Connectedness as a predictor of sexual and reproductive health outcomes for youth

Congruity and Divergence in Perceptions of Adolescent Romantic Experience Between Chinese Parents and Adolescents

This qualitative research article explored the convergences and divergences of perceptions of adolescent romantic experience between a group of adolescents and parents in China. One-to-one, in-depth interviews were conducted with 38 adolescents (aged 15-18 years; 26 girls, 12 boys) and 27 parents (aged 40-52 years; 16 mothers, 11 fathers) from the urban areas of a northern Chinese city. Data analysis was conducted using thematic analysis and interpreted using a socio-ecological approach. Four major themes were identified: opportunities and risks, acceptable versus unacceptable sexual intimacy, generational difference, and girls’ vulnerability and “self-respect.” In these themes, congruity and divergence of perceptions were found between the groups of adolescents and parents. These perceptions were largely influenced by traditional cultural beliefs of education, sexuality, gender, and family as well as the current socio-cultural context of modernization and globalization in China. The findings provide implications regarding how to support both adolescents and parents in managing adolescent romantic experience for adolescent health-promoting romantic and sexual behaviors.

Cultural Individualism Is Linked to Later Onset of Adult-Role Responsibilities Across Time and Regions

This article explores links between cultural individualism and the age at which adult-role responsibilities are assumed (the speed of maturation to adulthood). Across 43 years (1973-2015) within the United States, yearly indicators of individualism were positively correlated with later onset of work and family responsibilities (a slow life strategy). The same pattern appeared cross-culturally: Across 53 nations, cultural individualism was significantly correlated with slower maturation to adulthood. These links remained over time and cross-culturally when unemployment rate, an indicator of economic strength, was included in the model. Analyses including GDP showed mixed results, suggesting a complex relationship between economic indicators, individualism, and maturation to adulthood. Across nations and time, more individualistic cultures are also those with slower maturation to adulthood (a slow life strategy).

Can family-centered programing mitigate HIV risk factors among orphaned and vulnerable adolescents? Results from a pilot study in South Africa

Let's Talk is a structured, family-centered adolescent HIV prevention program developed for use in South Africa using key components adapted from programs successfully implemented in the US and South Africa. It is designed to address individual HIV transmission risk factors common among orphaned and vulnerable adolescents, including elevated risk for poor psychological health and sexual risk behavior. These efforts are accentuated through parallel programing to support caregivers' mental health and parenting skills. Twelve Let's Talk groups, each serving approximately 10 families, were piloted by two local community-based organizations in Gauteng and Kwa-Zulu Natal provinces, South Africa. Face-to-face interviews were conducted among participating caregivers and adolescents at baseline and three months post-intervention to explore the potential effects of the program on intermediate outcomes that may support HIV preventive behavior. Specifically, generalized estimation equations were used to estimate average change on HIV prevention knowledge and self-efficacy, caregiver and adolescent mental health, and family dynamics. Among the 105 adolescents and their 95 caregivers who participated in Let's Talk and completed both surveys, statistically significant improvements were found for adolescents' HIV and condom use knowledge as well as condom negotiation self-efficacy, but not sexual refusal self-efficacy. Both caregivers and adolescents demonstrated significantly better mental health at post-test. Adolescent/caregiver connection and communication about healthy sexuality also improved. These preliminary results highlight the potential of HIV prevention interventions that engage caregivers alongside the vulnerable adolescents in their care to mitigate adolescent HIV risk factors. A more rigorous evaluation is warranted to substantiate these effects and identify their impact on adolescents' risk behavior and HIV incidence.

Gender Differences in Sexual and Reproductive Health Protective and Risk Factors of Batswana Adolescents: Implications for Parent and Adolescent Interventions

Adolescents in sub-Saharan Africa and in Botswana in particular continue to bear the brunt of the HIV epidemic. This analysis assessed gender differences among theory-based sexual and reproductive health protective and risk factors in a cross-sectional sample of 228 Batswana adolescents. Incongruence between preferred and actual sources of sexual information and several important gender differences in parent-adolescent relationships, psychosocial influences, and adolescent sexual behaviors were identified. Parents were the fourth most common source of information about sex; yet, over three-quarters of adolescents preferred to have parents teach them about sex. Boys reported more positive relationships with their parents and girls reported more positive attitudes toward transactional sex. Both boys and girls reported similarly low levels of parental monitoring, parental communication, and parental responsiveness, all of which are important protective factors. These findings suggest interventions should address these gender differences and consider offering parallel interventions for adolescents and their parents in Botswana.

Adolescent Sexual Risk Taking: The Distribution of Youth Behaviors and Perceived Peer Attitudes Across Neighborhood Contexts

PURPOSE

Sexual activity is a normative part of adolescent development, yet early sexual debut and sex with multiple partners undermine health and well-being. Both structural (e.g., poverty) and social (e.g., norms) characteristics of neighborhoods shape sexual risk taking, yet scholarship remains focused on urban areas. Thus, this study explores sexually permissive attitudes and sexual risk taking across a wider expanse of neighborhood types.

METHODS

Among 8,337 nonsexually active respondents in Wave I (1994-1995 [ages 11-18]) of the National Longitudinal Study of Adolescent to Adult Health (Add Health), a hierarchical linear model and a hierarchical generalized linear model were used to estimate the effect of neighborhood type and permissive sexual climate on youths' sexual debut, age at debut, and lifetime number of sexual partners by Wave III (2001-2002 [ages 18-26]), controlling for individual, familial, and peer factors.

RESULTS

Sexual climates varied in overall permissiveness and internal consistency both across and within neighborhood types and were linked to increased sexual risk taking. Compared with youth from upper middle class white suburbs, the odds of sexual debut and the number of partners were highest among youth from rural (black and white) neighborhoods; youth from almost all other neighborhood types initiated sex earlier.

CONCLUSIONS

Early sexual debut in adolescence is a public health issue with immediate and long-term implications. Adolescence unfolds in neighborhood environments, the characteristics of which may spur youth into such risk taking. Continued scholarship on sexual risks should consider further variations in the geographic distributions of such risks to investigate more fully their consequences.

School Environment Is Related to Lower Health and Safety Risks Among Sexual Minority Middle and High School Students

PURPOSE

The objective of this study was to examine the relationship between school involvement and connectedness with measures of sexual risk, substance use, and experience of violence among students who had sexual contact with the same sex or with both sexes.

METHODS

A sample of middle school and high school students who participated in a study conducted in a large urban school district were selected based on their reported experience of having initiated sexual activity with same-sex partners. In classroom-based surveys, we assessed self-reported involvement in school-based activities and feelings of school connectedness, as well as self-reported sexual risk, substance use, and experience of violence.

RESULTS

Significant protective associations were found between school involvement and lifetime alcohol and marijuana use, and between school connectedness and ever having been in a fight, feeling safe at school, and drug use other than marijuana (all p < .05).

