The Role of Communication with Friends in Sexual Initiation

Patterns of Verbal and Nonverbal Communication During Sex

Sexual communication functions as an important relational process expediating satisfying sexual experiences (Sprecher & Hendrick, 2004). Much of the existing literature on sexual communication concerning sexual pleasure biases verbal communication (Babin, 2012). This study adds to the existing research regarding patterns of communication surrounding sex and during sex through qualitative analysis. Further, this inquiry focused on participants' full histories, rather than their tendencies within any current relationship. We analyzed 78 qualitative interview transcripts from participants between the ages of 18 and 69. Participants reported a reluctance to communicate anything but pleasure, discomfort, or dislike during sex to avoid discouraging their partners. Though participants reported a perception that communicating pleasure served as encouragement and affirmation to their partners, most preferred to communicate pleasure nonverbally. Some participants reported a tendency to communicate pain or dislike verbally. Some preferred communication about sexual topics only before or after sexual activities. Participants shared that a high level of comfort with their partner increased sexual communication. How sexual partners communicate sex not only affects pleasure but can only affect intimacy between partners and health. This adds to the scant literature on nonverbal communication during sex and some people's preference for that style (Blunt-Vinti et al., 2019).

How Sexual Information Sources are Related to Emerging Adults' Sex-Positive Scripts and Sexual Communication

Prior research suggests that parents, peers, and media are popular sources of sexual information and beliefs among emerging adults. Sex-positivity is an orientation toward sex that emphasizes open-minded beliefs and communication about varying sexual behaviors, preferences, and orientations. The current study investigated whether these sexual information sources were associated with emerging adults' endorsement of sex-positive and sexual orientation-related sexual scripts, and if these sources and scripts were associated with sexual communication among a sample of college students ages 18-22 (n = 341). Results indicate that learning from television was positively related to sex-positive sexual script endorsement, and that sex-positive scripts were associated with more positive sexual communication. An interaction also emerged between gender and learning from television on sex-positive script endorsement, and between gender and learning from social media on sexual orientation-related script endorsement. The implications of these findings are contextualized within emerging adults' sexual agency and behavior. Future directions of research are also discussed.

Descriptive norms about condom use predict odds of using a condom during last sexual experience in a large, national survey of adolescents from Australia

BACKGROUND

Reducing sexually transmitted infections among adolescents is an important public health goal in Australia and worldwide. This study estimated the association between condom use during last heterosexual sexual experience with two descriptive norms among a large, national sample of secondary school students from Australia.

METHODS

A large, national online survey of 14- to 18-year-olds in Australia was conducted in 2018; a sub-analysis of sexually active participants (n=2989) used multivariable logistic regression to estimate the relationships between condom use during last sexual experience and condom use norms. The analysis controlled for the effects of age, sex, sexual orientation, religious affiliation, remoteness and knowledge of sexually transmitted diseases.

RESULTS

Overall, 1673 (56.0% [95% confidence interval: 54.2%, 57.8%]) sexually active respondents reported using condoms during their last sexual experience. Perceiving that all same-age peers used condoms conferred higher odds of using condoms during their last heterosexual sexual experience (adjusted odds ratio: 3.06 [95% CI: 1.6, 6.0]). Perceptions about whether the suggestion to initiate condom use came from boys, girls, or both boys and girls was not associated with condom use. Differences in condom use related to socio-demographic characteristics are reported.

CONCLUSIONS

As part of a holistic approach to sexuality education, health educators and service providers may emphasise that young people frequently choose to use condoms.

