The role of disclosure & perceptions about providers in health discussions among gay and bisexual young men.

OBJECTIVES: Gay and bisexual men may feel discomfort discussing sensitive topics such as sexual behaviors and substance use with their health providers, which may prevent them from receiving important health information. This study investigates whether patients' perceptions of their provider's sexual orientation predicts patient-provider discussions of sexual and general health topics, and whether this relationship is moderated by patients' disclosure of sexual orientation to providers. METHODS: Data were collected online from a sample of 576 gay and bisexual men living in the USA, aged 18-26. Adjusted risk ratios were estimated by using modified Poisson regression with robust error variance. RESULTS: Participants who believed their providers were gay or bisexual were more likely to have discussed sexual health topics, but not general health topics; simple slopes analyses revealed that this effect was stronger among those who had not disclosed to their providers. Disclosure was also consistently associated with increased likelihood of discussing almost all topics. CONCLUSIONS: Findings highlight differences in communication based on disclosure and perceived sexual orientation of provider, suggesting the need to further explore how these differences influence young gay and bisexual men's health. PRACTICE IMPLICATIONS: Dyads may be more likely to discuss sexual health topics when patients believe their providers are sexual minorities themselves. In addition, patient-provider dyads may be likelier to discuss various health topics when providers are aware of patients' sexual minority statuses.

Human Papillomavirus Vaccines: Successes and Future Challenges.

Over a decade has passed since the first human papillomavirus (HPV) vaccine was introduced. These vaccines have received unequivocal backing from the scientific and medical communities, yet continue to be debated in the media and within the general public. The current review is an updated examination that the authors made five years ago on some of the key sociocultural and behavioral issues associated with HPV vaccine uptake and acceptability, given the changing HPV vaccine policies and beliefs worldwide. We explore current worldwide HPV vaccination rates, outline HPV vaccine policies, and revisit critical issues associated with HPV vaccine uptake including: risk compensation, perceptions of vaccine safety and efficacy, age of vaccination, and healthcare provider (HCP) recommendation and communication. While public scrutiny of the vaccine has not subsided, empirical evidence supporting its safety and efficacy beyond preventing cervical cancer has amassed. There are conclusive findings showing no link that vaccinated individuals engage in riskier sexual behaviors as a result of being immunized (risk compensation) both at the individual and at the policy level. Finally, HCP recommendation continues to be a central factor in HPV vaccine uptake. Studies have illuminated how HCP practices and communication enhance uptake and alleviate misperceptions about HPV vaccination. Strategies such as bundling vaccinations, allowing nurses to vaccinate via "standing orders," and diversifying vaccination settings (e.g., pharmacies) may be effective steps to increase rates. The successes of HPV vaccination outweigh the controversy, but as the incidence of HPV-related cancers rises, it is imperative that future research on HPV vaccine acceptability continues to identify effective and targeted strategies to inform HPV vaccination programs and improve HPV coverage rates worldwide.

Young Men's Disclosure of Same Sex Behaviors to Healthcare Providers and the Impact on Health: Results from a US National Sample of Young Men Who Have Sex with Men.

Many men who have sex with men (MSM) do not disclose their same sex behaviors to healthcare providers (HCPs). We used a series of logistic regression models to explore a conceptual framework that first identified predictors of disclosure to HCPs among young MSM (YMSM), and subsequently examined young men's disclosure of male-male sexual behaviors to HCPs as a mediator between sociodemographic and behavioral factors and three distinct health outcomes [HIV testing, sexually transmitted infection (STI) testing, and human papillomavirus (HPV) vaccination]. We determined the predictors of disclosure to HCPs among YMSM and examined the relationship between disclosure and the receipt of appropriate healthcare services. Data were collected online through a US national sample of 1750 YMSM (ages 18-29 years) using a social and sexual networking website for MSM. Sexual history, STI/HIV screening history, sexual health, and patient-provider communication were analyzed in the logistic regression models. Participants were predominantly white (75.2%) and gay/homosexual (76.7%) with at least some college education (82.7%). Young men's disclosure of male-male sexual behaviors to HCPs was associated with the receipt of all healthcare outcomes in our model. Disclosure was a stronger mediator in HPV vaccination than in HIV and STI testing. Disclosure to non-HCP friends and family, HCP visit in the past year, and previous STI diagnosis were the strongest predictors of disclosure. Young men's disclosure of male-male sexual behaviors to HCPs is integral to the receipt of appropriate healthcare services among YMSM. HPV vaccination is more dependent on provider-level interaction with patients than HIV/STI testing.