CONCLUSIONS

Findings suggest that efforts to increase school involvement and connectedness provide a starting point for addressing significant health and safety concerns among students with same-sex sexual activity.

Bidirectional Associations Between Adolescents' Sexual Behaviors and Psychological Well-Being

PURPOSE

Assessing bidirectional longitudinal associations between early sexual behaviors (≤16.0 years) and psychological well-being (global self-esteem, physical self-esteem, depression) among 716 adolescents, and the direct and buffering effect of parent-adolescent relationship quality.

METHODS

We used data from Project STARS (Studies on Trajectories of Adolescent Relationships and Sexuality), a longitudinal study on adolescent sexual development in the Netherlands. Participants were 11.0-16.0 years old (mean age at T1 = 13.3 years). Self-reports from four waves of online questionnaires were used. Bidirectional longitudinal associations were assessed by linear mixed-effects models.

RESULTS

At most waves, boys had significantly higher levels of psychological well-being than girls, but genders did not differ in experience with sexual behaviors. Engagement in early sexual behaviors did not predict lower levels of psychological well-being over time, and lower levels of psychological well-being did not predict more engagement in early sexual behaviors over time. Parent-adolescent relationship quality did not moderate these associations in either direction, although we found a significant direct effect, in which a higher-quality parent-adolescent relationship predicted more optimal levels of the three indicators of adolescents' psychological well-being (but not lower levels of early sexual activity) over time.

CONCLUSIONS

Our results show that, among Dutch adolescents, early sexual behaviors and psychological well-being were not interrelated. This may be explained by socio-cultural aspects of the Dutch society, such as more normalization of sexual behaviors during adolescence. As a result, early sexual activity in and of itself was not related to lower psychological well-being over time. Yet, cross-cultural differences in links between adolescents' sexuality and well-being should be further investigated.

The Context of Sexual Decisions and Intrapersonal and Interpersonal Factors Related to Sexual Initiation Among Female Military-Dependent Youth

Despite the sizable population of military-dependent youth (MDY) in the United States and the military stressors they experience (e.g., relocations, parental deployment), little is known about MDY's sexual behavior, especially about the perceived role that military stressors play in their sexual decisions, such as the decision to initiate sex. We conducted 25 semistructured, in-depth interviews with sexually experienced female MDY aged 15 to 19 years to (a) describe MDY's general perceptions of military life and (b) identify intrapersonal and interpersonal characteristics related to MDY's sexual initiation, including the perceived impact of military stressors. We analyzed life history grids and transcripts to identify common and unique themes across participants' experiences. Most participants reported having positive experiences related to military life, and most did not believe that military stressors influenced their decision to initiate sex. Common intrapersonal and interpersonal characteristics related to sexual initiation were having an older first sexual partner, being in a dating relationship, receiving sexual health education prior to their first sexual experience, and discussing sex with a parent prior to their first sexual experience. These intrapersonal and interpersonal characteristics should be considered when developing sexual health programs for MDY, which should focus on building supportive peer and parental relationships.

Psychosexual Functioning of Cognitively-able Adolescents with Autism Spectrum Disorder Compared to Typically Developing Peers: The Development and Testing of the Teen Transition Inventory- a Self- and Parent Report Questionnaire on Psychosexual Functioning

To gain further insight into psychosexual functioning, including behaviors, intrapersonal and interpersonal aspects, in adolescents with Autism Spectrum Disorder (ASD), comprehensive, multi-informant measures are needed. This study describes (1) the development of a new measure of psychosexual functioning in both parent- and self-reports (Teen Transition Inventory; TTI) covering all three domains of psychosexual functioning (i.e. psychosexual socialization, psychosexual selfhood, and sexual/intimate behavior). And (2) the initial testing of this instrument, comparing adolescents with ASD (n = 79 parent-report; n = 58 self-report) to Typically Developing (TD) adolescents (n = 131 parent-report; n = 91 self-report) while taking into account gender as a covariate. Results from both informants indicate more difficulties regarding psychosexual socialization and psychosexual selfhood in the ASD group. With regard to sexual/intimate behavior, only parents reported significantly more problems in adolescents with ASD.

Systematic Mapping of Relationship-Level Protective Factors and Sexual Health Outcomes Among Sexual Minority Youth: The Role of Peers, Parents, Partners, and Providers

Sexual minority youth (SMY) experience elevated rates of adverse sexual health outcomes. Although risk factors driving these outcomes are well studied, less attention has been paid to protective factors that potentially promote health and/or reduce negative effects of risk. Many factors within interpersonal relationships have been identified as protective for the sexual health of adolescents generally. We sought to systematically map the current evidence base of relationship-level protective factors specifically for the sexual health of SMY through a systematic mapping of peer-reviewed observational research. Articles examining at least one association between a relationship-level protective factor and a sexual health outcome in a sample or subsample of SMY were eligible for inclusion. A total of 36 articles reporting findings from 27 data sources met inclusion criteria. Included articles examined characteristics of relationships with peers, parents, romantic/sexual partners, and medical providers. Peer norms about safer sex and behaviorally specific communication with regular romantic/sexual partners were repeatedly protective in cross-sectional analyses, suggesting that these factors may be promising intervention targets. Generally, we found some limits to this literature: few types of relationship-level factors were tested, most articles focused on young sexual minority men, and the bulk of the data was cross-sectional. Future work should expand the types of relationship-level factors investigated, strengthen the measurement of relationship-level factors, include young sexual minority women in samples, and use longitudinal designs. Doing so will move the field toward development of empirically sound interventions for SMY that promote protective factors and improve sexual health.

Beyond the Effects of Comprehensive Sexuality Education: The Significant Prospective Effects of Youth Assets on Contraceptive Behaviors

PURPOSE

The purpose of the study was to prospectively determine if youth assets were significantly associated with contraception use after accounting for the effects of youths' exposure to comprehensive sexuality education programming.

METHODS

Prospective associations between youth asset scores, comprehensive sexuality education topics received, type of contraceptive used, and consistent contraceptive use were analyzed using multinomial and binomial logistic regression in a sample of 757 sexually active youth.

RESULTS

Higher youth asset scores were associated with condom use (adjusted odds ratio [AOR] = 1.51, 95% CI = 1.01-2.28), hormonal birth control use (AOR = 2.71, 95% CI = 1.69-4.35), dual method use (AOR = 2.35, 95% CI = 1.44-3.82), and consistent contraceptive use (AOR = 1.97, 95% CI = 1.38-2.82). After controlling for youths' experience with comprehensive sexuality education, higher youth asset scores remained a significant predictor of hormonal birth control use (AOR = 2.09, 95% CI = 1.28-3.42), dual method use (AOR = 2.58, 95% CI = 1.61-4.15), and consistent contraceptive use (AOR = 1.95, 95% CI = 1.36-2.80).

