Huerfanos digitales: Una realidad en pandemia / Digital orphans: A reality in a pandemic

Webinar N° 76 del ORAS-CONHU, realizado el 01 de julio de 2021 con el objetivo de analizar el uso e impacto de las Tecnologías de Información y Comunicación en el desarrollo de los niños y en la relación con sus padres. Los temas analizados son cibercultura y educación digital. Educación, medios y Tecnologías de la Información y Comunicación (TIC),las experiencias significativas en el uso de estrategias apoyadas con TIC como apoyo a los adolescentes y el impacto de los Videojuegos de rol en línea: ¿Afectan a los adolescentes?.

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.

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.

Traditional and Web-Based Technologies to Improve Partner Notification Following Syphilis Diagnosis Among Men Who Have Sex With Men in Lima, Peru: Pilot Randomized Controlled Trial.

BACKGROUND: Patient-initiated partner notification (PN) following the diagnosis of a sexually transmitted infection is a critical component of disease control in men who have sex with men (MSM) sexual networks. Both printed and internet-based technologies offer potential tools to enhance traditional partner notification approaches among MSM in resource-limited settings. OBJECTIVE: This randomized controlled trial aimed to evaluate the effect of 2 different PN technologies on notification outcomes following syphilis diagnosis among MSM in Peru: a Web-based notification system and patient-delivered partner referral cards. METHODS: During 2012-2014, we screened 1625 MSM from Lima, Peru, for syphilis infection and enrolled 370 MSM with symptomatic primary or secondary syphilis (n=58) or asymptomatic latent syphilis diagnosed by serology (rapid plasma reagin, RPR, and Microhemagglutination assay for Treponema pallidum antibody; n=312). Prior to enrollment, potential participants used a computer-based self-interviewing system to enumerate their recent sexual partnerships and provide details of their 3 most recent partners. Eligible participants were randomly assigned to one of 4 intervention arms: (1) counseling and patient-initiated Web-based PN (n=95), (2) counseling with Web-based partner notification and partner referral cards (n=84), (3) counseling and partner referral cards (n=97), and (4) simple partner notification counseling (control; n=94). Self-reported partner notification was assessed after 14 days among 354 participants who returned for the follow-up assessment. RESULTS: The median age of enrolled participants was 27 (interquartile range, IQR 23-34) years, with a median of 2 partners (IQR 1-5) reported in the past month. Compared with those who received only counseling (arm 4), MSM provided with access to Web-based partner notification (arms 1 and 2) or printed partner referral cards (arms 2 and 3) were more likely to have notified one or more of their sexual partners (odds ratio, OR, 2.18, 95% CI 1.30-3.66; P=.003 and OR 1.68, 95% CI 1.01-2.79; P=.045, respectively). The proportion of partners notified was also higher in both Web-based partner notification (241/421, 57.2%; P<.001) and referral card (240/467, 51.4%; P=.006) arms than in the control arm (82/232, 35.3%). CONCLUSIONS: Both new Web-based technologies and traditional printed materials support patient-directed notification and improve self-reported outcomes among MSM with syphilis. Additional research is needed to refine the use of these partner notification tools in specific partnership contexts. TRIAL REGISTRATION: ClinicalTrials.gov NCT01720641; https://clinicaltrials.gov/ct2/show/NCT01720641 (Archived by WebCite at http://www.webcitation.org/70A89rJL4).

YTH StreetConnect: Development and Usability of a Mobile App for Homeless and Unstably Housed Youth.

BACKGROUND: Homeless and unstably housed (H/UH) youth are disproportionately affected by sexual health issues, including human immunodeficiency virus/sexually transmitted diseases, teen pregnancy, and dating violence, and are at a higher risk for poor mental health and underutilization of services. Research suggests that linking health care to H/UH adolescents might help improve their continuity of care, with most preferring to access health care information via the Internet. YTH StreetConnect is a dual-purpose mobile app that helps H/UH youth access health and vital services in Santa Clara County, CA, USA. We developed YTH StreetConnect PRO in parallel with the youth app as a companion tablet app for providers who serve H/UH youth. OBJECTIVE: The objective of our study was to develop a mobile app to support H/UH youth and their providers in accessing health and vital resources, and to conduct usability and feasibility testing of the app among H/UH youth and technical consultants with local expertise in serving H/UH youth. METHODS: Formative research included a literature review on H/UH youths' mobile phone and Internet usage. In January 2015, we conducted interviews with medical and service providers of H/UH youth. Usability and feasibility testing were done with target audiences. Additionally, we conducted focus groups with youth regarding the app's youth friendliness, accessibility, and usefulness. RESULTS: H/UH youth and their providers noted the app's functionality, youth friendliness, and resources. Usability testing proposed improvements to the app, including visual updates to the user interface, map icons, new underrepresented resource categories, and the addition of a peer rating system. Limitations included a small sample size among H/UH youth and providers and a single site for the study (Santa Clara County, CA), making the findings ungeneralizable to the US population. CONCLUSIONS: YTH StreetConnect is a promising way to increase service utilization, provide referral access, and share resources among H/UH youth and providers. Input from H/UH youth and providers offers insights on how to improve future models of YTH StreetConnect and similar programs that assist H/UH youth.

The hookup: collaborative evaluation of a youth sexual health program using text messaging technology.

