Medicine and Health Sciences Commons^™

Addressing Adolescent Sexual Health Through An Educational Toolkit For Providers In Rural Alaska, Anna M. Martin, Tracy L. Brewer, Hannah E. Warren

Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Introduction. Adequately addressing an adolescent’s sexual health is essential during the child’s development yet, 33% of adolescents have health visits with no mention of sexual health. On average, primary care providers spend approximately thirty-six seconds discussing sexual health topics with adolescents despite recommendations for comprehensive education. Alaska Native youth face significant disparities regarding sexual and reproductive health care. Implementation and evaluation of a comprehensive educational toolkit regarding various sexual health topics for rural healthcare providers in Alaska revealed positive outcomes in discussing sexual health with an adolescent.

Methods. Larrabee's Model for Evidence-based Practice Change guided the development, implementation, and …

Parental Perceptions Of The Hpv Vaccine For Prevention Of Anogenital And Oropharyngeal Cancers, Beth I. Schwartz, Merissa Maccani, Shalini Bansal, Meghan Gannon

Department of Obstetrics and Gynecology Faculty Papers

Background and Objectives

Human papillomavirus (HPV) is implicated in the development of both anogenital and oropharyngeal cancers. Although HPV vaccination prevents the majority of anogenital and head and neck cancers (HNC), vaccination rates remain low, especially among males. Known barriers to vaccination are knowledge gaps and vaccine acceptability. The objective of this study is to explore parental knowledge, perceptions, and decision-making processes about HPV and HPV vaccination for both anogenital and HNC.

Methods

This qualitative study recruited parents of children and adolescents aged 8–18 to participate in semi-structured telephone interviews. Data were analyzed using thematic analyses, informed by an inductive …

Identification Of Cancer Related Risk And Protective Factors For American Indian Youth: A Mixed Studies Review, Melanie Nadeau, Kathryn Wise, Vianca Farfan Cuela, Devon Olson, Karan Saravana

Indigenous Health Faculty Publications

Introduction: Many causes of cancer related morbidity and mortality can be traced back to childhood behaviors. The culmination of cancer related risk and protective factors impacting the health and wellbeing of American Indian youth is unknown. The aim of this Mixed Studies Review was to identify cancer related risk and protective factors among American Indian youth. Results will be shared with Tribal communities to inform surveillance efforts.

Methods: A Mixed Studies Review process was deemed most appropriate for the search process and data collection. 7 databases were included in the search along with 3 databases that were hand searched. Google …

Assessment Of Macronutrients Consumption In The Diet Of Adolescent School Children In Four Seasons: A Longitudinal Study From An Urban City In Pakistan, Syed Hasan Raza Abidi, Aysha Almas, Abdul Ghani, Sania Sabir, Romaina Iqbal

Medical College Documents

Background: A healthy diet in the adolescence period is essential for physical, mental, and immunological development. We aimed to assess macronutrient consumption in the diet of adolescent school children using 24 h recalls in four seasons of the year.
Method: This was a longitudinal study conducted from February 2014 to June 2015. The study population included 155 school children aged 7-14 years from an urban school in Karachi. 24HR recall was conducted on 4 random days of the 4 main seasons. A food composition table was developed where the weight, calories, carbohydrate, fat, and protein content of the food items …

Adolescent E-Cigarette Use, Carley Lueken

The Eleanor Mann School of Nursing Student Works

Adolescent e-cigarette use in the United States (U.S.) is trending upward at a concerning rate. Many of the short-term and long-term effects of e-cigarette use are unknown. However, scientists do know that e-cigarettes can have harmful effects on the respiratory system playing a role in E-cigarette or Vaping Use-Associated Lung Injury (EVALI) and Coronavirus Disease 2019 (COVID-19). Additionally, some e-cigarettes contain nicotine, which is widely known to have negative effects on the developing adolescent brain. Previously, there is only one e-cigarette prevention program that has been developed, implemented, and evaluated in the U.S. Thus, showing the need for further research …

Adolescent Mental Health Training For Middle School Educators, Sarah Minton

Doctor of Nursing Practice (DNP) Projects

Abstract

Background: Adolescent mental health disorders are an increasing concern in the United States. School systems, specifically educators, are in the unique role to aid in early identification of mental health disorders, as well to intervene in mental health distress. However, mental health training for educators is lacking, leaving educators unprepared to manage mental health concerns within their classroom.

