Special Issue Introduction: We Can Do More: Challenges and Opportunities for Teen Pregnancy Prevention

Guest editors Susan Tortolero Emery and Kimberly Johnson Baker introduce Volume 8, Issue 1 of the Journal of Applied Research on Children

Thematic Analysis of Mainstream Rap Music - Considerations for Culturally Responsive Sexual Consent Education in High School

Background: Much of the research literature on sexual consent and sexual consent education has been focused on college students, providing a significant gap in our understanding of high school students, especially ethnic minority youth, who are at greatest risk for unwanted sexual contact and sexual activity. Furthermore, recent research suggests that music with sexually suggestive and misogynistic themes influence sexual communication and consenting behaviors. An analysis of rap music produced after the year 2000 is necessary to identify themes that may influence sexual communication among youth. Methods: A thematic analysis was conducted to examine the lyrics of mainstream rap music songs. Songs from the Billboard Hot Rap Singles Year-End Charts for the years 2001 through 2011 served as the data corpus for thematic analysis. Results: Each year, an average of 18 songs in the top 25 rap music hits included some level of sexual content. Overall, approximately 74% of the 244 songs made references to sex, sexual expectations and/or relationships. Three major themes emerged from the analysis: (1) It’s Really About Sex or Nothing At All, (2) Substances as the Precursor/Enhancer, and (3) Performance, Parts & Brand. Conclusion: The major themes found here highlight the prevalence of norms that perpetuate non-consensual sex and non-verbal sexual communication in a dominant musical genre. Each theme presented in this study represents rules and expectations related to sexual interactions that could influence an adolescent’s view of sexual communication and consent. Findings here should be further examined to identify how adolescents may perceive them and resonate with their meanings

Cervical Cancer Survival by Socioeconomic Status, Race/Ethnicity, and Place of Residence in Texas, 1995–2001

Objective: The current study explored whether socioeconomic status (SES), race/ethnicity, and rural residence may be linked to poorer cervical cancer survival by stage at diagnosis. Methods: Data from 7,237 cervical cancer cases reported to the Texas Cancer Registry from 1995–2001 were used to address the association by stage at diagnosis and cause of death. Zip code-level census data were used to classify residence and to develop a composite variable for SES. Multilevel Cox proportional hazards modeling was used to estimate hazard ratios (HR) and 95% confidence intervals (CI). Results: Late stage at diagnosis was a strong predictor of cervical cancer mortality (HR _6.2, 95% CI 5.5-7.2). SES and race/ethnicity were independently associated with stage at diagnosis. Women residing in areas with lower SES had significantly shorter survival times when diagnosed at an early stage (HR _ 3.0, 95% CI 2.1-4.3). Hispanic women had a lower probability of dying from cervical cancer during the follow-up period (HR _ 0.7, 95% CI 0.6- 0.8) after adjusting for confounders. The association between lower SES and poorer survival was consistent across all racial/ethnic groups, suggesting the effect of SES may be more important than race. Conclusions: SES and race/ethnicity were independently associated with poorer cervical cancer survival in this large Texas sample. Further research is needed to investigate the role of optimal treatment and comorbid conditions in the association between SES and cervical cancer survival

Using Formative Research and Audience-Centric Intelligence to Develop the #JustBe Digital Magazine: An mHealth Strategy to Improve Adolescent Sexual Health

Digital strategies may help to overcome challenges in providing contraception education to overlooked and key sub-populations (older teens, ethnic minority youth, LGBTQ youth, high school dropouts and males). However, many current digital strategies are not culturally specific and often have limited information on the most effective contraceptive methods. In this article, we describe the preliminary steps used to develop #JustBe, a user-centered digital strategy for ethnic minority older youth and young adults with a specific focus contraception, sexual health, consent, and healthy relationships. Technology-based strategies such as #JustBe offer advantages over traditional face-to-face methods by utilizing a confidential way to retrieve sexual health information that may be sensitive and potentially embarrassing. Questions still remain regarding the feasibility and long-term effects of mobile health interventions for contraception use

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

Working With Faith-Based Communities to Develop an Education Tool kit on Relationships, Sexuality, and Contraception

Communities disproportionately affected from higher rates of unplanned teen births are in need of sustainable approaches to prevention strategies. One approach is to build the capacity of faith-based communities (FBCs) to address the sexual health needs of the surrounding community. However there is a need for comprehensive, user-friendly resources designed for FBCs that provide critical decision-making information related to pregnancy prevention inclusive of contraception. Using community-based, theoretical and practice-informed strategies, we developed a user-friendly sexuality education tool kit in five phases: (1) building relationships with faith leaders; (2) piloting educational sessions within churches; (3) gaining insight from participating faith leaders; (4) creating the tool kit; and (5) collecting feedback from training and implementation. Our findings suggest faith leaders remained motivated to overcome perceived barriers by their mission to serve their communities. A sexuality education tool kit that is respectful and guided by the input of FBCs can be a viable and innovative approach to address teen pregnancy

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

Sense of control and diabetes mellitus among U.S. adults: A cross-sectional analysis

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens

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