Longitudinal Associations Between Sexual Communication With Friends and Sexual Behaviors Through Perceived Sexual Peer Norms

The role of peers in adolescents' sexual behaviors is not yet fully understood. We investigated the association between sexual communication with friends (at T1) and subsequent changes in adolescents' experience with sexual behaviors (between T1-T3), and examined whether this association was explained by adolescents' perceptions of three sexual peer norms (at T2): (1) peers' sexual behaviors (descriptive norms), (2) peers' approval of sexual behaviors (injunctive norms), and (3) peer pressure to have sex. The data source was Project STARS, a longitudinal study on adolescent sexual development in the Netherlands, collected via online self-report questionnaires from 1,116 adolescents (11.5-17.9 years). Adolescents who communicated more frequently with their friends about sexuality-related topics at T1 reported significantly larger increases in their experience with different sexual behaviors between T1-T3. More sexual communication with friends also predicted adolescents subsequently perceiving more 1) peer sexual behaviors, 2) peer approval of sex, and 3) peer pressure to have sex. These stronger perceptions, in turn, predicted larger increases in their sexual behaviors between T1-T3. After adjusting for the three norms simultaneously, the main association between sexual communication with friends and sexual behavior change weakened but remained significant. Inspection of specific indirect effects showed this link was explained by injunctive norms only. No gender differences were found.

Applying Self-Determination Theory to Adolescent Sexual-Risk Behavior and Knowledge: A Structural Equation Model [Formula: see text]

BACKGROUND

National health priorities identify adolescent sexual-risk behavior outcomes as research and intervention targets for mental health.

OBJECTIVE

Reduce sexual-risk behavioral outcomes by applying self-determination theory to focus on decision-making autonomy. This study examined late adolescents' recollections of parental autonomy support/sexual-risk communication experiences and autonomy motivation as predictors of sexual-risk behaviors/knowledge.

METHOD

A convenience sample ( N = 249) of 19- and 20-year-old university students completed self-report questionnaires. Structural equation modeling with latent variables examined direct/indirect effects in the hypothesized model.

RESULTS

Parents contributed uniquely through sexual-risk communication and/or autonomy support to late adolescents' autonomous motivation. The final model evidenced acceptable fit and explained 12% of the variation in adolescent sexual-risk behavior, 7% in adolescent autonomous motivation, and 2% in adolescent sexual-risk knowledge.

CONCLUSIONS

Psychiatric mental health nurses should conduct further research and design interventions promoting parent autonomy support and adolescent autonomous motivation to reduce sexual risk-behavior and increase sexual-risk knowledge.

Observed Normativity and Deviance in Friendship Dyads' Conversations About Sex and the Relations With Youths' Perceived Sexual Peer Norms

The current study examined the relations between observed normativity and deviance during adolescents' and young adults' conversations about sex with their friends and their individual perceptions of sexual peer norms. Participants were 16-21-year-old same-sex friendship dyads (31 male and 30 female dyads) who performed a peer interaction task that consisted of five discussion assignments focusing on party planning, sexual double standards, condom use, homosexuality, and consensual sex. Videotaped discussions were coded to capture the amounts of normative talk (e.g., consistent with notions of healthy sexuality) and deviant talk (e.g., consistent with notions of risky sexuality), and the verbal or nonverbal reinforcement thereof. Participants also completed individual questionnaires to assess their perceived sexual descriptive norms, injunctive norms, pressure, and risk norms among their peers. Actor-partner interdependence model (APIM) results revealed that youths' perceived descriptive, injunctive, and risk norms, but not their experienced peer pressure, were related to both their own (actor effects) and their friends' (partner effects) normativity and deviance. Overall, more deviance was related to perceiving friends to be more sexually active, more approving of having sex, and engaging in more risky sex, whereas more normativity was related to these perceptions in the opposite direction. Gender differences in the APIMs indicated that interactive normativity and deviance was related to perceived descriptive, injunctive, and risk norms for boys, but only to perceived injunctive norms for girls. These findings demonstrate the importance of assessing the dyadic nature of youths' sexual communication with friends, their relation to individual sexual peer norm perceptions, and gender differences therein.

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.

Correlates of Young Men's Intention to Discuss Birth Control with Female Partners

CONTEXT

Heterosexually active men who wish to prevent conception, but are not willing to use condoms consistently, need to discuss birth control with female partners. Improving the understanding of correlates of men's intention to have such discussions is one step toward supporting this health-facilitating behavior.