CONCLUSIONS

Youth serving organizations that are interested in preventing teen pregnancy should consider widespread implementation of evidence-based youth development programs that focus on building and strengthening specific youth assets.

Understanding the relationship between religiosity and caregiver-adolescent communication about sex within African-American families

Caregiver-adolescent communication about sex plays a critical role in the sexual socialization of youth. Many caregivers, however, do not engage their youth in such conversations, potentially placing them at risk for negative sexual health outcomes. Lack of caregiver-adolescent communication about sex may be particularly harmful for rural African American youth, as they often report early sex initiation and are disproportionately impacted by STIs. Moreover, sexual communication may be particularly challenging for families with strong religious backgrounds, potentially affecting the occurrence and breadth of topics covered during communication. Study aims were to: determine whether there was a relationship between caregiver religiosity and type of topics covered during communication about sex (e.g., general sexual health vs. positive aspects of sexuality) among 435 caregivers of early adolescent, African American youth; and if so, identify factors that might explain how religiosity affects communication about sex. Results indicated that caregiver religiosity was positively associated with communication about general, but not positive aspects of sexuality for caregivers of males. Attitudes towards communication about sex and open communication style mediated the relationship. There was no association between religiosity and communication about sex for caregivers of females. The findings from this study could provide a base to better understand and support the sexual socialization process within religious, African American families.

Parental Monitoring Among Young Men Who Have Sex With Men: Associations With Sexual Activity and HIV-Related Sexual Risk Behaviors

PURPOSE

Young men who have sex with men (YMSM) are at disproportionate risk for HIV infection. Parental monitoring is protective against adolescent sexual risk behavior among heterosexual adolescents, yet it is unclear whether these findings generalize to YMSM. YMSM experience unique family dynamics during adolescence, including coming out to parents and parental rejection of sexual orientation. The present study examined how theoretically derived parental monitoring constructs were associated with sexual activity and sexual risk behaviors among YMSM.

METHODS

YMSM aged 14-18 years completed a cross-sectional online survey (n = 646). Factor analysis was completed to determine factor structure of monitoring measure. Sexual behaviors were predicted from monitoring constructs and covariates within regression models.

RESULTS

Parental knowledge and adolescent disclosure, parental solicitation, parental control, and adolescent secret-keeping emerged as four distinct monitoring constructs among YMSM. Higher knowledge and disclosure (b = -.32, p = .022), higher control (b = -.28, p = .006), lower solicitation (b = .31, p = .008), and lower secret-keeping (b = .25, p = .015) were associated with lower odds of sexual activity with males in the past 6 months. Higher knowledge and disclosure (b = -.12, p = .016), higher control (b = -.08, p = .039), and lower secret-keeping (b = .11, p = .005) were associated with having fewer recent sexual partners. Monitoring constructs were unassociated with condomless anal intercourse instances among sexually active YMSM.

CONCLUSIONS

YMSM disclosure is closely tied with parental knowledge, and parents should foster relationships and home environments where YMSM are comfortable disclosing information freely. Effective parental monitoring could limit YMSM's opportunities for sexual activity, but monitoring is not sufficient to protect against HIV-related sexual risk behaviors among sexually active YMSM.

Attitudes, Norms, and the Effect of Social Connectedness on Adolescent Sexual Risk Intention

BACKGROUND

Risky sexual behaviors put adolescents at increased risk of adverse outcomes. Parents, school-based adults, and peers play important roles in influencing these sex intentions.

METHODS

This work explored the influence of parent-child sex communication on adolescent attitudes, perceived norms, and intentions to have sex, including the moderating role of social support from school-based adults, in a sample of 21,731 adolescents in California.

RESULTS

Although increased parent-child sex communication was associated with intentions to have sex, it also exhibited protective effects, increasing abstinence attitudes among youth that led to decreased intention directly and via support from school-based adults.

CONCLUSIONS

Although many factors influencing sexual behaviors are largely intrapersonal, these findings indicate the importance of an ecological approach to reducing adolescent sexual risk behaviors through engagement of parents and increased school connectedness.

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.

Predictors of parental knowledge of adolescent sexual experience: United States, 2012

Parent-child sexual health communication has been shown to protect against adolescent sexual risk-taking behavior. Parent knowledge of adolescent sexual experience can inform timing and content of conversations; however, little is known about factors associated with such knowledge. To investigate this question, parent-child dyads (N = 942) from a U.S. nationally-representative internet panel were surveyed in June 2012. Agreement between adolescent report of vaginal sex and parent's knowledge of such behavior was assessed. Multivariate regression was used to assess predictors of accurate parental knowledge of adolescent sex. Most parents (87%) reported knowledge of their adolescents' sexual experience. Parents with accurate knowledge of adolescent sexual experience were more likely to report at least one prior conversation with their child about sexual health (OR 2.35), have a daughter (OR 1.88), and have a child who expressed comfort discussing sexual health (OR 1.71). Results indicate that parental knowledge of adolescent sexual experience reflects more comfortable parent-child sexual health communication. Developing tools to improve adolescent comfort discussing sexuality may improve parent-child conversations about sexuality, contributing to efforts to increase safer sex practices among adolescents.

Parent-Adolescent Sexual Communication

Risky sexual behavior among adolescents is a major public health concern with potentially long-lasting consequences, including pregnancy, sexually transmitted infections, and HIV/AIDS. Researchers have demonstrated that parent-adolescent sexual communication can mitigate adolescent risky sexual behaviors; the development of interventions that support this process are vital. This column examines a recent study that evaluated a parent-adolescent sexual communication intervention.

Predictors of parental knowledge of adolescent sexual experience: United States, 2012

Parent-child sexual health communication has been shown to protect against adolescent sexual risk-taking behavior. Parent knowledge of adolescent sexual experience can inform timing and content of conversations; however, little is known about factors associated with such knowledge. To investigate this question, parent-child dyads (N = 942) from a U.S. nationally-representative internet panel were surveyed in June 2012. Agreement between adolescent report of vaginal sex and parent's knowledge of such behavior was assessed. Multivariate regression was used to assess predictors of accurate parental knowledge of adolescent sex. Most parents (87%) reported knowledge of their adolescents' sexual experience. Parents with accurate knowledge of adolescent sexual experience were more likely to report at least one prior conversation with their child about sexual health (OR 2.35), have a daughter (OR 1.88), and have a child who expressed comfort discussing sexual health (OR 1.71). Results indicate that parental knowledge of adolescent sexual experience reflects more comfortable parent-child sexual health communication. Developing tools to improve adolescent comfort discussing sexuality may improve parent-child conversations about sexuality, contributing to efforts to increase safer sex practices among adolescents.

