Observational codes were entered into Word 2019, Version 16.0, and data were analyzed using Spearman’s correlation coefficient and the Mann-Whitney U test. Stigma was assessed through several individual items (e.g., belief that sexual health is taboo, comfort discussing contraception, use of internet for privacy). A composite stigma score was not created. Instead, item-level correlations and Mann-Whitney tests were used to examine associations between stigma indicators, demographics, and screening behaviors.

A total of 112 American young adults (53 males and 59 females) aged 18 to 30 participated. The majority were Caucasian, followed by African American, and most were in the 22 - 30 age group. Table 1 summarizes participant demographics, while Figure 1 illustrates the age distribution.

Most respondents reported being sexually active within the past year, but just over half used contraception consistently. While the majority were comfortable discussing sexual health with providers and loved ones, 57% still viewed sexual health as taboo. These results are summarized in Table 2 and illustrated in Figure 2 .

Table 2 and Figure 2 summarize sexual health attitudes and practices.

Our survey yielded results that show remarkable differences in age, ethnic, and religious groups as well as educational backgrounds. 78.6% of participants revealed that they have been sexually active within the past year; however, only 52% reported using contraceptive methods, which can explain the increasing numbers of sexually transmitted diseases among other factors. This could reflect an association between younger age and increasing risky behaviors due to impulses governed by cognitive growth and development in young adulthood [4] [11] . The advent of modern medicine and scientific advances allowed those diagnosed with a sexually transmitted disease to receive treatment in a timely fashion and avoid subsequent complications, such as infertility. Despite this, our study revealed that the majority of young adults have never discussed contraceptive methods with their primary care provider, nor do they feel comfortable discussing sexual health with their primary care provider. This could directly relate to a lack of sexual health communication between young adults and health care professionals in the United States and the increasing numbers of undiagnosed cases. The Institute of Medicine [12] argues that “sexuality is a value-laden subject that makes people—including health care professionals, researchers, educators, and the public—feel anxious and uncomfortable talking about it.” Park and Kwon [13] argue that “sexual health information online was also closely linked to privacy issues. The resulting inability to address issues of sexuality places individuals at risk of STDs” [11] [14] . 55.4% of our subjects reported that they prefer to use the Internet as a source to learn about sexual health ( Table 2 ). This could explain the reluctance of American young adults to seek information about sexual and reproductive health from a health care professional. Many youths felt reluctant to speak with an HCP about sensitive issues surrounding sexuality and instead use the Internet to avoid embarrassment and overcome privacy issues” [15] . Furthermore, 57% of our subjects reported that they believe sexual health is still seen as a taboo topic in today’s society, which reinforces the aforementioned statement. Human sexuality throughout history has primarily been reserved for reproductive purposes. Women were expected to repress their sexuality as sexual activity other than for the purposes of conception was frowned upon and even punished at times [16] . Contrary to popular belief, our study did not find a significant difference in sexual activity among males and females, which reveals that gender differences in sexual activity are absent in today’s social climate.

Overall, 95.5% of participants reported awareness of STDs beyond HIV/AIDS. However, misconceptions persisted—20.7% agreed that most STDs can be cured without treatment. Additionally, 74.8% disagreed that there is “too much talk” about STDs in the media, suggesting that public health messaging remains insufficient. A statistically significant correlation was observed between education level and STD awareness (r = −0.21, p = 0.026). Education was coded numerically, with lower values indicating higher attainment, meaning that higher education was linked to greater awareness. Results are presented in Table 3 .

Table 3 presents awareness and beliefs about STDs.

Differences in response rates according to religious groups must also be noted. Our data showed a statistically significant correlation between various religious groups and perceived norms (r = 0.202, p = 0.033), as seen in Table 3 . Participants who identified themselves as Hindu, Muslim, or Jewish agreed with the statement that sexual health is still seen as a taboo topic in today’s society. On the other hand, participants who identified themselves as Atheist or Christian were more likely to disagree with the above-mentioned statement. This can explain the influence of certain religious institutions on ethnic minorities in the United States. As Wingood and DiClemente [17] suggest, certain religious beliefs, such as Islam, condemn premarital sexual activity, thus creating difficulties for young adults, particularly females, to access sexual and reproductive health services [18] . When comparing different ethnic groups, the data collected suggest a level of discomfort when discussing sexual health and sexually transmitted diseases. Some studies suggest that sexual attitudes and beliefs are highly influenced by the cultural and familial context [19] . This attitude is seen more in Caucasian and Hispanic families in contrast to ethnic families in which religion dictates their communication regarding sexual health ( Table 3 ). The disparity among differing ethnicities is clearly visible. Although a majority of ethnic groups consider the subject taboo, they still express a willingness to seek information as evidenced by Table 3 . The results of the survey conclude that a majority of young adults across a wide demographic are not willing to discuss sexual and reproductive health matters.

In the United States, young adults are highly influenced by the media, where views on sex and sexuality tend to be more relaxed and without consequences. The media portrayal of human sexuality can often lead to negative health impacts, particularly in vulnerable populations, such as adolescents and young adults. 95.5% of our participants reported that they are aware of sexually transmitted diseases (STDs), indicating that there is general knowledge among young adults in the United States. Furthermore, 68.5% reported having attended a school-based program for sexual health education at some point in their lives; however, our study revealed that only a small percentage of our sample size are willing to receive sexual and reproductive health information from other sources, such as schools ( Table 2 ). Regarding the treatment of sexually transmitted diseases, 79.3% disagreed with the statement that “most sexually transmitted diseases can be cured without any treatment whatsoever,” indicating a general awareness of the risk of health complications if left untreated. We can conclude that a high level of education directly contributes to greater awareness, as evidenced by a statistically significant correlation found in our study between these two variables (r = −0.21, p = 0.026). Despite this, the number of undiagnosed cases continues to rise. Manlove, Fish, & Moore [20] proposed that this may be caused by several other factors leading to a shortage of information, such as lack of youth-friendly resources, budget cuts, and staff reductions [2] . Our study also revealed that there continues to be a lack of awareness about sexually transmitted diseases in the media, as evidenced by 74.8% of our participants disagreeing with the statement that “there is too much talk about sexually transmitted diseases in the media,” as outlined in Table 4 . This finding reinforces the need for more STD/STI prevention and screening methods.

Social stigma emerged as a significant barrier. Participants aged 18 - 21 were less likely to seek medical treatment if they suspected infection compared to those 22 - 30 (r = 0.26, p = 0.006). Discomfort discussing contraception with a PCP was negatively correlated with willingness to schedule a consultation (r = −0.317, p = 0.001). Perceiving sexual health as taboo was correlated with both ethnicity (r = 0.239, p = 0.011) and religion (r = 0.202, p = 0.033). Mann-Whitney tests showed that educational attainment significantly influenced whether participants discussed contraception with a PCP (U = 0.000, Z = −2.449, p = 0.014). These findings are summarized in Table 4 .

Table 4 shows key correlations and Mann-Whitney U test results linking stigma and screening behavior.