Why are young college women not using condoms? Their perceived risk, drug use, and developmental vulnerability may provide important clues to sexual risk

Sexual Decision Making When Intoxicated: Women's Reasons for and Against Having Sex in a Laboratory-Based Scenario

Young adult women report high condom use intentions, but inconsistent condom use. Cognitive appraisals during sexual encounters are important determinants of condom use decisions, but a nuanced understanding of what cognitions emerge during women's "hot states" (e.g., sexual arousal, alcohol intoxication) remains lacking. To address this gap, we examined women's heat of the moment cognitions in their own words using mixed methods. Young adult women (N = 503; Mage = 25.01, SDage = 2.66) were randomized to a beverage condition (alcohol or control), then read and responded to questions about an eroticized sexual scenario. The nature and strength of reasons for and against having sex were reported before and after learning no condom was available. Multilevel models revealed intoxicated participants were more likely to let the partner decide how far to go sexually than sober participants at both timepoints, but the strength of cognitive appraisals (reasons for, reasons against, and feeling conflicted) only differed between beverage conditions after knowledge of no condom. These results suggest alcohol myopia was evident in the presence of inhibition conflict. Content analysis of these reasons revealed multifaceted cognitions that changed upon learning there was no condom. Findings highlight cognitions to target through interventions and underscore the importance of both alcohol and situational context in decision making.

Do Traditional Gender Role Beliefs Promote Abstinence and Sexual Health Behaviors Among Latina College Students?

Traditional gender role beliefs, or marianismo beliefs, are theorized to be largely protective against health risk behaviors, including sexual risk behaviors among Latina young adults. However, measurement differences across studies and research with heterogeneous samples of abstinent and sexually active Latina young adults have led to unclear findings. Thus, we investigated whether endorsement of certain marianismo beliefs may promote sexual health behaviors or solely promote abstinence. Guided by gender role schema theory, this study investigated the multidimensional construct of marianismo beliefs in relation to past-year abstinence from sexual activity, STI and HIV testing, and condom use among 611 Latina young adults. Results indicated that endorsement of the Virtuous and Chaste belief was associated with decreased odds of sexual activity (i.e., increased odds of being abstinent) in the past year. None of the five marianismo beliefs were significantly linked with condom use. Among sexually active participants, the Virtuous and Chaste belief was associated with decreased likelihood to be tested for both STIs and HIV in the past year. Findings support the notion that certain marianismo beliefs (e.g., the Virtuous and Chaste belief) may promote abstinence, yet pose a risk for sexual health via reduced likelihood for STI and HIV testing. Results may inform culturally-tailored HIV prevention interventions with Latinas to reduce the disproportionate HIV burden in this population.

"It's Always among Us. I Can't Act Like It's Not.": Women College Students' Perceptions of Physicians' Implicit Bias

Physicians have an opportunity to provide accurate and timely information about sexual behavior to individuals in their care. However, many young people, and in particular college women, are reticent to talk to their physicians about sexual behavior. One explanation for this reticence may be the fact that physicians' implicit bias has the potential to denigrate communication between physicians and patients. However, little is known about how patients perceive physicians' implicit bias, or to what extent it shapes a patient's beliefs about communicating with their physician. Qualitative analysis of in-depth, semi-structured interviews was used to describe and explain the way women college students perceive issues concerning physicians' implicit bias. Results were interpreted through the lens of Communication Privacy Management theory and revealed that participants either avoided or limited communication with a physician as a result of anticipating implicit bias. Major themes included "untangling identity and the effects of physicians' implicit bias" and "seeking to understand physicians' cognition and emotion." These findings have the potential to improve communication interventions both for women college students and healthcare professionals by introducing evidence of patients' perceptions of implicit biases along the intersection of race, young age, sexuality, and female gender in physician-patient communication about sexual behavior.

Assessing Sexual Behavior Patterns among Student Athletes of Senior High Schools in the Upper East Region, Ghana

The purpose of this study was to investigate the sexual behavior patterns of student athletes of senior high schools in the Upper East Region of Ghana and to assess the differences in sexual behavior patterns between male and females. A sample of 400 student athletes using a convenience sampling technique from public senior high schools was drawn to complete a self-designed research study. Descriptive statistics and the Chi-square test tool were used to analyze the collected data. The results showed that student athletes practiced various forms of sexual behaviors such as celibacy, foreplay, vaginal-penile sex, sexual fantasy, masturbation, oral sex, and anal sex. The Chi-square analysis showed significant gender differences in prevalence of masturbation (χ2 (1, n = 400) = 4.6962, probability = 0.030) and sexual fantasy (χ2 (1, n = 400) = 6.8477, probability = 0.009), but not vaginal-penile intercourse (χ2 (1, n = 400) = 1.3197, probability = 0.251) and celibacy (χ2, (1, n = 400) = 0.0721, probability = 0.788). The study concludes that student athletes of senior high schools might be vulnerable to unplanned parenthood and are at risk of STIs, including HIV. Regular health promotion campaigns on sexual risk-taking behaviors are required to help reduce the prevalence of student athletes’ indulgence in risky sexual behavior patterns that can harm their health. It is essential to implement gender-specific interventions (e.g., decision-making skills) when addressing the problems of sexual behaviors among the student athletes in the region.

Invincibility threatens vaccination intentions during a pandemic

Some people feel they are invincible to the novel coronavirus SARS-CoV-2 (COVID-19). They believe that being infected with COVID-19 would not be a serious threat to their health. While these people may or may not be correct in their personal risk assessment, we find that such perceived invincibility may undermine community efforts to achieve herd immunity. Multi-level analysis of survey respondents across 51 countries finds that perceived invincibility from COVID-19 is negatively associated with believing there is a need to prevent the spread of COVID-19 in one's community (n = 218,956) and one's willingness to inoculate against the disease (n = 71,148). These effects are most pronounced among individuals from countries lower in cultural collectivism (e.g., USA, UK, Canada) and highlight the need to consider the interplay of individual and cultural factors in our efforts to understand, predict, and promote preventative health behavior during a pandemic.