School connectedness and suicidal thoughts and behaviors: A systematic meta-analysis

Among the protective factors associated with reduced risk for suicide, scientific inquiries into school connectedness are especially important considering that schools are ideally situated to provide interventions reaching the vast majority of youth. Although there is a wealth of research that supports the association between school connectedness and reduced self-report of adolescents having a suicidal thought or making a suicide attempt, inconsistencies in the way studies have measured and operationalized school connectedness limit synthesis across findings. This meta-analytic study investigates the literature exploring associations between school connectedness and suicidal thoughts and behaviors across general and subpopulations (high risk and sexual minority youth) using a random effects model. Eligible studies examined a measure of school connectedness explicitly referred to as "school connectedness" or "connections at school" in relation to suicidal ideation or suicide attempts among youth enrolled in school (Grades 6-12). Multiple metaregression analyses were conducted to explore the influence of school connectedness measurement variation, as well as participant characteristics. Results, including 16 samples, support that higher school connectedness is associated with reduced reports of suicidal thoughts and behaviors across general (odds ratio [OR] = 0.536), high-risk (OR = 0.603), and sexual minority (OR = 0.608) adolescents. Findings are consistent when analyzed separately for suicidal ideation (OR = 0.529) and suicide attempts (OR = 0.589) and remain stable when accounting for measurement variability. Although limited by its cross-sectional nature, findings support recent calls to increase school connectedness and proffer important implications for screening and intervention efforts conducted in schools. (PsycINFO Database Record

Prevalence of communication between mothers and daughters on sexuality and associated factors in Sagamu, southwest Nigeria

BACKGROUND

As adolescents transition from childhood to adulthood, effective mother-daughter communication on sexuality plays a role in reducing high-risk behaviours linked to human immunodeficiency virus (HIV) infection and early pregnancy and childbirth. The objective of the study was to examine the prevalence of mother-daughter communication on sexuality and associated factors in Sagamu, southwest Nigeria.

METHODS

Using multistage sampling, surveys were conducted using 234 female youth enrolled at a secondary school. The chi-square or Fisher's exact test was used to examine associations between categorical variables. The independent sample t-test was used to compare mean values of variables with reported evidence of mother-daughter communication on sexuality.

RESULTS

The mean age of respondents was 16+1.56 years. The majority (89.7%) had engaged in mother-daughter communication on sexuality, but three-quarters (80.8%) of the respondents could not freely discuss sexuality with their mothers. About one-third (31.6%) of the respondents reported at least one sexual encounter with the mean age of sexual debut of 14.23±2.12 years. Mother-daughter communication on sexuality was significantly associated with religion (p=0.047), mother's age (p=0.019), who the respondents live with (p=0.029), mother's highest educational status (p<0.001), age of sexual debut (p=0.030), and condom use (p<0.001), but not with freedom to discuss sexuality with their mother (p=0.552) or freedom to introduce male friends to their mother (p=0.077).

CONCLUSION

Despite the high prevalence of mother-daughter communication on sexuality, mothers' approach appeared unfriendly, as most girls could not freely discuss topics concerning sexuality with their mothers. Poor communication on sexuality was associated with sexual risk behaviours. Mothers should engage in adolescent-friendly transferring of knowledge on sexuality in order to reduce pregnancy rates and HIV transmission in female adolescents.

Barriers and Facilitators of Screening for Sexually Transmitted Infections in Adolescent Girls and Young Women in Mombasa, Kenya: A Qualitative Study

OBJECTIVE

Young women bear the greatest burden of sexually transmitted infections (STIs), so it is important to identify and address barriers to STI screening in this population. We conducted a qualitative study to explore the feasibility of STI screening among adolescent girls and young women in Mombasa, Kenya.

METHODS

We conducted 17 in-depth interviews (IDIs) (8 with adolescent girls and 9 with young women) and 6 focus group discussions (FGDs) (4 with adolescent girls and 2 with young women, total 55 participants). The audio recordings for the IDIs and FGDs were translated and transcribed into English. Transcripts were independently reviewed by two researchers, and a set of codes was designed to help analyze the data using the content analysis approach. Data content was then analyzed manually and digitally using ATLAS.ti, and consensus was reached on central and specific emergent themes discussed by the research team.

RESULTS

Adolescent girls and young women in Mombasa, Kenya expressed willingness to participate in STI screening. A major incentive for screening was participants' desire to know their STI status, especially following perceived high-risk sexual behavior. Lack of symptoms and fear of positive test results were identified as barriers to STI screening at the individual level, while parental notification and stigmatization from parents, family members and the community were identified as barriers at the community level. Uncomfortable or embarrassing methods of specimen collection were an additional barrier. Thus, urine-based screening was felt to be the most acceptable.

CONCLUSION

Kenyan adolescent girls and young women seem willing to participate in screening for STIs using urine testing. Addressing stigmatization by parents, health care workers and the community could further facilitate STI screening in this population.

Attachment to Conventional Institutions and Adolescent Rapid Repeat Pregnancy: A Longitudinal National Study Among Adolescents in the United States

Introduction There is limited research on rapid repeat pregnancies (RRP) among adolescents, especially using nationally representative samples. We examine distal factors-school, family, peers, and public/private religious ties-and their associations with RRP among adolescent mothers. Methods Guided by social development theory, we conducted multivariate logistic regression analyses, adjusted for sociodemographic characteristics, to examine associations between RRP and attachment to school, family, peers, and religion among 1158 female respondents from the National Longitudinal Study of Adolescent to Adult Health (Add Health) who reported at least one live birth before age 20. Results Attachments to conventional institutions were associated with lower likelihood of RRP. Adolescent mothers who had a stronger relationship with their parents had reduced odds of RRP (adjusted odds ratio [aOR] 0.83, 95 % CI 0.71-0.99). Increased odds of RRP were associated with anticipating fewer negative social consequences of sex (aOR 1.18, 95 % CI 1.02-1.35), never praying (versus praying daily; aOR 1.47, 95 % CI 1.10-1.96), and never participating in church-related youth activities (versus participating once a week; 1.04, 95 % CI 1.01-1.07). Discussion After an adolescent birth, social support from family, peers, and the community can benefit young mothers. Private aspects of religiosity may be especially important. Understanding the processes by which these distal factors are linked to the likelihood of RRP is needed to create multifaceted intervention programs that provide diverse methods of support customized to specific circumstances of adolescent mothers.

Structural and Behavioral Correlates of HIV Infection among Pregnant Women in a Country with a Highly Generalized HIV Epidemic: A Cross-Sectional Study with a Probability Sample of Antenatal Care Facilities in Swaziland

INTRODUCTION

HIV disproportionately affects women in Sub-Saharan Africa. Swaziland bears the highest HIV prevalence of 41% among pregnant women in this region. This heightened HIV-epidemic reflects the importance of context-specific interventions. Apart from routine HIV surveillance, studies that examine structural and behavioral factors associated with HIV infection among women may facilitate the revitalization of existing programs and provide insights to inform context-specific HIV prevention interventions.

