Discovering Sexual Health Conversations between Adolescents and Youth Development Professionals.

Youth development professionals (YDPs), working at community-based organizations are in a unique position to interact with the adolescents as they are neither parents/guardians nor teachers. The objectives of this study were to explore qualitatively what sexual health issues adolescents discuss with YDPs and to describe those issues using the framework of the Sexuality Information and Education Council of the United States (SIECUS) comprehensive sexuality education guidelines. YDPs reported conversations with adolescents that included topics related to the SIECUS key concepts of human development, relationships, personal skills, sexual behavior, and sexual health.

Evaluation of an intervention among adolescents to reduce preventive misconception in HIV vaccine clinical trials.

PURPOSE: Placebo and randomization are important concepts that must be understood before youth can safely participate in HIV vaccine studies or other biomedical trials for HIV prevention. These concepts are central to the phenomenon of preventive misconception that may be associated with an increase in risk behavior among study participants related to mistaken beliefs. Persuasive messaging, traditionally used in the field of marketing, could enhance educational efforts associated with randomized clinical trials. METHODS: Two educational brochures were designed to increase knowledge about HIV vaccine clinical trials via one- and two-sided persuasive messaging. Through the Adolescent Medicine Trials Network, 120 youth were enrolled, administered a mock HIV vaccine trial consent, and then randomized to receive either no supplemental information or one of the two brochures. RESULTS: The two-sided brochure group in which common clinical trial misconceptions were acknowledged and then refuted had significantly higher scores on knowledge of randomization and interpretation of side effects than the consent-only control group, and the willingness to participate in an HIV vaccine trial was not decreased with the use of this brochure. CONCLUSION: Two-sided persuasive messaging improves understanding of the concepts of randomization and placebo among youth who would consider participating in an HIV vaccine trial. Further evaluation of this approach should be considered for at-risk youth participating in an actual trial of a biomedical intervention for HIV prevention.

Patient and partner perspectives on patient-delivered partner screening: acceptability, benefits, and barriers.

The study examined willingness to engage in patient-delivered partner screening (PDPS) and preferences for expedited partner services (EPS). Forty urban U.S. sexually transmitted infection (STI) clinic patients participated in individual mixed-methods interviews exploring EPS preferences and PDPS willingness. Most participants selected PDPS and PDPT together and uptake varied by patient­partner relationship closeness. For PDPS, several potentially important barriers and benefits were identified. Perceived benefits included improved sexual health for patients and their sexual partner(s) as well as convenience, privacy, and the potential to enhance trust between sexual partners. Perceived barriers included concerns about PDPS processes (e.g., time it would take to receive the result, risk of sample contamination), the accuracy of results, STI stigma and associated blame, lack of trust for a sexual partner, and the packaging/appearance of the screening kit. PDPS affords benefits and may overcome treatment barriers in some situations; however, it shares common PDPT barriers and has its own unique challenges. There are also concerns regarding how the offer of PDPS may interact with PDPT utilization.

Prescription medication sharing among adolescents: prevalence, risks, and outcomes.

We interviewed 594 adolescents throughout the United States. One in five reported sharing prescription medication. Of these, less than half received instructions, many delayed professional care, few informed providers, and a third reported experiencing side effects. Efforts to reduce medication sharing prevalence and risks among adolescents may be justified.

New and improved: the role of text augmentation and the application of response interpretation standards (coding schemes) in a final iteration of birth defects warnings development.

BACKGROUND: Several birth defects warning symbols identified as most successful in an earlier study (Mayhorn and Goldsworthy, 2007) were further modified and then evaluated within a nationally distributed field trial (n = 2773). The purpose for the current research was to determine whether symbol warning components could be improved further, whether the addition of text enhanced comprehension uniformly across symbols, and whether results varied by the application of different interpretation standards (coding schemes). METHOD: A total of 11 warning labels were examined: four new symbols plus the existing baseline symbol, each in versions with and without text, plus a text-only condition. Participant interpretation accuracy and preferences were assessed during face-to-face interview sessions. RESULTS: For symbol-only conditions, several candidate symbols outperformed the existing symbol, one substantially so. The effect of adding text to symbols varied significantly by symbol. Symbol plus text and text-only conditions performed equivalently, generally exceeded symbol-only conditions, and often surpassed the American National Standards Institute benchmark of 85% accurate interpretation. CONCLUSIONS: The research effort has identified a teratogen symbol and warning that outperforms the one currently in use. The effort has also identified important pragmatic and conceptual issues that should inform future work to improve medication labeling and other hazard communication.

Patterns and determinants of patient-delivered therapy uptake among healthcare consumers.

BACKGROUND: Patient-delivered partner therapy (PDPT) may be an effective alternative to traditional approaches to sexually transmitted infection control and prevention. Consumer PDPT uptake is comprised of two behaviors: (1) patient willingness to deliver medicine (patient-delivery) and (2) partner willingness to take it (partner-use). METHODS: 505 participants aged 18 to 47 completed a nationally distributed survey of intentions, attitudes, perceived norms, perceived control, and specific outcome beliefs, normative influences, and barriers/facilitators related to PDPT. Zero-order correlations and multivariate statistics were used to describe PDPT uptake patterns and determinants. RESULTS: Consumer uptake exhibited a highly polarized response pattern with the majority willing to participate in patient-delivery (83%) or partner-use (69.4%). Psychosocial determinants of uptake varied by behavior. Regression models of the psychosocial variables (Adj. R>.75) indicate that, across behaviors, PDPT uptake was most closely associated with perceived norm, followed by attitude and perceived control. Specific factors related to uptake include: beliefs that PDPT makes curing disease easier, reduces the spread of the disease, and ensures people are cured; recommendation by healthcare providers; and that the medicine comes with a note from the healthcare provider and is sealed. Several participant characteristics were also significantly correlated with uptake. CONCLUSIONS: Consumers are willing to engage in PDPT and perceive delivery and use differently. Several beliefs and participant characteristics emerged as potentially important factors in willingness to participate. This information can inform the passage of enabling legislation; the selection of PDPT participants; and the development of provider, patient, and partner informational materials.

