Sexting and Mental Health: A School-based Longitudinal Study Among Youth in Texas

Background: Sexting has emerged as a common socio-cultural problem in our society today. Few studies have estimated the prevalence of sexting among younger middle school youth and even fewer have assessed the relationship between sexting and mental health outcomes like anxiety and depression symptoms among middle school youth. Objectives: To estimate the prevalence of sexting among sixth and seventh-grade middle school students in a large urban school district in Southeast Texas and to assess its relationship with mental health outcomes (both anxiety and depression) among these youth. Methods: A retrospective analysis of an existing three-year randomized, two-arm, nested longitudinal study was conducted. Associations between sexting and depression symptoms; and sexting and anxiety symptoms were assessed via univariate and multivariate logistic analysis. Results: The prevalence of sexting among sixth graders was found to be 12%. Compared to youth who were not engaged in sexting, engagement in sexting was associated with significantly increased odds of depression and anxiety symptoms. Conclusion: Sexting is common among youth and is associated with poorer mental health outcomes such as anxiety and depression among these youth, but further validation of these findings is needed

Sexual health education for behavior change: How much is enough?

Purpose: Successful implementation of sexual health curricula in school settings is often compromised by competing academic priorities. This study explores the association between exposure to sexual health lessons (time-on-task in hours and lesson content topics) and delayed sexual initiation of middle school students at long term follow-up. Methods: Post hoc data analysis was conducted from a RCT (n=15 middle schools) in the south-central U.S. in which grade 7 students demonstrated delayed sexual initiation (adjusted odds ratio [AOR]: 1.54, 95% CI: 1.20 to 1.99) by grade 9 follow-up after using It’s Your Game (IYG), a 24 lesson sexual health curriculum. Logistic regression was conducted on a sub-sample of 314 grade 7 and 8 students who received IYG and who were sexually inexperienced at baseline, adjusting for covariates of age, gender, and race/ethnicity to address the impact of lesson exposure variables (time-on-task in hours and type of sexual health content) on initiation of any sex by grade 9. Results: The greatest impact of exposure on delayed sexual initiation was a duration of 13 or more lesson hours (OR = 8.40; p\u3c0.05) and exposure to lesson content on HIV/STI and pregnancy consequences (OR = 4.93; p\u3c0.05). Conclusions: Results support previous exposure studies and provide guidance on how effective sexual health curricula can meet the challenges of delivery in a reduced and competitive academic environment

An Innovative Approach to Impacting Student Academic Achievement and Attitudes: Pilot Study of the HEADS UP Virtual Molecular Biology Lab

Introduction: The Virtual Molecular Biology Lab is an innovative, computer-based educational program designed to teach advanced high school biology students how to create a transgenic mouse model in a simulated laboratory setting. It was created in an effort to combat the current decrease in adolescent enthusiasm for and academic achievement in science and science careers, especially in Hispanic students. Because studies have found that hands-on learning, particularly computer-based instruction, is effective in enhancing science achievement, the Virtual Lab is a potential tool for increasing the number of Hispanic students that choose to enter science fields. [See PDF for complete abstract

Implementation costs of a multi-component program to increase human papillomavirus (HPV) vaccination in a network of pediatric clinics

Introduction: HPV vaccination is both a clinically and cost-effective way to prevent HPV-related cancers. Increased focus on preventing HPV infection and HPV-related cancers has motivated development of strategies to increase adolescent vaccination rates. This analysis estimates the average cost associated with implementing programs aimed at increasing HPV vaccination from the perspective of the clinic decision makers. As providers and healthcare organizations consider vaccination initiatives, it is important for them to understand the costs associated with implementing these programs. Methods: Healthcare provider assessment and feedback, reminders, and education; and parent education/reminder strategies were implemented in a large pediatric clinic network between October 2015 and February 2018 to improve HPV vaccination rates. A micro-costing method was used in 2018 to prospectively estimate program implementation costs with the clinic as the unit of analysis. A sensitivity analysis assessed the effects of variability in levels of participation. Results: Assessment and feedback reports and provider education were implemented among 51 clinics at average per clinic cost of $786 and$368 respectively. Electronic vaccination reminders were delivered to providers and parents at a per clinic cost of $824. The parent education implementation cost was$2,126 per clinic. Conclusion: The four complimentary HPV evidence-based strategies were delivered at a total cost of $157,534 or$4,749 per clinic, including staff training and participant recruitment, reaching 155,000 HPV vaccine eligible adolescents

