Inclusion of a Parental Component in a Sports-Based HIV Prevention Program for Dominican Youth

BACKGROUND

Underprivileged youth in the Dominican Republic (DR) are at high risk of acquiring the human immunodeficiency virus (HIV). Protective parenting practices may inhibit sexual risk-taking.

OBJECTIVE

We investigated whether parental involvement in a sports-based HIV prevention program increased self-efficacy to prevent HIV and safe sex behavior among Dominican youth.

METHOD

The study had a quasi-experimental design with repeated measures. N = 90 participants between 13 and 24 years of age participated in the program through two different trainings, UNICA and A Ganar, both of which had an experimental (i.e., program with parental component) and a control (i.e., program without parental component) condition.

RESULTS

Self-efficacy to prevent HIV significantly increased among participants in the experimental condition of UNICA. Self-efficacy for safe sex increased among sexually active participants in the experimental condition of A Ganar. Implications for Impact: These findings are important to meet the United Nations' Sustainable Development Goal of good health and wellbeing, as they suggest that parental involvement in sports-based HIV prevention programs can enhance their positive effects for increasing youth's self-efficacy to practice HIV-preventive behaviors. Randomized control trials and longitudinal studies are needed.

"We have to figure it out ourselves": Transfeminine adolescents' online sexual experiences and recommendations for supporting their sexual health and wellbeing

The internet plays a significant role in adolescent sexual development. Sexual and gender minority (SGM) adolescents are more likely than their cisgender, heterosexual peers to use online spaces for sexual and romantic purposes, as they may have a smaller pool of potential partners and more concerns about the risks of in-person partner seeking. Among SGM adolescents, gender identity may shape how youth navigate online spaces for sexual purposes but there is limited research focused on transgender and gender diverse (TGD) adolescents' online partner seeking. Previous research has focused on cisgender gay and bisexual boys' experiences with sexual networking applications designed for adult men who have sex with men. This perspective article integrates clinical expertise and survey data from transfeminine adolescents (N = 21) in the United States reporting their online sexual behavior and experiences. We use qualitative data to describe the sexual health, safety, and wellbeing of transfeminine adolescents and offer suggestions for clinical assessment of online versus offline sexual activity and call for inclusive sexual health resources for transfeminine adolescents.

More than the sum of their parts: A dyad-centered approach to understanding adolescent sexual behavior

BACKGROUND

Research has documented multiple levels of influences on adolescent sexual behavior, but has generally focused less on the relational nature of this behavior. Studies with dyadic data have provided important findings on relationship process, including the role of gender in different-sex dyads. However, both of these bodies of literature typically utilize a variable-centered approach, which examines average influences of particular variables on sexual behavior. This study expands upon this research by presenting a dyad-centered approach to adolescent sexual behavior that can identify types of couples based on patterns of multidimensional risk and protective factors.

METHODS

I demonstrate the dyad-centered approach using data from different-sex dyads in the National Longitudinal Study of Adolescent to Adult Health to uncover profiles marked by individual, parent, peer, and religion predictors for both male and female partners.

RESULTS

Analyses uncovered five classes of dyadic influences, four of which were marked by relative similarity between partners and one marked by lesser approval of sex for women compared to men. Dyads marked by both partners intending to have sex and being in a context that is more approving of sex were more likely to engage in sexual intercourse.

CONCLUSIONS

Findings demonstrate the heterogeneity of influences and intentions to have sex among adolescent couples, and identify profiles of dyads who are more likely to engage in sexual intercourse. This approach can explicate dyadic processes involved in sexual behavior and the types of couples that exist in a population, leading to more tailored and efficacious interventions.

Gender Perspectives on Social Norms Surrounding Teen Pregnancy: A Thematic Analysis of Social Media Data

BACKGROUND

Social concern with teen pregnancy emerged in the 1970s, and today's popular and professional health literature continues to draw on social norms that view teen pregnancy as a problem-for the teen mother, her baby, and society. It is unclear, however, how adolescents directly affected by teen pregnancy draw upon social norms against teen pregnancy in their own lives, whether the norms operate differently for girls and boys, and how these social norms affect pregnant or parenting adolescents.

OBJECTIVE

This research aims to examine whether and how US adolescents use, interpret, and experience social norms against teen pregnancy.

