02477 657459, k.newby@coventry.ac.uk %K sexually transmitted infection %K condoms %K sexual behavior %K young adult %K intervention development %K internet %K eHealth %K co-design %D 2019 %7 01.05.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Young people aged 16-24 years are disproportionately affected by sexually transmitted infections (STIs). STIs can have serious health consequences for affected individuals and the estimated annual cost of treatment to the National Health Service is £620 million. Accordingly, the UK government has made reducing the rates of STIs among this group a priority. A missed opportunity to intervene to increase condom use is when young people obtain self-sampling kits for STIs via the internet. Objective: Our aim was to develop a theory-based tailored intervention to increase condom use for 16-24-years-olds accessing chlamydia self-sampling websites. Methods: The intervention, Wrapped, was developed using Intervention Mapping and was co-designed with young people. The following steps were performed: (1) identification of important determinants of condom use and evidence of their changeability using computer and digital interventions; (2) setting the intervention goal, performance objectives, and change objectives; (3) identification of Behavior Change Principles (BCPs) and practical strategies to target these determinants; and (4) development of intervention materials able to deliver the BCPs and practical strategies. Results: Users of existing chlamydia self-sampling websites are signposted to Wrapped after placing an order for a sampling kit. Salient barriers to condom use are identified by each user and relevant intervention components are allocated to target these. The components include the following: (1) a sample box of condoms, (2) an online condom distribution service, (3) a product for carrying condoms, (4) a condom demonstration video, (5) a series of videos on communication about condom use, and (6) erotic films of real couples discussing and demonstrating condom use. Conclusions: This intervention will be directed at young people who may be particularly receptive to messages and support for behavior change due to their testing status. %M 31042156 %R 10.2196/11242 %U http://formative.jmir.org/2019/2/e11242/ %U https://doi.org/10.2196/11242 %U http://www.ncbi.nlm.nih.gov/pubmed/31042156 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 4 %P e11829 %T Developing a Sexual Health Promotion Intervention With Young Men in Prisons: A Rights-Based Participatory Approach %A Templeton,Michelle %A Kelly,Carmel %A Lohan,Maria %+ Queen's University Belfast, School of Nursing and Midwifery, Medical Biology Centre, Belfast, BT97BL, United Kingdom, 44 (0) 28 90 97 ext 2233, m.templeton@qub.ac.uk %K sexual health %K male %K prison %K health promotion %K rights-based participation %D 2019 %7 29.04.2019 %9 Original Paper %J JMIR Res Protoc %G English %X Background: The sexual health of young men in prisons is often among the poorest in any given country. They may have developed sexual behaviors that, from a public health perspective, are considered problematic and burdensome. These include poorer use of condoms and engaging in more frequent casual sex, resulting in higher rates of sexually transmitted infections, including HIV and viral hepatitis. Thus, young incarcerated men are a highly marginalized and socially excluded high-risk group, in greater need of sexual health education and services. Objective: The aim of this study was to create an innovative sexual health promotion intervention, made for and with young men in prisons, to encourage them to avail of regular sexual health checkups. This included developing a Web-based animated-style sexual health promotion intervention (1.42 min) coupled with upskilling the prison nurses to offer a partnership approach to prison health care. This paper focuses on the development of the intervention and the importance of the underpinning rights-based (RB) participatory intervention design. Methods: We employed an RB participatory approach and recruited 14 participants who attended 3 coproduction workshops held within a prison site in Northern Ireland, United Kingdom. A bespoke 3-day training for nurses beforehand, ensured they gained a deeper understanding of the determinants of poor sexual health. The coproduction team comprised young men, prison nurses, nurse sexual health consultant, media company representatives, and facilitator. Workshops focused on content, design, tone and medium of communication for a Web-based intervention that would be appealing and engaging for young incarcerated men. Results: A 1.42-min animation Dick loves Doot was created to promote a positive attitude toward sexual health checkups. The RB approach enabled the young men to participate, have their voices heard and see their stories reflected through the animation. The nurses’ capacities to protect, fulfill, and respect the young men’s rights to appropriate sexual health services and education was also enhanced. Evaluations confirmed that we successfully provided accurate sexual health information in a way that was engaging and accessible and that encouraged the young men to avail of the new prison sexual health services that were set up in the prison and now provided by nurses. Conclusions: The RB participatory approach to health advanced in this study provided a means to (1) gain invaluable insider knowledge to understand the impact of structural determinants on health and health inequalities and strategies by which to target young incarcerated men (2) create inclusive opportunities for developing bespoke targeted interventions, and (3) galvanize collaborative partnerships to disrupt the structures and processes that lead to and encourage health inequities. To reduce future risk, effective treatment, coupled with coproduced interventions that transmit relevant health messages in a relevant and meaningful way, is key to success. %M 31033447 %R 10.2196/11829 %U https://www.researchprotocols.org/2019/4/e11829/ %U https://doi.org/10.2196/11829 %U http://www.ncbi.nlm.nih.gov/pubmed/31033447 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 7 %N 2 %P e8540 %T FightHPV: Design and Evaluation of a Mobile Game to Raise Awareness About Human Papillomavirus and Nudge People to Take Action Against Cervical Cancer %A Ruiz-López,Tomás %A Sen,Sagar %A Jakobsen,Elisabeth %A Tropé,Ameli %A Castle,Philip E %A Hansen,Bo Terning %A Nygård,Mari %+ HPV Research Group, Department of Research, Cancer Registry of Norway, Ullernchausseen 64, 0379 Oslo, Norway, Oslo,, Norway, 47 95181886, mari.nygard@kreftregisteret.no %K papillomavirus vaccines %K educational technology %K uterine cervical neoplasms %K papillomavirus infections %K primary prevention %K secondary prevention %K early detection of cancer %K mobile applications %K health education %K learning %D 2019 %7 08.04.2019 %9 Original Paper %J JMIR Serious Games %G English %X Background: Human papillomavirus (HPV) is the most common sexually transmitted infection globally. High-risk HPV types can cause cervical cancer, other anogenital cancer, and oropharyngeal cancer; low-risk HPV types can cause genital warts. Cervical cancer is highly preventable through HPV vaccination and screening; however, a lack of awareness and knowledge of HPV and these preventive strategies represents an important barrier to reducing the burden of the disease. The rapid development and widespread use of mobile technologies in the last few years present an opportunity to overcome this lack of knowledge and create new, effective, and modern health communication strategies. Objective: This study aimed to describe the development of a mobile app called FightHPV, a game-based learning tool that educates mobile technology users about HPV, the disease risks associated with HPV infection, and existing preventive methods. Methods: The first version of FightHPV was improved in a design-development-evaluation loop, which incorporated feedback from a beta testing study of 40 participants, a first focus group of 6 participants aged between 40 and 50 years and a second focus group of 23 participants aged between 16 and 18 years. Gameplay data from the beta testing study were collected using Google Analytics (Google), whereas feedback from focus groups was evaluated qualitatively. Of the 29 focus group participants, 26 returned