METHODS AND FINDINGS

This cross-sectional study employed a two-stage random cluster sampling in ten antenatal health care facilities in the Hhohho region of Swaziland in August and September 2015. Participants were eligible for the study if they were 18 years or older and had tested for HIV. Self-administered tablet-based questionnaires were used to assess HIV risk factors. Of all eligible pregnant women, 827 (92.4%) participated, out of which 297 (35.9%) were self-reportedly HIV positive. Among structural factors, family function was not significantly associated with self-reported HIV positive status, while lower than high school educational attainment (AOR, 1.65; CI, 1.14-3.38; P = 0.008), and income below minimum wage (AOR, 1.81; CI, 1.09-3.01; P = 0.021) were significantly associated with self-reported HIV positive status. Behavioral factors significantly associated with reporting a positive HIV status included; ≥2 lifetime sexual partners (AOR, 3.16; CI, 2.00-5.00; P<0.001), and ever cohabited (AOR, 2.39; CI, 1.66-3.43; P = 0.00). The most cited reason for having multiple sexual partners was financial gain. HIV/AIDS-related knowledge level was high but not associated to self-reported HIV status (P = 0.319).

CONCLUSIONS

Structural and behavioral factors showed significant association with self-reported HIV infection among pregnant women in Swaziland while HIV/AIDS-related knowledge and family function did not. This suggests that HIV interventions should be reinforced taking into consideration these findings. The findings also suggest the importance of future research sensitive to the Swazi and African sociocultural contexts, especially research for family function.

Youth perspectives on sexually transmitted infections and sexual health in Northern Canada and implications for public health practice

OBJECTIVE

High rates of sexually transmitted infections in the Arctic have been a focus of recent research, and youth are believed to be at greatest risk of infection. Little research has focused on understanding youth perspectives on sexual health. The goal of this study was to collect the perspectives of youth in Nunavut on sexual health and relationships with the intent of informing public health practice.

METHOD

This qualitative research study was conducted within an Indigenous knowledge framework with a focus on Inuit ways of knowing. Data were collected through face-to-face interviews in three Nunavut communities with 17 youth between the ages of 14 and 19 years. Participants were asked open-ended questions about their experiences talking about sexual health and relationships with their family, peers, teachers or others in the community.

RESULTS

There are four key findings, which are important for public health: (a) Parents/caregivers are the preferred source of knowledge about sexual health and relationships among youth respondents; (b) youth did not report using the Internet for sexual health information; (c) youth related sexual decision-making to the broader community context and determinants of health, such as poverty; and (d) youth discussed sexual health in terms of desire and love, which is an aspect of sexual health often omitted from the discourse.

IMPLICATIONS AND CONTRIBUTION

The youth in this study articulated perspectives on sexual health, which are largely neglected in current public health practice in the North. The findings from this study underscore the important role of community-led participatory research in contributing to our understanding of the public health challenges in our communities today, and provide direction for future interventions and research.

Sense of Mission and Sexual Health Outcomes Among Young Adult Women

STUDY OBJECTIVE

To examine the association between self-reported sense of mission and sexual health behaviors in a geographically diverse cohort of U.S. young adult females in the Growing Up Today Study (GUTS).

DESIGN

We conducted a cross-sectional analysis of the 2007 wave of GUTS data from self-reported online or mailed surveys. Outcomes were early sex initiation and history of sexually transmitted infection (STI), which were analyzed as a binary outcome using logit link, and number of sex partners, which was analyzed as a continuous outcome. Models for number of sex partners and history of STIs were adjusted for age.

PARTICIPANTS

There were 5,624 young women aged 20 to 25 years who participate in GUTS and who answered the question on "sense of mission."

MAIN OUTCOME MEASURES

Age at sexual initiation, history of STIs, and number of lifetime partners.

RESULTS

When asked whether they had a sense of mission in their life, 28.1% of women strongly agreed, 54.9% agreed, and 17% disagreed. Women with a low sense of mission had higher odds of reporting a history of STI (odds ratio 1.35, 95% confidence interval 1.08 to 1.70), and more lifetime sexual partners (β = .83, P < .001).

CONCLUSIONS

Having a high sense of mission is associated with lower sexual risk in young women. Interventions to increase sense of mission among young women may improve sexual health outcomes.

Parents as partners in adolescent HIV prevention in Eastern and Southern Africa: an evaluation of the current United Nations' approach

The United Nations's (UN) sustainable development goals (SDGs) include the target (3.3) of ending the HIV/AIDS epidemic by 2030. A major challenge in this regard is to curb the incidence of HIV among adolescents, the number two cause of their death in Africa. In Eastern and Southern Africa, they are mainly infected through heterosexual transmission. Research findings about parental influence on the sexual behavior of their adolescent children are reviewed and findings indicate that parental communication, monitoring and connectedness contribute to the avoidance of risky sexual behavior in adolescents. This article evaluates the extent to which these three dimensions of parenting have been factored in to current HIV prevention recommendations relating to adolescent boys and girls. Four pertinent UN reports are analyzed and the results used to demonstrate that the positive role of parents or primary caregivers vis-à-vis risky sexual behavior has tendentially been back-grounded or even potentially undermined. A more explicit inclusion of parents in adolescent HIV prevention policy and practice is essential - obstacles notwithstanding - enabling their indispensable partnership towards ending an epidemic mostly driven by sexual risk behavior. Evidence from successful or promising projects is included to illustrate the practical feasibility and fruitfulness of this approach.

Risky sexual behavior of foreign and native-born women in emerging adulthood: The long reach of mother-daughter relationships in adolescence

Parents' influence on young adult sexual behavior receives little attention compared to influence on adolescent behavior. Yet effective parenting should have lasting effects. Even fewer studies examine parents' influence on sexual behavior of both foreign and native-born young adults. Using the National Longitudinal Study of Adolescent to Adult Health (Add Health) Waves I (1994-95) and III (2001-02), we examine longitudinal associations among mother-daughter relationship quality and nativity during adolescence and young adults' risky sexual behaviors of condom use at last intercourse, number of sexual partners, and STI diagnoses (N = 4460). Women, 18-26 years old, who had good mother-adolescent daughter relationships have fewer partners and STIs in the past year. Second generation women have worse mother-adolescent daughter relationships, compared to third generation. Relationship quality does not explain associations between nativity and risky behavior. Lasting associations between relationship quality and risk behaviors suggest that reproductive health interventions should enhance mother-adolescent relationships.

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.