Public Health Entrepreneurship: A Novel Path for Training Future Public Health Professionals

Background: As schools of public health adapt to the new Council on Public Health (CEPH) competencies there is increased relevance in training public health professionals in public health entrepreneurship. Public health entrepreneurship provides an alternate process to traditional academic approaches focusing on translating public health knowledge into effective, sustainable, and scalable solutions.Objective: This study reports student perceptions of public health entrepreneurship and training needs for successfully equipping future public health professionals.Methods: Focus groups were conducted in April 2018 with graduate public health students in pilot entrepreneurship courses at two U.S.-based CEPH-accredited schools of public health.Results: Participating students (n = 29) were mainly pursing MPH degrees (62%) within Health Management and Policy (38%) or Health Promotion/Global Health (31%) departments. Most students (52%) were between 21 and 30 years old. For 71% of students this was their first academic course with a focus on entrepreneurial thinking. Four themes emerged regarding public health entrepreneurship and training needs for becoming a successful public health professional of the future. Students confirmed a place for public health entrepreneurship in the emerging educational paradigm because it is action-oriented, skills-driven, and fosters innovation through inter-professional collaboration and cross-pollination of knowledge and skills between professional disciplines.Conclusions: The competencies required for public health entrepreneurship are in alignment with CEPH competencies and are well-received by the next generation of public health professionals as an adjunct but nascent approach to stimulate public health innovation

Reducing Sexual Risk among Racial/ethnic-minority Ninth Grade Students: Using Intervention Mapping to Modify an Evidenced-based Curriculum

Background: Racial/ethnic-minority 9th graders are at increased risk for teen pregnancy, HIV, and STIs compared to their White peers. Yet, few effective sexual health education programs exist for this population. Purpose: To apply IM Adapt—a systematic theory- and evidence-based approach to program adaptation—to modify an effective middle school sexual health education curriculum, It’s Your Game…Keep It Real! (IYG), for racial/ethnic-minority 9th graders. Methods: Following the six steps of IM Adapt, we conducted a needs assessment to describe the health problems and risk behaviors of the new population; reviewed existing evidence-based programs; assessed the fit of IYG for the new population regarding behavioral outcomes, determinants, change methods, delivery, and implementation; modified materials and activities; planned for implementation and evaluation. Results: Needs assessment findings indicated that IYG targeted relevant health and risk behaviors for racial/ethnic-minority 9th graders but required additional focus on contraceptive use, dating violence prevention, active consent, and access to healthcare services. Behavioral outcomes and matrices of change objectives for IYG were modified accordingly. Theoretical methods and practical applications were identified to address these behavioral outcomes, and new activities developed. Youth provided input on activity modifications. School personnel guided modifications to IYG’s scope and sequence, and delivery. The adapted program, Your Game, Your Life, comprised fifteen 30-minute lessons targeting determinants of sexual behavior and healthy dating relationships. Pilot-test data from 9th graders in two urban high schools indicate promising results. Conclusion: IM Adapt provides a systematic theory- and evidence-based approach for adapting existing evidence-based sexual health education curricula for a new population whilst retaining essential elements that made the original program effective. Youth and school personnel input ensured that the adapted program was age-appropriate, culturally sensitive, and responsive to the needs of the new population. IM Adapt contributes to the limited literature on systematic approaches to program adaptation

Formative Evaluation of the Time Twisters : A Comic Book Based Obesity Prevention Curriculum for Elementary School Students

Introduction: Obesity is a public health problem, particularly in Hispanic children. Alternative media channels may offer the potential to motivate children to engage in health promoting behaviors. A comic book, “Time Twisters”, was developed to impact screen time use, physical activity, and dietary behavior for elementary school children and evaluated for acceptability and feasibility prior to implementation in a multi-component physical activity intervention. [See PDF for complete abstract

Using Intervention Mapping to Develop an Efficacious Multicomponent Systems-Based Intervention to Increase Human Papillomavirus (HPV) Vaccination in a Large Urban Pediatric Clinic Network

