Differences by gender and sexual experience in adolescent sexual behavior: implications for education and HIV prevention

Condom use self-efficacy centered on sexual experience, cannabis, and CBD use among college students

OBJECTIVES

The goal of this study was to understand how condom use self-efficacy varies based on sexual experience, cannabis and CBD use.

METHODS

A cross-sectional survey was implemented through Qualtrics. A total of 455 undergraduate students were surveyed at a large U.S. northeastern university.

RESULTS

Findings suggested that sexual experience itself and sexual experience with cannabis and CBD are associated with a person's condom use self-efficacy. Precisely, non-sexually active and cannabis or CBD nonusers perceived themselves as less efficacious in their future use of condoms compared with sexually active adolescents.

CONCLUSIONS

Implications for health interventions are discussed, such as the importance of giving attention to non-sexually active adolescents and strengthening their condom use self- efficacy. It is critical to promote healthy sexual behaviors among future sexually active college students and reinforce healthy sexual behaviors among sexually active adolescents.

Self-efficacy and response-efficacy: critical components of sexual and reproductive health interventions targeting condom use intention among American Indian adolescents

The Respecting the Circle of Life (RCL) intervention is a comprehensive, skills-based sexual/reproductive health program shown to be effective for reducing sexual risk among American Indian (AI) adolescents (13-19 years of age). This paper seeks to identify critical program components of the RCL intervention for replication of impacts on condom use intention (CUI) when scaling to additional communities. RCL was tested among AI adolescents through a cluster randomized controlled trial (N = 267) embedded in an 8-day basketball camp. Data were collected at baseline, immediately post-camp, at 6 and 12 months post-camp. Previously established predictors of CUI that were statistically significantly impacted by RCL at the post-camp time point were tested as mediators of RCL impact on CUI. Condom use self-efficacy and response efficacy fully mediated the effect of RCL on CUI. The indirect path through condom use self-efficacy had the greatest effect on CUI, explaining 79% of the direct effect. When stratified by gender, there was only evidence of mediation among girls. Results indicate condom use self-efficacy and response efficacy are critical components of the RCL intervention for AI girls, and sexual/reproductive health programs should include practical skills training to improve these constructs to maximize intervention impact on CUI.

Sex Differences in Contraception Non-Use Among Urban Adolescents: Risk Factors for Unintended Pregnancy

BACKGROUND

Contraception non-use among sexually active adolescents is a major cause of unintended pregnancy (UP).

METHODS

In this cross-sectional study we sought to identify overall and sex-specific correlates of contraception non-use using the 2015 Philadelphia Youth Risk Behavior Survey (YRBS) (N = 9540). Multivariate regression models were used to examine mental health, sexual activity, substance use, and violence indicators on reported contraception non-use among sexually active youth.

RESULTS

Marijuana use among boys and girls was a statistically significant risk factor for contraception non-use. Availability of illegal drugs on school property in the past year was also significantly related to contraception non-use among boys.

CONCLUSIONS

These results may inform overall and sex-specific adolescent programs to promote consistent contraception use among urban youth within school-based communities.

Seeking sexual health information? Professionals' novel experiences of the barriers that prevent female adolescents seeking sexual health information

Objective Sexual health professionals are key stakeholders in implementing sexual health intervention programmes, yet their views are largely absent from the literature. Sexual health professionals provide a unique perspective on teen sexual health issues as they engage in confidential discussions with a wide range of teenagers. This study aimed to provide an in-depth exploration of professionals' perceptions of teenagers' sexual health information seeking practices and barriers. Furthermore, the research provided a unique re-examination of key predictors of risky sexual behaviours, which have been highlighted by previous research. Methods Nine semi-structured interviews were undertaken with sexual health professionals to explore their perceptions of teenagers' sexual health information seeking practises and barriers. Subsequently the professionals rank ordered the 57 factors identified in previous research in terms of their perceived importance in predicting risky sexual behaviours. Results Four themes emerged: "society and media"; "environment and family"; "peer influences"; and "the self". The rank order task confirmed that 33 of the 57 factors were perceived as highly important by sexual health professionals. Conclusion Society, peers, environment and family are perceived as barriers to teenagers seeking reliable sexual health information, but these are dependent on the individual person. An individual with higher self-esteem is more confident in seeking sexual health information and applying this knowledge appropriately. Self-esteem was also identified as a key perceived predictor of risky sexual behaviours. Therefore, there is scope for intervention programmes targeting self-esteem and knowledge, so teenagers have the confidence to seek out sexual health information and to make their own informed sexual health decisions.