Psychological Distress as a Primer for Sexual Risk Taking Among Emerging Adults

Emerging adults experience increased morbidity as a result of psychological distress and risky sexual behavior. This study examines how sexual behaviors (e.g., condom use inconsistency and past year STI history) differ among emerging adults with low, moderate, and high psychological distress. Participants are 251,254 emerging adults attending colleges and universities in the United States who participated in the National College Health Assessment (NCHA). Findings suggest a dose-response relationship between psychological distress, condom use inconsistency, and past STI history, such that an association between greater psychological distress and condom use inconsistency and/or past year history of sexually transmitted infections (STIs).

(Mis)perceptions of HIV and HPV among female college students: a qualitative study

Background This study aims to investigate college women's misperceptions about the human papillomavirus virus (HPV) and the human immunodeficiency virus (HIV).

METHODS

Twenty college women from an urban, Midwestern university in the United States were recruited to participate in interviews exploring their beliefs about HIV and HPV. In-depth interviews were conducted and analysed via interpretive methods.

RESULTS

The college women in this study often conflated or confused HPV and HIV and revealed misperceptions about the severity and prevalence of HPV and HIV.

CONCLUSION

The results have important implications for understanding college women's sexual risk behaviour and, as a result, can inform the practices of both healthcare providers and public health professionals.

Contraceptive use in Appalachian women who use drugs and were recruited from rural jails

This study describes a secondary data analysis of contraceptive use across the lifetime and within the six months prior to incarceration in a sample of 400 currently incarcerated women recruited from rural, Appalachian jails, who were using drugs prior to incarceration. Phase 1 (baseline) data from an NIH funded study were used to examine rates of contraceptive use, reasons for nonuse of condoms, and correlates of condom use. Results indicate that the majority (96.5%) of respondents reported lifetime use of contraceptives, and most (70.5%) had a history of using multiple methods, with male condoms, oral contraceptive pills, and contraceptive injections being the most commonly used methods. Almost 69% of respondents reported nonuse of contraceptives within the last six months, despite high rates of involvement in risky, intimate male partnerships prior to incarceration. Contraceptive use was found to be historically acceptable in this sample, in stark contrast to rates of use within the last six months prior to incarceration, suggesting that reproductive justice-informed, social work interventions to help improve current contraceptive use are warranted as a harm-reduction approach.

Intimate Partner Violence and Coerced Unprotected Sex Among Young Women Attending Community College

The present study examined the mediating role of sexual assertiveness in the relationship between psychological, physical, and sexual intimate partner violence (IPV) victimization and unprotected sex as a result of condom use resistance among sexually active young women attending community college. Women reported engagement in unprotected sex as a result of a partner's use of one of 32 forms of condom use resistance (e.g., physical force, deception, or other forms of coercion to avoid using a condom during intercourse). Women ages 18-24 years (N = 212) attending community college were recruited through paper advertisements to complete assessments of social and dating behavior in the campus computer laboratory. Only the women with a history of sexual intercourse (N = 178; 84% of the sample) were included in analyses. More frequent engagement in unprotected sex as a result of a partner's condom use resistance was associated with physical, psychological, and sexual IPV victimization. Sexual assertiveness mediated the relationship between physical IPV victimization and the frequency of unprotected sex as a result of condom use resistance. Efforts to prevent dating violence and enhance the sexual health of community college women may benefit from focusing on targeting sexual assertiveness as a protective factor.

Latkin C, C. M. Ho R, S. H. Ho C. Patterns of Risky Sexual Behaviors and Associated Factors among Youths and Adolescents in Vietnam

Youths and adolescents are vulnerable to HIV/STIs from unprotected sex. Promotion of young population's awareness about risky sexual behaviors is essential to develop contextualized interventions. A cross-sectional study was conducted in five Vietnamese provinces to document current attitudes and practices regarding sexual behaviors among youths. The information on sociodemographic characteristics, substance use, and sexual behaviors was collected via self-reported questionnaires. The factors associated with risky sexual behaviors were identified by the multivariate logistic regression. Among the 1200 participants, 73.5% reported having sex in their lifetime, and 48.1% used condoms at their latest sexual intercourse. Participants in urban areas were more likely not to intend to use condoms and had a higher unintended pregnancy rate than in rural areas. Older age was positively associated with not wanting to use and not using condoms. Substance-using participants were more likely to not use condoms. The participants taking alcohol or other stimulants before sex had a higher likelihood of unintended pregnancy. Respondents' attitudes and practices regarding sexual behaviors were associated with gender and employment. This study indicated that young population's awareness in Vietnam is high, however, risky sexual behaviors also remain common. Sex-related educational programs about the consequences of substance use, multiple sex partners, and unprotected sex should be developed.

Impact of HIV testing and treatment services on risky sexual behaviour in the uMgungundlovu District, KwaZulu-Natal, South Africa: a cross-sectional study

INTRODUCTION

The South African public health system plays an important role in the delivery of HIV testing and treatment services. The health system is also an important conduit for targeted behaviour change communication with the expectation that clients who undergo counselling from health personnel, adopt safer sexual practices. Literature remains mixed on the impact these HIV services have on risky sexual behaviour. This analysis examines the sexual behaviour of clients following the utilisation of HIV testing and treatment services in Kwazulu-Natal, South Africa.

METHODS

Data were used from two consecutive cross-sectional household surveys undertaken from June 2014 to June 2015 (2014/2015 survey) and from July 2015 to June 2016 (2015/2016 survey) in the uMgungundlovu District of KwaZulu-Natal, South Africa. Collectively, 20,048 randomly selected individuals aged 15 to 49 years old were interviewed across the two surveys. Utilisation of HIV testing and treatment services were used as independent variables and three sexual risk behaviours were used as dependent variables. Multiple regression models assessed the impact HIV testing and treatment services had on sexual risk behaviour while controlling for socio-demographic characteristics.

RESULTS

Having tested for HIV had no association with any of the three sexual risk behaviours. However, receiving an HIV positive diagnosis reduced the likelihood of using condoms inconsistently with the respondents' most recent partner (AOR: 0.64; 95% CI 0.54-0.77). Antiretroviral use was negatively associated with inconsistent condom use (AOR: 0.45; 95% CI 0.35-0.58) and number of sexual partners in the previous year (AOR: 0.61; 95% CI 0.46-0.81).

