Using Text Message Surveys to Evaluate a Mobile Sexual Health Question-and-Answer Service.

Text message programs for sexual health are becoming increasingly popular as practitioners aim to meet youth on media they use frequently. Two-way mobile health (mHealth) interventions allow for feedback solicitation from participants. This study explores the use of a text message survey to assess demographics and program feedback from users of an adolescent sexual health text message question-and-answer service. Development and feasibility of the short-message service survey are discussed. The text message survey achieved a 43.9% response rate, which is comparable to response rates of surveys conducted via other methods. When compared to respondents who used the service and completed an online in-school questionnaire, text survey respondents were more likely to be female and older. They also reported higher service satisfaction. Results have implications for text message service providers and researchers. This article examines a community application of a new intervention strategy and research methodology.

Influence of perceived interactivity of a sexual health text message service on young people's attitudes, satisfaction and repeat use.

Sexual health text message services are becoming an increasingly popular way to reach young people with sexual health information. A variety of service types exist: some send automated messages on a set schedule; others provide personalized responses to individual questions. Young people's perceptions of interactivity, which is often based on system responsiveness, may vary. This study examines perceptions of interactivity for users of a two-way text message service that connects young people directly with a health educator and examines the relationship between perceived interactivity and attitudes toward the service, service satisfaction, and repeated service use. Data from 131 users in the southeastern U.S.A. were analysed. Perceived interactivity was associated with positive attitudes, user satisfaction and repeat use. Data suggest that for sexual health information seeking, young people may view a program as more useful if they perceive it is interactive. Services that provide a back-and-forth dialog between health educators and users may be perceived as interactive, and those perceptions of interactivity can influence attitudes toward the service as well as behaviors, such as using the service repeatedly. Since such services offer accurate and timely health information, repeated use allows for the additional exchange of health information and educational opportunities.

Bridge over troubled waters: considerations in transitioning emergency contraceptive users to hormonal methods.

BACKGROUND: As emergency contraceptive pills (ECPs) become increasingly available through pharmacies, concerns about potential overuse of this product have emerged. In response, bridging women from ECPs to ongoing contraception was advanced as a solution. STUDY DESIGN: We collected information in Ghanaian pharmacies on ECP users' sexual activity, use of contraceptive methods and reasons for buying ECPs. Further, two behavioral indicators were examined to determine whether a woman should consider using an ongoing contraceptive method: how often she has sex and how she uses ECPs. RESULTS: Of the four types of ECP users, stratified by those two indicators, only women who have sex frequently and use ECPs as their main contraceptive method would be appropriate for, but not necessarily amenable to, bridging. CONCLUSIONS: The challenges of bridging to meet the contraceptive needs of women are discussed in light of the characteristics of emergency contraceptive users and suggest that bridging is not as straightforward as initially conceived.

"I love my ECPs": challenges to bridging emergency contraceptive users to more effective contraceptive methods in Ghana.

BACKGROUND AND METHODS: Emergency contraceptive pills (ECPs) are becoming more popular, yet little is known about the contraceptive preferences of women who take ECPs. Women purchasing ECPs were recruited from pharmacies in Accra, Ghana. A total of 24 semi-structured, qualitative interviews were conducted in May 2008. RESULTS: Nearly all participants preferred ECPs to other contraceptive methods. Although fear of side effects from oral contraceptive pills (OCPs), intrauterine devices and injectables were deterrents to use of those methods, side effects from ECPs were acceptable to this small and highly self-selected group of ECP users. Participants had little knowledge about how other contraceptive methods work and expressed a strong distrust and dislike of condoms. DISCUSSION AND CONCLUSION: Study participants loved their ECPs, despite minor discomforts like bleeding, and most had no concerns about repeated use, though these findings may not apply to women outside Accra or women who obtain ECPs from non-pharmacy settings. Future interventions should work to dispel myths about OCPs, condoms and other modern methods, and focus on basic contraception education.

Comprehension of a prototype emergency contraception package label by female adolescents.

BACKGROUND: We evaluated female adolescents' comprehension of a prototype over-the-counter package label for an emergency contraceptive pill product. STUDY DESIGN: Volunteers aged 12-17 years who could read English were recruited at malls and clinics in six United States metropolitan areas. After completing a literacy assessment, subjects examined the prototype package and answered 20 questions that assessed understanding of six key concepts related to appropriate use of the product. RESULTS: The analysis population included 335 subjects, 54 to 59 of each year of age between 12 and 17 years. When asked what the product is used for, 264 respondents (79%) specifically indicated contraception. The six key concepts were each understood by 83-96% of subjects. In all 24 population subgroups examined, each key concept was understood by at least 72% of subjects. CONCLUSION: Female adolescents aged 17 years and younger understand the prototype package label well enough to enable safe and effective use without assistance from a clinician.

Early adolescents' cognitive susceptibility to initiating sexual intercourse.