Cancer Genetic Counselors' Current Practices and Attitudes Related to the Use of Tumor Profiling.

Tumor profiling (TP) is primarily used to identify driver mutations within a tumor for treatment purposes, but it may also identify germline mutations. Current involvement of cancer genetic counselors (GCs) in the TP process is not clear. Members of the National Society of Genetic Counselors Cancer Special Interest Group were invited to participate in a confidential, web-based survey to characterize current practices and attitudes related to the use of TP. Of 105 useable responses, 86.7% of GCs reported their institutions were using TP, although only 6.7% did this routinely. Although 63.7% reported personal involvement in the process, largely with result interpretation and follow-up germline testing, 69.7% reported seeing fewer than 5 patients for this reason and 97.9% desired further education on this topic. Work and regional setting were not predictors of involvement with TP; however, GCs in the academic setting were less aware of who obtains consent (p = 0.001). GCs reported they were not often utilized as a resource regarding TP. Overall, GCs believed TP is beneficial in identifying hereditary cancer syndromes, although most reported finding a germline mutation in <10% of cases. This study provides a snapshot of current GC involvement with TP, and documents the desire by GCs for additional education on tumor profiling.

Differences in cervical cancer screening knowledge, practices, and beliefs: An examination of survey responses.

Among the identified barriers to HPV vaccination is the concern that women may compensate for their reduced susceptibility to cervical cancers by reducing cervical cancer screening. This exploratory study examined the relationship between cervical cancer screening rates and HPV vaccination. We conducted a cross-sectional survey using a convenience sample of women aged 21-35 attending a local minority health fair in July 2015. Data were analyzed in 2015-2016. Outcomes assessed were: receiving a Pap test within the last three years, awareness and comfort with current Pap test recommendations, and knowledge regarding the purpose of a Pap test. A total of 291 women were included in the analyses. Mean age was 28.5 years and 62% were non-Hispanic black. 84% had received a Pap test in the last three years and 33% had received at least one HPV vaccine. Logistic regression results showed that women who had been vaccinated did not have lower odds of having a Pap test in the past three years (OR = 1.32; 95% CI = 0.66-2.65). In an adjusted regression model controlling for age and race, vaccinated women were significantly more likely to have had a Pap test (AOR = 3.06; 95% CI = 1.37-6.83). Yet only 26% of women knew the purpose of a Pap test and the proportion who answered correctly was higher among non-Hispanic white women. Women who have been vaccinated for HPV are more likely to have been screened for cervical cancer. These results suggest areas for more robust studies examining pro-health attitudes, behaviors, and communication regarding vaccination and preventive screening.

The Influence of Age, Health Literacy, and Affluence on Adolescents' Capacity to Consent to Research.

While adults are assumed to have the capacity to consent to medical research, and young children to have no capacity, adolescents' capacity to consent is not well described. Adapting the MacArthur Competence Assessment Tool for Clinical Research (MacCAT-CR), we describe adolescents' capacity to consent to medical research and factors influencing that capacity. Our pilot study included a community-based sample of 30 adolescents, 14 to 21 years of age, who completed the MacCAT-CR after undergoing a simulated informed consent process. We found that adolescents' capacity to consent to research was associated with age, health literacy, and family affluence. These findings suggest that investigators and institutional review boards should be aware that factors other than age may influence capacity to consent, and, for modifiable factors, such as health literacy, consent processes for medical research with adolescents can be modified.