CONCLUSIONS

Results indicate that HIV testing and treatment services and the assumed exposure of clients to behaviour change communication, had a limited effect in reducing risky sexual behaviour. Data suggests that the engagement between health personnel and individuals accessing HIV testing and treatment services does not necessarily translate into the adoption of safer sexual practices, with the exception of individuals testing positive for HIV and those on ARV treatment, who had adopted safer sexual practices.

Factors Influencing Adherence to Standard Precautions Scale: A psychometric validation

Despite the mandated use of standard precaution guidelines to limit infection transmission in health-care settings, adherence by health-care professionals is suboptimal. There is currently no psychometrically-validated scale to assess influences on workers' adherence. After the data collection was conducted, Michinov et al. (2016) published a questionnaire to determine sociocognitive determinants of adherence to Standard Precautions. The aim of the present study was to develop and test the psychometric properties of such a scale. Forty nine items were derived from interviews with 29 nurses and tested across two studies. Study 1 was a repeated-measures survey using principal components analysis with data from 363 participants; a 29 item, five factor solution was extracted with good to acceptable internal reliabilities (α = .61-.85). Data from 122 of the original participants retested at 4 weeks showed intraclass correlations of .69-.84. Study 2, which was 6 months later, used confirmatory factor analysis with data from a second sample of 384 participants, and supported the five factor structure of leadership, justification, culture/practice, contextual cues, and judgement. The Factors Influencing Adherence to Standard Precautions Scale has good psychometric properties and stability across time and samples. The scale is suitable for use with nurses, and its validation with other health-care professionals and trainees is important in order to tailor effective interventions to promote adherence.

The barriers to linkage and retention in care for women living with HIV in an high income setting where they comprise a minority group

Women comprise a minority population of individuals living with HIV in Australia, and are often poorly represented in research and clinical trials so their needs remain largely unknown. Data suggests that they are diagnosed later than men and start antiretroviral therapy at a lower CD4 cell count. This raises the question whether there are sex specific barriers to linkage and retention in care. This study analyzed 484 surveys received from clinicians collecting demographic, virological, and reproductive health data along with perceived barriers to linkage and retention in care. Most women (67%) were estimated to have been linked into care within 28 days of diagnosis. For women who were not linked into care for more than 28 days, the most commonly reason cited was fear of disclosure to others, followed by fear of disclosure to their partner. The main reasons given for non-retention in care were related to transport, carer responsibilities, financial pressure, health beliefs and concern about stigma or disclosure.

Self-Silencing, but Not Sexual Relationship Power Associated with Condom Use for Black College-Aged Women

Black adolescent and young adult women in the United States experience a disproportionately higher rate of HIV infections than White and Hispanic adolescent and young adult women. Heterosexual sexual activity is the main route of infection for women, regardless of race or ethnicity. We examined two potential barriers to reducing Black adolescent and young adult women's HIV risk: high levels of self-silencing and low levels of sexual relationship power. Data were collected on a small convenience sample of sexually active Black college-aged women (N = 57, Mage = 19.6, SD = 1.4) who answered questions about their current or most recent dating relationship. We found that higher levels of self-silencing were significantly related to lower condom use frequency and to a lower likelihood of reporting condom use at last sex. No significant associations were found between sexual relationship power and condom use (frequency or at last sex). Data from this study suggest that self-silencing, which involves putting the needs of others ahead of one's own in order to avoid conflict in relationships, is an important variable to consider when examining potential risk factors for sexually transmitted HIV among Black college-aged women. Implications for future studies on HIV risk are reviewed.

Explaining HIV Risk Multiplexity: A Social Network Analysis

Risk multiplexity (i.e., overlap in drug-use, needle exchange and sexual relations) is a known risk factor for HIV. However, little is known about predictors of multiplexity. This study uses egocentric data from the Colorado Springs study to examine how individual, behavioral and social network factors influence engagement in multiplex risk behavior. Analyses revealed that compared to Whites, Hispanics were significantly more likely to engage in risk multiplexity and Blacks less so. Respondents who were similar to each other (e.g., in terms of race) had significantly higher odds of being in risk multiplex relationships, and respondents' risk perceptions and network size were significantly associated with engaging in multiplex risk behaviors. Findings from interaction analysis showed the effect of knowing someone with HIV on the odds of multiplexity depends partly on whether respondents' know their HIV status. Findings suggest that demographics, HIV behaviors and network factors impact engagement in multiplex risk behaviors, highlighting the need for multi-level interventions aimed at reducing HIV risk behavior.

Exploring Canadians' and Europeans' Health Care Professionals' Perception of Biological Risks, Patient Safety, and Professionals' Safety Practices

Patient safety has become a worldwide concern in relation to infectious diseases (Ebola/severe acute respiratory syndrome/flu). During the pandemic, different sanitary responses were documented between Europe and North America in terms of vaccination and compliance with infection prevention and control measures. The purpose of this study was to explore the health care professionals' perceptions of biological risks, patient safety, and their practices in European and Canadian health care facilities. A qualitative-descriptive design was used to explore the perceptions of biological risks and patient safety practices among health care professionals in 3 different facilities. Interviews (n = 39) were conducted with health care professionals in Canada and Europe. The thematic analysis pinpointed 3 main themes: risk and infectious disease, patient safety, and occupational health and safety. These themes fit within safety cultures described by participants: individual culture, blame culture, and collaborative culture. The preventive terminology used in the European health care facility focuses on hospital hygiene from the perspective of environmental risk (individual culture). In Canadian health care facilities, the focus was on risk management for infection prevention either from a punitive perspective (blame culture) or from a collaborative perspective (collaborative culture). This intercultural dialogue described the contextual realities on different continents regarding the perceptions of health care professionals about risks and infections.

Infection prevention and control: Who is the judge, you or the guidelines?

OBJECTIVES

The aim of this study was to explore the attitudes and behaviours of registered nurses and their colleagues around the adoption of standard precautions in order to determine strategies to promote adherence.

DESIGN

A qualitative exploratory descriptive design used interviews and focus group to collect data.

SETTING

Registered nurses and registered midwifes from a tertiary metropolitan hospital took part in the study.

