Outcomes of sexual behaviors among sexual minority youth

Not Who You Are, But Who You Are With: Re-examining Women's Less Satisfying Sexual Debuts

Gender differences in appraisals of first intercourse are among the largest in sexuality research, with women indicating less satisfying "sexual debuts" than men. Dispositional or "actor-level" explanations for this gender gap are pervasive, yet research has largely examined heterosexual debuts in which actor gender and partner gender are confounded. We assessed whether women's less satisfying sexual debuts are better explained by actor gender or partner gender, comparing experiences of women who debuted with men (WDM) with those of men and women who debuted with women (MDW, WDW). Retrospective accounts of sexual debut were collected from 3033 adults. At first intercourse, we found that WDW had equal physical and emotional satisfaction to MDW, and more satisfaction than WDM, suggesting satisfaction gaps owing to partner gender, not actor gender. This pattern did not extend to a comparison event (first masturbation), where WDW and WDM had similar satisfaction, but less satisfaction than MDW, suggesting an actor gender gap. To identify sources of satisfaction gaps, we probed for corresponding differences in the circumstances of sexual debut. Sexual circumstances were more strongly implicated than nonsexual ones, with relative deprivation of glans stimulation explaining relative dissatisfaction at first intercourse, but not first masturbation, and orgasm explaining it at both. Findings challenge the view that the satisfaction gap at first intercourse reflects an inherent difference between genders. Indeed, they demonstrate similarities when partner gender does not differ and suggest strategies for ensuring equal sexual satisfaction-and equal sexual rights realization-at (hetero) sexual debut.

Differential resilience effects of everyday political engagement against heterosexist victimization among sexual minority youth: The importance of identity-based action

Everyday forms of political engagement, such as civic participation and collective action, have been recognized as a crucial factor for positive youth development, but less is known about their resilience effects on youth from marginalized populations, especially in less democratic societies. The present study investigated experiences of everyday political engagement among sexual minority youth in China and examined their compensatory and protective effects against heterosexist victimization. A sample of 793 Chinese sexual minority youth was included in the study. The results showed that collective action operated as a protective factor in buffering the effect of heterosexist victimization, such that its association with academic engagement was not significant among those with higher levels of collective action. In contrast, civic participation served the compensatory function and was associated with greater academic engagement, a stronger sense of school belonging, and fewer depression symptoms, but it did not protect against the negative effects of heterosexist victimization. The findings highlight the importance of identity-based action among sexual minority youth and provide insight into the differential resilience effects of everyday political engagement. The study has implications for fostering resilience among sexual minority youth with victimization experiences in school and counseling settings.

Physical and Emotional Satisfaction at First Same-Sex Anal Sex in Young Gay and Bisexual Men

Research has focused on adolescents' feelings about their first sexual experiences, but little research has examined this topic in sexual minority adolescents. In this study, we examined how experiencing emotional and physical satisfaction at first same-sex anal sex differed by age of first sex for young gay and bisexual men. We applied the time-varying effect model to data from an Internet survey of men who initiated first sex between ages 14-26 (n = 6401) to examine emotional and physical satisfaction at first same-sex anal sex across continuous age of onset and by partner factors. The majority of men reported satisfaction across all ages; however, satisfaction was generally less likely for men who had first anal sex with a non-relationship partner, an older partner, or a partner they had sex with only once and this was particularly true at earlier ages. Findings suggest that many young gay and bisexual men report satisfaction with their first anal sex and that relationship context can be important in predicting satisfaction, particularly at younger ages.

"It's Almost Like Gay Sex Doesn't Exist:" Parent-Child Sex Communication According to Gay, Bisexual, and Queer Adolescent Sons

Sex communication interventions facilitate positive sexual health outcomes with heterosexual adolescents. The same has yet to be established for male youth with same-sex attractions, behaviors, and identities. Our study describes the experiences of gay, bisexual and queer-identifying adolescent males with parent-child sex communication. We conducted 30 in-depth semi-structured interviews with a diverse group of 15 to 20 year-old gay, bisexual, and queer (GBQ) males. Interview transcripts were coded and themes were identified using thematic and content analysis. Narratives revealed that sex communication with parents occurs rarely, is heteronormative in content prior to adolescent males' disclosure as GBQ, and after disclosure is reactionary and based on stereotypes that associate this population with negative health outcomes. Parents were rated poorly as sex educators by adolescent males and the findings are mixed regarding perception of parents' knowledge about GBQ-specific information. Parents and healthcare providers were identified as preferred sources of sex information by GBQ adolescent males. Sex communication with parents throughout adolescence that excludes GBQ males' same-sex concerns is a missed opportunity for targeted sexual risk reduction. There are multiple ways healthcare providers can assist parents to plan age-appropriate, sexuality-inclusive, home-based discussions about sex for this group.