Association between parent-adolescent communication about sex-related topics and HIV testing, United States. 2006-2013

Adolescents need information about sex-related topics in order to reduce risk behavior and engage in healthy sexual decision-making. Parents have the potential to be an important source of this information. Using the 2006-2010 and 2011-2013 National Survey of Family Growth, we examined associations between parent-adolescent communication before age 18 about sex-related topics and HIV testing among respondents aged 18-24 that ever had sexual intercourse (women = 3893; men = 3359). Analyses showed that for both men and women, discussing how to prevent HIV/AIDS and how to use a condom with a parent before age 18 were positively associated with HIV testing. Among women only, discussions about methods of birth control, where to get birth control, and STDs were positively associated with HIV testing. Developing strategies and interventions to facilitate parent-adolescent communication about sex-related topics, particularly HIV prevention and condom use, may be important to increase HIV testing among young women and men.

Positive Youth Development and Contraceptive Use Consistency

INTRODUCTION

Understanding protective factors associated with adolescent contraceptive use can guide strategies to prevent unprotected sex and its consequences. The current study investigated associations between a set of protective factors, specifically indicators of positive youth development, and consistency of contraceptive use.

METHOD

This cross-sectional study examined relationships between positive youth development indicators and consistency of contraceptive use among sexually active adolescent girls at elevated risk for pregnancy. Multivariate models assessed whether measures of individual attributes, social attachments, and social norms were associated with consistent condom and hormonal contraceptive use.

RESULTS

Adolescents with higher self-esteem and greater family connectedness reported more consistent hormonal contraceptive use. Two factors, stress management skills and perceived peer prosocial norms, were protective for consistent condom use. In contrast, steady partnership status was associated with less consistent condom use.

DISCUSSION

Findings suggest that interventions targeting protective factors may influence adolescents' contraceptive use, in addition to promoting their healthy development.

Housing and sexual health among street-involved youth

Street-involved youth (SIY) carry a disproportionate burden of sexually transmitted diseases (STD). Studies among adults suggest that improving housing stability may be an effective primary prevention strategy for improving sexual health. Housing options available to SIY offer varying degrees of stability and adult supervision. This study investigated whether housing options offering more stability and adult supervision are associated with fewer STD and related risk behaviors among SIY. A cross-sectional study was performed using public health survey and laboratory data collected from Toronto SIY in 2010. Three exposure categories were defined a priori based on housing situation: (1) stable and supervised housing, (2) stable and unsupervised housing, and (3) unstable and unsupervised housing. Multivariate logistic regression was used to test the association between housing category and current or recent STD. Secondary analyses were performed using the following secondary outcomes: blood-borne infection, recent binge-drinking, and recent high-risk sexual behavior. The final analysis included 184 SIY. Of these, 28.8 % had a current or recent STD. Housing situation was stable and supervised for 12.5 %, stable and unsupervised for 46.2 %, and unstable and unsupervised for 41.3 %. Compared to stable and supervised housing, there was no significant association between current or recent STD among stable and unsupervised housing or unstable and unsupervised housing. There was no significant association between housing category and risk of blood-borne infection, binge-drinking, or high-risk sexual behavior. Although we did not demonstrate a significant association between stable and supervised housing and lower STD risk, our incorporation of both housing stability and adult supervision into a priori defined exposure groups may inform future studies of housing-related prevention strategies among SIY. Multi-modal interventions beyond housing alone may also be required to prevent sexual morbidity among these vulnerable youth.

Improving the paradigm of approaches to adolescent sexual and reproductive health

Traditional approaches to improving adolescent sexual and reproductive health (ASRH) have focused on changing individual behavior, with little emphasis on addressing the factors that contribute to this behavior: biological changes; the influence of family and friends; the communities in which young people live; and access to economic and academic opportunities. This article provides an overview of the various factors that influence ASRH behaviors and outcomes and suggests an approach grounded in the principles of positive youth development to reduce risk factors and improve the protective factors that contribute to adolescents' successful and healthy transition into adulthood.

Individual-level protective factors for sexual health outcomes among sexual minority youth: a systematic review of the literature

Although factors associated with negative sexual health outcomes among sexual minority youth (SMY) have been well documented, protective factors have been less studied. This review summarises the current state of science on individual-level protective factors for SMY and identifies gaps to inform future research. A systematic search of non-intervention, empirical peer-reviewed research was conducted. Articles that examined an a priori-identified individual-level protective factor and at least one sexual health outcome in a sample or subsample of SMY aged 10-24 years in Western, industrialised countries were eligible for inclusion. A total of 21 articles that reported data from 13 unique studies met inclusion criteria. Only two studies described findings for young sexual minority women and thus the literature synthesis was limited to studies reporting on young men who have sex with men (YMSM) in the USA. A total of 11 individual-level protective factors were examined. Subjective peer norms and attitudes about condom use were repeatedly protective in cross-sectional analyses. Findings related to self-efficacy, self-esteem and clear and positive identity were more mixed. The findings of this review suggest that attitudes and subjective peer norms related to condom use are promising intervention targets for YMSM. There is a need, however, for longitudinal research to confirm these protective effects and to consider them among other SMY. Moreover, protective factors related to skills and competencies have been insufficiently studied among SMY. Addressing these gaps will help develop a robust body of evidence to inform interventions.

African American Parent-Son Sexual Communication Among a College Sample

To investigate whether reports of parent-child sexual communication (PCSC) varied by parental gender, education and living environments among African American adolescent and young male students attending a historically black university (n=146).

DESIGN AND METHODS

Using secondary data a paired t-test was used to determine mean differences for PCSC by gender. Factorial ANOVA was calculated to examine the interaction between PCSC and living environment.

RESULTS

Overall African American mothers were significantly more likely to engage in PCSC with their sons than African American fathers (t(68)=4.143, p<0.001). African American fathers from suburban areas were significantly more likely to engage in PCSC with their sons than urban fathers (t(137)=-2.295, p=0.023). No significant difference in PCSC by parental educational level was found.

CONCLUSION

Findings from this research suggest that African American mothers continue to be the primary conversant in PCSC with their sons. Additional research is needed to understand the role that living environment (urban vs. suburban) plays in the father PCSC process.

PRACTICE IMPLICATIONS

PCSC can play an important role in reducing adolescent sexual risk behaviors. Nurses should encourage and support PCSC among African American parents and their adolescent and young adult sons.

Sibling teenage pregnancy and clinic-referred girls' condom use: The protective role of maternal monitoring

Younger sisters of teenage parents have elevated rates of engaging in unprotected sex. This may result from changes in parenting behavior after a sibling becomes pregnant or impregnates a partner, and be particularly pronounced for girls seeking mental health treatment. The current study examines condom use over time in 211 African-American girls recruited from outpatient psychiatric clinics. Findings indicate that having a sibling with a teenage pregnancy history predicts less consistent condom use two years later. After accounting for earlier condom use and mental health problems, maternal monitoring moderates condom use such that for girls with a sibling with a pregnancy history, more vigilant maternal monitoring is associated with increased condom use, while for girls with no sibling pregnancy history, maternal monitoring is unrelated to adolescents' condom use two years later. Findings suggest that targeted interventions to increase maternal monitoring of high-risk teens may be beneficial for girls with a sibling history of teenage pregnancy.