PARTICIPANTS

A voluntary sample of 29 adults was recruited from the Australian nursing (n = 25) and midwifery (n = 4) workforce. There were six men (mean age = 36.83 years; SD = 8.93) and 23 women (mean age = 41.36 years; SD = 10.25). Participants were recruited through advertisement on notice boards and emails from unit managers.

RESULTS

Thematic analysis revealed five themes but the focus here is on staff judgements which are against the guidelines. Participants indicated that where in their judgement the patient posed no risk and they judged themselves skilled in the procedure, they were justified in deviating from the guidelines. Some staff judgements appeared to be self-protecting, while others were irrational and inconsistent.

CONCLUSIONS

Despite use of standard precautions being mandated, staff often deviated from them based on their own assessment of the situation or the patient. Any deviance from the guidelines is of concern but especially so when staff take it upon themselves to apply their own criteria or judgements. These results also suggest there may be some organisational inadequacies with regards to training and supervision of staff.

Using Qualitative Methods to Understand Perceptions of Risk and Condom Use in African American College Women: Implications for Sexual Health Promotion

BACKGROUND

Young African American women are disproportionately affected with sexually transmitted infections (STIs) and unintentional pregnancies. Despite adequate knowledge, assertiveness, and negotiation skills, consistent condom use remains low.

AIMS

We sought to assess the role of pregnancy and STI risk perception in condom decision making among African American women.

METHOD

We conducted a phenomenological qualitative study. Utilizing a purposive sampling strategy, 100 African American women (18-24 years) were recruited from a historically Black college and university for an open discussion of condom use. Thirteen focus groups were conducted via a semistructured interview guide and analyzed with an inductive thematic approach.

RESULTS

Uniformly women perceived pregnancy as a greater threat than STIs which appears to be maintained by (a) their sense of fertility, (b) self-care concept, and (c) experiences with condom failure. Thus, women were skeptical about using condoms as a form of contraception. Women perceived casual sex as having the greatest HIV/STI risk and emphasized the importance of assertiveness and self-respect to negotiate condom use. However, condom use in monogamous relationships is less likely due to (a) testing/knowing partner's status, (b) relationship trust, and (c) the use of hormonal contraception for pregnancy prevention. Perceived threat of infidelity increases condom use.

CONCLUSION

The implications of these findings suggest sexual health promotion programs may focus on improving women's estimate of the effectiveness of condoms to prevent pregnancy and addressing women's reliance on testing for STI prevention.

"Jimmy Cap Before You Tap": Developing Condom Use Messages for African American Women

This study examined which characteristics of persuasive communications are most effective in changing African American women's condom use attitudes. Focus groups were convened with 40 African American women (M_age = 25.54, SD = 4.67) to assess their opinions on current effective strategies used to promote condom use among their peers. Participants discussed effective characteristics of messaging campaigns (i.e., source, message type, channel) and how these could be used in future prevention messages. Findings revealed that making messages that are fun, catchy, and informative, delivered frequently through social media, TV, or radio by a peer or celebrity would be perceived as most effective in changing young African American women's attitudes. Other themes that emerged were that condom use is more strongly associated with pregnancy prevention than HIV prevention and that sexual partners were perceived to have negative condom use attitudes. Recommendations centered on increasing exposure of HIV prevention messages by placing messages on the Internet and including a funny phrase or jingle in the message so that it is easy to remember and could potentially serve as a conversation starter for discussing safe sex with partners.

Violence Victimization, Social Support, and Papanicolaou Smear Outcomes: A Longitudinal Study from Adolescence to Young Adulthood

BACKGROUND

African American youth are among those at greatest risk for experiencing violence victimization. Notably, the mortality rate of cervical cancer for African American women is also twice that of white women. To date, we know of no literature using longitudinal data to examine how violence victimization relates to Papanicolaou (Pap) smear results or cervical cancer in this population. Our study examines how violence victimization during adolescence (age 15 to 18) influences psychological distress, perceived social support, heavy substance abuse, and sexual risk behaviors during emerging adulthood (age 20 to 23), and subsequent Pap smear outcomes during young adulthood (age 29 to 32).

METHOD

This study is based on 12 waves of data collected in a longitudinal study of 360 African American women from mid-adolescence (ninth grade, mean age = 14.8 years) to young adulthood (mean age = 32.0 years). We used structural equation modeling analysis to examine the hypothesized model.

RESULT

Violence victimization during adolescence had a direct effect on decreased social support, increased psychological distress, and increased heavy cigarette use during emerging adulthood. Better social support was also associated with fewer sexual partners during emerging adulthood and lower odds of abnormal Pap smear results during young adulthood. The effect of violence victimization on abnormal Pap smear was mediated by social support.

CONCLUSION

Our results show that violence victimization during adolescence has long-term negative effects through multiple pathways that persist into adulthood. Our findings also suggest that social support may help to compensate against other risk factors. Interventions designed to address the perceived support may help victims cope with their experience.

US Black college women's sexual health in hookup culture: intersections of race and gender

Approximately 60-80% of college students in the USA report a hookup experience in the form of a casual sexual encounter between individuals without the expectation of a dating or romantic relationship. Given the potential health risk posed by these sexual encounters, the need exists to critically examine this cultural phenomenon on college campuses. Yet, the existing hookup literature is overwhelming White and often exclusive of historically marginalised populations such as Black women. Accordingly, this paper examines the role of the intersecting identities of race and gender and other social factors that influence the sexual health and wellbeing of Black women on US college campuses. Specifically, we explore issues related to the gender ratio disparities present on college campuses, relationship power imbalances, inconsistent condom use and low sexual-risk perception. Moving forward, hookup research needs to utilise an intersectional approach; we offer specific suggestions for the important inclusion of Black women in the broader hookup discourse and future research.

Risky sexual behaviors among sexually active first-year students matriculating at a historically Black college: Is a positive self-image an instigator?