Source of Sex Information and Condom Use Intention Among Latino Adolescents

Adolescence is a common time for sexual initiation and information seeking about sexual health, yet little is known about how adolescents’ sources of information about sex influence their sexual beliefs and behaviors. This is particularly true for Latino adolescents, whose sources of sex information and sexual behaviors are vastly understudied. A survey of ninth-grade Latino adolescents ( N = 1,186) was employed to examine the relationship between adolescents’ primary source of sex information and their intention to use condoms. The study also examined the potential influences of demographics (age, gender), sociodemographics (socioeconomic status, parent education, and linguistic acculturation), and sexual experience on condom use intention. Among Latino youth, the most commonly reported source of sex information was parents (37.8%), followed by another relative (17.1%), school (13.4%), and friends (11.4%). Hierarchical regression analyses showed that after controlling for other factors, primary source of sex information was significantly associated with condom use intention ( p = .042). Hierarchical regression results stratified by gender showed that this relationship remained significant for males ( p = .004) but not for females ( p = .242). Males who reported friends (odds ratio [ OR] = 0.44, p = .003) or the media/Internet ( OR = 0.44, p = .008) as their primary sources of sex information, as compared to parents as their primary source, reported significantly lower intention to use condoms. These findings suggest it may be important for Latino adolescents, particularly males, to have additional or other sources for sex information in order to promote healthy sexual behaviors. Alternatively, interventions targeting parents or other family members to improve sexual health communication with adolescent boys may prove essential.

The Impacts of Using Smartphone Dating Applications on Sexual Risk Behaviours in College Students in Hong Kong

Dating applications (apps) on smartphones have become increasingly popular. The aim of this study was to explore the association between the use of dating apps and risky sexual behaviours. Data were collected in four university campuses in Hong Kong. Subjects completed a structured questionnaire asking about the use of dating apps, sexual behaviours, and sociodemographics. Multiple linear and logistics regressions were used to explore factors associated with sexual risk behaviours. Six hundred sixty-six subjects were included in the data analysis. Factors associated with having unprotected sexual intercourse with more lifetime sexual partners included use of dating apps (β = 0.93, p<0.01), having one’s first sexual intercourse before 16 years of age (β = 1.74, p<0.01), being older (β = 0.4, p<0.01), currently being in a relationship (= 0.69, p<0.05), having a monthly income at least HKD$5,000 (β = 1.34, p<0.01), being a current smoker (β = 1.52, p<0.01), and being a current drinker (β = 0.7, p<0.01). The results of a multiple logistic regression analysis found that users of dating apps (adjust odds ratio: 0.52, p<0.05) and current drinkers (adjust odds ratio: 0.40, p<0.01) were less likely to have consistent condom use. Users of dating apps (adjust odds ratio: 1.93, p<0.05), bisexual/homosexual subjects (adjust odds ratio: 2.57, p<0.01) and female subjects (adjust odds ratio: 2.00, p<0.05) were more likely not to have used condoms the last time they had sexual intercourse. The present study found a robust association between using dating apps and sexual risk behaviours, suggesting that app users had greater sexual risks. Interventions that can target app users so that they can stay safe when seeking sexual partners through dating apps should be developed.