Barriers and enablers to sexual health service use among university students: a qualitative descriptive study using the Theoretical Domains Framework and COM-B model

BACKGROUND

University students are within the age group at highest risk for acquiring sexually transmitted infections and other negative health outcomes. Despite the availability of sexual health services at university health centres to promote sexual health, many students delay or avoid seeking care. This study aimed to identify the perceived barriers and enablers to sexual health service use among university undergraduate students.

METHODS

We used a qualitative descriptive design to conduct semi-structured focus groups and key informant interviews with university students, health care providers, and university administrators at two university health centres in Nova Scotia, Canada. The semi-structured focus group and interview guides were developed using the Theoretical Domains Framework and COM-B Model. Data were analyzed using a directed content analysis approach, followed by inductive thematic analysis.

RESULTS

We conducted 6 focus groups with a total of 56 undergraduate students (aged 18-25) and 7 key informant interviews with clinicians and administrators. We identified 10 barriers and enablers to sexual health service use, under 7 TDF domains: knowledge; memory, attention and decision-making processes; social influences; environmental context and resources; beliefs about consequences; optimism; and emotion. Key linkages between students' social opportunity and motivation were found to influence students' access of sexual health services.

CONCLUSIONS

We identified barriers and enablers related to students' capability, opportunity and motivation that influence sexual health service use. We will use these findings to design an intervention that targets the identified barriers and enablers to improve students' use of sexual health services, and ultimately, their overall health and well-being.

Sexual Positioning Practices and Sexual Risk Among Black Gay and Bisexual Men: A Life Course Perspective

Increased attention has highlighted the role of age and sexual development on HIV risk among Black MSM (BMSM); limited focus has been given to the relationship of sexual positioning to HIV risk along the life course. This study examined BMSM's life course sexual positioning practices and accompanying HIV/STI risks. Twenty-six Black gay and bisexual men ages 24-61 completed life history interviews in Los Angeles, California, between September and November 2015. Thematic analysis evaluated domains including major life events, substance use, social support, and partner selection. Varying exposure to HIV treatment and prevention options and venues to meet male partners revealed generational differences in sexual risks. Childhood sexual abuse and internalized homonegativity impacted personal development, sexual positioning, and condom negotiation. BMSM also assumed sexual positioning using masculinity stereotypes and body language. Clarifying the sexual development and HIV/STI risk contexts among BMSM could better inform current treatment and prevention needs.

Non-Heterosexuality, Relationships, and Young Women's Contraceptive Behavior

Non-heterosexual young women have a higher rate of unintended pregnancy than their heterosexual peers, but their fertility behaviors are understudied. We use longitudinal data from the Relationship Dynamics and Social Life study to investigate mechanisms contributing to non-heterosexual women's higher pregnancy risk. These data include weekly reports of relationships, sex, and contraceptive use over 30 months. We compare the relationships and fertility behaviors of three groups: exclusively heterosexual (consistent heterosexual behavior, identity, and attraction); mostly heterosexual (heterosexual identity with same-sex behavior and/or same-sex attraction); and LGBTQ (any non-heterosexual identity). We find that mostly heterosexual and LGBTQ women behave differently from exclusively heterosexual women in ways likely to elevate their risk of unintended pregnancy: more distinct partners during the study period, more sexual intercourse with men, less frequent contraceptive use, less use of a dual method (condom plus hormonal method), and more gaps in contraceptive coverage. Mostly heterosexual women resemble LGBTQ women in their contraceptive behavior but have significantly more intercourse with men, which may increase their pregnancy risk relative to both LGBTQ and exclusively heterosexual women. We conclude by considering implications for LGBTQ health and the measurement of sexual minority populations.

Meeting the Needs of Sexual and Gender Minority Youth: Formative Research on Potential Digital Health Interventions

PURPOSE

Sexual and gender minority youth (SGMY) have unique risk factors and worse health outcomes than their heterosexual and cisgender counterparts. SGMY's significant online activity represents an opportunity for digital interventions. To help meet the sex education and health needs of SGMY and to understand what they consider important, formative research was conducted to guide and inform the development of new digital health interventions.

METHODS

Semistructured interviews, in-person focus groups, and online focus groups were conducted with 92 youths (aged 15-19 years) who self-identify as nonheterosexual, noncisgender, questioning, and/or have engaged in same-sex sexual behavior. Data were coded and analyzed using inductive thematic analysis.

RESULTS

Thematic analysis revealed that SGMYs are often driven online by experiences of isolation, stigmatization, and lack of information and are looking for a supportive, validating community and relevant, accurate information. Gender minority youths felt that they faced a larger number of and more extreme incidences of discrimination than sexual minority youths. Most youths described interpersonal discrimination as having substantial negative effects on their mental health.