self-administered questionnaires. HPV knowledge before and after playing the game was evaluated in the 22 participants from the second focus group who returned a questionnaire. Results: FightHPV communicates concepts about HPV, associated diseases and their prevention by representing relationships among 14 characters in 6 episodes of 10 levels each, with each level being represented by a puzzle. Main concepts were reinforced with text explanations. Beta testing revealed that many players either failed or had to retry several times before succeeding at the more difficult levels in the game. It also revealed that players gave up at around level 47 of 60, which prompted the redesign of FightHPV to increase accessibility to all episodes. Focus group discussions led to several improvements in the user experience and dissemination of health information in the game, such as making all episodes available from the beginning of the game and rewriting the information in a more appealing way. Among the 26 focus group participants who returned a questionnaire, all stated that FightHPV is an appealing educational tool, 69% (18/26) reported that they liked the game, and 81% (21/26) stated that the game was challenging. We observed an increase in HPV knowledge after playing the game (P=.001). Conclusions: FightHPV was easy to access, use, and it increased awareness about HPV infection, its consequences, and preventive measures. FightHPV can be used to educate people to take action against HPV and cervical cancer. %M 30958271 %R 10.2196/games.8540 %U https://games.jmir.org/2019/2/e8540/ %U https://doi.org/10.2196/games.8540 %U http://www.ncbi.nlm.nih.gov/pubmed/30958271 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 2 %P e11196 %T Informing HIV Prevention Programs for Adolescent Girls and Young Women: A Modified Approach to Programmatic Mapping and Key Population Size Estimation %A Cheuk,Eve %A Isac,Shajy %A Musyoki,Helgar %A Pickles,Michael %A Bhattacharjee,Parinita %A Gichangi,Peter %A Lorway,Robert %A Mishra,Sharmistha %A Blanchard,James %A Becker,Marissa %+ Centre for Global Public Health, Rady Faculty of Health Sciences, University of Manitoba, R070 Medical Rehabilitation Building, 771 McDermot Avenue, Winnipeg, MB,, Canada, 1 204 789 3396, eve.cheuk@umanitoba.ca %K programmatic mapping %K key population size estimation %K female sex workers %K adolescent girls and young women %K sex work %K transactional sex %K casual sex %K HIV prevention %D 2019 %7 01.04.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Standard programmatic mapping involves identifying locations where key populations meet, profiling of these locations (hotspots), and estimating the key population size. Information gained from this method has been used for HIV programming—resource allocation, program planning, service delivery, and monitoring and evaluation—for people who inject drugs, men who have sex with men, and female sex workers (FSWs). With an increasing focus on adolescent girls and young women (AGYW) as a priority population for HIV prevention, programs need to know the location of and how to effectively reach individuals who are at increased risk for HIV but were conventionally considered part of the general population. We hypothesize that AGYW who engage in transactional and casual sex also congregate at sex work hotspots to meet sex partners. Therefore, we adapted the standard programmatic mapping approach to understand the geographic distribution and population size of AGYW at increased HIV risk in Mombasa County, Kenya. Objectives: The objectives are several-fold: (1) detail and compare the modified programmatic mapping approach used in this study to the standard approach, (2) estimate the number of young FSWs, (3) estimate the number of AGYW who congregate in sex work hotspots to meet sex partners other than clients, (4) estimate the overlap in sexual network in hotspots, (5) describe the distribution of sex work hotspots across Mombasa and its four subcounties, and (6) compare the distribution of hotspots that were known to the local HIV prevention program prior to this study and those newly identified. Methods: The standard programmatic mapping approach was modified to estimate the population of young women aged 14 to 24 years who visit sex work hotspots in Mombasa to meet partners for commercial, transactional, and casual sex. Results: We estimated that there were 11,777 FSWs (range 9265 to 14,290) in Mombasa in 2014 among whom 6127 (52.02%) were 14 to 24 years old. The population estimates for women aged 14 to 24 years who engaged in transactional and casual sex and congregated at the hotspots were 5348 (range 4185 to 6510) and 4160 (range 3194 to 5125), respectively. Of the 1025 validated sex work hotspots, 870 (84.88%) were locations also visited by women engaged in transactional and casual sex. Only 47 (4.58%) hotspots were exclusive sex work locations. The geographic and typological distribution of hotspots were significantly different between the four subcounties (P<.001). Of the 1025 hotspots, 419 (40.88%) were already known to the local HIV prevention program and 606 (59.12%) were newly identified. Conclusions: Using the adapted programmatic mapping approach detailed in this study, our results show that HIV prevention programs tailored to AGYW can focus delivery of their interventions to sex work hotspots to reach subgroups that may be at increased risk for HIV. %M 30932868 %R 10.2196/11196 %U https://publichealth.jmir.org/2019/2/e11196/ %U https://doi.org/10.2196/11196 %U http://www.ncbi.nlm.nih.gov/pubmed/30932868 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 7 %N 1 %P e11861 %T Creating a Theoretically Grounded Gaming App to Increase Adherence to Pre-Exposure Prophylaxis: Lessons From the Development of the Viral Combat Mobile Phone Game %A Whiteley,Laura %A Mena,Leandro %A Craker,Lacey K %A Healy,Meredith Garver %A Brown,Larry K %+ Department of Psychiatry, Warren Alpert Medical School, Brown University, Residency Training Program-Brown University-Butler Hospital, 345 Blackstone Boulevard, Providence, RI, 02906, United States, 1 401 455 6375, laura_whiteley@brown.edu %K cell phone %K HIV %K young adult %K sexual and gender minorities %D 2019 %7 27.03.2019 %9 Original Paper %J JMIR Serious Games %G English %X Background: In the United States, young minority men who have sex with men (MSM) are most likely to become infected with HIV. The use of antiretroviral medications to reduce the risk of acquiring HIV infection (pre-exposure prophylaxis, PrEP) is an efficacious and promising prevention strategy. There have been significant advances regarding PrEP, including the definitive demonstration that PrEP reduces HIV acquisition and the development of clinical prescribing guidelines. Despite these promising events, the practical implementation of PrEP can be challenging. Data show that PrEP’s safety and effectiveness could be greatly compromised by suboptimal adherence to treatment, and there is concern about the potential for an increase in HIV risk behavior among PrEP users. Due to these challenges, the prescribing of PrEP should be accompanied by behavioral interventions to promote adherence. Objective: This study aimed to develop an immersive, action-oriented iPhone gaming intervention to improve motivation for adherence to PrEP. Methods: Game development was guided by social learning theory, taking into consideration the perspectives of young adult MSM who are taking PrEP. A total of 20 young men who have sex with men (YMSM; aged 18-35 years) were recruited from a sexually transmitted infection (STI), HIV testing, and PrEP care clinic in Jackson, Mississippi, between October 2016 and June 2017. They participated in qualitative interviews guided by the information-motivation-behavioral skills (IMB) model of behavior change. The mean age of participants was 26 years, and all the participants identified as male. Acceptability of the game was assessed with the Client Service Questionnaire and session evaluation form. Results: A number of themes emerged that informed game development. YMSM taking PrEP desired informational game content that included new and comprehensive details about the effectiveness of PrEP, details about PrEP as it relates to doctors’ visits, and general information about STIs other than HIV. Motivational themes that emerged were the desire for enhancement of future