A sample of 498 sexually active first-year students matriculating at a historically Black college in North Carolina was used to determine correlates of risky sexual behaviors. In an Ordinary Least Squares regression, the self-esteem element "I take a positive attitude toward myself" (B = 1.12, p = .05), non-condom use because of partner issues (B = .53, p = .05) and being drunk or high (B = 1.20, p = .001), oral sex (B = 1.74, p = .001), anal sex (B = .61, p = .04), and bisexuality (B = .85, p = .03) all increased the number of these behaviors. Higher scores on the condom usage scale (B = -.38, p = .002) were found to decrease the number of risky sexual behaviors. Illicit drug use was an underpinning of the surprisingly positive relationship between positive self-image and risky sexual behaviors. It was concluded that school-based social workers, mental health care professionals, and community-based prevention providers can play a critical role in the training of peer facilitators, development, and supervision of peer-driven risk-reduction programs to address the complex interplay among self-esteem, sex, and substances.

Perceptions of Community HIV/STI Risk Among U.S Women Living in Areas with High Poverty and HIV Prevalence Rates

Although studies have consistently demonstrated that women at high risk for HIV and non-HIV sexually transmitted infections (STIs) tend to underestimate their individual risk, little is known about how women at risk perceive their community's HIV/STI risk. We explored perceptions of community HIV/STI risk among U.S. women living in areas with high poverty and HIV prevalence rates as part of a qualitative substudy of the Women's HIV SeroIncidence Study. Semi-structured focus groups were conducted. Data were coded and analyzed using the constant comparative method. Participants expressed the perception that their communities were at elevated HIV/STI risk, mostly due to contextual and structural factors such as lack of access to health care and education. Findings suggest that HIV prevention messages that target U.S. women at high risk for HIV may be strengthened by addressing the high perceived community HIV/STI risk driven by structural factors.

Sexual protective strategies and condom use in middle-aged African American women: a qualitative study

The heterosexual transmission of HIV has affected middle-aged African American women at alarming rates; yet there is a paucity of research and interventions focused on this population. This study used a qualitative approach to understand middle-aged urban African American women's experiences with HIV-related sexual risk behaviors and to identify the sexual protective strategies they employed to reduce their risk for HIV infection. Ten African American women, ages 45 to 56 years, were recruited from low-income neighborhoods in New York City. Data were collected using in-depth interviews and analyzed using content analysis. Investigator triangulation and member checking were used to ensure rigor. Five salient themes emerged that highlighted the individual, gender/relationship power factors, and the sociocultural elements that influenced sexual protection or risk-taking behavior. Findings provide new insight into the complexities of HIV sexual risk behavior and can guide future HIV prevention interventions for middle-aged, African American, urban women.

Risky Sexual Behavior and Substance Use among Adolescents: A Meta-analysis

This study presents the results of a meta-analysis of the association between substance use and risky sexual behavior among adolescents. 87 studies fit the inclusion criteria, containing a total of 104 independent effect sizes that incorporated more than 120,000 participants. The overall effect size for the relationship between substance use and risky sexual behavior was in the small to moderate range (r = .22, CI = .18, .26). Further analyses indicated that the effect sizes did not substantially vary across the type of substance use, but did substantially vary across the type of risky sexual behavior being assessed. Specifically, mean effect sizes were smallest for studies examining unprotected sex (r = .15, CI = .10, .20), followed by studies examining number of sexual partners (r = .25, CI = .21, .30), those examining composite measures of risky sexual behavior (r = .38, CI = .27, .48), and those examining sex with an intravenous drug user (r = .53, CI = .45, .60). Furthermore, our results revealed that the relationship between drug use and risky sexual behavior is moderated by several variables, including sex, ethnicity, sexuality, age, sample type, and level of measurement. Implications and future directions are discussed.

Adaptation and Validation of the Sexual Assertiveness Scale (SAS) in a Sample of Male Drug Users

The aim of the present study was to adapt and validate the Sexual Assertiveness Scale (SAS) in a sample of male drug users. A sample of 326 male drug users and 322 non-clinical males was selected by cluster sampling and convenience sampling, respectively. Results showed that the scale had good psychometric properties and adequate internal consistency reliability (Initiation = .66, Refusal = .74 and STD-P = .79). An evaluation of the invariance showed strong factor equivalence between both samples. A high and moderate effect of Differential Item Functioning was only found in items 1 and 14 (∆R 2 Nagelkerke = .076 and .037, respectively). We strongly recommend not using item 1 if the goal is to compare the scores of both groups, otherwise the comparison will be biased. Correlations obtained between the CSFQ-14 and the safe sex ratio and the SAS subscales were significant (CI = 95%) and indicated good concurrent validity. Scores of male drug users were similar to those of non-clinical males. Therefore, the adaptation of the SAS to drug users provides enough guarantees for reliable and valid use in both clinical practice and research, although care should be taken with item 1.

Sexual-risk behaviour among sexually active first-year students at the University of the Western Cape, South Africa

In South Africa, new HIV infections are concentrated among persons aged 15-24 years. The university population falls within this age group and are prone to higher-risk behaviours that place them at risk of acquiring HIV. In a study to assess this risk among sexually active students, we classified higher-risk sexual behaviours as not using condoms at every instance of sex, having had more than one sexual partner during the preceding 12 months, a relatively young age at first sexual intercourse (7-16 years), and experience of sexual violence and/or transactional sex. In total, 796 first-year students at the University of the Western Cape in Cape Town, South Africa, completed a self-administered questionnaire in 2006. The sample included 263 sexually active, unmarried students, aged 16 to 24 years. The responses showed that 62% did not use a condom for every instance of sex, 39% had two or more sexual partners in the previous 12 months, 53% had initiated sexual intercourse at a younger age (7-16 years), and 2% had ever exchanged money or gifts for sexual intercourse. Eight percent of the respondents said they did not give their consent or permission at initiation of first sexual intercourse. One in every 10 respondents claimed that they had ever been forced to have sexual intercourse, and 4% said that they had ever forced someone to have sexual intercourse. The sexually active students who reported an earlier age of initiation of sexual intercourse and having only one sexual partner during the last year were more likely to not use a condom every time, whereas the sexually active students that had experienced initiation of sexual intercourse while in an older age group (17-24 years) and who had two or more sexual partners in the last year were more likely to use a condom every time. Sexually active university students are in need of particular HIV-prevention interventions given their tendencies for poor condom usage and having multiple sexual partners.