METHODS

Online ethnographic methods were used for the analysis of peer-to-peer exchanges from an online social network site designed for adolescents. Data were collected between March 2010 and February 2015 (n=1662). Thematic analysis was conducted using NVivo software.

RESULTS

American adolescents in this online platform draw on dominant social norms against teen pregnancy to provide rationales for why pregnancy in adolescence is wrong or should be avoided. Rationales range from potential socioeconomic harms to life-course rationales that view adolescence as a special, carefree period in life. Despite joint contributions from males and females to a pregnancy, it is primarily females who report pregnancy-related concerns, including experiences of bullying, social isolation, and fear.

CONCLUSIONS

Peer exchange in this online forum indicates that American adolescents reproduce prevailing US social norms of viewing teen pregnancy as a social problem. These norms intersect with the norms of age, gender, and female sexuality. Female adolescents who transgress these norms experience bullying, shame, and stigma. Health professionals must ensure that strategies designed to prevent unintended adolescent pregnancy do not simultaneously create hardship and stigma in the lives of young women who are pregnant and parent their children.

Sexual media exposure, sexual behavior, and sexual violence victimization in adolescence

BACKGROUND

Emerging research suggests sexual media affects sexual behavior, but most studies are based on regional samples and few include measures of newer mediums. Furthermore, little is known about how sexual media relates to sexual violence victimization.

METHODS

Data are from 1058 youth 14 to 21 years of age in the national, online Growing up with Media study.

RESULTS

Forty-seven percent reported that many or almost all/all of at least one type of media they consumed depicted sexual situations. Exposure to sexual media in television and movies, and music was greater than online and in games. All other things equal, more frequent exposure to sexual media was related to ever having had sex, coercive sex victimization, and attempted/completed rape but not risky sexual behavior.

CONCLUSIONS

Longer standing mediums such as television and movies appear to be associated with greater amounts of sexual media consumption than newer ones, such as the Internet. A nuanced view of how sexual media content may and may not be affecting today's youth is needed.

Understanding multiple levels of norms about teen pregnancy and their relationships to teens' sexual behaviors

Researchers seeking to understand teen sexual behaviors often turn to age norms, but they are difficult to measure quantitatively. Previous work has usually inferred norms from behavioral patterns or measured group-level norms at the individual level, ignoring multiple reference groups. Capitalizing on the multilevel design of the Add Health survey, we measure teen pregnancy norms perceived by teenagers, as well as average norms at the school and peer network levels. School norms predict boys' perceived norms, while peer network norms predict girls' perceived norms. Peer network and individually perceived norms against teen pregnancy independently and negatively predict teens' likelihood of sexual intercourse. Perceived norms against pregnancy predict increased likelihood of contraception among sexually experienced girls, but sexually experienced boys' contraceptive behavior is more complicated: When both the boy and his peers or school have stronger norms against teen pregnancy he is more likely to contracept, and in the absence of school or peer norms against pregnancy, boys who are embarrassed are less likely to contracept. We conclude that: (1) patterns of behavior cannot adequately operationalize teen pregnancy norms, (2) norms are not simply linked to behaviors through individual perceptions, and (3) norms at different levels can operate independently of each other, interactively, or in opposition. This evidence creates space for conceptualizations of agency, conflict, and change that can lead to progress in understanding age norms and sexual behaviors.

Teen birth rates in sexually abused and neglected females

OBJECTIVE

Prospectively track teen childbirths in maltreated and nonmaltreated females and test the hypothesis that child maltreatment is an independent predictor of subsequent teen childbirth over and above demographic characteristics and other risk factors.

METHODS

Nulliparous adolescent females (N = 435) aged 14 to 17 years were assessed annually through age 19 years. Maltreated females were referred by Child Protective Services agencies for having experienced substantiated sexual abuse, physical abuse, or neglect within the preceding 12 months. Comparison females were matched on race, family income, age and family constellation. Teen childbirth was assessed via self-report during annual interviews. Births were confirmed using hospital delivery records.

RESULTS

Seventy participants gave birth during the study, 54 in the maltreated group and 16 in the comparison group. Maltreated females were twice as likely to experience teen childbirth after controlling for demographic confounds and known risk factors (odds ratio = 2.17, P = 0.01). Birth rates were highest for sexually abused and neglected females. Sexual abuse and neglect were both independent predictors of teen childbirth after controlling for demographic confounds, other risk factors and alternative forms of maltreatment occurring earlier in development.