orientation; reinforcement of positive influences from partners, parents, and friends; collaboration with health care providers; decreasing stigma; and a focus on personal relevance of PrEP-related medical care. Behavioral skills themes centered around self-efficacy and strategies for adherence to PrEP and self-care. Conclusions: We utilized youth feedback, IMB, and agile software development to create a multilevel, immersive, action-oriented iPhone gaming intervention to improve motivation for adherence to PrEP. There is a dearth of gaming interventions for persons on PrEP. This study is a significant step in working toward the development and testing of an iPhone gaming intervention to decrease HIV risk and promote adherence to PrEP for YMSM. %M 30916652 %R 10.2196/11861 %U http://games.jmir.org/2019/1/e11861/ %U https://doi.org/10.2196/11861 %U http://www.ncbi.nlm.nih.gov/pubmed/30916652 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 3 %P e11209 %T A Smartphone Game to Prevent HIV Among Young Africans: Protocol for a Randomized Pilot Study of a Mobile Intervention %A Sabben,Gaëlle %A Akelo,Victor %A Mudhune,Victor %A Ondeng'e,Ken %A Ndivo,Richard %A Stephenson,Rob %A Winskell,Kate %+ Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, United States, 1 4046833103, gaelle.sabben@emory.edu %K HIV %K youth %K sub-Saharan Africa %K Kenya %K serious game %K narrative %K mobile phone %K pilot test %K randomized controlled trial %K mhealth %K prevention %K smartphone %D 2019 %7 27.03.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Young people aged under 25 years make up an increasing proportion of the population in emerging economies such as Kenya, where half of new adult HIV infections are among 15- to 24-year olds. Interventions targeting this age group have the potential to avert HIV infections among an increasingly large at-risk population. Interactive communication technologies offer a promising platform for reaching young people in engaging ways. Objective: Tumaini is a narrative-based smartphone game designed to help young Africans protect themselves from HIV. The objective of this study was to pilot test the game, focusing on the data needed to inform a future randomized controlled efficacy trial, including assessments of study feasibility and safety. Methods: The study took place in Kisumu Town, western Kenya, in spring 2017. The game-based intervention was pilot tested for 16 days with a sample of 60 preadolescents aged 11 to 14 years. Participant recruitment was initiated through schools. Participants were randomly assigned to the control or intervention arms of the study. One parent for each of the intervention arm participants was also recruited (n=30). The intervention arm participants were provided with smartphones on which Tumaini was loaded so that they could play the game at home. Youth completed behavioral surveys at baseline, posttest, and 6-week follow-up. The intervention arm participants provided quantitative feedback on their experience of the game-based intervention at posttest. They and their parents further participated in postintervention focus group discussions. Feasibility-related study metrics were collected on recruitment, enrollment, attrition, safety of participants, and return of phones. Results: Recruitment and enrollment of the 60 preadolescents and parents were successfully completed within 18 days. No participants were lost to follow-up: all youth completed all 3 waves of the survey and 27 intervention arm youth and 22 parents and caregivers participated in the focus groups. No safety concerns were reported. All phones were returned after the intervention period; none were damaged or lost. All intervention arm participants initiated gameplay, recording a mean exposure time just under 27 hours. Conclusions: Findings indicate that it is feasible and safe to test a smartphone-based HIV prevention intervention for very young adolescents in urban and peri-urban sub-Saharan Africa by initiating recruitment in schools and temporarily providing youth participants with smartphones on which the game is loaded. A randomized controlled trial powered to assess the efficacy of the game-based intervention is being designed to be carried out in the same geographic area as the pilot, using similar methods. Trial Registration: ClinicalTrials.gov NCT03054051; https://clinicaltrials.gov/ct2/show/NCT03054051 (Archived by WebCite at http://www.webcitation.org/6wjwpX8Bg.) International Registered Report Identifier (IRRID): DERR1-10.2196/11209 %M 30916661 %R 10.2196/11209 %U http://www.researchprotocols.org/2019/3/e11209/ %U https://doi.org/10.2196/11209 %U http://www.ncbi.nlm.nih.gov/pubmed/30916661 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 3 %P e10795 %T Community-Based, Point-of-Care Sexually Transmitted Infection Screening Among High-Risk Adolescents in Los Angeles and New Orleans: Protocol for a Mixed-Methods Study %A Shannon,Chelsea Lee %A Koussa,Maryann %A Lee,Sung-Jae %A Fournier,Jasmine %A Abdalian,Sue Ellen %A Rotheram,Mary Jane %A Klausner,Jeffrey D %A , %+ Division of Infectious Diseases, David Geffen School of Medicine, University of California Los Angeles, 10920 Wilshire Blvd, Suite 350, Los Angeles, CA,, United States, 1 310 557 2273, jdklausner@mednet.ucla.edu %K sexually transmitted infections %K adolescents %K point-of-care testing %D 2019 %7 22.03.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Sexually transmitted infection (STI) rates are increasing in the United States, with approximately half of new infections occurring among adolescents aged 15-24 years. Gay, bisexual, and transgender youth (GBTY), homeless youth, and youth with histories of drug use, mental health disorders, and incarceration are all at uniquely high risk for STIs. However, these adolescents often lack access to sexual health services. Objective: This study aims to use point-of-care STI tests in community-based settings to screen for and treat STIs in adolescents. Methods: We are recruiting 1500 HIV-uninfected youth and 220 HIV-infected youth from homeless shelters, GBTY organizations, and community health centers in Los Angeles, California and New Orleans, Louisiana. Study participants will receive STI screening every 4 months for 24 months. STI screening includes rapid HIV, syphilis, Chlamydia trachomatis, Neisseria gonorrhoeae, and Hepatitis C virus testing. Trained paraprofessionals will conduct all STI testing. When a participant screens positive for an STI, they are either linked to a partner medical clinic or provided with same-day antibiotic therapy and expedited partner therapy. We will monitor STI prevalence among study participants as well as point-of-care test performance, linkage to care, and treatment outcomes. Results: The project was funded in 2016, and enrollment will be completed in 2019. Preliminary data analysis is currently underway. Conclusions: As STI rates continue to rise, it is important to improve access to screening and treatment services, particularly for high-risk adolescents. In this study, we aim to evaluate the use of point-of-care STI diagnostic tests in community-based organizations. We hope to determine the prevalence of STIs among these adolescents and evaluate the acceptability and feasibility of community-based STI screening and treatment. Trial Registration: ClinicalTrials.gov NCT03134833; https://clinicaltrials.gov/ct2/show/NCT03134833 International Registered Report Identifier (IRRID): DERR1-10.2196/10795 %M 30900994 %R 10.2196/10795 %U http://www.researchprotocols.org/2019/3/e10795/ %U https://doi.org/10.2196/10795 %U http://www.ncbi.nlm.nih.gov/pubmed/30900994 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 3 %P e11163 %T A Mobile Health Contraception Decision Support Intervention for Latina Adolescents: Implementation Evaluation for Use in School-Based Health Centers %A Tebb,Kathleen P %A Leng Trieu,Sang %A Rico,Rosario %A Renteria,Robert %A Rodriguez,Felicia %A Puffer,Maryjane %+ Department of Pediatrics, University of California, San Francisco, 3333 California Street, Suite 245, San Francisco, CA, 94118, United States, 1 415 514 0941, Kathleen.tebb@ucsf.edu %K mobile health %K adolescent health %K pregnancy in adolescence %D 2019 %7 14.03.