Prevalence and factors associated with sexually transmitted infections among HIV positive women opting for intrauterine contraception

Background

Women living with HIV/AIDS (WLHA) are a high risk group for sexually transmitted infections (STIs). However, the majority of women with STIs are asymptomatic. Data on prevalence of STIs among WLHA in Uganda are limited. The objective of the study was to determine prevalence and factors associated with STIs among WLHA opting for intrauterine contraceptive device (IUD).

Methods

Three hundred fifty one WLHA deemed free of STIs using a syndromic logarithm were enrolled into the study. Endo-cervical swabs were taken before IUD insertion and PCR test for Nisseria gonorrhea (NG), Trichomonas vaginalis (TV) and Chlamydia trachomatis (CT) infections conducted.

Results

Participants’ mean age was 29.4 ± 6.2 years, 83% were under 35years, 50% had secondary education and 73% were married. The majority (69%) had disclosed their HIV sero status to their spouses, 82% used Cotrimoxazole prophylaxis, 70% were on antiretroviral therapy, 90% had CD4 count greater than 350, about 60% reported condoms use and 70% were of parity 2-4. Over 50% of the participants’ spouses were older than 35 years and 72% had attained secondary education. STIs prevalence was 11.1%, (95% CI 7.8-14.4) and individual prevalence for TV, NG, and CT was 5.9%, 5.4% and 0.9% respectively. Factors independently associated with STI were having primary or less education (OR= 2.3, 95% CI: 1.09 - 4.85) having a spouse of primary or less education (OR= 3.3, 95% CI: 1.6 - 6.78) and muslim faith (OR= 0.2, 95% CI: 0.04 - 0.78).

Conclusion

STI prevalence was 11.1%. TV and NG were the commonest STIs in this population. Having primary or less education for both participant and spouse was associated with increased risk while being of muslim faith was associated with reduced risk of STI.

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

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

Is gonorrhea becoming untreatable?

An estimated 498 million new cases of curable sexually transmitted infections occur worldwide annually. Of these, 106 million are gonococcal infections, rendering gonorrhea the second most prevalent bacterial sexually transmitted infection after chlamydia. A decline in susceptibility to extended-spectrum cephalosporins, as well as treatment failures, have been identified worldwide. This, together with the associated epidemiological and socioeconomic burden, is of increasing concern. Currently, the effectiveness of antibiotic resistance control measures is limited. Barriers include the lack of therapeutic options, the difficulties of reducing high-risk sexual behavior and Neisseria gonorrhoeae's propensity to rapidly acquire resistance determinants. While the disease remains treatable for the moment, we need to anticipate and be prepared for the arrival and spread of untreatable gonorrhea by using a multifaceted approach and search for other, perhaps novel control strategies.

Perceived risk for sexually transmitted infections aligns with sexual risk behavior with the exception of condom nonuse: data from a nonclinical sample of sexually active young adult women

BACKGROUND

Research on the relationship between sexual risk behavior and perceived risk for contracting a sexually transmitted infection (STI) has yielded mixed results. The objective of this study is to investigate the extent to which 3 measures of perceived risk accurately reflect 5 sexual risk behaviors in a sample of healthy, sexually active young adult women. A positive monotonic relationship between sexual risk behavior and perceived risk for STIs is hypothesized.

METHODS

A sample of 1192 female U.S. Marine Corps on their first duty assignment 10 to 11 months (on average) after graduation from recruit training answered a self-administered paper-and-pencil questionnaire as part of a larger study evaluating an intervention to prevent STIs and unintended pregnancy that was administered during recruit training.

RESULTS

All but 1 of the 15 bivariate associations between sexual risk behavior and perceived risk for STIs was statistically significant. The expected positive monotonic relationship was observed except for condom use. Women who never used condoms during intercourse reported lower levels of perceived risk than occasional users and, in some subgroups, consistent condom users. Multivariate analyses further explored the relationship between condom use and perceived risk.

CONCLUSIONS

The results suggest that interventions directed at raising awareness of susceptibility to STIs should emphasize how the individual's own behavior puts them at risk, regardless of situation or context.

When two is better than one: differences in characteristics of women using condoms only compared to those using condoms combined with an effective contraceptive

BACKGROUND

There remain high rates of unintended pregnancy around the world. Adding an effective contraceptive to those who currently only use male condoms may reduce these rates. The aim of this study is to identify the prevalence of and factors associated with the combination use of an effective contraception with male condoms in sexually active women who are already using male condoms.

METHODS

Women attending Family Planning Victoria Clinics from April to July 2011 were approached to complete a questionnaire about contraception usage in the last 3 months and 34 associated variables. Univariate and multivariate analyses were conducted to determine women with greater odds of an effective contraception together with male condoms compared with those using male condoms only.

RESULTS

Of 1006 women surveyed, 872 women stated it was "very important" or "important" to avoid pregnancy at this stage of their life. Of these 872 women, 690 reported male condom use-274 women used male condoms and an effective contraception, while 416 used male condoms only. Of note, only 67 (16%) of the 416 solely male condom users were using this consistently. On multivariate analysis, characteristics associated with combination use (compared with condom use only) were discussion with a health professional in the last 12 months (adjusted odds ratio [AOR] 2.9; 95% confidence interval [CI] 1.9, 4.4), satisfaction with contraception (AOR 1.8; 95% CI 1.3, 2.7), having more than 1 partner in the last 3 months (AOR 1.8; 95% CI 1.2, 2.6) and past pregnancy (AOR 0.3; 95% CI 0.1, 0.5).

CONCLUSIONS

In a group of women not intending to be pregnant who were using male condoms, a significant number remained at risk for unintended pregnancy due to inconsistent use of male condoms and poor use of concurrent effective contraception.

Invincibility fable: tool development to measure invincibility

Invincibility is a phase of social-cognitive development of the adolescent and has been associated with risk behavior involvement.

OBJECTIVE

To determine psychometric properties of the Adolescent Invincibility Tool (AIT).

METHODS

Reliability was assessed and validity was examined using principal components analysis.

RESULTS

Internal consistency was demonstrated with a Cronbach's alpha of .88; factor analysis led to the confirmation of subscales. Criterion validity was validated with similar and opposing measures of invincibility.

DISCUSSION

Initial testing suggests that the AIT is a valid and reliable tool for screening invincibility. Further testing is recommended to determine relevance for other populations of youth.