METHODS

A sample of 372 heterosexually active men aged 18-25 were recruited and surveyed online between December 2010 and June 2011. Men answered questions on attitudes toward, norms regarding and self-efficacy about discussing birth control, and about endorsement of two sexual scripts. Multiple regression analyses tested these measures' associations with intention to discuss birth control, controlling for age and relationship status.

RESULTS

Attitudes, norms and self-efficacy were each positively associated with men's intention to discuss birth control, accounting for 34% of variance. The more strongly men endorsed a traditional masculinity sexual script, the less likely they were to intend to discuss birth control (coefficient, -0.2). Endorsement of an alternative, gender-equitable "sex-positive woman" script, which emphasizes sexual pleasure and emotional connection as goals for both partners, had no association with intention.

CONCLUSION

Strategies that merit further exploration as potential supports for men's intention to discuss birth control include improving men's self-efficacy and positive attitudes and norms pertaining to such discussions, and reducing belief in traditionally masculine sexual scripts or transforming them to include discussing birth control. Future research should work both experimentally and longitudinally to document each element of the process that ends with men's full participation in effective contraceptive use.

How peer conversations about HIV/AIDS media messages affect comprehension and beliefs of young South African women

Most existent research on the effects of interpersonal discussions about health campaign messages is based on surveys. In this study, we analysed actual conversations about an HIV/AIDS poster to find out possible effects. Young South African women in 59 dyads (n = 118) participated in conversations about a deliberately puzzling HIV and AIDS poster that cautioned the target group to be faithful to one sexual partner. We measured their comprehension of the poster and beliefs about the message, before and after the conversations. Overall, actual comprehension (AC) was low, and we observed a large discrepancy between actual and perceived comprehension. In general, conversations did not improve AC. It proved to be even more probable that a correct interpretation before a conversation turned into an incorrect interpretation than the other way around. However, having a well-informed conversation partner increased the chance of acquiring adequate subsequent comprehension. We found, in general, that conversations did not decrease undesirable beliefs. One important undesirable belief even became reinforced after the conversations. Conversations among peers might be valuable in health campaigns, but our study shows that intended positive effects do not automatically follow.

The Double Standard at Sexual Debut: Gender, Sexual Behavior and Adolescent Peer Acceptance

A sexual double standard in adolescence has important implications for sexual development and gender inequality. The present study uses longitudinal social network data (N = 914; 11-16 years of age) to test if gender moderates associations between adolescents' sexual behaviors and peer acceptance. Consistent with a traditional sexual double standard, female adolescents who reported having sex had significant decreases in peer acceptance over time, whereas male adolescents reporting the same behavior had significant increases in peer acceptance. This pattern was observed net of respondents' own perceived friendships, further suggesting that the social responses to sex vary by gender of the sexual actor. However, findings for "making out" showed a reverse double standard, such that female adolescents reporting this behavior had increases in peer acceptance and male adolescents reporting the same behavior had decreases in peer acceptance over time. Results thus suggest that peers enforce traditional sexual scripts for both "heavy" and "light" sexual behaviors during adolescence. These findings have important implications for sexual health education, encouraging educators to develop curricula that emphasize the gendered social construction of sexuality and to combat inequitable and stigmatizing peer responses to real or perceived deviations from traditional sexual scripts.

Acceptance of Home-Based Chlamydia Genital and Anorectal Testing Using Short Message Service (SMS) in Previously Tested Young People and Their Social and Sexual Networks

Background

Control strategies for Chlamydia trachomatis (CT) are most effective when targeting people at highest risk. We assessed test acceptance of home-collection test kits offered by short messaging services (SMS) texts, in high-risk young people, i.e. those who had previously tested CT positive (positive indices), or negative reporting more than 3 sex partners (negative indices), and their sexual and social networks.