Background: The CDC recommends HPV vaccine for all adolescents to prevent cervical, anal, oropharyngeal, vaginal, vulvar, and penile cancers, and genital warts. HPV vaccine rates currently fall short of national vaccination goals. Despite evidence-based strategies with demonstrated efficacy to increase HPV vaccination rates, adoption and implementation of these strategies within clinics is lacking. The Adolescent Vaccination Program (AVP) is a multicomponent systems-based intervention designed to implement five evidence-based strategies within primary care pediatric practices. The AVP has demonstrated efficacy in increasing HPV vaccine initiation and completion among adolescents 10-17 years of age. The purpose of this paper is to describe the application of Intervention Mapping (IM) toward the development, implementation, and formative evaluation of the clinic-based AVP prototype. Methods: Intervention Mapping (IM) guided the development of the Adolescent Vaccination Program (AVP). Deliverables comprised: a logic model of the problem (IM Step 1); matrices of behavior change objectives (IM Step 2); a program planning document comprising scope, sequence, theory-based methods, and practical strategies (IM Step 3); functional AVP component prototypes (IM Step 4); and plans for implementation (IM Step 5) and evaluation (IM Step 6). Results: The AVP consists of six evidence-based strategies implemented in a successful sequenced roll-out that (1) established immunization champions in each clinic, (2) disseminated provider assessment and feedback reports with data-informed vaccination goals, (3) provided continued medical and nursing education (with ethics credit) on HPV, HPV vaccination, message bundling, and responding to parent hesitancy, (4) electronic health record cues to providers on patient eligibility, and (5) patient reminders for HPV vaccine initiation and completion. Conclusions: IM provided a logical and systematic approach to developing and evaluating a multicomponent systems-based intervention to increase HPV vaccination rates among adolescents in pediatric clinics

Latino Teen Pregnancy in Texas: Prevalence, Prevention, and Policy

Texas is home to over one million Latino teens who are at risk for negative reproductive health outcomes, such as teen pregnancy and STIs. Teen pregnancy disproportionately impacts the health of Latino teens in Texas and places them at risk of continued high rates of poverty, school dropout, and unemployment unless Texas makes a concerted effort to reduce its teen pregnancy rate. The birth rate among Latina girls is astonishing: 98 per 1000 Latinas (aged 15-19) are giving birth. This translates to over 32,000 births each year among Latina teens, costing almost $98 million in direct medical expenditures and well over$638 million if other costs are included. Most teens become sexually experienced while they are of school age, which translates to an estimated 414,583 sexually experienced Latino students attending Texas public schools. Of these Latino youth, 237,466 report being currently sexually active, and 89,000 report having had four or more sexual partners in their lifetime. While causes of teen pregnancy are complex, the solutions to teen pregnancy are known. Texas needs an effective, comprehensive approach to address the sexual health needs of Texas Latino youth that includes: statewide implementation and monitoring of evidence-based sex education for middle school and high school students, access to reproductive health services for students who are already sexually experienced, and widespread training on adolescent sexual health for teachers, service providers, and parents. By tackling teen pregnancy, we can positively impact the future and well-being of not only Latinos, but of all Texans, and subsequently can contribute to the social and economic success of Texas

Adolescent Sexual Behavior: Examining Data from Texas and the US

Background: The US has higher rates of teen births and sexually transmitted infections (STI) than other developed countries. Texas youth are disproportionately impacted. Purpose: To review local, state, and national data on teens’ engagement in sexual risk behaviors to inform policy and practice related to teen sexual health. Methods: 2009 middle school and high school Youth Risk Behavior Survey (YRBS) data, and data from All About Youth, a middle school study conducted in a large urban school district in Texas, were analyzed to assess the prevalence of sexual initiation, including the initiation of non-coital sex, and the prevalence of sexual risk behaviors among Texas and US youth. Results: A substantial proportion of middle and high school students are having sex. Sexual initiation begins as early as 6th grade and increases steadily through 12th grade with almost two-thirds of high school seniors being sexually experienced. Many teens are not protecting themselves from unintended pregnancy or STIs – nationally, 80% and 39% of high school students did not use birth control pills or a condom respectively the last time they had sex. Many middle and high school students are engaging in oral and anal sex, two behaviors which increase the risk of contracting an STI and HIV. In Texas, an estimated 689,512 out of 1,327,815 public high school students are sexually experienced – over half (52%) of the total high school population. Texas students surpass their US peers in several sexual risk behaviors including number of lifetime sexual partners, being currently sexually active, and not using effective methods of birth control or dual protection when having sex. They are also less likely to receive HIV/AIDS education in school. Conclusion: Changes in policy and practice, including implementation of evidence-based sex education programs in middle and high schools and increased access to integrated, teen-friendly sexual and reproductive health services, are urgently needed at the state and national levels to address these issues effectively