Evaluating Teach One Reach One-An STI/HIV Risk-Reduction Intervention to Enhance Adult-Youth Communication About Sex and Reduce the Burden of HIV/STI

PURPOSE

Parents and caregivers play an important role in sexual socialization of youth, often serving as the primary source of information about sex. For African American rural youth who experience disparate rates of HIV/sexually transmitted infection, improving caregiver-youth communication about sexual topics may help to reduce risky behaviors. This study assessed the impact of an intervention to improve sexual topic communication.

DESIGN

A Preintervention-postintervention, quasi-experimental, controlled, and community-based trial.

SETTING

Intervention was in 2 rural North Carolina counties with comparison group in 3 adjacent counties.

SUBJECTS

Participants (n = 249) were parents, caregivers, or parental figures for African American youth aged 10 to 14.

INTERVENTION

Twelve-session curriculum for participating dyads.

MEASURES

Audio computer-assisted self-interview to assess changes at 9 months from baseline in communication about general and sensitive sex topics and overall communication about sex.

ANALYSIS

Multivariable models were used to examine the differences between the changes in mean of scores for intervention and comparison groups.

RESULTS

Statistically significant differences in changes in mean scores for communication about general sex topics ( P < .0001), communication about sensitive sex topics ( P < .0001), and overall communication about sex ( P < .0001) existed. Differences in change in mean scores remained significant after adjusting baseline scores and other variables in the multivariate models.

CONCLUSIONS

In Teach One Reach One intervention, adult participants reported improved communication about sex, an important element to support risk reduction among youth in high-prevalence areas.

The association between smartphone dating applications and college students' casual sex encounters and condom use

OBJECTIVE

This study aims to explore the association between using smartphone dating applications (apps) and having unprotected sex with a casual sex partner.

STUDY DESIGN

This is a cross-sectional study. Students were recruited from four university campuses in Hong Kong by convenience sampling.

MAIN OUTCOME MEASURES

Subjects completed a structured questionnaire asking about the use of dating apps, sexual history and socio-demographic information. Multiple logistic regressions were used to explore the association between using dating apps and having unprotected sex with a casual sex partner.

RESULTS

Six hundred and sixty-six subjects were included in the analysis. Users of dating apps were more likely to have had unprotected sex with a casual sex partner the last time they engaged in sexual intercourse (aOR: 10.06). Using dating apps for more than 12 months was associated with having a casual sex partner in the last sexual intercourse (aOR: 3.21), as well as having unprotected sex with that casual partner (aOR: 13.56).

CONCLUSION

We found a robust association between using dating apps and having unprotected sex with a casual sex partner, implying that using dating apps is an emerging sexual risk factor. We recommend that interventions promoting the safe use of dating apps should be implemented.

Sexuality (and Lack Thereof) in Adolescence and Early Adulthood: A Review of the Literature

Youth sexuality has been primarily studied with a focus on its potential public health issues, such as sexually transmitted infections and unwanted pregnancies, and its comorbidity with other risky behaviors. More recently, it has been studied as a normative step in romantic partnerships, either pre- or post-marital, as well as outside the context of romantic involvement. In this paper, we review the extensive literature on sexuality in adolescence and early adulthood both within and outside romantic relationships (i.e., casual sexual relationships and experiences; CSREs). Furthermore, the recent recognition of youth sexuality as a developmental task has led to a renewed interest from scholars in youth who abstain from sexual encounters, whether deliberately or not. A brief overview of the literature on cultural differences in sexuality, and sexual-minority youth sexual development is also provided. This paper concludes by suggesting future directions to bring the field of youth sexuality and romantic relationships forward.