Purpose: The purpose was to utilize an evidence-based training, the “Teacher Knowledge Update Guide” from TeenMentalHealth.org to train middle school educators on the signs and symptoms of mental health conditions in the adolescent population with the intent to increase awareness, knowledge, …

Model-Based Methods To Translate Adolescent Medicine Trials Network For Hiv/Aids Interventions Findings Into Policy Recommendations: Rationale And Protocol For A Modeling Core (Atn 161), Anne M. Neilan, Kunjal Patel, Allison L. Agwu, Ingrid V. Bassett, K. Rivet Amico, Catherine M. Crespi, Aditya H. Gaur, Keith J. Horvath, Kimberly A. Powers, H. Jonathon Rendina, Lisa B. Hightow-Weidman, Xiaoming Li, Sylvie Naar, Sharon Nachman, Jeffrey T. Parsons, Kit N. Simpson, Bonita F. Stanton, Kenneth A. Freedberg, Audrey C. Bangs, Michael G. Hudgens, Andrea L. Ciaranello

Publications and Research

BACKGROUND: The United States Centers for Disease Control and Prevention estimates that approximately 60,000 US youth are living with HIV. US youth living with HIV (YLWH) have poorer outcomes compared with adults, including lower rates of diagnosis, engagement, retention, and virologic suppression. With Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) support, new trials of youth-centered interventions to improve retention in care and medication adherence among YLWH are underway.

OBJECTIVE: This study aimed to use a computer simulation model, the Cost-Effectiveness of Preventing AIDS Complications (CEPAC)-Adolescent Model, to evaluate selected ongoing and forthcoming ATN interventions to improve viral load suppression …

The Association Between Health-Related Fitness And Physical Activity During Weekdays: Do Fit Students Exercise More After School?, Dehong Yang, Xihe Zhu, Justin A. Haegele, Patrick B. Wilson, Xueping Wu

Human Movement Sciences & Special Education Faculty Publications

Physically active students are more likely to be fit and learn better in school than sedentary ones. For school-aged children, it is unclear whether physical fitness level is an important determinant for student's activity afterschool. This study examined the association between health-related physical fitness test performance and afterschool physical activity during weekdays. Participants (n = 97, 11-13 years old) completed health-related fitness tests. They wore Actigraph GT3X accelerometers for five consecutive days, recording physical activity participation during after school hours. Descriptive statistics for both afterschool physical activity and health-related fitness were summarized. Regression analyses were conducted to determine the association …

A Systematic Review Of Observational Studies, Demonstrating Smoking Among School Going Adolescents, Shafquat Rozi, Gillian Lancaster, Sadia Mahmud, Zahid Ahmad Butt, Talat Roome, Nida Zahid

Community Health Sciences

Objective: To characterize the methods of design and analysis currently adopted in survey research of school-based observational studies for smoking, and to identify the common pitfalls made by researchers.
Methods: The systematic review was conducted in 2009 and consisted of observational studies in school settings published between January 2005 and January 2009. Smoking status was the main outcome of interest. Following Cochrane style, five steps were followed: setting selection criteria for studies and conducting a literature search; review of abstracts; review of complete articles; data extraction and quality assessment of included studies; and, finally, synthesis of studies.
Results: Of the …

Study Protocol Of "Our Choice": A Randomized Controlled Trial Of The Integration Of Safer Conception Counseling To Transform Hiv Family Planning Services In Uganda., Kathy Goggin, Emily A. Hurley, Jolly Beyeza-Kashesya, Violet Gwokyalya, Sarah Finocchario-Kessler, Josephine Birungi, Deborah Mindry, Rhoda K Wanyenze, Glenn J Wagner

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: About 40% of HIV-positive women in sub-Saharan Africa become pregnant post-diagnosis. Despite about half of their pregnancies being planned, safer conception methods (SCM) are underutilized among serodiscordant couples, partially due to the fact that safer conception counseling (SCC) has not been integrated into routine HIV family planning (FP) services.