Exploring HIV-testing intentions in young Asian/Pacific Islander (API) women as it relates to acculturation, theory of gender and power (TGP), and the AIDS risk reduction model (ARRM)

While HIV rates are low for Asian/Pacific Islanders (APIs), they have been increasing, especially for API women in the USA. We conducted a cross-sectional study with 299 young API women (18-24 years old) in the Inland Empire region of Southern California to better understand their intention for HIV testing and their perceptions about HIV/AIDS. Data analyses included descriptive statistics, bivariate exploration for model building and multivariate analyses to determine variables associated with HIV-testing intentions. Results suggest that more lifetime sexual partners, greater perceived gender susceptibility, higher HIV/AIDS knowledge, sexually active, more positive attitudes about HIV testing and higher self-perceptions/experiences related to risk contribute to stronger intentions for HIV testing in young API women. Findings from this study will contribute to the limited literature on HIV/AIDS in API women and provide information that can be used for developing and implementing culturally appropriate programs that encourage HIV prevention and testing in this population.

Religiosity, alcohol use, and sex behaviors among college student-athletes

College student-athletes tend to consume more alcohol, engage in sex, and report more sex partners than nonathlete students. The current study examined the relationship between religiosity (e.g., influence of religious beliefs and church attendance) and alcohol use and sex behavior among college student-athletes. Most of the student-athletes (n=83) were religious. Influence of religious beliefs was a significant predictor of less alcohol use and less sexual activity (i.e., oral and vaginal sex, number of sex partners). However, increased church attendance was not found to be a protective factor. Findings suggest that religious beliefs may contribute to reduction of alcohol use and sexual risk among college student-athletes. Consideration should be given to incorporating religiosity aspects in sexual and alcohol risk-reduction interventions for student-athletes.

Conceptualizing women's attitudes toward condom use with the tripartite model

BACKGROUND

The Centers for Disease Control and Prevention (2011) estimated that women represent 24% of HIV diagnoses in the United States, with most infections resulting from heterosexual contact. However, consistent condom use is highly effective in preventing the spread of HIV. The current study examined women's attitudes toward condom use and potential inconsistencies related to the conceptualization and measurement of attitudes.

METHOD

Data were collected from October 2009 through March 2010. Researchers included 556 female undergraduate students from the Southeast region of the United States. Exploratory and confirmatory factor analyses were used to determine whether women's condom use attitudes were composed of an affective and a cognitive component.

RESULTS

Evidence for a two-factor model of condom use attitudes consisting of an affective and cognitive component was found, with participants reporting slightly negative feelings toward condom use but favorable beliefs about using condoms. Affect accounted for more variance (42%) than cognition (8%) in condom use attitudes. Notably, affect and cognition were differentially associated with past behavior and intentions to use condoms.

CONCLUSION

Understanding the structure of women's attitudes toward using condoms can aid in the creation of appropriate HIV prevention and condom use messaging targeted toward promoting positive attitudes and normative change. Changing women's attitudes in this manner could enhance the effectiveness of condom use interventions.

Impact of nursing intervention on improving HIV, hepatitis knowledge and mental health among homeless young adults

In a prospective two-group pilot study of a convenient sample of 156 young adults, we assessed improvement in HIV cognitive and transmission knowledge, hepatitis knowledge, and mental health at six-month follow-up. Multiple linear regression analysis revealed higher six-month scores in total HIV/AIDS knowledge, HIV/AIDS cognitive knowledge, HIV transmission knowledge and HBV and HCV knowledge at 6 months in the Hepatitis Health Promotion (HHP) group compared to the Art Messaging (AM) group. Moreover, homeless young participants who reported having significant others in their lives, and excellent or very good health did better than their counterparts. Youth who were attempting to get their lives together had higher scores for all types of knowledge except HBV. Hallucinogen users had significantly worse scores on all knowledge measures than non-users. Lastly, the HHP group revealed an improvement in psychological well-being compared to the AM group.

Ethnic differences in alcohol and drug use and related sexual risks for HIV among vulnerable women in Cape Town, South Africa: implications for interventions

Background

Alcohol and other drug (AOD) use among poor Black African and Coloured women in South Africa compounds their sexual risk for HIV. Given South Africa’s history of ethnic disparities, ethnic differences in sex risk profiles may exist that should be taken into account when planning HIV risk reduction interventions. This paper aims to describe ethnic differences in AOD use and AOD-related sexual risks for HIV among vulnerable women from Cape Town, South Africa.

Method

Cross-sectional data on 720 AOD-using women (324 Black African; 396 Coloured) recruited from poor communities in Cape Town were examined for ethnic differences in AOD use and AOD-related sexual risk behavior.

Results

Ethnic differences in patterns of AOD use were found; with self-reported drug problems, heavy episodic drinking and methamphetamine use being most prevalent among Coloured women and cannabis use being most likely among Black African women. However, more than half of Black African women reported drug-related problems and more than a third tested positive for recent methamphetamine use. More than a third of women reported being AOD-impaired and having unprotected sex during their last sexual encounter. Coloured women had four-fold greater odds of reporting that their last sexual episode was AOD-impaired and unprotected than Black African women. In addition, close to one in two women reported that their sexual partner was AOD-impaired at last sex, with Coloured women having three-fold greater odds of reporting that their partner was AOD-impaired at last sex than Black African women.

Conclusions

Findings support the need to develop and test AOD risk reduction interventions for women from both ethnic groups. In addition, findings point to the need for tailored interventions that target the distinct profiles of AOD use and AOD-related sex risks for HIV among Black African and Coloured women.

Receipt of the human papillomavirus vaccine among female college students in the United States, 2009

OBJECTIVE

To determine receipt of the human papillomavirus (HPV) vaccine among female college students by demographic/descriptive characteristics and sexual behaviors.

METHODS

A secondary analysis of the Spring 2009 National College Health Assessment-II was conducted with 40,610 female college students (aged 18 to 24 years) attending 4-year institutions in the United States.

RESULTS

Less than half (45.0%) the respondents had received the HPV vaccine. Students who were younger, white, noninternational, and sorority members, had health insurance, attended a college/university in the northeastern United States, did not have or did not live with a partner, participated in sports, ever had vaginal intercourse, had male sex partner(s) (past year), and had a gynecological examination (past year) were more likely to have received the vaccine.