Testing the Invariance of the National Health and Nutrition Examination Survey's Sexual Behavior Questionnaire Across Gender, Ethnicity/Race, and Generation

Federal and state policies are based on data from surveys that examine sexual-related cognitions and behaviors through self-reports of attitudes and actions. No study has yet examined their factorial invariance--specifically, whether the relationship between items assessing sexual behavior and their underlying construct differ depending on gender, ethnicity/race, or age. This study examined the factor structure of four items from the sexual behavior questionnaire part of the National Health and Nutrition Examination Survey (NHANES). As NHANES provided different versions of the survey per gender, invariance was tested across gender to determine whether subsequent tests across ethnicity/race and generation could be done across gender. Items were not invariant across gender groups so data files for women and men were not collapsed. Across ethnicity/race for both genders, and across generation for women, items were configurally invariant, and exhibited metric invariance across Latino/Latina and Black participants for both genders. Across generation for men, the configural invariance model could not be identified so the baseline models were examined. The four item one factor model fit well for the Millennial and GenerationX groups but was a poor fit for the baby boomer and silent generation groups, suggesting that gender moderated the invariance across generation. Thus, comparisons between ethnic/racial and generational groups should not be made between the genders or even within gender. Findings highlight the need for programs and interventions that promote a more inclusive definition of "having had sex."

Exploring the role of gender norms in nutrition and sexual health promotion in a piloted school-based intervention: The Philadelphia Ujima™ experience

Perceptions of masculinity and femininity influence behaviors and can be identified in young children and adolescents (Brannon, 2004). Thus, adolescents' engagement in health risk or promoting behaviors is influenced by perceptions of masculinity and femininity and the differences in expectations, norms and responsibilities for girls and boys (WHO, 2007). Girls and boys have different needs, and gender-based interventions that consider similarities as well as differences are needed. A gender-based nutrition and sexual health promotion program was developed and piloted by the Philadelphia Ujima Coalition in a high school setting. To explore the gender differences in adolescents' perceptions of the influence of gender norms on weight, nutrition, physical activity, and sexual health and the implication of these differences in future gender-integrated health promotion programming for youth, a content analysis of student and facilitator debriefing forms were implemented for the participating schools. The content analysis was used to identify central themes, concepts gained, and overall impact of the intervention sessions. Overall, gender norms influence healthy eating practices and activity through influencing perceptions of body type in adolescents. Gender norms also influence sexual activity and decision making through influencing perceptions of beauty, masculinity, femininity, pressures and popular concepts related to sexual activity. Thus, interventions that address gender may more effectively promote health and wellness in adolescents.

Factors contributing to the risk of HIV infection in rural school-going adolescents

The objective of this study was to determine the factors that increase the risk of HIV infection in rural school-going adolescents and young adults. This was a cross-sectional study of 430 secondary school students (47.4% boys and 52.6% girls) from two rural schools in South Africa. Data were collected with a self-administered questionnaire on demographic information, sources of HIV/AIDS information, HIV knowledge, sexual behaviors, communication and negotiation skills, self-efficacy to refuse sex, peer influence and time perspective. Out of 113 (27.2%) participants who reported being sexually active, about 48% reported having had sex before the age of 15 and 42.2% reported penetrative sex with more than one partner in their lifetime. Only 44.8% of them reported consistent and regular use of condoms for every sexual encounter. Peer influence (OR = 3.01 (95% CI = 1.97-4.60)), gender difference (OR = 6.60 (95% CI = 1.62-26.84)) and lack of HIV information (OR = 1.22 (95% CI = 1.03-1.44)) influenced the sexual risk behaviors of the adolescents. Greater numbers of school-going adolescents in rural areas are sexually active. Peer influence, especially in boys, is a factor that increases the preponderance of risky sexual behaviors in adolescents. Positively, adolescents with high knowledge of HIV infection are more likely to use condoms for every sexual encounter. There is a need to strengthen comprehensive sexual health education and youth-friendly HIV prevention strategies to promote abstinence and safe sexual behaviors, especially among boys.

A Systematic Review and Meta-analysis of Interventions for Sexual Health Promotion Involving Serious Digital Games

OBJECTIVE

Serious games may be effective in promoting sexual health behavior. Their confidential nature may encourage users to discuss sensitive sexuality topics. Furthermore, they can tailor messages to the individual's needs and may be intrinsically motivating. This meta-analysis investigates the effectiveness of interventions for sexual health promotion that use serious games.