Preparing Student Nurses as Parent-based Adolescent Sexual Health Educators: Results of a Pilot Study

OBJECTIVES

While health promotion and patient education are central to the scope of practice of professional nurses, they often feel ill-equipped to assume the role of sexual health educator and lack adequate knowledge and skills to effectively engage parents in adolescent sexual and reproductive health efforts.

DESIGN AND SAMPLE

Employing a mixed-methods study consisting of both pre- and post-test survey and exit interviews, a pilot study was conducted to assess the impact of implementing a parent-based adolescent sexual health intervention on baccalaureate nursing student outcomes (N = 31).

RESULTS

We found statistically significant improvements in student outcome expectancies of parenting strategies, barriers to sexual health communication, self-efficacy, and sexual health counseling experience. Using thematic content analysis of exit interview content, emerging themes were (1) need for increased sexual and reproductive health (SRH) preparation, (2) wanting greater experience and opportunity for involvement in nursing research, and (3) educational gaps in family-focused community public health.

CONCLUSIONS

Incorporating adolescent sexual health education into public health nursing clinical training can prepare nurses as parent-based adolescent sexual health educators, a core competency for nurses working with families in communities and across all health care delivery settings.

Young people's parental discussion about sexual and reproductive health issues and its associated factors in Awabel woreda, Northwest Ethiopia

BACKGROUND

In Ethiopia besides the very low health seeking behavior of young people, they do not have access to sexual and reproductive health information and even the existing health services are adult-centered. Furthermore, health providers are not well equipped in addressing young people sexual and reproductive health needs. Therefore, parent-young people discussion about sexual and reproductive health issues are crucial in increasing their awareness and reduces their risky sexual behaviors. This study was aimed to assess young people's parental discussion about sexual and reproductive health issues and its associated factors in Awabel woreda, Northwest Ethiopia.

METHODS

A community based cross-sectional study was conducted among 781 young people aged 10-24 years in Awabel Woreda, Northwest Ethiopia. A pre-tested structured interview administered questionnaire was used for the data collection. The collected data were entered using Epi Data 3.1 and analyzed using SPSS for windows version 21.

RESULTS

In the past 6 months, about one quarter, 25.3% of young people had a parental discussion about sexual and reproductive health issues. Young people who reside in urban areas were more likely to discuss on sexual and reproductive health issues with their parents [AOR = 2.44, 95% CI: 1.54-3.89]. Similarly, being male was more likely to have a parental discussion about sexual and reproductive health issues than females [AOR = 1.63, 95% CI: 1.11-2.38]. Furthermore, the odds of parent-young people discussion about SRH matters was more likely among young people aged 20-24 years [AOR = 4.57, 95% CI: 2.13-9.82], living with fathers [AOR = 2.46, 95% CI: 1.20-5.04] and had attained a primary level of education [AOR = 2.89, 95% CI: 1.22-6.87]. Parents lack of interest to discuss, feeling ashamed and culturally not acceptable to talk about sexual matters were found to deter young people's in discussing sexual and reproductive health matters.

CONCLUSION

Parent-young people discussion about sexual and reproductive health is very low and there are different hindering factors. And therefore, young people's sexual and reproductive health programs or policies should be designed in addressing the cultural and societal factors besides the individual or behavioral factors.

Qualitative Evaluation of Historical and Relational Factors Influencing Pregnancy and Sexually Transmitted Infection Risks in Foster Youth

PURPOSE

To explore how attitudes, norms, behaviors, responses to early life experiences, and protective factors influence pregnancy and sexually transmitted infection risks from the perspectives of current and former foster youth to inform the development of prevention strategies.

METHODS

We conducted semi-structured individual qualitative interviews with a diverse sample of 22 current/former foster youth aged 15-21 years (63% female; average age = 18.6 years). We then used Theoretical Thematic Analysis to systematically analyze the data for key themes related to sexual health in four categories: 1) norms and attitudes, 2) responses to early life experiences, 3) protective factors, and 4) youth-driven intervention ideas.

RESULTS

Participants reported a range of sexual experience levels, varied sexual orientations, and also reported varied life experiences prior to and during foster care. We detected several norms and attitudes that likely contribute to risks of early pregnancies and sexually transmitted infections. These included that one can tell by looking whether a partner is trustworthy or has a sexually transmitted infection, that condoms aren't necessary with long-term or infrequent partners or if birth control is used, and that teen pregnancy is an inevitable event. With respect to responses to early life experiences, youth frequently described difficulties dealing with strong emotions in the context of romantic and/or sexual relationships; many attributed these difficulties to early experiences with biological family members or in foster care. Participants linked emotion regulation difficulties with struggles in trust appraisal, effective communication, and impulsive behaviors. Youth also described a variety of protective factors that they felt helped them prevent sexual risk behaviors or improved their lives in other respects. Finally, participants endorsed factors likely to improve intervention acceptability and efficacy, including an open, non-judgmental group-based environment, involvement of peer mentors, and inclusion of caregiver and caseworker training components.

CONCLUSIONS

Trauma-informed, tailored intervention strategies which address key norms and attitudes and provide broad-based assertiveness and emotion regulation skills are likely to be the most effective strategies to reduce risks of teen pregnancies and sexually transmitted infections among teens in foster care. Group-based interventions that involve peer mentors and caregiver and caseworker components may be especially acceptable and effective for teens in foster and/or kinship care.

Relationship Satisfaction and Communication Among Urban Minority HIV-Positive and HIV-Negative Mothers: The Influence on Daughter's Alcohol Use

Family relationships influence children's beliefs and behaviors. This work examined qualities associated with communication about alcohol among 176 mothers and the influence of this communication on daughters' alcohol use. Path analyses by maternal HIV status indicated significant differences. Relationship satisfaction was associated with self-efficacy for both HIV-positive (β = 0.545, p < .001) and HIV-negative (β = 0.557, p < .001) mothers. Maternal self-efficacy was associated with communication for both HIV-positive (β = 0.364, p < .01) and HIV-negative (β = 0.310, p < .05) mothers; maternal attitudes toward alcohol use were associated with communication among HIV-negative mothers (β = 0.20, p < .05). Relationship satisfaction was indirectly related to daughter's alcohol use in HIV-positive dyads (β = 0.153, p < .05). In families with interfamilial and environmental stressors, investing in the mother-daughter relationship, in part by discussing issues related to alcohol use, is protective in nature.