Methods

Young (16 to 25 years old) heterosexuals who previously tested positive (n=536) or negative (n=536) in our STI clinic received, 3 to 20 months after their initial screening, an SMS inviting them to re-test. They were offered a free home-collection test kit including a genital (men and women) and anorectal (women only) test, and a test kit to pass on to a friend or sex partner (peer). SMS reminders were sent in case of non-response. We assessed proportions of tests requested and returned, peers tested, and positivity. Associations with the individual’s initial screening result and other factors were explored using logistic regression.

Results

Of 1072 people invited to retest, 34.4% (n=369) requested a test. Of these, 55.8% (n=206) retested. Overall, retest participation was higher in positive (22%) than in negative indices (16%) (p<0.001); it was also higher in women and in those aged >22 years. Positivity was 13% and 7% in positive and negative indices, respectively. One in 3 retesters also had a peer tested. Of tested peers (n=87), 84% were friends, 31% were first-time testers, and 7% tested positive.

Conclusion

Acceptance of a relatively low-cost strategy for genital and anorectal testing, i.e. using SMS and home-collection test kits, was highest in individuals who previously tested CT positive suggesting that implementation for this group may be considered. By further including a peer-led testing component, undetected CT positives can be identified in the social networks surrounding a high-risk individual.

Chlamydia trachomatis testing among young people: what is the role of stigma?

BACKGROUND

To reach young people for Chlamydia trachomatis (CT) testing, new web-based strategies are used to offer testing via young people's sexual and social networks. The success of such peer-driven strategies depends on whether individuals disclose their own testing and encourage others to get tested. We assessed whether public- and self-stigma would hamper these behaviours, by comparing anticipations and experiences relating to these issues in young men and women who already tested or never tested for CT.

METHODS

Participants were recruited at an STI clinic and two schools in the Netherlands. Semi-structured interviews were analysed from 23 sexually active heterosexual young people between 16-24 years using qualitative content analysis with a framework approach.

RESULTS

Both tested and never tested participants perceived public stigma and anticipated shame and self-stigma in relation to testing. Maintaining good health was identified as main reason for testing. Never tested and tested participants anticipated that they would feel shame and receive stigmatizing reactions from people outside their trusted network if they would disclose their testing, or encourage them to test. From a selected group of trusted peers, they anticipated social support and empathy. When tested participants disclosed their testing to trusted peers they did not experience stigma. Due to the fact that no one disclosed their testing behaviour to peers outside their trusted network, stigma was avoided and therefore tested participants reported no negative reactions. Similarly, regarding the encouragement of others to test, most tested participants did not experience negative reactions from sex partners and friends.

CONCLUSIONS

Young people perceive public stigma and anticipate self-stigma and shame in relation to CT testing, disclosure and encouraging others to test. People do test for CT, including those who anticipate stigma. To avoid stigmatizing reactions, stigma management strategies are applied, such as selective disclosure and the selective encouragement of others to test (i.e. only in a small trusted peer network). Care strategies that deploy sexual and social networks of individuals can reach into small networks surrounding a person. These strategies could be improved by exploring methods to reach high-risk network members outside the small trusted circle of a person.

A Three-Factor Cancer-Related Mental Condition Model and Its Relationship With Cancer Information Use, Cancer Information Avoidance, and Screening Intention

Cancer-related affect and cognition, such as cancer fear, cancer worry, and cancer risk perception, are important predictors of cancer prevention and communication behaviors. However, they have not been clearly conceptualized in cancer communication literature, and in particular, the role of affect (i.e., cancer fear) in cancer prevention and communication has not been fully investigated. The present study developed a 3-factor cancer-related mental condition model encompassing affective (cancer fear), cognitive (cancer risk perception), and affective-cognitive (cancer worry) conditions. Two studies were conducted. Study 1 developed the model with Sample 1 (U.S. undergraduates, N = 309), and subsequently validated the model with Sample 2 (Korean general population, ages 40 years or older, N = 1,130). Study 2, using Sample 2, tested the model's relationship with cancer information use, cancer information avoidance, and screening intention. While Sample 1 participants were asked about cancer in general, Sample 2 participants were asked specifically about stomach cancer. Thus, the model derived from the specific sample in a general context was confirmed via the general sample in a specific context. The results showed that both cancer worry and cancer risk perception are positively associated with cancer information use and screening intention, but they are negatively associated with cancer information avoidance. Cancer fear was positively associated with cancer information use, but it was also positively related to cancer information avoidance. Moreover, cancer fear was negatively associated with screening intention. Although the three components of the model are positively related to one another, they function differently in the cancer context.