CONTEXT: Better methods for investigating sexual risk before the initiation of sexual intercourse are needed to support programming for younger adolescents, especially for abstinent adolescents who are susceptible to initiating intercourse. METHODS: A sample of 854 adolescents in seventh or eighth grade who had never had sexual intercourse completed sexuality surveys in 2002 and 2004. A five-item index that assessed beliefs and expectations about the onset of intercourse was created to indicate adolescents' cognitive susceptibility to initiating intercourse. Logistic regression analysis was used to assess associations between levels of susceptibility and initiation of intercourse by follow-up. The construct and predictive validity of the index were examined using a variety of tests. RESULTS: Thirty-eight percent of respondents were classified as being nonsusceptible to initiating intercourse, 34% as having low susceptibility and 28% as being highly susceptible. Adolescents who were susceptible were more physically mature, had greater sexual feelings and competency, perceived that more peers were sexually active and had fewer positive connections with parents, school and religion than nonsusceptible respondents. Males, blacks and older adolescents were more susceptible than females, whites and younger adolescents, respectively. Compared with nonsusceptible respondents, those with low and high susceptibility had higher odds of initiating intercourse two years later (odds ratios, 2.5 and 8.1, respectively). CONCLUSIONS: The cognitive susceptibility index provides a valid method for assessing sexual risk before the onset of intercourse. Assessing susceptibility among early adolescents could support efforts to delay the onset of intercourse through targeted research and health programming.

Sexy media matter: exposure to sexual content in music, movies, television, and magazines predicts black and white adolescents' sexual behavior.

OBJECTIVE: To assess over time whether exposure to sexual content in 4 mass media (television, movies, music, and magazines) used by early adolescents predicts sexual behavior in middle adolescence. METHODS: An in-home longitudinal survey of 1017 black and white adolescents from 14 middle schools in central North Carolina was conducted. Each teen was interviewed at baseline when he or she was 12 to 14 years old and again 2 years later using a computer-assisted self interview (audio computer-assisted self-interview) to ensure confidentiality. A new measure of each teen's sexual media diet (SMD) was constructed by weighting the frequency of use of 4 media by the frequency of sexual content in each television show, movie, music album, and magazine the teen used regularly. RESULTS: White adolescents in the top quintile of sexual media diet when 12 to 14 years old were 2.2 times more likely to have had sexual intercourse when 14 to 16 years old than those who were in the lowest SMD quintile, even after a number of other relevant factors, including baseline sexual behavior, were introduced. The relationship was not statistically significant for black adolescents after controlling for other factors that were more predictive, including parental disapproval of teen sex and perceived permissive peer sexual norms. CONCLUSIONS: Exposure to sexual content in music, movies, television, and magazines accelerates white adolescents' sexual activity and increases their risk of engaging in early sexual intercourse. Black teens appear more influenced by perceptions of their parents' expectations and their friends' sexual behavior than by what they see and hear in the media.

The mass media are an important context for adolescents' sexual behavior.

PURPOSE: This study compared influences from the mass media (television, music, movies, magazines) on adolescents' sexual intentions and behaviors to other socialization contexts, including family, religion, school, and peers. METHODS: A sample of 1011 Black and White adolescents from 14 middle schools in the Southeastern United States completed linked mail surveys about their media use and in-home Audio-CASI interviews about their sexual intentions and behaviors. Analysis of the sexual content in 264 media vehicles used by respondents was also conducted. Exposure to sexual content across media, and perceived support from the media for teen sexual behavior, were the main media influence measures. RESULTS: Media explained 13% of the variance in intentions to initiate sexual intercourse in the near future, and 8-10% of the variance in light and heavy sexual behaviors, which was comparable to other contexts. Media influences also demonstrated significant associations with intentions and behaviors after all other factors were considered. All contextual factors, including media, explained 54% of the variance in sexual intentions and 21-33% of the variance in sexual behaviors. CONCLUSIONS: Adolescents who are exposed to more sexual content in the media, and who perceive greater support from the media for teen sexual behavior, report greater intentions to engage in sexual intercourse and more sexual activity. Mass media are an important context for adolescents' sexual socialization, and media influences should be considered in research and interventions with early adolescents to reduce sexual activity.

Mass media as a sexual super peer for early maturing girls.

PURPOSE: To investigate the possibility that the mass media (television, movies, music, and magazines) serve as a kind of super peer for girls who enter puberty sooner than their age-mates. Multiple studies have demonstrated significant associations between earlier pubertal timing and earlier transition to first sex. Does puberty also stimulate interest in sexual media content that is seen as giving permission to engage in sexual behavior? METHODS: White and African-American female adolescents (n = 471; average age 13.7 years) recruited from public middle schools in central North Carolina completed two self-administered surveys in their homes about their pubertal status, interest in and exposure to various media, and perceptions of sexual media content. RESULTS: Earlier maturing girls reported more interest than later maturing girls in seeing sexual content in movies, television, and magazines, and in listening to sexual content in music, regardless of age or race. Earlier maturing girls were also more likely to be listening to music and reading magazines with sexual content, more likely to see R-rated movies, and to interpret the messages they saw in the media as approving of teens having sexual intercourse. CONCLUSIONS: The mass media may be serving as a kind of sexual super peer, especially for earlier maturing girls. Given the lack of sexual health messages in most media adolescents attend to, these findings give cause for concern. The media should be encouraged to provide more sexually healthy content, and youth service providers and physicians should be aware that earlier maturing girls may be interested in sexual information.