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In 2011, both the National Prevention Strategy and Healthy People 2020 recognized "reproductive and sexual health" as a key area for improving the lives of Americans.1,2 This increasing national emphasis on sexual health provides an important opportunity to refocus the efforts of U.S. health-care professionals. While reproductive health has historically been considered a U.S. public health priority, 3 the addition of sexual health to the short list of national priorities has important implications for clinicians and patients. Broadly embracing the concept of sexual health in health-care settings has the potential to reduce redundancy in care compared with current, more categorical approaches and to minimize the stigma associated with some aspects of sexuality and related adverse outcomes. These changes could increase both clinical efficiency and the proportion of the population receiving sexual health services.To foster sexual health, the National Prevention Strategy and Healthy People 2020 recommend increasing access to sexual health services, emphasizing sexual health education and encouraging screening for sexually transmitted infections (STIs) including human immunodeficiency virus (HIV).1,2 To be most effective, these activities should involve both health-care providers (physicians, nurses, and related clinical providers) and patient audiences. Although this new national emphasis represents an opportunity to improve sexual health throughout the country, it also represents a challenge for the health-care community. The approach to patient care in matters of sexuality and sexual behavior will need to be reframed in subtle but critical ways. To meet this challenge, educational efforts for both health-care providers and patients will need to shift to support a more comprehensive approach to understanding and promoting sexual health throughout the life span.

BackgroundCervical cancer claims the lives of 275,000 women each year; most of these deaths occur in low-or middle-income countries. In Kenya, cervical cancer is the leading cause of cancer-related mortality among women of reproductive age. Kenya’s Ministry of Public Health and Sanitation has developed a comprehensive strategy to prevent cervical cancer, which includes plans for vaccinating preteen girls against human papillomavirus (HPV) by 2015. To identify HPV vaccine communication and mobilization needs, this research sought to understand HPV vaccine-related perceptions and concerns of male and female caregivers and community leaders in four rural communities of western Kenya.MethodsWe conducted five focus groups with caregivers (n = 56) and 12 key-informant interviews with opinion leaders to explore cervical cancer-related knowledge, attitudes and beliefs, as well as acceptability of HPV vaccination for 9–12 year-old girls. Four researchers independently reviewed the data and developed codes based on questions in interview guides and topics that emerged organically, before comparing and reconciling results through a group consensus process.ResultsCervical cancer was not commonly recognized, though it was understood generally in terms of its symptoms. By association with cancer and genital/reproductive organs, cervical cancer was feared and stigmatized. Overall acceptability of a vaccine that prevents cervical cancer was high, so long as it was endorsed by trusted agencies and communities were sensitized first. Some concerns emerged related to vaccine safety (e.g., impact on fertility), program intent, and health equity.ConclusionFor successful vaccine introduction in Kenya, there is a need for communication and mobilization efforts to raise cervical cancer awareness; prompt demand for vaccination; address health equity concerns and stigma; and minimize potential resistance. Visible endorsement by government leaders and community influencers can provide reassurance of the vaccine’s safety, efficacy and benefits for girls and communities. Involvement of community leadership, parents and champions may also be critical for combatting stigma and making cervical cancer relevant to Kenyan communities. These findings underscore the need for adequate planning and resources for information, education and communication prior to vaccine introduction. Specific recommendations for communication and social-marketing strategies are made.

BackgroundHomeless 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.ObjectiveThe 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.MethodsFormative 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.ResultsH/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.ConclusionsYTH 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.

This article takes a new approach to the study of college sexual assault by conducting an analysis of female students’ most recent “hookup.” By isolating a particular hookup event and examining the features of that event, I am able to examine predictors of sexual assault during hookups. My analysis focuses on the implications of alcohol consumption and knowing a male partner before a hookup, while controlling for multiple individual, school, and situational characteristics, using data from the Online College Social Life Survey collected 2005–2011. In my sample, 2.4% of women experienced sexual assault during their most recent hookup. Results show women do not experience an increased risk of physically forced intercourse until they have consumed nine or more drinks. In addition, women were more likely to report sexual assault during a hookup with a man they did not know well. Together, these findings suggest that men are more likely to assault women who are drunk, possibly because the double standard has made them respect such women less, or because they target women who are likely unable to resist or recall what happened. It also appears that the “in‐network stranger” may be the individual most dangerous to women in college hookups.

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Data quality is limited in a manner similar to many STD prevention efforts. Within these limitations, evidence suggests that GYT reaches youth and is associated with increased STD testing.

Psychological theories of identity concealment locate the ultimate source of concealment decisions within the social environment, yet most studies have not explicitly assessed stigmatizing environments beyond the immediate situation. We advanced the identity-concealment literature by objectively measuring structural forms of stigma related to sexual orientation (e.g., social policies) at proximal and distal geographic levels. We linked these measures to a new, population-based data set of 502 gay and bisexual men (residing in 44 states and Washington, DC; 269 counties; and 354 cities) who completed survey items about stigma, including identity-concealment motivation. Among gay men, the association between structural stigma and concealment motivation was (a) observed across three levels (city, county, and state), (b) conditional on one’s exposure at another geographic level (participants reported the least motivations to conceal their identity if they resided in both cities and states that were lowest in structural stigma), and (c) mediated by subjective perceptions of greater structural stigma.