CONCLUSIONS

Results provide evidence that sexual abuse and neglect are unique predictors of subsequent teen childbirth. Partnerships between protective service providers and teen childbirth prevention strategists hold the best promise for further reducing the US teen birth rate. Additional research illuminating the pathways to teen childbirth for differing forms of maltreatment is needed so that tailored interventions can be realized.

Association of maltreatment with high-risk internet behaviors and offline encounters

OBJECTIVE

High-risk Internet behaviors, including viewing sexually explicit content, provocative social networking profiles, and entertaining online sexual solicitations, were examined in a sample of maltreated and nonmaltreated adolescent girls aged 14 to 17 years. The impact of Internet behaviors on subsequent offline meetings was observed over 12 to 16 months. This study tested 2 main hypotheses: (1) maltreatment would be a unique contributor to high-risk Internet behaviors and (2) high-quality parenting would dampen adolescents' propensity to engage in high-risk Internet behaviors and to participate in offline meetings.

METHODS

Online and offline behaviors and parenting quality were gleaned from 251 adolescent girls, 130 of whom experienced substantiated maltreatment and 121 of whom were demographically matched comparison girls. Parents reported on adolescent behaviors and on the level of Internet monitoring in the home. Social networking profiles were objectively coded for provocative self-presentations. Offline meetings with persons first met online were assessed 12 to 16 months later.

RESULTS

Thirty percent of adolescents reported having offline meetings. Maltreatment, adolescent behavioral problems, and low cognitive ability were uniquely associated with high-risk Internet behaviors. Exposure to sexual content, creating high-risk social networking profiles, and receiving online sexual solicitations were independent predictors of subsequent offline meetings. High-quality parenting and parental monitoring moderated the associations between adolescent risk factors and Internet behaviors, whereas use of parental control software did not.

CONCLUSIONS

Treatment modalities for maltreated adolescents should be enhanced to include Internet safety literacy. Adolescents and parents should be aware of how online self-presentations and other Internet behaviors can increase vulnerability for Internet-initiated victimization.

Forced intercourse, individual and family context, and risky sexual behavior among adolescent girls

PURPOSE

This study tested the hypothesis that individual and family factors associated with adolescent risky sexual behavior (RSB) operate differently in their relationship to RSB among girls who have experienced forced sexual intercourse (FSI), as compared to those girls who have not.

METHODS

Data were collected from 3,863 eighth-grade girls from a larger statewide sample. Different subgroups of participants received different sets of questions, so 655-2,548 students were included in each analysis. Multilevel modeling was used to examine relationships of individual (social negotiation skills, personal safety, depression, and sensation-seeking personality) and family factors (sibling deviance, parental monitoring, and quality of family relationships) to RSB. FSI was examined as a predictor of RSB and as a moderator of the relationship between individual and family variables and sexual risk.

RESULTS

In the case of individual predictors, social negotiation skills were associated with lower RSB for all girls, but these skills had a stronger relationship to RSB among girls who had experienced FSI. Depression and sensation-seeking tendencies had small positive relationships to RSB for all girls. In the case of family predictors, for girls without a history of FSI, parental monitoring was associated with lower RSB. However, among girls who had experienced FSI, parental monitoring was not significantly related to RSB, but sibling deviance was associated with lower RSB.

CONCLUSIONS

Results suggest that social negotiation skills and parental monitoring may warrant further attention in research and intervention.

Improving notification of sexually transmitted infections: a quality improvement project and planned experiment

BACKGROUND AND OBJECTIVE

Inadequate follow-up of positive sexually transmitted infection (STI) test results is a gap in health care quality that contributes to the epidemic of STIs in adolescent women. The goal of this study was to improve our ability to contact adolescent women with positive STI test results after an emergency department visit.

METHODS

We conducted an interventional quality improvement project at a pediatric emergency department. Phase 1 included plan-do-study-act cycles to test interventions such as provider education and system changes. Phase 2 was a planned experiment studying 2 interventions (study cell phone and patient activation card), using a 2 × 2 factorial design with 1 background variable and 2 replications. Outcomes were: (1) the proportion of women aged 14 to 21 years with STI testing whose confidential telephone number was documented in the electronic medical record; (2) the proportion of STI positive women successfully contacted within 7 days.