Catching Up or Missing Out? Human Papillomavirus Vaccine Acceptability Among 18- to 26-Year-old Men Who Have Sex With Men in a US National Sample.

BACKGROUND: Men who have sex with men (MSM) are disproportionately affected by human papillomavirus (HPV)-related outcomes and would benefit from HPV vaccination in adolescence. We assessed HPV vaccine attitudes, uptake, and barriers in this high-risk young MSM (YMSM) population. METHODS: An online US sample of 1457 YMSM aged 18 to 26 years were recruited in December 2011 to examine HPV vaccine acceptability and uptake. The online survey included sociodemographics, HPV vaccine attitudes, acceptability, HPV vaccination status, health care use, and HPV knowledge. RESULTS: Despite high use of health care in the past year (86%) and high acceptability (87.8/100) for free HPV vaccine, only 6.8% had received one or more vaccine doses. In addition, only 4% of unvaccinated men had been offered the vaccine by their health care provider (HCP). In a multivariate regression of unvaccinated men, increased vaccine acceptability was associated with an HCP recommendation, worry about getting infected with HPV, and being tested for a sexually transmitted disease in the past year, whereas safety concerns, lower perceived risk of infection, and shame associated with HPV infection/disease were associated with decreased vaccine acceptability. Through logistic regression, vaccine uptake was associated with being tested for a sexually transmitted disease in the past year, disclosure of being gay or bisexual to a doctor, and greater HPV knowledge. CONCLUSIONS: Health care providers need to use routine points of contact with YMSM patients to vaccinate against HPV. These data indicated missed opportunities to vaccinate YMSM who are open to HPV vaccination. In the future, HCPs of YMSM should be careful to avoid missed opportunities to vaccinate.

Vaccinating sons against HPV: results from a U.S. national survey of parents.

PURPOSE: The quadrivalent HPV vaccination was approved for use in males ages 9 to 26 in 2009 and recommended for routine administration in 2011. The purpose of this study was to uncover predictable commonalities amongst parents who chose to vaccinate their 11-17 year old sons against HPV. METHODS: We compiled data from a U.S. national sample of 779 parents with sons 11-17 years old using a web-based survey to gather information about behavioral and sociodemographic factors which predicted receipt of 1 or more HPV vaccine doses based on parental report. Predictors were first modeled individually for univariable associations. Significant predictors (p<0.10) were combined in a multivariable model. RESULTS: In the adjusted model, independent predictors included receipt of flu vaccination, health insurance coverage and sexual health topic discussions with sons. Sons who had received a flu shot in the last two years more frequently received at least one dose of the vaccine (OR 1.82; 95% CI 1.45-2.26). Sons covered by private health insurance had decreased odds of HPV vaccination (OR 0.56 95% CI 0.37-0.83). Lastly, parents who had discussed sexual health topics with their sons were more likely to vaccinate (OR 1.61; 95% CI 1.37-1.89). CONCLUSIONS: Male vaccination rates in the U.S. have increased, but males continue to be under-immunized. Utilization of health care is an important factor in HPV vaccine uptake; therefore, health care providers should use every contact as an opportunity to vaccinate. Communication about sexual health topics may provide a forum for parents and health care providers to have conversations about HPV vaccination as those more comfortable discussing these topics may also be more comfortable discussing HPV vaccination.

Acceptability of the human papillomavirus vaccine and reasons for non-vaccination among parents of adolescent sons.