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Health care providers are a trusted and accurate source of sexual health information for most adolescents, and clinical guidelines recommend that all youth receive comprehensive, confidential sexual health information and services. However, these guidelines are followed inconsistently. Providers often lack the time, comfort, and skills to provide patient-centered comprehensive contraceptive counseling and services. There are significant disparities in the provision of sexual health services for Latino adolescents, which contribute to disproportionately higher rates of teenage pregnancy. To address this, we developed Health-E You or Salud iTu in Spanish, an evidence-informed mobile health (mHealth) app, to provide interactive, individually tailored sexual health information and contraception decision support for English and Spanish speakers. It is designed to be used in conjunction with a clinical encounter to increase access to patient-centered contraceptive information and services for adolescents at risk of pregnancy. Based on user input, the app provides tailored contraceptive recommendations and asks the youth to indicate what methods they are most interested in. This information is shared with the provider before the in-person visit. The app is designed to prepare youth for the visit and acts as a clinician extender to support the delivery of health education and enhance the quality of patient-centered sexual health care. Despite the promise of this app, there is limited research on the integration of such interventions into clinical practice. Objective: This study described efforts used to support the successful adoption and implementation of the Health-E You app in clinical settings and described facilitators and barriers encountered to inform future efforts aimed at integrating mHealth interventions into clinical settings. Methods: This study was part of a larger, cluster randomized control trial to evaluate the effectiveness of Health-E You on its ability to reduce health disparities in contraceptive knowledge, access to contraceptive services, and unintended pregnancies among sexually active Latina adolescents at 18 school-based health centers (SBHCs) across Los Angeles County, California. App development and implementation were informed by the theory of diffusion of innovation, the Patient-Centered Outcomes Research Institute’s principles of engagement, and iterative pilot testing with adolescents and clinicians. Implementation facilitators and barriers were identified through monthly conference calls, site visits, and quarterly in-person collaborative meetings. Results: Implementation approaches enhanced the development, adoption, and integration of Health-E You into SBHCs. Implementation challenges were also identified to improve the integration of mHealth interventions into clinical settings. Conclusions: This study provides important insights that can inform and improve the implementation efforts for future mHealth interventions. In particular, an implementation approach founded in a strong theoretical framework and active engagement with patient and community partners can enhance the development, adoption, and integration of mHealth technologies into clinical practice. Trial Registration: ClinicalTrials.gov NCT02847858; https://clinicaltrials.gov/ct2/show/NCT02847858 (Archived by WebCite at http://www.webcitation.org/761yVIRTp). %M 30869649 %R 10.2196/11163 %U http://mhealth.jmir.org/2019/3/e11163/ %U https://doi.org/10.2196/11163 %U http://www.ncbi.nlm.nih.gov/pubmed/30869649 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 12 %P e10448 %T Testing the Efficacy of a Social Networking Gamification App to Improve Pre-Exposure Prophylaxis Adherence (P3: Prepared, Protected, emPowered): Protocol for a Randomized Controlled Trial %A LeGrand,Sara %A Knudtson,Kelly %A Benkeser,David %A Muessig,Kathryn %A Mcgee,Andrew %A Sullivan,Patrick S %A Hightow-Weidman,Lisa %+ Center for Health Policy and Inequalities Research, Duke Global Health Institute, Duke University, 310 Trent Drive, Room 305, Durham, NC, 27710, United States, 1 9194380448, sara.legrand@duke.edu %K HIV %K men who have sex with men %K mobile phone %K mobile apps %K pre-exposure prophylaxis %K transgender women %K youth %D 2018 %7 18.12.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: HIV prevalence is high among young men who have sex with men (YMSM) and young transgender women who have sex with men (YTWSM), particularly among minorities. Despite its proven efficacy and safety, the uptake of and adherence to pre-exposure prophylaxis (PrEP) among YMSM and YTWSM is currently limited. To date, evidence-based interventions to promote and sustain PrEP adherence have been limited and not shown to be highly efficacious. Given the widespread adoption of smartphones, mobile apps can be utilized to increase PrEP adherence for many YMSM and YTWSM. Objective: The study consists of a formative research phase to develop an app-based intervention, P3 (Prepared, Protected, emPowered), to increase PrEP adherence, and a randomized controlled trial (RCT) to test its efficacy. P3 is a mobile app built on an established health platform, which includes social networking and game-based components to encourage PrEP adherence among YMSM and YTWSM. P3+ includes all P3 features plus adherence counseling delivered via two-way text messaging (short message service, SMS) through the app. Methods: The formative research phase includes usability testing to assess users’ comprehension of P3’s educational content, understanding and use of intervention features, and overall impressions of app functionality, followed by app refinements. A subsequent field trial will identify and resolve any remaining technical challenges. A three-arm RCT (P3, P3+, and standard of care) will then be conducted at 6 iTech subject recruitment venues to assess intervention efficacy and to conduct a comparison of costs to deliver the 2 intervention arms. Results: This is an ongoing research project with initial results from the formative work expected in 2020 and those from the RCT in 2021. Conclusions: P3 aims to provide an engaging, interactive experience that is highly appealing for the target population, leveraging technology already heavily integrated into the lives of young people, and thus meeting users’ needs in a familiar, stimulating way. If efficacious, P3 could be a sustainable, easily disseminated, lower-cost PrEP intervention for YMSM and YTWSM. Further, the research aims to determine the processes that are essential to developing and implementing future health-related gamification interventions. Trial Registration: ClinicalTrials.gov NCT03320512; https://clinicaltrials.gov/ct2/show/NCT03320512 (Archived by WebCite at http://www.webcitation.org/74OVZkICl) International Registered Report Identifier (IRRID): DERR1-10.2196/10448 %M 30563818 %R 10.2196/10448 %U http://www.researchprotocols.org/2018/12/e10448/ %U https://doi.org/10.2196/10448 %U http://www.ncbi.nlm.nih.gov/pubmed/30563818 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e10190 %T Insights From a Text Messaging–Based Sexual and Reproductive Health Information Program in Tanzania (m4RH): Retrospective Analysis %A Olsen,Patrick S %A Plourde,Kate F %A Lasway,Christine %A van Praag,Eric %+ Health Services Research, Global Health, Population, and Nutrition, FHI 360, 359 Blackwell Street, Suite 200, Durham, NC, 27701, United States, 1 919 544 7040 ext 11713, polsen@fhi360.org %K data analysis %K mobile phone %K mHealth %K short message service %K user engagement %D 2018 %7 01.11.