RESULTS

Phase 1 interventions increased the proportion of records with a confidential number from 24% to 58% and the proportion contacted from 45% to 65%, and decreased loss to follow-up from 40% to 24%. In phase 2, the proportion contacted decreased after the electronic medical record system changed and recording of the confidential number decreased. Study interventions (patient activation card and study cell phone) had a synergistic effect on successful contact, especially when confidential numbers were less reliably documented.

CONCLUSIONS

Feasible and sustainable interventions such as improved documentation of a confidential number worked synergistically to increase our ability to successfully contact adolescent women with their STI test results.

Beyond age at first sex: patterns of emerging sexual behavior in adolescence and young adulthood

PURPOSE

Although the emergence of sexual expression during adolescence and early adulthood is nearly universal, little is known about patterns of initiation.

METHODS

We used latent class analysis to group 12,194 respondents from waves I and IV of the National Longitudinal Study of Adolescent Health (Add Health) into one of five classes based on variety, timing, spacing, and sequencing of oral-genital, anal, and vaginal sex. Multinomial logistic regression models, stratified by biological sex, examined associations between sociodemographic characteristics and class membership.

RESULTS

Approximately half of respondents followed a pattern characterized predominately by initiation of vaginal sex first, average age of initiation of approximately 16 years, and spacing of >1 year between initiation of the first and second behaviors; almost one-third initiated sexual activity slightly later but reported first experiences of oral-genital and vaginal sex within the same year. Classes characterized by postponement of sexual activity, initiation of only one type of behavior, or adolescent initiation of anal sex were substantially less common. Compared with white respondents, black respondents were more likely to appear in classes characterized by initiation of vaginal sex first. Respondents from lower socioeconomic backgrounds were more likely to be in classes distinguished by early/atypical patterns of initiation.

CONCLUSIONS

A small number of typical and atypical patterns capture the emergence of sexual behavior during adolescence, but these patterns reveal complex associations among different elements of emerging sexuality that should be considered in future research.

Social Exchange and Sexual Behavior in Young Women's Premarital Relationships in Kenya

Transactional sex, or the exchange of money and gifts for sexual activities within nonmarital relationships, has been widely considered a contributing factor to the disproportionate prevalence of HIV/AIDS among young women in sub-Saharan Africa. This study applied social exchange theory to premarital relationships in order to investigate the linkages between a variety of young women's resources-including employment and material transfers from male partners-and sexual behaviors. Data on the first month of premarital relationships (N=551 relationships) were collected from a random sample of young adult women ages 18-24 in Kisumu, Kenya, using a retrospective life history calendar. Consistent with the hypotheses, results showed that young women's income increases the likelihood of safer sexual activities, including delaying sex and using condoms consistently. Material transfers from the male partner displayed the opposite effect, supporting the view that resources obtained from within the relationship decrease young women's negotiating power.

Educational effectiveness of an HIV pretest video for adolescents: a randomized controlled trial

OBJECTIVE

The goal of this study was to compare the effectiveness of a youth-friendly HIV video with in-person counseling in conveying HIV knowledge and obtaining consent for HIV testing among adolescent patients of an urban emergency department.

METHODS

A 2-armed, randomized controlled trial was conducted on a convenience sample of 200 stable, sexually active people aged 15 to 21 years in an urban emergency department. Participants in both the in-person counseling group and the video intervention group completed preintervention and postintervention HIV knowledge measures. HIV knowledge was the primary outcome measure, and consent for HIV testing was the secondary outcome. Characteristics associated with voluntary HIV testing were identified.

RESULTS

Of 333 eligible people, 200 agreed to participate. There was no difference in preintervention HIV knowledge scores between groups. Mean postintervention knowledge scores differed significantly between the video (78.5% correct) and the counselor (66.3% correct) (P < 0.01) groups. Overall, 51% of the video group accepted HIV testing compared with 22% in the control group (P < .01). Watching the video (OR: 3.6 [95% CI: 1.8-7.2]), being female (OR: 2.1 [95% CI: 1.0-4.2]), engaging in oral sex (OR: 2.8 [95% CI: 1.4-5.9]), and being older than 18 years (OR: 3.8 [95% CI: 1.8-7.8]) were all positively associated with testing.