METHODS: Our Choice is a comprehensive FP intervention that promotes unbiased childbearing consultations to ensure clients receive SCC or contraception services to achieve their desired reproductive goals. The intervention is theoretically grounded and has demonstrated preliminarily feasibility and acceptance through pilot testing. This three-arm cluster randomized controlled trial compares two …

The Contributing Factors To Adolescent Depression, Josie H. Lee

Independent Study Project (ISP) Collection

Objective: This paper reviews individual, familial, peer, and societal factors influencing adolescent depression in developed countries. Background: Depression usually onsets at adolescence and contributes to high DALYs. Since depression is treatable, efforts should be made to reduce its prevalence and effect. Methods: The research consisted of looking at literature relevant to the topic and age group and conducting interviews with experts who know about and have worked with adolescent depression. Discussion: Adolescents begins at the onset of puberty, allowing different biological factors such as genetics, stress of puberty, and cognitive changes to increase vulnerability to depression. Adolescents who had substance …

Identifying Health Conditions, Priorities, And Relevant Multilevel Health Promotion Intervention Strategies In African American Churches: A Faith Community Health Needs Assessment., Jannette Berkley-Patton, Carole Bowe Thompson, Andrea Bradley-Ewing, Marcie Berman, Alexandria Bauer, Delwyn Catley, Kathy Goggin, Eric Williams, Cassandra Wainright, Therese Petty, Natasha Aduloju-Ajijola

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.

Adolescent Medicine Trials Network For Hiv/Aids Interventions Data Harmonization: Rationale And Development Of Guidelines, Micah Mccumber, Demetria Cain, Sara Legrand, Kenneth H. Mayer, Debra A. Murphy, Matthew A. Psioda, Arlene C. Seña, Tyrel J. Starks, Michael Hudgens

Publications and Research

Background: The Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) research program aims to defeat the rising HIV epidemic among adolescents and young adults in the United States.

Objective: This study aims to optimize cross-study analyses and comparisons of standardized measures (variables) collected in the ATN. Methods: Guidelines were developed for harmonizing measures to be collected across ATN studies.

Results: Eight domains were identified for harmonization—Demographics and Socioeconomic Characteristics, Sexual Behavior and Risk, Substance Use and Abuse, HIV-Positive Cascade, HIV-Negative Cascade, Mental Health, Social Support and Isolation, and Pre-exposure Prophylaxis Cascade.

Conclusions: The collection of selected key measures in a …

Within-Person Associations Of Young Adolescents' Physical Activity Across Five Primary Locations: Is There Evidence Of Cross-Location Compensation?, Jordan A. Carlson, Tarrah B. Mitchell, Brian E. Saelens, Vincent S. Staggs, Jacqueline Kerr, Lawrence D. Frank, Jasper Schipperijn, Terry L. Conway, Karen Glanz, Jim E. Chapman, Kelli L. Cain, James F. Sallis

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Youth are active in multiple locations, but it is unknown whether more physical activity in one location is associated with less in other locations. This cross-sectional study examines whether on days with more physical activity in a given location, relative to their typical activity in that location, youth had less activity in other locations (i.e., within-person associations/compensation).

METHODS: Participants were 528 adolescents, ages 12 to 16 (M = 14.12, SD = 1.44, 50% boys, 70% White non-Hispanic). Accelerometer and Global Positioning System devices were used to measure the proportion of time spent in moderate-to-vigorous physical activity (MVPA) in five …

Expectations For Treatment In Pediatric Weight Management And Relationship To Attrition., Erinn T. Rhodes, Richard E. Boles, Kimberly Chin, Amy Christison, Elizabeth Getzoff Testa, Kimberly Guion, Mary Jane Hawkins, Carter R. Petty, Bethany Sallinen Gaffka, Melissa Santos, Laura Shaffer, Jared Tucker, Sarah Hampl

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Attrition in pediatric weight management negatively impacts treatment outcomes. A potentially modifiable contributor to attrition is unmet family expectations. This study aimed to evaluate the association between adolescent and parent/guardian treatment expectations and attrition.

PATIENTS AND METHODS: A prospective, nonrandomized, uncontrolled, single-arm pilot trial was conducted among 12 pediatric weight management programs in the Children's Hospital Association's FOCUS on a Fitter Future collaborative. Parents/guardians and adolescents completed an expectations/goals survey at their initial visit, with categories including healthier food/drinks, physical activity/exercise, family support/behavior, and weight management goals. Attrition was assessed at 3 months.