CONCLUSIONS

Any digital intervention for SGMY should focus on mental health and well-being holistically rather than solely on risk behaviors, such as preventing HIV. Interventions should include opportunities for interpersonal connection, foster a sense of belonging, and provide accurate information about sexuality and gender to help facilitate positive identity development. Content and delivery of digital interventions should appeal to diverse sexualities, genders, and other intersecting identities held by SGMY to avoid further alienation.

Age-varying associations between nonmarital sexual behavior and depressive symptoms across adolescence and young adulthood

Research has demonstrated associations between adolescent sexual behavior and depressive symptoms, but no single study has examined individuals at different ages throughout adolescence and young adulthood in order to determine at what ages sexual behavior may be associated with higher or lower levels of depressive symptoms. Using nationally representative longitudinal data and an innovative method, the time-varying effect model (TVEM), which examines how the strength of an association changes over time, this study examines how nonmarital sexual intercourse is associated with depressive symptoms at different ages, which behaviors and contexts may contribute to these associations, and whether associations differ for male and female participants. Findings indicate that sexual behavior in adolescence is associated with a higher level of depressive symptoms, particularly for female adolescents, and this association is relatively consistent across different partner types and adolescent contexts. Associations between sexual behavior and depressive symptoms in young adulthood are more dependent on partner factors and adolescent contexts; sexual behavior in young adulthood is associated with fewer depressive symptoms for women who have sex with a single partner and for men whose parents did not strongly disapprove of adolescent sexual behavior. Findings suggest that delaying sexual behavior into young adulthood may have some benefits for mental health, although contextual and relationship factors also play a role. (PsycINFO Database Record

Oral vs. Vaginal Sex Experiences and Consequences Among First-Year College Students

To fully understand late adolescents' experiences of oral sex, we must consider both risk and normative developmental perspectives. Sexual experiences include a range of behaviors, but research on sexual behaviors and consequences focuses primarily on vaginal sex. Oral sex occurs at rates similar to vaginal sex, and carries some, though less, risk than vaginal sex. The current study examined the event-level prevalence and consequences of oral sex compared to vaginal sex with other-sex partners in first-year college students. Daily data were from recently sexually active first-year college students (N = 253 people, 834 days; M age, 18.4 years; SD = 0.4; 56% female; 31% Hispanic/Latino; 17% African American, 14% Asian American/Pacific Islander, 25% European American, 12% multiracial) who reported on sexual behaviors and consequences. Both positive (intimacy, physical satisfaction) and negative (worrying about health, guilt) consequences were less common for oral than vaginal sex. Gender differences suggested that female adolescents may find vaginal sex more rewarding than oral sex, whereas male adolescents may find them equally rewarding.

Sexual Esteem in Emerging Adulthood: Associations with Sexual Behavior, Contraception Use, and Romantic Relationships

Sexual esteem is an integral psychological aspect of sexual health (Snell & Papini, 1989 ), yet it is unclear whether sexual esteem is associated with sexual health behavior among heterosexual men and women. The current analysis used a normative framework for sexual development (Lefkowitz & Gillen, 2006 ; Tolman & McClelland, 2011 ) by examining the association of sexual esteem with sexual behavior, contraception use, and romantic relationship characteristics. Participants (N = 518; 56.0% female; mean age = 20.43 years; 26.8% identified as Hispanic/Latino; among non-Hispanic/Latinos, 27.2% of the full sample identified as European American, 22.4% Asian American, 14.9% African American, and 8.7% multiracial) completed Web-based surveys at a large Northeastern university. Participants who had oral sex more frequently, recently had more oral and penetrative sex partners (particularly for male participants), and spent more college semesters in romantic relationships tended to have higher sexual esteem than those who had sex less frequently, with fewer partners, or spent more semesters without romantic partners. Sexually active male emerging adults who never used contraception during recent penetrative sex tended to have higher sexual esteem than those who did use it, whereas female emerging adults who never used contraception tended to have lower sexual esteem than those who did use it. Implications of these results for the development of a healthy sexual self-concept in emerging adulthood are discussed.

"It felt good but weird at the same time": Emerging adults' first experiences of six different sexual behaviors

Although sexual behavior is multidimensional, little research has focused on the experience of non-intercourse behaviors for adolescents and emerging adults. This paper uses open-ended coded data from a longitudinal study of college students (N = 346; Mean age = 18.5, 52% female, 27% Hispanic/Latino [HL], 25% non-HL European American, 23% non-HL Asian American, 16% non-HL African American, 9% non-HL Multiracial) to examine what emotional responses emerging adults report about their first experiences of six sexual behaviors. The four most common emotional reactions were happy, excited, fearful, and indifferent. Descriptions were largely positive, although mixed reactions were relatively common and emotional reactions varied by behavior. Results suggest the importance of including multiple types of sexual behaviors, as well as their possible positive and negative outcomes, in sexuality education programs.