CONCLUSIONS

A youth-friendly HIV educational video improved adolescents' HIV knowledge and increased their participation in HIV testing more than in-person counseling. video-based HIV counseling can perform as well or better than in-person counseling for adolescents in the ED.

Variation in sexual behaviors in a cohort of adolescent females: the role of personal, perceived peer, and perceived family attitudes

PURPOSE

Little is known about how adolescent sexual behaviors develop and the influence of personal or perceived social attitudes. We sought to describe how personal, perceived peer, and perceived family attitudes toward adolescent sexual activity influence sexual behaviors of adolescent females' over time.

METHODS

Between the years of 1999 and 2006, 358 English-speaking female adolescents, aged 14-17 years, were recruited from three urban adolescent clinics. Participants completed quarterly and annual questionnaires over a span of 4 years. Primary outcomes included engagement in any of the following eight sexual behaviors: kissing, having breasts touched, having genitals touched, touching partners' genitals, oral giving, oral receiving, anal, or vaginal sex. Three attitudinal scales assessed personal importance of abstinence, perceived peer beliefs about when to have sex, and perceived family beliefs that adolescent sex is negative. We used generalized estimating equations to identify predictors of each sexual behavior and compared whether personal, perceived peer, or perceived family attitudes predicted sexual behaviors over time.

RESULTS

The odds of reporting each sexual behavior increased with age but were lower among those whose personal or perceived family attitudes were less positive. Participants' personal attitudes toward adolescent sex were the strongest predictor of engagement in all eight sexual behaviors even after controlling for perceived peer and perceived family attitudes.

CONCLUSIONS

Female adolescent's personal attitudes toward abstinence appear to be the strongest predictor of engagement in a variety of sexual behaviors. Efforts to influence adolescent attitudes toward abstinence may be an important approach to reducing sexual behaviors that increase the risk of pregnancy and sexually transmitted infections.

Estimating the longitudinal association between adolescent sexual behavior and exposure to sexual media content

The purpose of this study is to estimate the association between adolescent sexual behavior and exposure to sexual media content. A three-wave, longitudinal survey sample (N = 506) of 14- to 16-year-olds at baseline is analyzed using growth curves. Growth trajectories are linear for sexual behavior but not for exposure to sexual media content. The signs of the exposure slopes are not uniformly positive: Hispanic and African American respondents show declines of exposure to sexual media content over the age range investigated here. Although changes in exposure to sex content are highly associated with changes in sexual behavior among Whites, there is little or no association between changes in these variables among Blacks.

Childhood abuse, avatar choices, and other risk factors associated with internet-initiated victimization of adolescent girls

OBJECTIVE

The objective of the study was to determine the risk factors for Internet-initiated victimization of female adolescents. In particular, it was expected that girls who experienced childhood abuse would show higher vulnerability than their nonabused peers. In addition, the study examined how provocative self-presentations might be related to online sexual advances and offline encounters.

PATIENTS AND METHODS

Adolescent girls aged 14 to 17 years who had experienced substantiated childhood abuse (N = 104) were demographically matched with nonabused girls (N = 69) and surveyed regarding Internet usage, maternal and paternal caregiver presence, substance use, high-risk sexual attitudes, and involvement with high-risk peers. To measure online self-presentation, participants each created avatars, which were quantified according to the degree of provocative physical features.

RESULTS

Forty percent of the sample reported experiencing online sexual advances, and 26% reported meeting someone offline who they first met online. Abused girls were significantly more likely to have experienced online sexual advances and to have met someone offline. Having been abused and choosing a provocative avatar were significantly and independently associated with online sexual advances, which were, in turn, associated with offline encounters.

CONCLUSIONS

A history of childhood abuse may increase Internet-initiated victimization vulnerability. Parents should be aware of the ways in which their adolescents are presenting themselves online. Making adolescent girls and their parents aware that provocative online self-presentations may have implications for sexual solicitation might help to ward off sexual advances and might help prevent Internet-initiated victimizations. Practitioners should consider standard inquiry into Internet and media usage an aspect of comprehensive care.