Facilitating communication about sexual health between aging women and their health care providers

Many women experience changes in sexual health as they age, and discussing these changes with health care providers is an essential component of optimal health management. The purpose of this study was to understand aging women's perspectives about communicating with providers about sexual health. We used the integrative model of behavioral prediction as a theoretical lens to explore women's attitudes, perceived norms, and perceived self-efficacy that promote or inhibit the likelihood of communicating about sexual health. In this theory-based qualitative study, we interviewed 28 community-dwelling older women in the Midwestern United States. Through thematic analysis, we identified both positive and negative attitudes about communicating with providers. Women seemed most inclined to discuss sexual health if they perceived that important patient-provider conditions, such as trust and rapport, were in place. Despite situational obstacles and perceived norms, these women held strong beliefs about their abilities to discuss sexual health topics with providers.

Will it help? Identifying socialization discourses that promote sexual risk and sexual health among African American youth

Because much of the existing research examining sexual communication to African American youth focuses on demographic and parental factors predicting sexual risk behaviors, less is known about factors predicting sexual health, and little is understood about the contributions of peer communications. The current study aimed to expand existing approaches by assessing which socialization discourses communicated by parents and peers contribute to sexual risk and health outcomes (sexual assertiveness, positive sexual affect, and condom self-efficacy). Participants were 631 African American undergraduates (73% female) who indicated the extent to which they had received from their parents and peers each of 28 messages representing four cultural discourses: abstinence, relational sex, sex positive, and gendered sexual roles. As expected, parents were perceived to emphasize relational sex and abstinence messages more than peers, and peers were perceived to communicate sex-positive and gendered sex role messages more than parents. Greater exposure to abstinence messages predicted lower levels of sexual experimentation, whereas exposure to sex-positive messages predicted higher levels. In addition, exposure to relational sex and sex-positive messages predicted higher levels of sexual assertiveness and positive sexual affect. Implications are discussed concerning sexual communications that could help Black youth develop healthy sexual perspectives.

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.

Adolescent sexual health communication and condom use: a meta-analysis

OBJECTIVE

Condom use is critical for the health of sexually active adolescents, and yet many adolescents fail to use condoms consistently. One interpersonal factor that may be key to condom use is sexual communication between sexual partners; however, the association between communication and condom use has varied considerably in prior studies of youth. The purpose of this meta-analysis was to synthesize the growing body of research linking adolescents' sexual communication to condom use, and to examine several moderators of this association.

METHOD

A total of 41 independent effect sizes from 34 studies with 15,046 adolescent participants (M(age) = 16.8, age range = 12-23) were meta-analyzed.

RESULTS

Results revealed a weighted mean effect size of the sexual communication-condom use relationship of r = .24, which was statistically heterogeneous (Q = 618.86, p < .001, I² = 93.54). Effect sizes did not differ significantly by gender, age, recruitment setting, country of study, or condom measurement timeframe; however, communication topic and communication format were statistically significant moderators (p < .001). Larger effect sizes were found for communication about condom use (r = .34) than communication about sexual history (r = .15) or general safer sex topics (r = .14). Effect sizes were also larger for communication behavior formats (r = .27) and self-efficacy formats (r = .28), than for fear/concern (r = .18), future intention (r = .15), or communication comfort (r = -.15) formats.

CONCLUSIONS

Results highlight the urgency of emphasizing communication skills, particularly about condom use, in HIV/STI prevention work for youth. Implications for the future study of sexual communication are discussed.