Routine administration of the quadrivalent human papillomavirus (HPV) vaccine has been recommended for 11-12-year-old males since 2011, but coverage remains low. In a U.S. national sample of parents of 11-17-year-old males (n=779), 78.6% of parents reported their sons had not received the HPV vaccine. The most common reason for non-vaccination (56.7%) was "My doctor or healthcare provider has not recommended it." Parents citing only logistical reasons for non-vaccination (e.g., lack of recommendation, access, or education, n=384) reported significantly higher vaccine acceptability than parents reporting a combination of attitudinal (e.g., concerns about vaccine safety or efficacy) and logistical barriers (n=92), while parents citing only attitudinal barriers (n=73) reported the lowest level of vaccine acceptability. In sum, many parents are willing but have not vaccinated sons due to logistical barriers, most commonly lack of healthcare provider recommendation. These findings have important implications for increasing HPV vaccination coverage among adolescent males.

What parents and their adolescent sons suggest for male HPV vaccine messaging.

OBJECTIVE: The purpose of this article was to identify the information parents and their adolescent sons deem important when making the decision to get vaccinated against human papillomavirus (HPV). METHOD: Twenty-one adolescent males (ages 13 to 17), with no previous HPV vaccination, and their parents were recruited from adolescent primary care clinics serving low- to middle-income families in a large Midwestern city. Dyad members participated in separate semistructured interviews eliciting the information participants felt would increase vaccine uptake and series completion via media and clinic-based sources. Interviews were recorded, transcribed, and coded using inductive content analysis. RESULTS: Overall, participants felt fear-based messages would be most effective for increasing vaccination uptake through commercials. When describing clinic messages, parents and sons felt the most important component was a recommendation for vaccination from the health care provider (HCP). Additionally, parents desired more information about the vaccine from the HCP than the sons, including cost, number of shots, and time since the approval of the vaccine for males. Compared with the clinic message, the commercial message was a vector for vaccine awareness, whereas the clinic message was a source of vaccine information. Vaccine initiation messages should provide vaccine information and come from an HCP, whereas completion messages should remind the patient why they initiated the vaccine and can come from any medical staff. CONCLUSIONS: Family/individual-focused interventions should be tailored to message source, timing, and target audience. This information can be used to guide public health professionals in the development of interventions to increase vaccine uptake.

Alcohol use trajectories after high school graduation among emerging adults with type 1 diabetes.

OBJECTIVE: To explore alcohol involvement trajectories and associated factors during the year post-high school (HS) graduation among emerging adults with type 1 diabetes. METHODS: Youth (N = 181) self-reported alcohol use at baseline and every 3 months for 1 year post-HS graduation. Data were also collected on parent-youth conflict, diabetes self-efficacy, major life events, living and educational situations, diabetes management, marijuana use, cigarette smoking, and glycemic control. Trajectories of alcohol use were modeled using latent class growth analysis. Associations between trajectory class and specific salient variables were examined using analysis of variance, chi square, or generalized linear mixed model, as appropriate. RESULTS: Identified alcohol involvement trajectory classes were labeled as (1) consistent involvement group (n = 25, 13.8%) with stable, high use relative to other groups over the 12 months; (2) growing involvement group (n = 55, 30.4%) with increasing use throughout the 12 months; and (3) minimal involvement group (n = 101, 55.8%) with essentially no involvement until the ninth month. Those with minimal involvement had the best diabetes management and better diabetes self-efficacy than those with consistent involvement. In comparison with those minimally involved, those with growing involvement were more likely to live independently of parents; those consistently involved had more major life events; and both the growing and consistent involvement groups were more likely to have tried marijuana and cigarettes. CONCLUSIONS: This sample of emerging adults with type 1 diabetes has three unique patterns of alcohol use during the first year after HS.

Beliefs, behaviors and HPV vaccine: correcting the myths and the misinformation.