RESULTS: From January to August 2013, …

Farm Work Injuries Among A Cohort Of Children In Kentucky, Usa, Steven R. Browning, Susan C. Westneat, Deborah B. Reed

Epidemiology and Environmental Health Faculty Publications

Children residing on farms with livestock may be at an increased risk for work-related injuries, compared to children who work on other commodity farms. This study characterizes children's work tasks on Kentucky farms and assesses whether children who work on beef cattle farms are at an increased risk for farm work injuries. The results of a cohort study of children aged 5-18 years (N=999 at baseline) working on family farms in Kentucky, followed for two consecutive years after an initial enumeration five years previously, found that 70% of the children were involved in animal-related chores. Across all age groups, children …

Update From The Advisory Committee On Immunization Practices., Jennifer E. Schuster, Sean O'Leary, David W. Kimberlin

Manuscripts, Articles, Book Chapters and Other Papers

The Advisory Committee on Immunization Practices (ACIP) consists of medical and public health experts who develop recommendations on vaccine use in the United States. The ACIP meets 3 times per year, and members and Centers for Disease Control (CDC) staff present findings and discuss vaccine research, vaccine effectiveness (VE) and safety, clinical trial results, and labeling/package insert information. Outbreaks of vaccine-preventable diseases and vaccine shortages are also discussed. Nonvoting representatives from the American Academy of Pediatrics and the Pediatric Infectious Diseases Society are present. The ACIP met on June 22-23, 2016 to discuss proposed recommendations for influenza vaccination, for human …

Developing Novel Machine Learning Algorithms To Improve Sedentary Assessment For Youth Health Enhancement., Gowtham Kumar Golla, Jordan A. Carlson, Jun Huan, Jacqueline Kerr, Tarrah Mitchell, Kelsey Borner

Manuscripts, Articles, Book Chapters and Other Papers

Sedentary behavior of youth is an important determinant of health. However, better measures are needed to improve understanding of this relationship and the mechanisms at play, as well as to evaluate health promotion interventions. Wearable accelerometers are considered as the standard for assessing physical activity in research, but do not perform well for assessing posture (i.e., sitting vs. standing), a critical component of sedentary behavior. The machine learning algorithms that we propose for assessing sedentary behavior will allow us to re-examine existing accelerometer data to better understand the association between sedentary time and health in various populations. We collected two …

The Behavioral Addiction Indoor Tanning Screener (Baits): An Evaluation Of A Brief Measure Of Behavioral Addictive Symptoms, Jerod L. Stapleton, Joel J. Hillhouse, Rob Turrisi, Katie Baker, Sharon L. Manne, Elliot J. Coups

ETSU Faculty Works

No abstract provided.

Juvenile Justice—Translational Research On Interventions For Adolescents In The Legal System (Jj-Trials): A Cluster Randomized Trial Targeting System-Wide Improvement In Substance Use Services, Danica K. Knight, Steven Belenko, Tisha Wiley, Angela A. Robertson, Nancy Arrigona, Michael Dennis, John P. Bartkowski, Larkin S. Mcreynolds, Jennifer E. Becan, Hannah K. Knudsen, Gail A. Wasserman, Eve Rose, Ralph Diclemente, Carl G. Leukefeld, Jj-Trials Cooperative

Behavioral Science Faculty Publications

Background: The purpose of this paper is to describe the Juvenile Justice—Translational Research on Interventions for Adolescents in the Legal System (JJ-TRIALS) study, a cooperative implementation science initiative involving the National Institute on Drug Abuse, six research centers, a coordinating center, and Juvenile Justice Partners representing seven US states. While the pooling of resources across centers enables a robust implementation study design involving 36 juvenile justice agencies and their behavioral health partner agencies, co-producing a study protocol that has potential to advance implementation science, meets the needs of all constituencies (funding agency, researchers, partners, study sites), and can be implemented …

Dog Walking Among Adolescents: Correlates And Contribution To Physical Activity., Jessa K. Engelberg, Jordan A. Carlson, Terry L. Conway, Kelli L. Cain, Brian E. Saelens, Karen Glanz, Lawrence D. Frank, James F. Sallis

Manuscripts, Articles, Book Chapters and Other Papers

PURPOSE: To assess the association of dog walking with adolescents' moderate-to-vigorous physical activity (MVPA) and body mass index (BMI), and identify correlates of dog walking.