STD and Abortion Prevalence in Adolescent Mothers With Histories of Childhood Protection Involvement

CONTEXT

Early sexual debut and unprotected sexual activity place adolescents at risk of adverse sexual health outcomes. Adolescents involved with child protective services (CPS) may be a particularly vulnerable population.

METHODS

California birth records for 86,946 adolescents who became first-time mothers in 2008-2010 were probabilistically linked to statewide CPS records from 1998 and later. The prevalence of STDs at birth and of abortion history were explored by preconception CPS involvement. Generalized linear models, adjusted for health, socioeconomic and demographic characteristics, were used to assess correlates of current STDs and history of abortion.

RESULTS

At the time they gave birth, 1% of adolescents had a documented STD, and 5% reported a previous abortion. After adjustment for other characteristics, CPS involvement was associated with a significantly elevated prevalence both of STDs (relative risk, 1.2) and of previous abortion (1.4). Other characteristics also were associated with both outcomes, but not always in the same direction. For example, delaying prenatal care until after the first trimester or getting none at all was associated with an increased prevalence of STDs (1.3), but a reduced prevalence of abortion (0.8-0.9); having public insurance coverage for the birth was associated with a reduced STD prevalence (0.9) and an elevated abortion history prevalence (1.2).

CONCLUSIONS

To assess whether adolescents with a history of CPS involvement need targeted sexual health interventions, further research is needed on the mechanisms that underlie associations between CPS involvement and adverse sexual health outcomes.

Is religiosity positively associated with school connectedness: evidence from high school students in Atlantic Canada?

School connectedness (SC) is associated with decreased student risk behavior and better health and social outcomes. While a considerable body of research has examined the factors associated with SC, there is limited evidence about the particular role of religiosity in shaping levels of SC. Employing data reported by junior and senior high school students from Atlantic Canada, this study examines whether religiosity is positively associated with SC and whether such associations differ by gender. We tested the association between SC and religiosity using a random intercept multilevel logistic regression. The between-school variability in SC was first determined by our estimating a null or empty model; three different model specifications that included covariates were estimated: in Model 1 we adjusted for gender, age, academic performance, parental education, and living arrangement; in Model 2 for sensation seeking and subjective social status in addition to Model 1 variables; and in Model 3 we added substance use to the analysis. Our multilevel regression analyses showed that religiosity was protectively associated with lower SC across the three model specifications when both genders were examined together. In gender-stratified analyses we found similar protective associations of religiosity, with lower SC for both males and females in all three models. Given the overwhelming positive impact of SC on a range of health, social and school outcomes, it is important to understand the role of religiosity, among other factors, that may be modified to enhance student's connectedness to school.

Changes in American Adults' Sexual Behavior and Attitudes, 1972-2012

In the nationally representative General Social Survey, U.S. Adults (N = 33,380) in 2000-2012 (vs. the 1970s and 1980s) had more sexual partners, were more likely to have had sex with a casual date or pickup or an acquaintance, and were more accepting of most non-marital sex (premarital sex, teen sex, and same-sex sexual activity, but not extramarital sex). The percentage who believed premarital sex among adults was "not wrong at all" was 29 % in the early 1970s, 42 % in the 1980s and 1990s, 49 % in the 2000s, and 58 % between 2010 and 2012. Mixed effects (hierarchical linear modeling) analyses separating time period, generation/birth cohort, and age showed that the trend toward greater sexual permissiveness was primarily due to generation. Acceptance of non-marital sex rose steadily between the G.I. generation (born 1901-1924) and Boomers (born 1946-1964), dipped slightly among early Generation X'ers (born 1965-1981), and then rose so that Millennials (also known as Gen Y or Generation Me, born 1982-1999) were the most accepting of non-marital sex. Number of sexual partners increased steadily between the G.I.s and 1960s-born GenX'ers and then dipped among Millennials to return to Boomer levels. The largest changes appeared among White men, with few changes among Black Americans. The results were discussed in the context of growing cultural individualism and rejection of traditional social rules in the U.S.

Is the sexual behaviour of young people in sub-Saharan Africa influenced by their peers? A systematic review

Adolescents in sub-Saharan Africa are highly vulnerable to HIV, other sexually transmitted infections (STIs) and unintended pregnancies. Evidence for the effectiveness of individual behaviour change interventions in reducing incidence of HIV and other biological outcomes is limited, and the need to address the social conditions in which young people become sexually active is clear. Adolescents' peers are a key aspect of this social environment and could have important influences on sexual behaviour. There has not yet been a systematic review on the topic in sub-Saharan Africa. We searched 4 databases to find studies set in sub-Saharan Africa that included an adjusted analysis of the association between at least one peer exposure and a sexual behaviour outcome among a sample where at least 50% of the study participants were aged between 13 and 20 years. We classified peer exposures using a framework to distinguish different mechanisms by which influence might occur. We found 30 studies and retained 11 that met quality criteria. There were 3 cohort studies, 1 time to event and 7 cross-sectional. The 11 studies investigated 37 different peer exposure-outcome associations. No studies used a biological outcome and all asked about peers in general rather than about specific relationships. Studies were heterogeneous in their use of theoretical frameworks and means of operationalizing peer influence concepts. All studies found evidence for an association between peers and sexual behaviour for at least one peer exposure/outcome/sub-group association. Of all 37 outcome/exposure/sub-group associations tested, there was evidence for 19 (51%). There were no clear patterns by type of peer exposure, outcome or adolescent sub-group. There is a lack conclusive evidence about the role of peers in adolescent sexual behaviour in Sub-Saharan. We argue that longitudinal designs, use of biological outcomes and approaches from social network analysis are priorities for future studies.

Indirect Over-Time Relations Between Parenting and Adolescents' Sexual Behaviors and Emotions Through Global Self-Esteem

The present study examined indirect over-time relations between parenting and adolescent sexuality through global self-esteem. Three waves of online questionnaire data were collected among a community sample of 1,116 Dutch adolescents (M = 13.9 years at baseline). Participants rated the quality of their relationship with parents, their global self-esteem, and their experience with various sexual behaviors. Sexually experienced adolescents (n = 168) evaluated their sexual experiences using six emotions. Path model results showed that a higher-quality relationship with parents at T1 predicted higher levels of self-esteem at T2, which in turn predicted less experience with sexual behaviors and more positive sexual emotions at T3. The indirect over-time path from relationship quality through self-esteem to adolescents' sexual emotions was significant; the indirect path to adolescents' experience with sexual behaviors was not significant at the .05 level. No significant age or gender differences were found in the path models. The findings indicate that self-esteem plays an important role in adolescent sexuality and that parents can contribute to positive sexual experiences of adolescents indirectly--through the enhancement of self-esteem--by fostering a high-quality relationship with their children. Implications for theory, future research, and strategies to promote healthy and positive youth sexuality are discussed.