MATERIALS AND METHODS

A database search was conducted in PubMed, Web of Science, CINAHL, and PsycINFO for publications before the end of July 2013. Serious digital games studies measuring effects on behavior or its determinants, using a control condition, allowing the calculation of an effect size (Hedges' g, random-effects model) were included.

RESULTS

Seven game studies for sexual health promotion were included. These showed positive effects on determinants (g=0.242; 95 percent confidence interval, 0.129, 0.356), albeit of small effect size. The effects on behavior, measured in only two studies, were not significant (g=0.456; 95 percent confidence interval, -0.649, 1.561). Most games did not use many game features that are considered to be immersive or enhancing flow. Instead, there was a strong reliance on pure gamification features, such as rewards and feedback.

CONCLUSIONS

The effectiveness of the next generation of games may be enhanced by building on the behavioral change and educational gaming literatures (e.g., using role-play and simulation game formats, individual tailoring, offering adaptation in the difficulty of the challenge, and amount and timing of the feedback). There is a need for studies with rigorous evaluations of game effectiveness, longer-term follow-up, and using measures of behavior rather than merely their determinants.

A Meta-Analysis of the Relations Between Three Types of Peer Norms and Adolescent Sexual Behavior

The aim of the present meta-analysis was to investigate the associations between three types of peer norms-descriptive norms (peer sexual behaviors), injunctive norms (peer sexual attitudes), and peer pressure to have sex-and two adolescent sexual behavior outcomes (sexual activity and sexual risk behavior). Adolescent sexual activity was more strongly associated with descriptive norms (ESrfixed=.40) than with injunctive norms (ESrfixed=.22) or peer pressure (ESrfixed=.10). Compared with the sexual activity outcome, the effect size for descriptive norms (peer sexual risk behavior) for sexual risk behavior was smaller (ESrfixed=.11). Age, gender, peer type, and socio-cultural context significantly moderated these associations. Additional analyses of longitudinal studies suggested that selection effects were stronger than socialization effects. These findings offer empirical support for the conceptual distinction between three types of peer norms and hold important implications for theory, research, and intervention strategies.

Chinese Adolescents’ Attitudes Toward Sexual Relationships and Premarital Sex

This study was designed to explore Taiwanese school students’ attitudes toward sexual relationships and premarital sex. This was an exploratory descriptive, qualitative study. Focus groups ( N = 8) were conducted with 47 adolescents from three high schools in Taiwan. Transcripts were transcribed and thematically analyzed using Atlas V 5.0. Adolescent attitudes toward sexual relationships and premarital sexual behavior comprise the following three dimensions: (1) external incentives, (2) the developmental process, and (3) internal control. External incentives include the normalization of sexual behavior between peers, the desire to feel included in a group, parental influence, and media influence. The developmental process includes imagining the sexual experience and onset of sexual activity. Internal control includes the fear of pregnancy, the fear of parental rejection, and the fear of being judged. These findings can provide a reference for designing future sex education curricula and counseling programs for adolescents.

Psychosocial correlates of the motivation to abstain from sexual intercourse among Indonesian adolescents

OBJECTIVES

Adolescents in Indonesia have limited access to sexuality education, resulting in increased risk of sexually transmitted infections and unplanned pregnancies. This study aimed to understand psychosocial correlates of sexual abstinence intentions to inform future sexuality education.

METHODS

Data were collected in 79 secondary schools among 2315 students, aged 14-20 years, in Jambi, Lampung, Jakarta and Bali. A self-completed questionnaire measured attitudes, risk perception, subjective norms, perceived behavioural control and intentions towards sexual abstinence.

RESULTS

Significant associations with intention to abstain from sexual intercourse were found for experience with sexual intercourse, perceived behavioural control, attitude and subjective norms of peers and parents, explaining 31% of the variance in abstinence intention.