METHODS/DESIGN: Participants were 12-17year-olds (n=925) from the Baltimore, MD and Seattle, WA regions. Differences in accelerometer-assessed minutes/day of MVPA and self-reported BMI (percentile) were compared among adolescents (1) without a dog (n=441) and those with a dog who (2) did (≥1days/week, n=300) or (3) did not (n=184) walk it. Correlates of (1) dog walking (any vs. none) among adolescents with dogs (n=484), and (2) days/week of dog walking among dog walkers (n=300) were investigated. Potential …

Locations Of Physical Activity As Assessed By Gps In Young Adolescents., Jordan A. Carlson, Jasper Schipperijn, Jacqueline Kerr, Brian E. Saelens, Loki Natarajan, Lawrence D. Frank, Karen Glanz, Terry L. Conway, Kelli L. Cain, James F. Sallis, J E. Chapman

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVES: To compare adolescents' physical activity at home, near home, at school, near school, and at other locations.

METHODS: Adolescents (N = 549) were ages 12 to 16 years (49.9% girls, 31.3% nonwhite or Hispanic) from 447 census block groups in 2 US regions. Accelerometers and Global Positioning System devices assessed minutes of and proportion of time spent in moderate to vigorous physical activity (MVPA) in each of the 5 locations. Mixed-effects regression compared MVPA across locations and demographic factors.

RESULTS: Forty-two percent of adolescents' overall MVPA occurred at school, 18.7% at home, 18.3% in other (nonhome, nonschool) locations, and …

Cost Effectiveness Analysis Of Year 2 Of An Elementary School-Located Influenza Vaccination Program-Results From A Randomized Controlled Trial., Byung-Kwang Yoo, Sharon Humiston, Peter G. Szilagyi, Stanley J. Schaffer, Christine Long, Maureen Kolasa

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: School-located vaccination against influenza (SLV-I) has the potential to improve current suboptimal influenza immunization coverage for U.S. school-aged children. However, little is known about SLV-I's cost-effectiveness. The objective of this study is to establish the cost-effectiveness of SLV-I based on a two-year community-based randomized controlled trial (Year 1: 2009-2010 vaccination season, an unusual H1N1 pandemic influenza season, and Year 2: 2010-2011, a more typical influenza season).

METHODS: We performed a cost-effectiveness analysis on a two-year randomized controlled trial of a Western New York SLV-I program. SLV-I clinics were offered in 21 intervention elementary schools (Year 1 n = 9,027; …

Adolescent Violence Prevention, Hatim A. Omar

Pediatrics Faculty Publications

Violence in adolescence has seen an increase since the 1990s with dramatic statistics on violent death and risk behaviors. School violence has been focused upon by a huge media coverage of especially violent cases that could have had some endemic consequences worldwide. We present a case of a 14 year old white male with change in school behavior, strategies for the case investigation, its results and long term prevention. Other research has shown that preventive measures during pregnancy, infancy and childhood can prevent adolescent and adult delinquency.

Comparison Of Ge Centricity Electronic Medical Record Database And National Ambulatory Medical Care Survey Findings On The Prevalence Of Major Conditions In The United States., Albert G. Crawford, Christine Cote, Joseph Couto, Mehmet Daskiran, Candace Gunnarsson, Kara Haas, Sara Haas, Somesh C Nigam, Rob Schuette, Joseph Yaskin

College of Population Health Faculty Papers

The study objective was to facilitate investigations by assessing the external validity and generalizability of the Centricity Electronic Medical Record (EMR) database and analytical results to the US population using the National Ambulatory Medical Care Survey (NAMCS) data and results as an appropriate validation resource. Demographic and diagnostic data from the NAMCS were compared to similar data from the Centricity EMR database, and the impact of the different methods of data collection was analyzed. Compared to NAMCS survey data on visits, Centricity EMR data shows higher proportions of visits by younger patients and by females. Other comparisons suggest more acute …