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Many mobile health (mHealth) interventions have the potential to generate and store vast amounts of system-generated participant interaction data that could provide insight into user engagement, programmatic strengths, and areas that need improvement to maximize efficacy. However, despite the popularity of mHealth interventions, there is little documentation on how to use these data to monitor and improve programming or to evaluate impact. Objective: This study aimed to better understand how users of the Mobile for Reproductive Health (m4RH) mHealth intervention engaged with the program in Tanzania from September 2013 to August 2016. Methods: We conducted secondary data analysis of longitudinal data captured by system logs of participant interactions with the m4RH program from 127 districts in Tanzania from September 2013 to August 2016. Data cleaning and analysis was conducted using Stata 13. The data were examined for completeness and “correctness.” No missing data was imputed; respondents with missing or incorrect values were dropped from the analyses. Results: The total population for analysis included 3,673,702 queries among 409,768 unique visitors. New users represented roughly 11.15% (409,768/3,673,702) of all queries. Among all system queries for new users, 46.10% (188,904/409,768) users accessed the m4RH main menu. Among these users, 89.58% (169,218/188,904) accessed specific m4RH content on family planning, contraceptive methods, adolescent-specific and youth-specific information, and clinic locations after first accessing the m4RH main menu. The majority of these users (216,422/409,768, 52.82%) requested information on contraceptive methods; fewer users (23,236/409,768, 5.67%) requested information on clinic location. The conversion rate was highest during the first and second years of the program when nearly all users (11,246/11,470, 98.05%, and 33,551/34,830, 96.33%, respectively) who accessed m4RH continued on to query more specific content from the system. The rate of users that accessed m4RH and became active users declined slightly from 98.05% (11,246/11,470) in 2013 to 87.54% (56,696/64,765) in 2016. Overall, slightly more than one-third of all new users accessing m4RH sent queries at least once per month for 2 or more months, and 67.86% (278,088/409,768) of new and returning users requested information multiple times per month. Promotional periods were present for 15 of 36 months during the study period. Conclusions: The analysis of the rich data captured provides a useful framework with which to measure the degree and nature of user engagement utilizing routine system-generated data. It also contributes to knowledge of how users engage with text messaging (short message service)-based health promotion interventions and demonstrates how data generated on user interactions could inform improvements to the design and delivery of a service, thereby enhancing its effectiveness. %M 30389651 %R 10.2196/10190 %U https://mhealth.jmir.org/2018/11/e10190/ %U https://doi.org/10.2196/10190 %U http://www.ncbi.nlm.nih.gov/pubmed/30389651 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 10 %P e11667 %T Discourse on Exposure to Pornography Content Online Between Arab Adolescents and Parents: Qualitative Study on its Impact on Sexual Education and Behavior %A Gesser-Edelsburg,Anat %A Abed Elhadi Arabia,Munawar %+ The Health and Risk Communication Research Center, School of Public Health, University of Haifa, 199 Aba Khoushy Avenue, Mount Carmel, Haifa, 3498838, Israel, 972 544243530, ageser@univ.haifa.ac.il %K internet %K pornography %K porn viewing %K sexuality %K taboo %K Israeli Arab adolescents %K discourse %K sexual education and behavior %K sexual double standard %D 2018 %7 09.10.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: The internet revolution of the 21st century has made sexual content available and accessible on a scale that has never existed before. Many studies have indicated that the use of pornography was associated with more permissive sexual attitudes and tended to be linked with stronger gender-stereotypical sexual beliefs. It also seemed to be associated with other risky behaviors and sexual promiscuity. Pornography exposure in conservative societies leads to conflicts with religious and cultural taboos. Objective: The aim of this study was to characterize the barriers and difficulties that prevent sexual discourse in the Arab society and enable pornography viewing according to the perceptions of adolescents and mothers. Methods: This study involved qualitative research methods and in-depth interviews with 40 participants. This study included 20 Arab adolescents, sampled by 2 age groups (14-16 years and 16-18 years), and 20 mothers of adolescents from both sexes. Results: The findings indicate that mothers “turn a blind eye” to porn viewing and sexual activity by boys; however, they show a sweeping prohibition and denial of such behavior by girls. Boys reported viewing porn routinely, whereas girls denied doing so, but admitted that their female friends watched porn. The study also found that boys experienced guilt during and after viewing porn as a result of the clash between modernity and traditional values. The mothers and adolescents emphasized the need for an open sexual discourse to reduce violent behaviors such as Web-based sexual harassment, including sending videos and pictures of naked girls, often accompanied by threats and blackmail. Conclusions: It is necessary to find a way to encourage a significant sexual discourse to prevent the violent consequences of its absence in the Arab society. A controlled, transparent, and critical sexual discourse could help youth make more informed decisions concerning the search for sexual content, porn viewing, and sexual behavior. %M 30305264 %R 10.2196/11667 %U http://www.jmir.org/2018/10/e11667/ %U https://doi.org/10.2196/11667 %U http://www.ncbi.nlm.nih.gov/pubmed/30305264 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 8 %P e10398 %T The Influence of Technology Delivery Mode on Intervention Outcomes: Analysis of a Theory-Based Sexual Health Program %A Levitz,Nicole %A Wood,Erica %A Kantor,Leslie %+ Planned Parenthood Federation of America, 123 William Street, New York, NY, 10038, United States, 1 9142623408, nicole.levitz@ppfa.org %K sexual and reproductive health %K public health %K text messaging %K instant messaging %K behavior theory %K internet %D 2018 %7 29.08.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: There are few studies on the role of technology delivery mode on health intervention outcomes. Furthermore, the opportunity to examine potential mode effects on a program that is theory-based and integrates principles of communication and decision-making science to influence sexual and reproductive health outcomes is a new contribution to the literature. Objective: Planned Parenthood Federation of America’s national Chat/Text program can be accessed via short message service (SMS; more commonly referred to as text messaging), Web-based desktop chatting, and mobile phone chatting. The program has been in existence since 2010 and has conducted over 1,000,000 conversations. In this study, we examined whether the mode used to access the program (SMS text, desktop chat, or mobile phone chat) affected program users’ intention to act on the action plan established in their conversation. Methods: Data were examined for a 6-month period from January 2016 to June 2016. The data were collected as a part of the monitoring and evaluation of an ongoing program. We limited our sample to the program’s priority audience of 15-24 years residing within the United States, which resulted in a sample of 64,939 conversations. Available data items for analysis included user demographics, delivery mode, topic discussed, helpfulness rating (on a 4-point scale), user confidence in following through on the intentions made during the conversation (on a 4-point scale), and educator confidence in whether the user would follow through on the stated intention. Linear and multinomial robust regression analyses were conducted to examine the relationships between conversation delivery mode and confidence. Results: No significant relationships between users’ confidence to carry out their intentions and gender or race were found. None of the 3 modalities (SMS text, desktop chat, or mobile phone chat) were significantly associated with user confidence. All the 3 modalities had significant associations with educator confidence and showed similar effect sizes to those of user confidence. Educator confidence was significantly associated with all the topics discussed. Conclusions: The Planned Parenthood Chat/Text program was designed as a tool to improve access to sexual and reproductive health care among young people. The mode of intervention delivery was not associated with users’ confidence in their ability to carry out their stated intention, suggesting that all modes are legitimate for delivering this intervention. Furthermore, each mode worked across gender and race or ethnicity, indicating that this is a modality that can work across groups. %M 30158100 %R 10.2196/10398 %U http://www.jmir.org/2018/8/e10398/ %U https://doi.org/10.2196/10398 %U http://www.ncbi.nlm.nih.gov/pubmed/30158100 