Latent Profiles of Social Media Users, STI Knowledge, and Condom Use among African American Young Adults

The abundance of social networking platforms has increased the frequency and the availability for which individuals communicate with one another. The feasibility and accessibility to go online to find sexual partners pose opportunity for contracting sexually transmitted infections (STI) in the absence of safe sexual practices. Low condom use has been reported among young adults who seek sexual partners online. African American young adults have some of the highest rates of infection for certain STIs. In order to mitigate the inci-dence and prevalence of STIs in at-risk populations, sexually active young adults must use condoms consistently and correctly during sexual activities. The present study sought to uncover the heterogeneity within African American young adults regarding their online networking utilization, STI knowledge, and sexual risk behavior. African American young adults (N = 236), ages 18 - 23, completed private online survey administration. Using latent class analysis, three classes were identified: Social Network Communicators (43%; N = 101), Social Networking Daters (36%; N = 83), and Media Sharers (21%; N = 52). Social Networking Daters exhibited the highest probability of using online dating sites daily, low STI knowledge, and a zero probability of consistent condom use. All three groups exhibited relatively low STI knowledge. Furthermore, having a history of STI increased the likelihood of being classified into the Social Networking Daters class relative to the other classes. Findings highlight the need to capitalize upon online platforms for African American young adults who utilize online dating sites and other online envi-ronments.


Introduction
Young people ages 15 -24 account for half of all newly diagnosed sexually transmitted infections (STIs) [1]. African Americans between the ages of 15 -24 have the highest rate of chlamydia and gonorrhea among all racial groups. The rate of chlamydia among African American adolescents and young adults was found to be 3.6 to 8.9 times the rate of their Caucasian counterparts [1]. Disparities in rates of gonorrhea are similar, with gonorrhea rates among African American adolescents and young adults reported to be 7.4 to 9.3 times the rate of their counterparts [1]. Furthermore, African American men, ages 20 -24, reported the highest rates of syphilis among all racial/ethnic groups in 2017 [1].
Among individuals who are sexually active, proper and consistent condom use remains one of the most efficacious ways to prevent the spread of STIs. Young adults are at a developmental time when dating, courtship, and arrangements for "hooking up" may be commonplace. This lends itself to opportunities for sexual encounters and probabilities associated with STI risk behavior.
The abundance of online networking platforms has increased the frequency and the mediums in which individuals communicate with one another. With an increase in online networking applications like Facebook, Instagram, and Snapchat, young adults have a way of socializing with others both inside and outside of their social circle with great frequency. Given the accessibility and the online connection to endless people within their peer groups, searching for sexual partners is one of the many reasons individuals use online networking sites catered to dating activities [2]. The ease of going online to find a sexual partner poses health risks such as opportunity for contracting STIs, especially in the absence of safer-sex practices such as consistent condom use. Low condom use has been reported among adults and young adults who seek sexual partners online [2] [3]. This is cause for alarm because STI or HIV status may not be disclosed during online partner seeking.
Young adults are of particular interest as they are spending more time on social media and engaging in riskier behaviors while using social media [4]. Gebremeskel and colleagues [5] found positive correlates between time spent on social media and number of sexual partners, onset age of sexual relationships, and frequency of engaging in risky sexual behaviors among older adolescents.
Meanwhile, perceived norms, descriptive norms, and attitudes regarding sexual behaviors online increase an individual's willingness to engage in risky behaviors online, such as communicating sexually with a stranger [6]. Self-presentation behaviors online such as "sexy" poses and semi-clothed profile pictures may misguide individuals on the behaviors of their peers, influencing them to engage in riskier behaviors than they would engage in otherwise [7]. Much of this research, however, has utilized adolescent samples, non-African American samples, men who have sex with men (MSM), other sexual minorities, or included substance use behaviors as a primary focus. Although adolescence is a crucial time of psychosocial development regarding sexuality, it does not discount that young

Participants
Two-hundred and thirty-six sexually active young adults were recruited at a 4-year minority-serving college in the U.S. South. Forty-one percent (N = 97) were males and 59% (N = 139) were females. Participant ages ranged from 18 -23 (M age = 19, SD = 1.3). All participants reported being African American.