CONCLUSIONS

To promote adolescents' informed sexual decision-making, sexuality education programmes in Indonesia may benefit from addressing past sexual behaviour and perceived behavioural control, subjective norms of peers and attitudes.

It's Your Game…Keep It Real: can innovative public health prevention research thrive within a comparative effectiveness research framework?

The federal comparative effectiveness research (CER) initiative is designed to evaluate best practices in health care settings where they can be disseminated for immediate benefit to patients. The CER strategic framework comprises four categories (research, human and scientific capital, data infrastructure, and dissemination) with three crosscutting themes (conditions, patient populations, and types of intervention). The challenge for the field of public health has been accommodating the CER framework within prevention research. Applying a medicine-based, research-to-practice CER approach to public health prevention research has raised concerns regarding definitions of acceptable evidence (an evidence challenge), effective intervention dissemination within heterogeneous communities (a dissemination and implementation challenge), and rewards for best practice at the cost of other promising but high-risk approaches (an innovation challenge). Herein, a dynamic operationalization of the CER framework is described that is compatible with the development, evaluation, and dissemination of innovative public health prevention interventions. An effective HIV, STI, and pregnancy prevention program, It's Your Game…Keep It Real, provides a case study of this application, providing support that the CER framework can compatibly coexist with innovative, community-based public health prevention research.

Developing sexual violence prevention strategies by bridging spheres of public health

Sexual violence (SV) is a significant public health problem with multiple negative physical and emotional sequelae for both victims and perpetrators. Despite substantial research and program activity over the past 20 years, there are few programs with demonstrated effectiveness in preventing SV. As a result, the field may benefit from considering effective approaches used with other risk behaviors that share risk factors with SV. The Division of Violence Prevention (DVP) at the Centers for Disease Control and Prevention (CDC) has taken several steps to identify and understand the breadth of risk factors for sexual violence and to delineate the implications of these factors in the development of effective prevention strategies. This report from CDC will highlight several risk factors that, although not traditionally included in SV prevention efforts, may be important areas on which to focus and may ultimately prevent youth from embarking on trajectories resulting in SV perpetration.

Sexual Health and Risk Behaviour among East Asian Adolescents in British Columbia

Despite the large number of adolescents of East Asian origin in Canada, there is limited research on sexual health among this population. A first step to develop strategies for sexual health promotion for adolescents is to document the prevalence of sexual behaviours. This study thus estimated the prevalence of sexual health and risk behaviours among East Asian adolescents in grades 7 to 12, using the province-wide, school-based 2008 British Columbia Adolescent Health Survey (unweighted N = 4,311). Less than 10% of East Asian adolescents have ever had sexual intercourse. However, most of these sexually active adolescents have engaged in risky sexual behaviours, including multiple sexual partners and non-condom use at last intercourse. In particular, nearly half of sexually active girls reported not using a condom at last intercourse. Compared to immigrant students whose primary language at home was not English, immigrant and Canadian-born students speaking English at home were more likely to experience sexual intercourse. Among students who have never had sexual intercourse, two most common reasons for sexual abstinence were not feeling ready and waiting to meet the right person. Findings suggest the need for sexual health interventions tailored to gender and sociocultural contexts in which adolescents live.

College-Bound Teens' Decisions about the Transition to Sex: Negotiating Competing Norms

The normative influence of parents, close friends, and other peers on teens' sexual behavior has been well documented. Yet, we still know little about the processes through which these oftentimes competing norms impact teens' own sexual norms and behaviors. Drawing on qualitative data from 47 interviews conducted with college-bound teens, we investigate the processes through which perceived parental, close friend, and other peer norms about sex influenced teens' decisions about whether and when to have sex. Although virtually all teens perceived that most of their peers were having sex and that parents were almost universally against teen sex, some teens had sex and others did not. Our findings demonstrate that teens who remained virgins and those who were sexually active during high school often negotiated different sets of competing norms. Differences in understandings of age norms, in close friends' sexual norms and behaviors, and in communication about sex with parents, close friends and other peers were related to different levels of sexual behavior for teens who otherwise shared many similarities in social location (e.g.. class, race, and educational status). While virgins reported an individualized process of deciding whether they were ready for sex, we find that their behavior fits within a traditional understanding of an age norm because of the emphasis on avoiding negative sanctions. Sexually experienced teens, on the other hand, explicitly reported abiding by a group age norm that prescribed sex as normal during high school. Finally, parents' normative objections to teen sex - either moral or practical - and the ways they communicated with their teen about sex had important influence on teens' own sexual norms and behaviors during high school.