Prevalence Of Obesity, Type Ii Diabetes Mellitus, Hyperlipidemia, And Hypertension In The United States: Findings From The Ge Centricity Electronic Medical Record Database., Albert G Crawford, Christine Cote, Joseph Couto, Mehmet Daskiran, Candace Gunnarsson, Kara Haas, Sara Haas, Somesh C Nigam, Rob Schuette

College of Population Health Faculty Papers

This study analyzed GE Centricity Electronic Medical Record (EMR) data to examine the effects of body mass index (BMI) and obesity, key risk factor components of metabolic syndrome, on the prevalence of 3 chronic diseases: type II diabetes mellitus, hyperlipidemia, and hypertension. These chronic diseases occur with high prevalence and impose high disease burdens. The rationale for using Centricity EMR data is 2-fold. First, EMRs may be a good source of BMI/obesity data, which are often underreported in surveys and administrative databases. Second, EMRs provide an ideal means to track variables over time and, thus, allow longitudinal analyses of relationships …

School-Based Approaches To Affect Adolescents’ Diets: Results From The Teens Study, Leslie A. Lytle, David M. Murray, Cheryl L. Perry, Mary Story, Amanda Birnbaum, Martha Y. Kubik, Sherri Varnell

Department of Public Health Scholarship and Creative Works

This article reports on the outcomes of the Teens Eating for Energy and Nutrition at School (TEENS) study, a 2-year intervention study conducted in 16 middle schools with a goal of increasing students’ intakes of fruits, vegetables, and lower-fat foods. Despite positive interim results for students randomized to intervention schools, the positive effects of the intervention were not seen for the primary outcomes at the end of the 2nd year. Positive effects were seen only for a food choice score (suggesting that the students usually choose lower versus higher fat foods) and not for measures of food intake. Future studies …

Decreasing Barriers For Teens: Evaluation Of A New Teenage Pregnancy Prevention Strategy In School-Based Clinics, Abbey C. Sidebottom, Amanda Birnbaum, Sarah S. Nafstad

Department of Public Health Scholarship and Creative Works

Sidebottom et al seek to evaluate the effects of the change in distribution systems on students' receipt of requested contraceptives and demand for contraceptive school-based clinics (SBC). The result of the study reveals that the average number of requests per student was higher under the voucher system, possibly as a consequence of expires vouchers resulting in repeated requests. The findings also suggest that SBCs could go a step further in reducing adolescents' barriers to accessing contraceptives by adopting an on-site direct delivery system..

Are Differences In Exposure To A Multicomponent School-Based Intervention Associated With Varying Dietary Outcomes In Adolescents?, Amanda S. Birnbaum, Leslie A. Lytle, Mary Story, Cheryl L. Perry, David M. Murray

Department of Public Health Scholarship and Creative Works

Multicomponent interventions are recommended for health behavior change among adolescents. However, it is difficult to disentangle the effects of multiple intervention components. This article reports outcomes associated with varying levels of exposure to a school-based nutrition intervention, Teens Eating for Energy and Nutrition at School (TEENS). Four incremental exposureswere possible: (1) control group, (2) school environment interventions only, (3) classroom plus environment interventions, and (4) peer leaders plus classroom plus environment interventions. Patterns suggesting dose response were observed, with peer leaders reporting the largest increases in fruit, vegetable, and lower fat food consumption. Students exposed to classroom plus environment interventions …

Condom Availability In New York City Public High Schools: Relationships To Condom Use And Sexual Behavior., Sally Guttmacher, Lisa D. Lieberman, David Ward, Nick Freudenberg, Alice Radosh, Don Des Jarlais

Department of Public Health Scholarship and Creative Works

OBJECTIVES: This study examines the impact of the condom availability program in New York City public high schools by comparing rates of sexual activity and condom use for New York students and similar students in Chicago.

METHODS: A total of 7119 students from 12 randomly selected New York schools and 5738 students from 10 Chicago schools participated in a cross-sectional survey.

RESULTS: New York students, compared with Chicago students, reported equal rates of sexual activity but higher rates of condom use at last intercourse (odds ratio [OR] = 1.36). For higher-risk students (those with three or more sexual partners in …