Measures
The survey instrument used for the present study consisted of 52 items that measured psychosocial constructs (attitudes, intentions, motivations, norms, and self-efficacy) related to sexual behavior and condom use, STI knowledge and self-reported STI history, social media usage, preferred online networking sites, and sexual behaviors.

Procedure
Upon obtaining IRB approval from the institution, participants were recruited through the university's online research participation platform to participate in the survey research. Potential participants were informed that their responses would remain anonymous and used as aggregate data only. Potential participants were also informed of the eligibility criteria: being officially enrolled as a university student and having been sexually active within the past 3 months.
Those who wished to participate were screened for eligibility online by answering affirmatively to the above-mentioned eligibility criteria in order to continue.
Participants were then consented via online consent form in which they were required to acknowledge that they have understood their voluntary participation in order to continue to the survey. Participants were administered a 52-item secure online survey. Participation (consenting and survey administration) took approximately 15 minutes.

Analytical Procedure
Latent class analysis (LCA) served as the analytic procedure for the current study. Analysis was conducted using Mplus Version 7.4. LCA was utilized to explore and identify participants' underlying online networking profiles and con-  [13]. Lastly, entropy and interpretability of the classes during model selection was considered for final model selection [13]. Table 1 shows the model selection analysis for the LCA.
After identifying the best-fitting latent class solution, STI history was used as a covariate in a multinomial regression model to identify whether it was a factor in predicting one class membership relative to another class. STI history was treated as an auxiliary variable using the R3STEP option, allowing the multinomial regression to control for uncertainty in class assignment while maintaining the class structure and initial meaning [14] [15]. Additionally this approach yielded adjusted odds ratios (AORs) and confidence intervals (CIs), illustrating associations between STI history and class membership.

Results
The present study reports conditional probabilistic classes of online networking users characterized by STI knowledge and self-reported condom use frequency.

Discussion
The present study explored the various uses of online networking for African American young adults attending a predominantly minority university. Differences

Out of the three groups, Social Network Communicators and Social Network
Daters had the lowest average STI knowledge scores. This is cause for concern, particularly for social networking daters who may be presented with multiple opportunities for sexual encounters. Although social media networking has been criticized for influencing sexual self-objectification [17], particularly among adolescent and adult women, social media and networking sites can be an excellent medium for employing interventions for a variety of populations and concerns. Online sexual health interventions may seek to implement programs on common online dating websites in order to reach the intended or at-risk audiences. In order for sexual-health web-based interventions to produce significant results, culturally appropriate materials are needed that addresses risk-related behaviors within a community or social context. For example, web-based interventions such as Safe Sistah [18] has been shown to increase safe-sex behaviors among African American women by taking into consideration and addressing cultural norms surrounding sexual behavior.
History of an STI played an interesting role in this study. Specifically, an STI history was related to the increased odds of being in the Social Networking Daters class. Yet this class resulted in a 0% chance of consistent condom use. This infers that those who have had an STI and actively use online networks for dating are not likely to use condoms consistently, more so than any other class. Social media-based interventions have the potential to influence young adults with a medium to which they are comfortable and with which they frequently interact. Dissemination of STI knowledge on online dating sites will capture those most in need of understanding their susceptibility associated with condomless sex.

Limitations
Limitations of this study include the self-reporting of consistent condom use.
We hoped to solicit a truer response by allowing a "sliding scale" of condom use frequency reporting. For example, those who may be inclined to report a socially-desirable response could report that they use condoms almost always to lessen the cognitive dissonance of untruthfulness; however, they were still categorized as non-consistent condom users on the consistent condom use variable.

Future Research and Conclusion
Future studies may want to identify the barriers associated with consistent condom use for those reporting an STI history in order to mitigate subsequent STI

Conflicts of Interest
The authors declare no conflicts of interest regarding the publication of this paper.

Ethical Approval
All procedures in this study involving human participants were in accordance

Informed Consent
Informed consent was obtained from all individual participants included in this study.