Character as a predictor of reproductive health outcomes for youth: a systematic review

To review research examining the influence of character on adolescent sexual and reproductive health (ASRH). We defined character as comprising two positive youth development constructs: prosocial norms and spirituality. We conducted a systematic review of behavioral research published from 1985 through 2007 that examined the association between two character constructs (prosocial norms and spirituality) and ASRH outcomes. We coded results as showing a protective association, risk association, or no association, and as longitudinal, or cross-sectional. We considered consistent associations from at least two longitudinal studies for a given outcome to be sufficient evidence for a protective or risk association. There is sufficient evidence to indicate that prosocial norms and spirituality can be protective factors for some ASRH outcomes including intention to have sex, early sex or ever having sex, contraceptive and condom use, frequency of sex, and pregnancy. The generalizability of findings by age, race/ethnicity, and gender was unclear. Findings suggest that some character sub-constructs are associated with a reduced likelihood of several adverse ASRH outcomes and with an increased likelihood of using contraceptives and intending to use condoms. Further research is needed to better understand mixed results and results showing some character sub-constructs, such as religious affiliation, to be associated with adverse ASRH outcomes.

Preliminary efficacy of a comprehensive HIV prevention intervention for abstinent adolescent girls: pilot study findings

We developed and pilot-tested a comprehensive HIV prevention/sexual risk reduction intervention with 54 sexually abstinent girls and estimated the effect of the intervention on three antecedents of sexual risk behavior: information, motivation, and behavioral skills. Girls ages 14-18 were randomized into either (a) an AbsPlus intervention or (b) a structurally equivalent control group. Assessments were obtained at baseline and 3 months follow-up using audio computer assisted self-interview. The intervention resulted in a large effect for information (d = 1.11); small to large effects for the motivational measures (d = .34-.88), and a moderate effect for a measure of behavioral skills (d = .67). The results indicate that antecedents of sexual risk behavior change were improved by a gender-specific theoretically guided intervention.

Sexuality, sexual and reproductive health: an exploration of the knowledge, attitudes and beliefs of the Greek-Cypriot adolescents

This study examines the knowledge, attitudes and beliefs of Greek-Cypriot adolescents regarding sexuality, sexual and reproductive health in Cyprus. This is the first study in Cyprus that focuses on these issues. During the study, a survey was administered to a random sample of third grade students ( N = 697, Mean age = 14 ± 1 years, 48% males). Descriptive and comparative statistics were primarily used for the data analysis. The results indicated that young Greek-Cypriots have limited knowledge on sexual health issues and that there are gender differences regarding role expectations of sexuality. Thus, in the promotion of healthy sexuality and sexual behaviours among youth, practitioners should include gender and cultural perspectives. Qualitative research is needed to explore in depth how young Greek-Cypriots feel about sexuality and sexual and reproductive health. (Promot Educ, 2008; 15 (4): pp. 24-31)

African American Adolescent Perceptions of Vulnerability and Resilience to HIV

HIV/AIDS is growing at a disproportional rate among African American adolescents. This trend has occurred despite the fact that 89% of schools have educational programs on HIV/AIDS. Barriers to effective HIV prevention may be related to a failure to develop educational programs based on the cultural competencies of vulnerable populations such as adolescents who are at risk for HIV. The purpose of this qualitative study was to explore African American adolescent perceptions of vulnerability and resilience to HIV/AIDS within a cultural competency paradigm. A group of 8 adolescents at an African American church participated in a focus group to discuss vulnerability and resilience to HIV. To facilitate discussion, the adolescents developed collages from pictures in African American magazines. Content analysis was used to identify themes. The themes revealed were confidence, safe social activities, innocence, image, music/drug culture, and peer pressure.