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 7 %N 7 %P e10174 %T Reducing HIV Vulnerability Through a Multilevel Life Skills Intervention for Adolescent Men (The iREACH Project): Protocol for a Randomized Controlled Trial %A Bauermeister,Jose %A Sullivan,Patrick S %A Gravens,Laura %A Wolfe,James %A Countryman,Kristina %A Smith-Bankhead,Neena %A Drab,Ryan A %A Sallabank,Gregory %A Helms,Jordan D %A Khatibi,Kristie %A Filipowicz,Rebecca %A Horvath,Keith Joseph %A Bonar,Erin %A Castel,Amanda %A Hightow-Weidman,Lisa %A Guest,Jodie %A Stephenson,Rob %+ School of Nursing, University of Pennsylvania, 418 Curie Boulevard, Suite 222L, Philadelphia, PA, 19104, United States, 1 2158989993, bjose@upenn.edu %K prevention %K mHealth %K adolescence %K LGBTQ %K sexuality %K life skills %K HIV %D 2018 %7 10.07.2018 %9 Protocol %J JMIR Res Protoc %G English %X Background: Few HIV interventions have demonstrated efficacy in reducing HIV risk among adolescent men who have sex with men (AMSM), and fewer still have recognized the unique needs of AMSM based on race/ethnicity or geographical setting. Recognizing that youths’ HIV vulnerability is intricately tied to their development and social context, delivering life skills training during adolescence might delay the onset or reduce the consequences of risk factors for HIV acquisition and equip AMSM with the skills to navigate HIV prevention. This protocol describes the development and testing of iREACH, an online multilevel life skills intervention for AMSM. Objective: This randomized controlled trial (RCT) aims to test the efficacy of an online-delivered life skills intervention, iREACH, on cognitive and behavioral HIV-related outcomes for AMSM. Methods: iREACH is a prospective RCT of approximately 600 cisgender adolescent males aged 13 to 18 years who report same-sex attractions. The intervention will be tested with a racial/ethnically diverse sample (≥50% racial/ethnic minority) of AMSM living in four regions in the United States: (1) Chicago to Detroit, (2) Washington, DC to Atlanta, (3) San Francisco to San Diego, and (4) Memphis to New Orleans. Results: This project is currently recruiting participants. Recruitment began in March 2018. Conclusions: iREACH represents a significant innovation in the development and testing of a tailored life skills-focused intervention for AMSM, and has the potential to fill a significant gap in HIV prevention intervention programming and research for AMSM. Registered Report Identifier: RR1-10.2196/10174 %M 29991470 %R 10.2196/10174 %U http://www.researchprotocols.org/2018/7/e10174/ %U https://doi.org/10.2196/10174 %U http://www.ncbi.nlm.nih.gov/pubmed/29991470 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 4 %P e96 %T Randomized Controlled Trials of Technology-Based HIV/STI and Drug Abuse Preventive Interventions for African American and Hispanic Youth: Systematic Review %A Córdova,David %A Mendoza Lua,Frania %A Ovadje,Lauretta %A Hong,Ethan %A Castillo,Berenice %A Salas-Wright,Christopher P %+ School of Social Work, University of Michigan, 1080 S. University Ave., Ann Arbor, MI, 48109, United States, 1 (734) 763 6201, cordovad@umich.edu %K technology %K HIV %K prevention %K drug use %K adolescents %D 2017 %7 13.12.2017 %9 Review %J JMIR Public Health Surveill %G English %X Background: HIV/sexually transmitted infections (STIs) and drug abuse remain significant public health concerns in the United States, and African American and Hispanic youth are disproportionately affected. Although technology-based interventions are efficacious in preventing and reducing HIV/STI and licit/illicit drug use behaviors, relatively little is known regarding the state of the science of these interventions among African American and Hispanic youth. Objective: The aim of this review is to identify and examine randomized controlled trials (RCTs) of technology-based HIV/STI and/or drug abuse preventive interventions for African American and Hispanic youth. Methods: We searched electronic databases (ie, PubMed, Proquest, PsycINFO, Ebscohost, Google Scholar) to identify studies between January 2006 and October 2016. RCTs of technology-based interventions targeting African American and Hispanic youth HIV/STI risk behaviors, including sexual risk, licit and illicit drug use, and HIV/STI testing were included. Results: Our search revealed a total of three studies that used an RCT design and included samples comprised of >50% African American and/or Hispanic youth. The follow-up assessments ranged from two weeks to six months and the number of participants in each trial ranged from 72 to 141. The three interventions were theory-driven, interactive, and tailored. The long-term effects of the interventions were mixed, and outcomes included reductions in sex partners, licit drug use, and condomless anal sex acts. Conclusions: Although technology-based interventions seem promising in the prevention of HIV/STI and drug abuse among African American and Hispanic youth, more research is needed. %M 29237577 %R 10.2196/publichealth.7129 %U http://publichealth.jmir.org/2017/4/e96/ %U https://doi.org/10.2196/publichealth.7129 %U http://www.ncbi.nlm.nih.gov/pubmed/29237577 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 11 %P e379 %T Sexual Health and the Internet: Cross-Sectional Study of Online Preferences Among Adolescents %A von Rosen,Antonella Juline %A von Rosen,Frederik Tilmann %A Tinnemann,Peter %A Müller-Riemenschneider,Falk %+ Institute for Social Medicine, Epidemiology and Health Economics, Charité – Universitätsmedizin Berlin, Luisenstr 57, Berlin, 10117, Germany, 49 15208804891, an_pa@uni-bremen.de %K adolescent %K adolescent behavior %K Internet %K reproductive health %K health literacy %K sex education %K cross-sectional studies %K online preferences %K eHealth literacy %D 2017 %7 08.11.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: The Internet is widely used by adolescents for sexual health information and bears the potential to increase knowledge and positively affect behavior. Objective: The objective of this study is to assess students’ preferences when looking for sexual health information online. Methods: We conducted a cross-sectional survey among ninth grade students in a convenience sample of 13 secondary schools in Berlin, Germany. During a regular school period, participants were requested to rate the importance they attribute to nine aspects of sexual health websites in a paper-based questionnaire. Bivariate and multivariable analyses were used to assess awareness and preferences by gender, age, migrant background, and school type. Results: Of 1190 eligible students, 1177 (98.91%) students with a mean age of 14.6 (SD 0.7) years participated, 52.52% (605/1152) were male, and 52.94% (612/1156) had at least one parent born abroad. Participant numbers were spread equally across three types of secondary schools in Berlin. Website aspects most frequently cited as important were easily comprehensible wording (88.33%, 961/1088), clear information layout (80.57%, 871/1081), and reliability of the website’s publisher (79.28%, 857/1081), whereas the visual style of a website was deemed important by the lowest number of students (35.13%, 378/1076). There was a marked gender difference in the importance students attached to website publisher reliability. Although 437/515 (84.9%) of female participants regarded this as important, only 420/566 (74.2%) of male participants did likewise (P<.001). In multivariable analyses, demographic differences were also particularly visible in the importance of publisher reliability: male participants were significantly less likely to find this aspect important (OR 0.50, 95% CI 0.37-0.69). The odds ratio for students with migrant background was 0.64 (95% CI 0.50-0.81, reference=no migrant background) and OR 2.04 (95% CI 1.03-4.03) for students in the most academic school type (reference=least academic). Conclusions: Students prefer easily understandable online resources. Setting up sexual health websites according to the explicit preferences of the target audience might encourage usage, especially by those subpopulations less likely to critically assess information validity: male adolescents, children of immigrants, and the academically disadvantaged. %M 29117927 %R 10.2196/jmir.7068 %U http://www.jmir.org/2017/11/e379/ %U https://doi.org/10.2196/jmir.7068 %U http://www.ncbi.nlm.nih.gov/pubmed/29117927 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 9 %P e314 %T Video Game Intervention for Sexual Risk Reduction in Minority Adolescents: Randomized Controlled Trial %A Fiellin,Lynn E %A Hieftje,Kimberly D %A Pendergrass,Tyra M %A Kyriakides,Tassos C %A Duncan,Lindsay R %A Dziura,James D %A Sawyer,Benjamin G %A Mayes,Linda %A Crusto,Cindy A %A Forsyth,Brian WC %A Fiellin,David A %+ play2PREVENT Lab, Yale School of Medicine, Yale University, 367 Cedar Street, New Haven, CT, 06510, United States, 1 203 737 3347, lynn.fiellin@yale.edu %K adolescent %K videogame %K intervention %K randomized controlled trial %K human immunodeficiency virus %K risk reduction %K primary prevention %D 2017 %7 18.09.