Development of sexual expectancies among adolescents: contributions by parents, peers and the media

To expand the scant research on sexual expectancies development among non-sexually active adolescents, we examined the relationship between adolescents' exposure to four socializing agents--mother/female guardian, father/male guardian, peers, and television programs with high sexual content--and their endorsement of four sexual expectancies: social benefit, pleasure, social risk, and health risk. Data are from Waves 2 and 3 of a three-wave annual longitudinal study conducted among California adolescents, the majority of whom were not sexually active (N = 914, 84%). Structural equation models were conducted to examine cross-sectional and longitudinal associations between the socializing agents and the sexual expectancies. Cross-sectional results indicate associations between peer sexual communication and social benefit, pleasure, and social risk expectancies. A positive association was found between exposure to music videos and social benefit expectancies, and a negative association was found between exposure to music videos and health risk expectancies. Longitudinal results suggest that communication with peers positively predicted pleasure expectancies and negatively predicted social risk expectancies. No other socializing agents were associated with any sexual expectancies. An invariance test found that significant correlations were similar across the different age groups. Results suggest that efforts to support positive sexual decision making among non-sexually active adolescents should target peer sexual communication.

Contributions of divergent peer and parent sexual messages to Asian American college students' sexual behaviors

Receiving more parent sexual communication is generally linked to a later age of first sexual intercourse and less sexual risk taking. However, Asian American youth report minimal parent sexual communication, later sexual initiation, and fewer sexual risks than their counterparts. What contributes to this unexpected pattern of sexual communication and sexual behaviors? To answer this question, we surveyed 312 Asian American college students ages 17 to 22 on their sexual behaviors, parent sexual communication, and peer sexual communication. Assessment of parent and peer sexual communication was completed via a measure in which participants rated the frequency with which they had received each of 22 sexual messages from each source. Young women generally received more messages promoting abstinence, traditional sex roles, and sex within a relational context than their male counterparts. Young men, however, reported greater parent and peer communications that were accepting of casual sex. Exposure to peer messages that were accepting of casual sex was associated with more sexual partners, casual sex encounters, and sexual experience. Being older, being raised outside the United States, being less religious, and being homosexual was each predictive of more sexual experience. Implications regarding the role of culture and gender on sexual socialization are discussed.

Improving sexual health communication between older women and their providers: how the integrative model of behavioral prediction can help

Talking about sexual health can be a challenge for some older women. This project was initiated to identify key factors that improve communication between aging women and their primary care providers. A sample of women (aged 60+) completed an online survey regarding their intent to communicate with a provider about sexual health. Using the integrative model of behavioral prediction as a guide, the survey instrument captured data on attitudes, perceived norms, self-efficacy, and intent to communicate with a provider about sexual health. Data were analyzed using structural equation modeling. Self-efficacy and perceived norms were the most important factors predicting intent to communicate for this sample of women. Intent did not vary with race, but mean scores of the predictors of intent varied for African American and White women. Results can guide practice and intervention with ethnically diverse older women who may be struggling to communicate about their sexual health concerns.

High risk sexual behaviors for HIV among the in-school youth in Swaziland: a structural equation modeling approach

Background

Global efforts in response to the increased prevalence of the human immunodeficiency virus (HIV) are mainly aimed at reducing high risk sexual behaviors among young people. However, knowledge regarding intentions of young people to engage in protective sexual behaviors is still lacking in many countries around the world, especially in Sub-Saharan Africa where prevalence of human immunodeficiency virus is the highest. The objective of this study was to test the theory of planned behavior (TPB) for predicting factors associated with protective sexual behaviors, including sexual abstinence and condom use, among in-school youths aged between 15 and 19 years in Swaziland.

Methods

This cross-sectional survey was conducted using a anonymous questionnaire. A two-stage stratified and cluster random sampling method was used. Approximately one hundred pupils from each of four schools agreed to participate in the study, providing a total sample size of 403 pupils of which 369 were ultimately included for data analysis. The response rate was 98%. Structural equation modeling was used to analyse hypothesized paths.