Adolescent human immunodeficiency virus and sexually transmitted disease prevention programmes: are gender-blind approaches justified?

OBJECTIVE

To present findings that gender might be more predictive of human immunodeficiency virus (HIV) and sexually transmitted disease (STD) knowledge, and sexual behaviour, compared with participation in knowledge-based HIV prevention programmes.

STUDY DESIGN

A cross-sectional study comparing students attending public high schools running an HIV and STD prevention programme. It is based on a study that evaluated the City of Houston HIV and STD prevention programme in public high schools. Comparison was initially between groups (intervention vs comparison) and subsequently between gender. The main variables for comparison were level of interest and knowledge of the subject of HIV and STD, and a range of sexual behaviour variables.

METHODS

Self-administered questionnaires were used for eliciting both knowledge and behavioural data. A specific question required participants to rate their level of interest in the subject of HIV and STD on a scale of 1-4 (lowest to highest). The knowledge component was marked and scores awarded in percentage form. Descriptive statistical analysis was followed by stratified analysis. Finally, a select number of variables were used in a logistic regression model. STATA version 8 was the main statistical software.

RESULTS

A significantly large proportion of girls reported the highest level of interest in the subject of HIV and STD (a score of 4); had higher HIV and STD knowledge scores; and reported less risk-taking sexual behaviour compared with boys. The only variable in which boys faired better was condom use, reporting higher rates of condom use than girls.

CONCLUSIONS

Gender-blind HIV and STD prevention programmes seem to have a minimal effect on boys. Although a myriad of other factors influence male response to such programmes, the relatively low level of interest in the subject of HIV and STD among boys might be contributory. HIV and STD prevention programmes need to be re-designed using approaches that are more appealing to boys. Boys will otherwise remain the weak link and therefore the rate-limiting step in the quest for sexual behaviour change among adolescents.

Predictors of adolescent sexual behavior and intention: a theory-guided systematic review

PURPOSE

To better understand why adolescents initiate sexual activity at early ages, we conducted a systematic literature review guided by eight key elements outlined in an integrative theoretical framework.

METHODS

Using the matrix method for literature reviews, we extracted-from 69 published studies-statistically significant and nonsignificant findings (related to the attempted prediction/explanation of adolescents' sexual behavior and intention) and organized them using the various integrative model elements. We also assessed these publications' methodological quality including each study's deployment of theory, appropriate design, and data analytic/reporting techniques.

RESULTS

Three integrative theoretical framework elements-intention, perceived norms, and an environmental constraint variable, time home alone-emerged as stable predictors of sexual behavior outcomes in this body of literature. This analysis revealed, however, a literature that has remained rather stagnant regarding its methodological quality, over time.

CONCLUSIONS

Implications for adolescent sexual health promotion practice and research are discussed.

Patterns of sexual behaviour among secondary school students in Swaziland, southern Africa

Among the many sub-Saharan African countries hardest hit by HIV/AIDS is the Kingdom of Swaziland. In an effort to reduce the spread of HIV, young people are an important group to reach with prevention messages. However, before developing such programmes, it is essential to understand young people's sexual risk behaviours. Students (n=941) from four coeducational secondary schools in Swaziland participated in a cross-sectional survey of sexual behaviours. Results indicate that considerable proportions of young people in this study were sexually experienced, irrespective of gender. Findings also suggest unacceptable high levels of sexual coercion, irrespective of age or gender. While boys may be less likely than girls to experience sexual coercion, being a male in this setting was not a protective factor. No significant differences were found on these variables in relation to location of the schools (rural vs. urban). Implications for developing and implementing HIV prevention programmes are suggested.