Rethinking Timing of First Sex and Delinquency

The relation between timing of first sex and later delinquency was examined using a genetically informed sample of 534 same-sex twin pairs from the National Longitudinal Study of Adolescent Health, who were assessed at three time points over a 7-year interval. Genetic and environmental differences between families were found to account for the association between earlier age at first sex and increases in delinquency. After controlling for these genetic and environmental confounds using a quasi-experimental design, earlier age at first sex predicted lower levels of delinquency in early adulthood. The current study is contrasted with previous research with non-genetically informative samples, including Armour and Haynie. Results suggest a more nuanced perspective on the meaning and consequences of adolescent sexuality than is commonly put forth in the literature.

Validating an index of adolescent sexual behavior using psychosocial theory and social trait correlates

Using a web-based survey of adolescents 14-16 years of age, a hierarchical index of heterosexual behavior was developed with excellent psychometric properties. The easiest sexual behavior to perform was "deep kissing" and the most difficult was "receiving anal sex" for females and "giving anal sex" for males. The index was validated with data that show increased sexual activity with being older and of minority status, with social traits such as physical development, having a romantic partner, and sensation seeking, and with psychosocial variables known to be associated with sexual behavior such as attitudes, norms, self-efficacy and intentions.

A longitudinal study of the prevalence, development, and persistence of HIV/sexually transmitted infection risk behaviors in delinquent youth: implications for health care in the community

OBJECTIVES

Our goal was to examine the prevalence, development, and persistence of drug and sex risk behaviors that place delinquent youth at risk for HIV and other sexually transmitted infections.

METHODS

At the baseline interview, HIV/sexually transmitted infection drug and sex risk behaviors were assessed in a stratified random sample of 800 juvenile detainees aged 10 to 18 years. Participants were reinterviewed approximately 3 years later. The final sample in these analyses (n = 724) included 316 females and 408 males; there were 393 African American participants, 198 Hispanic participants, 131 non-Hispanic white participants, and 2 participants who self-identified their race as "other."

RESULTS

More than 60% of youth had engaged in > or = 10 risk behaviors at their baseline interview, and nearly two thirds of them persisted in > or = 10 risk behaviors at follow-up. Among youth living in the community, many behaviors were more prevalent at follow-up than at baseline. Among incarcerated youth, the opposite pattern prevailed. Compared with females, males had higher prevalence rates of many HIV/sexually transmitted infection risk behaviors and were more likely to persist in some behaviors and develop new ones. Yet, injection risk behaviors were more prevalent among females than males and were also more likely to develop and persist. Overall, there were few racial and ethnic differences in patterns of HIV/sexually transmitted infection risk behaviors; most involved the initiation and persistence of substance use among non-Hispanic whites and Hispanics.

CONCLUSIONS

Because detained youth have a median stay of only 2 weeks, HIV/sexually transmitted infection risk behaviors in delinquent youth are a community public health problem, not just a problem for the juvenile justice system. Improving the coordination among systems that provide HIV/sexually transmitted infection interventions to youth--primary care, education, mental health, and juvenile justice--can reduce the prevalence of risk behaviors and substantially reduce the spread of HIV/sexually transmitted infection in young people.

Quality of parent communication about sex and its relationship to risky sexual behavior among youth in psychiatric care: a pilot study

BACKGROUND

The number of HIV infections among adolescents is increasing, and youth in psychiatric care are at particular risk because of their high rates of risky sexual behavior.

METHODS

As part of a larger longitudinal study examining AIDS-risk behavior among adolescents in psychiatric care, this pilot study investigated the relationship between parent communication about sex and sexual risk-taking among treatment-seeking adolescents. Adolescents reported their risky sexual behavior (e.g., inconsistent condom use, sex with multiple partners), and parents reported how frequently they bring up topics related to sex, HIV/AIDS, and birth control. Parents and adolescents participated together in videotaped discussions of fictional vignettes describing situations related to sex, birth control, and AIDS/HIV. Quality of the parent-teen discussions was coded based on a system developed by Whalen, Henker, Hollingshead, and Burgess (1996) to code AIDS-related discussions.

RESULTS

Quality but not frequency of parent-teen communication was associated with adolescent sexual risk-taking, and ethnic differences in communication were found.

CONCLUSIONS

Findings from this pilot investigation underscore the importance of studying the relationship between parent-teen communication and risky sexual behavior among troubled youth and provide direction for the development of family-based intervention programs that focus on parental behavior during conversations with teens.