Results

The TPB model used in this study was effective in predicting protective sexual behavior among Swazi in-school youths, as shown by model fit indices. All hypothesized constructs significantly predicted intentions for abstinence and condom use, except perceived abstinence controls. Subjective norms were the strongest predictors of intention for premarital sexual abstinence; however, perceived controls for condom use were the strongest predictors of intention for condom use.

Conclusions

Our findings support application of the model in predicting determinants of condom use and abstinence intentions among Swazi in-school youths.

Influence of friends on children's physical activity: a review

We examined evidence for friendship influences on children's physical activity (PA) through systematic searches of online databases in May 2012. We identified 106 studies (25 qualitative) published in English since 2000 that analyzed indicators of friendship influences (e.g., communication about PA, friends' PA, and PA with friends) among persons younger than 19 years. Children's PA was positively associated with encouragement from friends (43 of 55 studies indicating a positive relationship), friends' own PA (30/35), and engagement with friends in PA (9/10). These findings are consistent with friends influencing PA, but most studies did not isolate influence from other factors that could explain similarity. Understanding friendship influences in childhood can facilitate the promotion of lifelong healthy habits. PA with friends should be considered in health promotion programs.

Is there evidence that friends influence body weight? A systematic review of empirical research

Researchers and policymakers from diverse fields are engaged in efforts to understand the biological and social causes of obesity in order to develop policies, interventions, and recommendations to stop or reverse increases in obesity. One potentially promising approach is to harness influence from social contacts. An important foundation for this approach involves critically analyzing available data regarding whether and how body weight can be affected by close social contacts, especially friends. This systematic review examines evidence from published studies addressing the influences of friends on body weight. The majority of the sixteen studies conclude that there is evidence of influence: six reported that friends influence body weight and ten reported evidence of influence in some circumstances or specifications. However, this literature sheds little light on mechanisms of influence. There is limited evidence that friends' communication about weight is associated with weight status and no compelling evidence that friends' behaviors affect one's weight. Many of the studies best designed to examine influence were the ones that did not explore mechanisms of influence. A priority for future research is to understand how, when, and how much friends affect the risk of obesity.

Do Parents Talk to Their Adolescent Children about Sex?—Findings from a Community Survey in Singapore

Introduction: Sexually transmitted infections have increased sharply among adolescents both locally and internationally in recent years. Parents play an important role in their children’s sexual health development. An integral part of this includes effective parent-child sexuality communication. Materials and Methods: A nationwide cross-sectional community-based household survey was conducted in Singapore between August 2008 and March 2009 to assess parents’/caregivers’ attitudes and practices regarding caregiver-child sexuality communication. With an overall response rate of 81.4%, 1169 questionnaires from parents/caregivers of children aged 10 to 17 years were analysed. Results: Almost all (94.2%) the caregivers were parents. A majority (>80%) of caregivers considered talking to their children about sexuality issues such as abstinence, consequences of premarital sex and condom use as important. However, a significantly lower percentage (about 60%) felt comfortable and confident doing so. Only 8.3% among them discussed sexual health issues with their children very often, 37.2% sometimes, 22.0% seldom/hardly ever (once or twice) and 32.5% never, in the past year. In the multivariate analysis, caregiver-child sexuality communication was significantly associated with caregivers’ relationship to children, ethnicity, educational level, and their perceived levels of comfort and confidence in sexuality communication. Conclusion: Caregivers generally felt it was important but were significantly much less comfortable and confident talking about sexuality issues with their children, which leads to a lower frequency of caregiver-child sexuality communication. Educational programmes on adolescent sexual health targeting parents/caregivers are needed. They must be equipped with skills and provided with resources to enable them to talk to their adolescent children about sexuality. Key words: Abstinence, Condom use, Confidence level, Importance, Parent-child sexuality communication