1. Using Technology to Improve Health and Health Behavior
Mary A. Gerend, PhD
Northwestern University
Learning for Life
Fall 2016

2. Cancer Prevention Behavior
Sexual Health
Health Messaging
Cancer Prevention Behavior
Technology

4. A Tailored Internet-based Intervention for Increasing STD Screening
Acknowledge FSU colleagues Mia Lustria and Julian Cortese – experts in health communication

6. STD Risk Factors Alcohol Serial monogamy
Biological susceptibility
Alcohol
STD
Risk Factors
Inadequate knowledge
Improper & inconsistent condom use
Persons who initiate sex early in adolescence are at higher risk for STDs, along with adolescents residing in detention facilities, those who use injection drugs, adolescents attending STD clinics, and young men who have sex with men (YMSM). Factors contributing to this increased risk during adolescence include having multiple sexual partners concurrently, having sequential sexual partnerships of limited duration, failing to use barrier protection consistently and correctly, having increased biologic susceptibility to infection, and facing multiple obstacles to accessing health care (118).
Obstacles accessing healthcare

7. STD Testing
Less than 50% of adults ages 18–44 have ever been tested for STDs
Barriers to Testing
Many STDS are asymptomatic
Low perceived risk
Concerns about cost and confidentiality

8. Message Tailoring
Tailoring is a multi-dimensional communication strategy that involves the
development of individualized messages
based on a pre-assessment of key individual-difference variables or characteristics
linked to the underlying model of health behavior change

9. Project Goals Increase STD screening among young adults
Correct misconceptions and increase knowledge
Increase perceived vulnerability to STDS
Reduce barriers to STD screening
Provide opportunity to order a free at-home test kit online

10. Invited to participate Randomized to condition N=1,065
Pre-test
Tailored Condition
Non-Tailored Condition
Post-test
Invited to order at-home test kit

11. Tailored Risk Assessment

12. Tailoring Variables Relationship Status
Committed Relationship: I’m in a committed relationship, so why should I care? It’s easy for people in committed relationships to let down their guard. Being in a committed relationship carries with it a certain amount of “trust” and it’s easy to make assumptions about your partner’s disease status. Many couples stop using condoms after awhile because they trust their partners. Aside from using condoms, the best way to protect yourself and your partner is to get tested for STDs. Not in a Committed Relationship: But I only date people I can trust, so why should I care? In today's dating world it is not unusual for men and women to have multiple partners, especially in casual dating. The best way to protect yourself and a potential sex partner, aside from wearing a condom, is to get an STD test. Many people don’t experience any symptoms with STDs….

13. Results Tailored Non-tailored % ordered test kit 20% 27% Pre- Test
2.8
Tailored
Non-tailored
2.7
Perceived Risk of STDS
Non- Tailored
Tailored
% ordered test kit
20%
27%
2.6
2.5
Pre- Test
Post- Test

14. Results Perceived Risk Order Test Kit Tailored Intervention
Personal Relevance
Attention & Engagement
Order Test Kit

15. Funded by the National Cancer Institute
Using Text Messaging to Increase HPV Vaccination among Sexual Minority Men
Funded by the National Cancer Institute

16. Human Papillomavirus (HPV)
Most common sexually transmitted infection in U.S.
Persistent infection with high-risk HPV (types 16 & 18) can cause cancer
Cervical cancer (women)
Penile cancer (men)
Anal and oropharyngeal cancers (men & women)
Men who have sex with men (MSM) are at particularly high risk for HPV infection and HPV-related cancer
Burden of anal cancer is especially high among HIV-positive men
Rates of anal cancer are 17 times higher among MSM relative to heterosexual men

18. Girls 1 dose: 56.7% in 2013 vs. 60.0% in 2014
Girls 3 doses: 36.8% in 2013 vs. 39.7% in 2014
Boys 1 dose: 33.6% in 2013 vs 41.7% in 2014
boys 3 doses: 13.4% in 2013 vs. 21.6% in 2014
Girls 60% initiate; 40% complete
Boys 42% initiate, 22% complete

19. HPV Vaccination and MSM
Although HPV vaccine is recommended for all MSM though age 26 years, relatively few have been vaccinated
Only 13-21% of young MSM have received ≥1 dose of HPV vaccine
HPV screening is not recommended by the CDC for anal, penile and throat cancers in men in the United States
Primary prevention of HPV infection through vaccination
best strategy for reducing HPV-related cancers in MSM

20. Txt2Protect Specific Aims
Aim 1: Develop, refine, and pre-test the text messages
Aim 2: Test the feasibility, acceptability, and preliminary efficacy of the Txt2Protect (t2p) intervention in a pilot randomized controlled trial (RCT)
Target population: Gay, bisexual, and queer men (ages 18-26) living in Chicago who have not been vaccinated

21. Formative Research to Inform Message Development
Conduct in-depth interviews and online survey
Goals:
Identify misconceptions about HPV and HPV vaccination
Identify barriers and facilitators to HPV vaccine uptake
Especially those factors specific to MSM

22. Interview Findings General Barriers to HPV vaccination
29 gay, bisexual and queer men living in Chicago
General Barriers to HPV vaccination
Lack of knowledge
Many saw HPV infection as a women’s health issue; Did not realize significant health consequences for men
Concerns about access, health insurance, potential side effects
Lack of recommendation from a doctor
Barriers Unique to MSM
Many receive health insurance through their parents; concern that parents would see HPV vaccine on bill
Low norms for HPV vaccination among MSM
Potential stigma from healthcare providers
Low norms - Most did not know other gay, bisexual or queer men who had been vaccinated

23. Interview Findings Facilitating Factors
29 gay, bisexual and queer men living in Chicago
Facilitating Factors
Unvaccinated men expressed strong interest in receiving vaccine after interview
Desire to protect partner/future partners from HPV
Comfort discussing HPV and HPV vaccine with doctor
Especially LGBT friendly providers
Convenience
Ability to receive HPV vaccine at local pharmacy
Enthusiastic about a text messaging campaign promoting HPV vaccination
Low norms - Most did not know other gay, bisexual or queer men who had been vaccinated

24. Next Steps Pilot RCT Use formative data to develop messages
Seek input from target population to refine messages
Test software functionality; Beta test protocol
Pilot RCT
Treatment t2p
Control

25. Interventions to Promote Health
Closing
Interventions to Promote Health
Health Decision Making
Health Messaging
Media/ Technology

26. Acknowledgements RU@Risk
Mia Lustria, Juliann Cortese, Karla Schmitt, Ying Mai Kung, and Casey McLaughlin
Citation: Lustria, Mia Liza A., Cortese, J., Gerend, M. A., Schmitt, K., Kung, Y. M., & McLaughlin, C. (2016). A model of tailoring effects: Examining the mechanisms of tailoring in a web-based STD screening intervention. Health Psychology, 35,
Txt2Protect
Gregory Phillips, Mike Bass, Magda Houlberg, Brian Mustanski, Krystal Madkins, and Shariell Crosby
Funding
National Cancer Institute (R21CA208329, PI: Gerend)

27. Thank You! Mary A. Gerend, PhD Northwestern University