OBJECTIVE: Human papillomavirus (HPV) vaccine uptake in many countries has been sub-optimal. We examine several issues associated with non-vaccination that have received particular attention, including fears about sexual risk compensation, concerns about vaccine safety, inadequate vaccination recommendations by health care providers (HCPs), and distrust due to the perceived "newness" of HPV vaccines. METHODS: Selective review of behavioral and social science literature on HPV vaccine attitudes and uptake. RESULTS: There is no evidence of post-vaccination sexual risk compensation, HPV vaccines are quite safe, and they can no longer be considered "new". Nonetheless, research findings point to these issues and, most importantly, to the failure of HCPs to adequately recommend HPV vaccine as major drivers of non-vaccination. CONCLUSION: Most fears related to HPV vaccine are more related to myth than reality. In the absence of major health policy initiatives, such as those implemented in Canada, the U.K., and Australia, a multi-level, multi-faceted approach will be required to achieve high rates of HPV vaccination. It will be essential to focus on the education of HCPs regarding indications for HPV vaccination and approaches to communicating most effectively with parents and patients about the safety and benefits of vaccination and the risks associated with non-vaccination.

Impulse control, diabetes-specific self-efficacy, and diabetes management among emerging adults with type 1 diabetes.

OBJECTIVE: To explore the relationships among impulse control, diabetes-specific self-efficacy, and diabetes management behaviors among emerging adults with type 1 diabetes. METHODS: A total of 204 high school seniors (M = 18.25 years, SD = .45, 55.9% females) with type 1 diabetes self-reported on impulse control, diabetes-specific self-efficacy, and diabetes management behaviors during the past 3 months. Mediation and path analyses were used to address aims. RESULTS: Greater impulse control was associated with better diabetes management among these emerging adults. In addition, diabetes-specific self-efficacy partially mediated the relationship between impulse control and diabetes management. CONCLUSIONS: Impulse control and diabetes-specific self-efficacy may be important in the management of type 1 diabetes among emerging adults. Diabetes-specific self-efficacy may play an important role in successful diabetes management among youth with lower impulse control.

Parent-son decision-making about human papillomavirus vaccination: a qualitative analysis.

BACKGROUND: Licensed for use in males in 2009, Human Papillomavirus (HPV) vaccination rates in adolescent males are extremely low. Literature on HPV vaccination focuses on females, adult males, or parents of adolescent males, without including adolescent males or the dynamics of the parent-son interaction that may influence vaccine decision-making. The purpose of this paper is to examine the decision-making process of parent-son dyads when deciding whether or not to get vaccinated against HPV. METHODS: Twenty-one adolescent males (ages 13-17), with no previous HPV vaccination, and their parents/guardians were recruited from adolescent primary care clinics serving low to middle income families in a large Midwestern city. Dyad members participated in separate semi-structured interviews assessing the relative role of the parent and son in the decision regarding HPV vaccination. Interviews were recorded, transcribed, and coded using inductive content analysis. RESULTS: Parents and sons focused on protection as a reason for vaccination; parents felt a need to protect their child, while sons wanted to protect their own health. Parents and sons commonly misinterpreted the information about the vaccine. Sons were concerned about an injection in the penis, while some parents and sons thought the vaccine would protect them against other sexually transmitted infections including Herpes, Gonorrhea, and HIV. Parents and sons recalled that the vaccine prevented genital warts rather than cancer. The vaccine decision-making process was rapid and dynamic, including an initial reaction to the recommendation for HPV vaccine, discussion between parent and son, and the final vaccine decision. Provider input was weighed in instances of initial disagreement. Many boys felt that this was the first health care decision that they had been involved in. Dyads which reported shared decision-making were more likely to openly communicate about sexual issues than those that agreed the son made the decision. CONCLUSION: Parents and sons play an active role in the decision-making process, with an individual's role being influenced by many factors. The results of this study may be used to guide the messages presented by clinicians when recommending the HPV vaccine, and future vaccine uptake interventions.

Sexual pleasure during condom-protected vaginal sex among heterosexual men.