BACKGROUND: The Hookup is a collaborative project reaching young people in California with valuable sexual and reproductive health information and linkage to local resources. Due to limited access to subscriber contact information, it has been a challenge to evaluate the program. OBJECTIVE: The aims of this study were to determine the feasibility of using text messaging (short message service, SMS) as an evaluation tool for an educational text message-based program and to evaluate the program itself. METHODS: All subscribers of The Hookup were sent four survey questions via SMS about age, gender, location, referral source and behavior change. An incentive was offered for completing the survey and an opt-out option was provided in the initial message. RESULTS: All existing subscribers of The Hookup (N=2477) received a request to complete the survey using the SMS application on their mobile phones. A total of 832 (33.6%) subscribers responded to the initial question and 481 (20%) answered all four questions. Of the responses, 85% were received in the first two hours of the initial request. Respondents who answered the question about behavior change, 90% reported having made some positive change since subscribing to Hookup, including getting tested for STDs and HIV. CONCLUSIONS: The survey methodology initiated a high response rate from The Hookup subscribers. The survey was able to provide data about subscribers in a short time period at minimal cost. The results show potential for using mobile SMS applications to evaluate SMS campaigns. The findings also support using SMS to provide young people with sexual health prevention messaging and linkage to health services.

Associations among text messaging, academic performance, and sexual behaviors of adolescents.

BACKGROUND: Text messaging is an increasingly common mode of communication, especially among adolescents, and frequency of texting may be a measure of one's sociability. This study examined how text messaging ("texting") frequency and academic performance are associated with adolescent sexual behaviors. METHODS: A cross-sectional survey was administered to students at a public charter high school in Los Angeles County, CA. Two hundred fifty-six high school students aged 14-20 years participated. Outcome measures were history of vaginal sex, condom use, and worries about pregnancy. The main predictors were text messaging frequency and self-reported academic performance. RESULTS: In general, students with lower grades were more likely to have had vaginal sex. Greater texting frequency, however, was associated with vaginal sex only among students with higher grades. In addition, despite similar rates of condom use, sexually active students who both had good grades and texted frequently were more likely than others to have thought they or their partner might be pregnant. CONCLUSIONS: The association between texting and sexual behaviors may vary based on adolescent's academic performance. Adolescent sexual health interventions may benefit from using a combination of sociability measures (such as texting frequency) and academic performance as risk predictors.

Adolescents' perspectives on the use of a text messaging service for preventive sexual health promotion.

PURPOSE: To understand adolescents' perspectives on the use of a preventive sexual health text messaging service. METHODS: Twenty-six adolescents aged 15-20 years old were recruited from two teen clinics in Los Angeles County to participate in focus groups. Three focus groups were held. Discussions focused on the content of the weekly text messages sent by a service called the Hookup, as well as the acceptability of using text messaging to relay sexual health education to adolescents. Codes and themes were developed from transcripts using standard constant comparison methods. RESULTS: Participants enjoyed receiving weekly text messages related to sexual health. They linked their enjoyment to the message content being informative (providing relevant and new information), simple (automatically limited to small words and short phrases), and sociable (easily able to be shared with friends). Participants also pointed to the convenience and ubiquity of text messaging and generally felt that cost of messages was not a concern. Most felt that text messaging provided a sense of privacy for learning about sensitive health topics, although a few expressed concerns about stigma from peers' seeing the messages. CONCLUSIONS: Teens may face several barriers to accessing reliable, useful, and age-appropriate information and services for their health. The use of text messaging is an innovative way to engage teens in preventive health learning and practices. Text messaging may allow efficient delivery of health messages and may offer a discreet way for teens to learn important health information, especially for sensitive topics like sexual health.

Understanding sociocultural and psychological factors affecting transgender people of color in San Francisco.

This ethnographic qualitative study explored the needs of transgender people of color, including biological transitioning issues, gender and group membership identity formation, HIV, and other health issues. The sample consisted of transgender youth and adults of color in San Francisco (N = 43). Data were collected from in-depth interviews with 20 youth and adults and focus groups with 23 individuals. The study focused on perspectives of racial and ethnic minorities from Asian/Pacific Islander, African American, and Latino backgrounds. The medical decision-making perspective was used to gain a deeper understanding of sociocultural and psychological factors affecting transgender individuals of color in San Francisco. The major themes that emerged were gender identity, group membership, transitioning and related issues, sex work, alcohol and drug use, mental health and health care, sense of community, HIV, resources, and other support. Key clinical considerations that health providers can use to improve care of transgender individuals of color are included.

National-level capacity-building assistance model to enhance HIV prevention for Asian & Pacific Islander communities.

OBJECTIVES: Asian & Pacific Islander (A&PI) communities in the United States face increasing risk for HIV, yet have limited access to US culturally competent HIV prevention services. We describe a national HIV prevention capacity-building program for A&PI communities using a multitiered approach addressing systems, institutional, and individual level outcomes. METHODS: The program developed a national network of A&PI HIV and health-focused institutions, and conducts regional-level replication and dissemination of this model to support four areas of capacity building. This network is led by two national organizations coordinating the planning, implementation, and evaluation of the National Capacity-Building Assistance Program. RESULTS: Baseline data are compared with the last 2 years of preliminary data that show increased capacity among community-based organizations and health departments to strengthen culturally competent models of HIV prevention. Systems-level outcomes so far show enhanced leadership skills for HIV-related advocacy efforts, increased ability to leverage the media, and stronger partnerships between peer providers, health departments, and community leaders. CONCLUSION: This program model preliminarily demonstrates that national capacity-building initiatives can foster coalition development, replication of program models, materials sharing, and new leadership that improve HIV-related prevention services for A&PI communities.