Interpretation of pharmaceutical warnings among adolescents.

PURPOSE: Warnings are an important component of pharmaceutical risk mitigation efforts, yet very little research attention has been directed toward adolescent interpretation of such warnings. This study examined adolescents' interpretations of and preferences for warning symbols and statements related to pharmaceuticals with teratogenic properties. METHODS: A total of 200 adolescents interpreted one of four warning symbols and four warning statements. Responses were coded using an established three-tier coding system. Symbol preferences were elicited. Interpretation accuracy and symbol preferences were analyzed by symbol and statement. RESULTS: The symbol in use on medication labels at the time of the study elicited nearly goal levels of interpretation accuracy; however it exceeded allowable levels of critical confusion. An alternative symbol elicited more fully correct responses than the existing symbol and was preferred to the existing symbol by a margin of 2 to 1. Yet another symbol was most preferred despite eliciting fewer correct interpretations. The impact of warning statements on overall warning interpretation varied by statement and statement-symbol combinations. At least one statement appeared to lessen the overall message of caution, and few adolescents expressed an awareness of risk if one "may become pregnant" until explicitly informed of this risk. CONCLUSIONS: Comprehension of medical warning symbols and statements among adolescents is an important public health issue. Those involved in adolescent health education and research have considerable theoretical and practical tools for approaching the development and evaluation of such warning messages. Understanding how warnings are interpreted can lead to more effective communication efforts and reduce risk.

Beyond abuse and exposure: framing the impact of prescription-medication sharing.

OBJECTIVES: We sought to document the frequency, circumstances, and consequences of prescription medication-sharing behaviors and to use a medication-sharing impact framework to organize the resulting data regarding medication-loaning and -borrowing practices. METHODS: One-on-one interviews were conducted in 2006, and participants indicated (1) prescription medicine taken in the past year, (2) whether they had previously loaned or borrowed prescription medicine, (3) scenarios in which they would consider loaning or borrowing prescription medicine, and (4) the types of prescription medicines they had loaned or borrowed. RESULTS: Of the 700 participants, 22.9% reported having loaned their medications to someone else and 26.9% reported having borrowed someone else's prescription. An even greater proportion of participants reported situations in which medication sharing was acceptable to them. CONCLUSIONS: Sharing prescription medication places individuals at risk for diverse consequences, and further research regarding medication loaning and borrowing behaviors and their associated consequences is merited.

Refining teratogen warning symbols for diverse populations.

BACKGROUND: The current research reports on efforts to refine the design of recently developed teratogen warning symbols and to examine their interpretation by different populations such as those with low health literacy, adolescents, and individuals who are not fluent in English. METHODS: Alternative symbols identified as most successful in an earlier study were further refined through the use of multiple focus groups and expert review. Six symbols emerged as potential candidates to replace the current symbol. A nationally distributed field trial (n = 700) examined these six alternate teratogen warnings in addition to the symbol presently in use. RESULTS: Five of the alternate warning symbols exceeded the level of correct interpretation elicited by the current symbol. No symbol exceeded the ANSI limit of 5% critical confusion. Two symbols consistently elicited the most accurate responses in terms of message interpretation, target audience, intended action, and perceived consequences of ignoring the warning. CONCLUSIONS: This effort produced at least two viable alternative symbols that appear to be more effective than the current symbol at communicating both the instruction to not take while pregnant and the consequence that exposure could cause birth defects. Several results varied by participant characteristics. Understanding how members of diverse subpopulations might interact with these warnings should be informative to healthcare professionals.

Exploratory evaluation of several teratogen warning symbols.

BACKGROUND: Previous research has noted potential inadequacies in the warning labels and symbols used with some teratogenic medications. A clear teratogen warning symbol represents an important component of risk mitigation for accidental teratogen exposure. METHODS: Several teratogen warning symbols were developed through rapid prototyping and focus groups. A nationally distributed field trial (n = 300) examined the relative effectiveness of 6 candidate symbols, including the symbol in use at the time of the study. Measures included open-ended interpretation, closed-ended preference, and demographic surveys. Each participant was shown a single symbol and asked what it meant, to whom it applied, and what that person should do. Text statements were added to the symbol and participants were asked to reinterpret the warning. Participants were told the intended message of the warning, shown all 6 symbols, and asked to choose the most effective symbol. RESULTS: Four of 6 symbols achieved levels of correct interpretation close to or exceeding the American National Standards Institute (ANSI) benchmark of 85% and none exceeded the ANSI limit of 5% critical confusion. Symbols elicited varying conceptual responses. Respondents considered 1 symbol to be the most effective, by a 4 to 1 margin. Several outcomes varied by age and by ethnicity. CONCLUSIONS: Several symbols emerged as viable alternatives to the current symbol; however, no 1 symbol was clearly found to be the most effective. Instead, the symbol considered "best" depends on the messages that are considered most essential to the warning. Additionally, it appears a symbol without the addition of text can convey most, but possibly not all, of the meaning required of the warning label. Next steps should include further symbol refinement, closer examination of text additions to symbols, and validation of the candidate symbols and warnings through a large-scale field trial.