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Human immunodeficiency virus (HIV) disproportionately impacts minority youth. Interventions to decrease HIV sexual risk are needed. Objective: We hypothesized that an engaging theory-based digital health intervention in the form of an interactive video game would improve sexual health outcomes in adolescents. Methods: Participants aged 11 to 14 years from 12 community afterschool, school, and summer programs were randomized 1:1 to play up to 16 hours of an experimental video game or control video games over 6 weeks. Assessments were conducted at 6 weeks and at 3, 6, and 12 months. Primary outcome was delay of initiation of vaginal/anal intercourse. Secondary outcomes included sexual health attitudes, knowledge, and intentions. We examined outcomes by gender and age. Results: A total of 333 participants were randomized to play the intervention (n=166) or control games (n=167): 295 (88.6%) were racial/ethnic minorities, 177 (53.2%) were boys, and the mean age was 12.9 (1.1) years. At 12 months, for the 258 (84.6%) participants with available data, 94.6% (122/129) in the intervention group versus 95.4% (123/129) in the control group delayed initiation of intercourse (relative risk=0.99, 95% CI 0.94-1.05, P=.77). Over 12 months, the intervention group demonstrated improved sexual health attitudes overall compared to the control group (least squares means [LS means] difference 0.37, 95% CI 0.01-0.72, P=.04). This improvement was observed in boys (LS means difference 0.67, P=.008), but not girls (LS means difference 0.06, P=.81), and in younger (LS means difference 0.71, P=.005), but not older participants (LS means difference 0.03, P=.92). The intervention group also demonstrated increased sexual health knowledge overall (LS means difference 1.13, 95% CI 0.64-1.61, P<.001), in girls (LS means difference 1.16, P=.001), boys (LS means difference 1.10, P=.001), younger (LS means difference 1.18, P=.001), and older (LS means difference=1.08, P=.002) participants. There were no differences in intentions to delay the initiation of intercourse between the two groups (LS means difference 0.10, P=.56). Conclusions: An interactive video game intervention improves sexual health attitudes and knowledge in minority adolescents for at least 12 months. Trial Registration: Clinicaltrials.gov NCT01666496; https://clinicaltrials.gov/ct2/show/NCT01666496 (Archived by WebCite at http://www.webcitation.org/6syumc9C0). %M 28923788 %R 10.2196/jmir.8148 %U http://www.jmir.org/2017/9/e314/ %U https://doi.org/10.2196/jmir.8148 %U http://www.ncbi.nlm.nih.gov/pubmed/28923788 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 3 %P e53 %T Vulnerable Youth as Prosumers in HIV Prevention: Studies Using Participatory Action Research %A Conn,Cath %A Nayar,Shoba %A Lubis,Dinar %A Maibvisira,Carol %A Modderman,Kristel %+ School of Public Health and Psychosocial Studies, Auckland University of Technology, AUT South, 640 Great South Road, Manukau City, Auckland, 2112, New Zealand, 64 0211266356, cath.conn@aut.ac.nz %K community participation %K social environments %D 2017 %7 14.08.2017 %9 Viewpoint %J JMIR Public Health Surveill %G English %X Background: Stigma, voicelessness, and legislative and rights barriers, coupled with top-down decision making, are the common experiences of vulnerable youth populations that limit their opportunities to participate in vital health promotion efforts such as HIV prevention. Objective: To consider new opportunities arising from a digital society for youth to creatively shape HIV prevention. Methods: Drawing on research with vulnerable youth in Busoga, Uganda; Bulawayo, Zimbabwe; Bangkok, Thailand; and Bali, Indonesia, we explore current youth participation, in theory and practice, while considering new opportunities arising from a digital society for youth to creatively shape HIV prevention. Results: Collaborative commons and prosumer models are defined as people employing new technology to codesign toward a common goal. Within the context of a diminishing role of the traditional institution and the rise of digitized networks, such models offer exciting new directions for youth as electronic health promotion prosumers to participate in difficult challenges such as HIV prevention in the 21st century. Conclusions: It is time for institutions to embrace such opportunities, especially in areas where access to technology is widening, while continuing to champion youth and advocate for supportive social environments. %M 28807890 %R 10.2196/publichealth.7812 %U http://publichealth.jmir.org/2017/3/e53/ %U https://doi.org/10.2196/publichealth.7812 %U http://www.ncbi.nlm.nih.gov/pubmed/28807890 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 5 %N 2 %P e9 %T Using Computer Simulations for Investigating a Sex Education Intervention: An Exploratory Study %A Eleftheriou,Anastasia %A Bullock,Seth %A Graham,Cynthia A %A Ingham,Roger %+ Institute for Complex Systems Simulation, Electronics and Computer Science, University of Southampton, Highfield Campus, Southampton,, United Kingdom, 44 07564035077, eleftheriouanastasia@gmail.com %K sex education %K personality %K STI %K gender %K computer simulation %D 2017 %7 03.05.2017 %9 Original Paper %J JMIR Serious Games %G English %X Background: Sexually transmitted infections (STIs) are ongoing concerns. The best method for preventing the transmission of these infections is the correct and consistent use of condoms. Few studies have explored the use of games in interventions for increasing condom use by challenging the false sense of security associated with judging the presence of an STI based on attractiveness. Objectives: The primary purpose of this study was to explore the potential use of computer simulation as a serious game for sex education. Specific aims were to (1) study the influence of a newly designed serious game on self-rated confidence for assessing STI risk and (2) examine whether this varied by gender, age, and scores on sexuality-related personality trait measures. Methods: This paper undertook a Web-based questionnaire study employing between and within subject analyses. A Web-based platform hosted in the United Kingdom was used to deliver male and female stimuli (facial photographs) and collect data. A convenience sample group of 66 participants (64%, 42/66) male, mean age 22.5 years) completed the Term on the Tides, a computer simulation developed for this study. Participants also completed questionnaires on demographics, sexual preferences, sexual risk evaluations, the Sexual Sensation Seeking Scale (SSS), and the Sexual Inhibition Subscale 2 (SIS2) of the Sexual Inhibition/Sexual Excitation Scales-Short Form (SIS/SES - SF). Results: The overall confidence of participants to evaluate sexual risks reduced after playing the game (P<.005). Age and personality trait measures did not predict the change in confidence of evaluating risk. Women demonstrated larger shifts in confidence than did men (P=.03). Conclusions: This study extends the literature by investigating the potential of computer simulations as a serious game for sex education. Engaging in the Term on the Tides game had an impact on participants’ confidence in evaluating sexual risks. %M 28468747 %R 10.2196/games.6598 %U http://games.jmir.org/2017/2/e9/ %U https://doi.org/10.2196/games.6598 %U http://www.ncbi.nlm.nih.gov/pubmed/28468747 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 2 %N 2 %P e154 %T Investigating Sociodemographic Factors and HIV Risk Behaviors Associated With Social Networking Among Adolescents in Soweto, South Africa: A Cross-Sectional Survey %A Dietrich,Janan Janine %A Laher,Fatima %A Hornschuh,Stefanie %A Nkala,Busisiwe %A Chimoyi,Lucy %A Otwombe,Kennedy %A Kaida,Angela %A Gray,Glenda Elisabeth %A Miller,Cari %+ Perinatal HIV Research Unit (PHRU), Faculty of Health Sciences, University of the Witwatersrand, Floor 12, Nurses Residence, Chris Hani Baragwanath Hospital, Old Potch Road, Diepkloof, Soweto, Johannesburg, 1864, South Africa, 27 119899831, dietrichj@phru.co.za %K mobile phone %K adolescent health %K HIV %K health %K social networking %K mhealth %K South Africa %D 2016 %7 28.09.2016 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Internet access via mobile phones and computers facilitates interaction and potential health communication among individuals through social networking. Many South African adolescents own mobile phones and can access social networks via apps. Objective: We investigated sociodemographic factors and HIV risk behaviors of adolescent social networking users in Soweto, South Africa. Methods: We conducted an interviewer-administered, cross-sectional survey of adolescents aged 14-19 years. Independent covariates of social networking were assessed by multivariate logistic regression analysis. Results: Of 830 adolescents, 57% (475/830) were females and the median age was found to be 18 years (interquartile range 17-18). Social networking was used by 60% of adolescents (494/830); more than half, that is, 87% (396/494) accessed social networks through mobile phones and 56% (275/494) spent more than 4 hours per day using their mobile phones. Social networking was independently associated with mobile usage 2-4 hours (adjusted odds ratio [AOR]: 3.06, CI: 1.69-5.51) and more than 4 hours per day (AOR: 6.16, CI: 3.46-10.9) and one (AOR: 3.35, CI: 1.79-6.27) or more sexual partner(s) (AOR: 2.58, CI: 1.05-6.36). Conclusions: Mobile phone–based social networking is prevalent among sexually active adolescents living in Soweto and may be used as an entry point for health promotion and initiation of low-cost adolescent health interventions. %M 27683173 %R 10.2196/publichealth.4885 %U http://publichealth.jmir.org/2016/2/e154/ %U https://doi.org/10.2196/publichealth.4885 %U http://www.ncbi.nlm.nih.gov/pubmed/27683173 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 8 %P e200 %T Reaching Adolescent Gay, Bisexual, and Queer Men Online: Development and Refinement of a National Recruitment Strategy %A Prescott,Tonya L %A Phillips II,Gregory %A DuBois,L. Zachary %A Bull,Sheana S %A Mustanski,Brian %A Ybarra,Michele L %+ Center for Innovative Public Health Research, 555 N. El Camino Real #A347, San Clemente, CA, 92672, United States, 1 877 302 6858 ext 801, michele@innovativepublichealth.org %K Facebook %K mHealth %K recruitment methods %K intervention development %K HIV %K adolescent %K AGBM %K sexual minority %D 2016 %7 04.08.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Using social networking websites to recruit research participants is increasingly documented in the literature, although few studies have leveraged these sites to reach those younger than 18 years. Objective: To discuss the development and refinement of a recruitment protocol to reach and engage adolescent gay, bisexual, and other teenaged men who have sex with men (AGBM). Participants were recruited for development and evaluation activities related to Guy2Guy, a text messaging–based human immunodeficiency virus infection prevention program. Methods: Eligibility criteria included being between 14 to 18 years old; being a cisgender male; self-identifying as gay, bisexual, and/or queer; being literate in English, exclusively owning a cell phone, enrolled in an unlimited text messaging plan, intending to keep their current phone number over the next 6 months, and having used text messaging for at least the past 6 months. Recruitment experiences and subsequent steps to refine the Internet-based recruitment strategy are discussed for 4 research activities: online focus groups, content advisory team, beta test, and randomized controlled trial (RCT). Recruitment relied primarily on Facebook advertising. To a lesser extent, Google AdWords and promotion through partner organizations working with AGBM youth were also utilized. Results: Facebook advertising strategies were regularly adjusted based on preidentified recruitment targets for race, ethnicity, urban-rural residence, and sexual experience. The result was a diverse sample of participants, of whom 30% belonged to a racial minority and 20% were Hispanic. Facebook advertising was the most cost-effective method, and it was also able to reach diverse recruitment goals: recruitment for the first focus group cost an average of US $2.50 per enrolled participant, and it took 9 days to enroll 40 participants; the second focus group cost an average of US $6.96 per enrolled participant, and it took 11 days to enroll 40 participants. Recruitment for the first content advisory team cost an average of US $32.52 per enrolled participant; the second cost US $29.52 per participant. Both recruitment drives required 10 days to enroll 24 participants. For the beta test, recruitment cost an average of US $17.19 per enrolled participant, and it took 16 days to complete enrollment of 20 participants. For the RCT, recruitment cost an average of US $12.54 per enrolled participant, and it took 148 days to enroll 302 participants. Google AdWords campaigns did not result in any enrolled participants of whom the research staff members were aware. Conclusions: Internet-based strategies can be a cost-efficient means to recruit and retain hard-to-reach populations from across the country. With real-time monitoring of participant demographic characteristics, diverse samples can be achieved. Although Facebook advertising was particularly successful in this study, alternative social media strategies can be explored in future research as these media are ever-changing. %M 27492781 %R 10.2196/jmir.5602 %U http://www.jmir.org/2016/8/e200/ %U https://doi.org/10.2196/jmir.5602 %U http://www.ncbi.nlm.nih.gov/pubmed/27492781 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 5 %N 2 %P e4654 %T Roles of Health Literacy in Relation to Social Determinants of Health and Recommendations for Informatics-Based Interventions: Systematic Review %D 2013 %7 ..2013 %9 %J Online J Public Health Inform %G English %X Objective: School-based sexual health education interventions can reach young people of diverse backgrounds and equip them with knowledge and skills for preventing themselves against HIV/AIDS, unwanted pregnancies, and live healthy and responsible lives. However, given that school-based sexual health education intervention are health projects implemented in educational settings, variety of social and institutional issues can present challenges. This study aimed to obtain rich insights into the facilitating or inhibiting mediators for the implementation of a school-based sexual health education intervention in Uganda.Method: This study conducted 16 qualitative interviews to investigate the mediators for the implementation of the school-based sexual health education intervention based on experiences of two Ugandan schools: the school which successfully completed the implementation of the intervention, and the school which abandoned the intervention half-way the implementation.Results: Rather than the technological aspects, results indicate that the implementation was strongly influenced by interplay of social and institutional mediators, which were more favourable in the “successful” school than in the “failure school”. These mediators were: perceived students’ vulnerability to HIV and unwanted pregnancies; teachers’ skills and willingness to deliver the intervention, management support; match with routine workflow, social-cultural and religious compatibility, and stakeholder involvement.Conclusion: Rather than focusing exclusively on technological aspects, experiences from this evaluation suggest the urgent need to also create social, institutional, and religious climate which are supportive of school-based computer-assisted sexual health education. Evidence-based recommendations are provided, which can guide potential replications, improvements, and policy formulation in subsequent school-based sexual health education interventions. %M 23923098 %R 10.5210/ojphi.v5i2.4654 %U %U https://doi.org/10.5210/ojphi.v5i2.4654 %U http://www.ncbi.nlm.nih.gov/pubmed/23923098