INTRODUCTION: Public health condom promotion efforts increasingly focus on the importance of sexual pleasure; however, little is known about sexual event-specific factors that may increase or decrease perceptions of sexual pleasure when condoms are used. AIMS: To examine event-level factors associated with ratings of sexual pleasure during condom-protected vaginal intercourse. METHODS: Data were collected in 2008 from 1,875 men during a prospective daily diary study of sexual behavior and condom use. Sexual pleasure was assessed during condom-protected vaginal intercourse considering situational, relational, intrapersonal, and behavioral predictors. Analyses were generalized estimating equation ordinal regression. MAIN OUTCOME MEASURES: Event-specific perceptions of sexual pleasure (three categories: not at all enjoyable to extremely enjoyable). RESULTS: Vaginal intercourse was reported on 29.8% (N = 8,876/29,714) of diary days; complete condom use was reported for 59.1% (5,249/8,876) of all vaginal intercourse events. This was confusing by using the word "all sexual events." Higher sexual pleasure ratings during complete condom use were associated with older age, manual stimulation of one's genitals, receiving oral sex, and performing oral sex. Sexual pleasure ratings also increased in association with intercourse duration, intercourse intensity, ejaculation, erection perception, and condom comfort. Sexual pleasure ratings were lower with erection difficulty and partner discomfort during sex. CONCLUSIONS: These data advance understanding of sexual pleasure during condom use, suggesting that sexual pleasure increases in conjunction with specific relational, physiological, and condom perceptions. These findings offer points upon which clinicians and health educators can engage men in an ongoing dialogue about augmenting sexual pleasure in the context of condom use.

Health beliefs and vaccine costs regarding human papillomavirus (HPV) vaccination among a U.S. national sample of adult women.

OBJECTIVE: Health beliefs have been found to be significant predictors of vaccine acceptability and uptake, including attitudes about HPV vaccine. In this study, we examined whether the predictive strength of health beliefs varied as a function of vaccine cost among adult women. METHODS: During April 2009, data were collected from a nationally representative internet sample of 1323 US-resident women aged 27-55 years. Participants completed items related to sociodemographics, health beliefs, and HPV vaccine acceptability. Acceptability was measured at three levels of cost: free, $30/dose, and $120/dose. RESULTS: Multiple linear regression (MLR) revealed that health belief variables accounted for 29.7% of the variability in overall HPV vaccine acceptability. However, there was a linear and significant decrease in R(2) values from 0.31 for a free vaccine, to 0.25 for a $30/dose vaccine, to 0.11 for a $120/dose vaccine. CONCLUSION: The results confirm previous findings that health beliefs predict HPV vaccine acceptability. However, the predictive strength of the association decreased with increasing cost. These findings suggest that interventions designed to increase vaccination by modifying health beliefs may have limited effect unless cost is minimized as a barrier.

Human papillomavirus vaccine and men: what are the obstacles and challenges?

PURPOSE OF REVIEW: The present review describes the indications for vaccinating men with the quadrivalent human papillomavirus (HPV) vaccine, reports on the US rates of male vaccination, and reviews the recent research on acceptability of vaccinating men and research on the cost-effectiveness of adding men to existing female HPV immunization programs. RECENT FINDINGS: Recent evidence shows that the quadrivalent HPV vaccine prevents several HPV-related diseases in men. However, despite the licensure of the vaccine in the USA for men 9 through 26 years of age, rates of male vaccination are very low. Research on acceptability, in general, indicates strong interest in vaccination among men, parents, and healthcare providers, though female vaccination is typically seen as a higher priority. Cost-effectiveness studies indicate that in the context of modest female vaccination rates and with the specification of a broad range of disease outcomes (e.g. genital warts, anogenital cancers, and oropharyngeal cancers), male vaccination can be quite cost-effective. SUMMARY: Men are at high risk for HPV infection and can benefit from vaccination, but vaccination rates among men remain extremely low. More research needs to be done on the predictors of uptake of HPV vaccine among men and on the development of interventions to increase male vaccination.

Accuracy of self-reported human papillomavirus vaccine receipt among adolescent girls and their mothers.

PURPOSE: The use of self-report of human papillomavirus (HPV) vaccination status has several implications for clinical care and research. Reports of HPV vaccination history of adolescent girls (ages: 14-17 years) and their mothers were compared with medical chart data to assess the accuracy of HPV vaccine recall. METHODS: Adolescent girls (N = 74) and their mothers independently completed questionnaires regarding HPV vaccination history, which were compared with medical chart data to assess the accuracy of HPV vaccine recall. RESULTS: There were high levels of inaccuracy between actual HPV vaccination and self-report of vaccine receipt. Both mothers and daughters had poor recall of HPV vaccination, and were more likely to underestimate than overestimate the coverage. Girls who accurately reported their vaccination status were not more likely to have been sexually active in the past 2 months (p = .75). CONCLUSIONS: These findings have clinical and research implications, as self-report is relied on to assess young women's vaccination status in research settings or in the absence of medical records. These data address the still prevalent concern that HPV vaccination encourages adolescent sexual behavior. It is unlikely that sexual behaviors will change as a result of vaccination in the large percentage of girls who cannot recall being vaccinated.

The natural history of incident gonococcal infection in adolescent women.

BACKGROUND: The natural history of Neisseria gonorrhoeae (GC) infections is largely unknown. The objective of the current study was to use sequential weekly vaginal samples and molecular techniques to describe the natural history of incident gonorrhea infections in adolescent women. METHODS: A cohort of 387 adolescent women aged 14 to 17 were enrolled from urban, primary care clinics and followed longitudinally for a period of up to 8 years. Weekly vaginal swabs and daily diaries were provided during 12-week periods biannually, beginning and ending with a clinic visit, where all identified infections were treated. For this study, specimens and data from 16 women who became infected with GC during a weekly sampling period were analyzed. RESULTS: GC organism load was highly variable between subjects. The number of organisms did not significantly differ across the first 6 weeks of infection (P = 0.59). Organism load did not differ among women with a previously documented GC infection at week 1 (P = 0.43) or across the first 6 weeks of infection (P = 0.67). The association of concurrent chlamydial infection on gonorrhea organism load was borderline significant over the first 6 weeks of infection (P = 0.06). CONCLUSIONS: Individual shedding patterns varied widely, and GC organism load did not decline in women for at least several weeks and were not associated with genitourinary symptoms. Chlamydia coinfection is associated with higher GC organism loads, potentially increasing chances of transmission. This study utilized a standardized quantification technique to assess GC organism load.

When condom use is not condom use: an event-level analysis of condom use behaviors during vaginal intercourse.

INTRODUCTION: Little is known about event-level condom use errors during vaginal sex. AIMS: The aim of this article is to examine factors associated with complete condom use compared to forms of incomplete condom use, including delayed condom application and early condom removal, over a 30-day period. METHODS: Data were collected in 2008 from 1,875 men during a prospective daily diary study of sexual behavior and condom use. Incomplete condom use was assessed during vaginal intercourse considering situational, relational, intrapersonal, and behavioral predictors. Analyses were generalized estimating equation multinomial logistic regression. MAIN OUTCOME MEASURES: Condom use during vaginal sex: complete use, delayed application, early removal, and both delayed application/early removal. RESULTS: Of 29,714 diary reports, 30% (8,876) included vaginal intercourse. Analyses were conducted (in 2009) on 83.2% of these intercourse events (6,325), during which condoms were used and for which participants provided complete data. Incomplete condom use included penetration before applying condoms during 12% of events (749), removing condoms before intercourse ended during 3.1% (198), and both types of incomplete use during 2% (129) of events. Erection quality (less than typical erect penile length and circumference, less rigidity, and difficulty maintaining erection) was associated with greater odds of incomplete use, as was a participant's history of other recent incomplete use. Perceptions of condom comfort and recent previous complete use were protective factors against incomplete use. CONCLUSIONS: Men's incomplete condom use is associated with recent condom use patterns, as well as with their physiological characteristics and perceptions of condoms during sexual intercourse. Event-level analyses such as these help describe how incomplete condom use occurs among individuals incorporating condoms into their sexual activities.