CONCLUSIONS

To allow for appropriate intervention, additional research should investigate why certain female college students have not obtained the HPV vaccine. Efforts should be made to link college women without health insurance to no- or low-cost HPV vaccine.

HIV Risk Behaviors among African American Women with at-Risk Male Partners

Background

HIV continues to impact African American women at alarming rates. Yet, few researchers have examined the relationship factors promoting unprotected sex within African American communities, especially instances in which women are aware that their male partners are engaging in high risk behaviors. This qualitative study explored the sexual behaviors, relationship characteristics, and HIV prevention strategies utilized by African American women in relationships with African American men at-risk for HIV.

Method

To understand the issues that should be addressed in a sexual risk-reduction intervention, data were collected from three, two-hour focus group discussions (n=24) comprised primarily of low-income African American women with histories of at-risk male sex partners. At-risk partners included specifically men who had sex with other men or with transgender individuals, used crack cocaine or injection drugs, had lengthy incarceration periods, or an unknown sexual history. Discussion questions examined external factors affecting sexual risk behaviors such as societal pressures, peer norms, and financial vulnerability. Discussions were audiotaped, transcribed, and analyzed using a consensual qualitative research approach.

Results

Five themes, including self-esteem, social influences on behavior, relationship fidelity, sexual risk behavior, and partners' sexual behaviors, were identified as placing women at increased risk for HIV. Reasons for inconsistent condom use included concern for maintaining the relationship and substance use before and during sex. African American women also believed that men who have sex with men and women (MSMW) were dishonest about their sexuality due to stigma towards homosexuality/bisexuality. Despite these challenges, participants indicated that African American women have a strong sense of pride that can positively impact behaviors in relationships.

Conclusion

The findings of this study support that social and contextual factor such as emotional and financial issues, culture, history, and relationship dynamics need to be considered when developing tailored sexual health interventions for this population.

Effects of an undergraduate HIV/AIDS course on students' HIV risk

This study utilizes a quasi-experimental pre- and post-test survey design to examine the effects of a course, called HIV/AIDS: Science, Behavior, and Society, on undergraduate students' HIV knowledge, attitudes and risky sexual behaviors. With the assistance of social work faculty the course incorporates experiential learning pedagogy and a transdisciplinary perspective. Although the course was not designed as a prevention program, the theory of health behavior suggests the incorporation of experiential learning will impact crucial HIV/AIDS attitudes and behaviors. When regression models were applied, relative to the comparison group (N = 111), the HIV/AIDS class students (N = 79) reported an increase in post-test HIV knowledge, perceived susceptibility to HIV among females, and a reduction of risky sexual attitudes among sexually active students.

Motivations for Secondary Abstinence Among African American Females at Risk for HIV/Sexually Transmitted Infections

Some sexually experienced African American females abstain from sexual activity for various reasons and periods of time following sexual debut (secondary abstinence), reducing their risk of HIV/sexually transmitted infection (STI) acquisition. However, few studies have sought to understand secondary abstinence motivations. Furthermore, the scope of existing knowledge may be limited by the quantitative approaches employed. Thus, the purpose of this qualitative study was to investigate secondary abstinence motivations among African American females using a grounded theory approach. Interviews were conducted with 20 young women, aged 18 to 23 years, who recently completed a sexual risk–reduction intervention. Motivations for secondary abstinence not identified in previous studies included feeling used for sex, partner infidelity, and abuse or sexual assault. Also, young women were motivated to abstain to focus on improving certain aspects of their lives. Other motivations similar to those previously identified included not being married or in a committed relationship, separation from one’s partner, and STI and pregnancy experiences or fears. Insight from this investigation can be used to improve measurement of motivations and to develop and refine HIV/STI interventions for this population.

Socio-cultural and economic antecedents of adolescent sexual decision-making and HIV-risk in rural Uganda

With more than half of new infections occurring among youth, HIV/AIDS remains a major contributor to morbidity and mortality in Uganda. Semi-structured interviews were performed with 48 adolescents and 15 adult key informants in a rural Ugandan community to identify influences on adolescent sexual decision-making. Inductive data analytic methods revealed five thematic influences: (1) social pressure, (2) decline of the Senga (a familial figure who traditionally taught female adolescents about how to run a household), (3) cultural barriers to condom use, (4) knowledge of HIV transmission and modes of prevention, and (5) a moral injunction against sex before marriage. Influences were classified as HIV/AIDS risk and protective factors and organized to form an explanatory framework of adolescent sexual risk-taking. Risk factors pull youth toward risky behavior, while protective factors push them away. Predominance of risk over protective influences explains persistent sexual risk-taking by Ugandan youth. HIV prevention programs designed for Ugandan adolescents should take competing factors and sociocultural and economic influences into account.

Clinicians poorly assess health literacy-related readiness for transition to adult care in adolescents with inflammatory bowel disease

BACKGROUND & AIMS

To prepare for the transition from pediatric to adult-oriented health care systems, adolescents must develop the ability to obtain, process, and understand basic health information; make appropriate health decisions; and interact effectively with health care professionals. However, physicians use subjective methods to determine patients' readiness for this transition. We investigated health care literacy-related readiness for transition of children and adolescents with inflammatory bowel disease (IBD) to identify determinants and compare actual levels with clinicians' opinions.

METHODS

The study included 74 pediatric patients with IBD ≥10 years old who were recruited from a pediatric hospital-based clinic. We evaluated their functional and interactive health literacy and recorded clinicians' perceptions of literacy and readiness for transition among pediatric patients. Relationships between health literacy measures, demographic variables, and clinician perceptions were determined.

RESULTS

Health literacy-related readiness for transition was observed in 11% of the patients analyzed. However, clinicians found 47% of the cohort ready for the transition, on the basis of literacy standards. Health literacy-related readiness for transition was associated with older age (P < .01), white race (P = .03), and low income (P < .02). Agreement was poor between measures-defined and clinician-defined levels of health literacy-related readiness for transition (P = .18).

CONCLUSIONS

Clinicians inadequately judge the health literacy-related readiness for transition to adult care of pediatric IBD patients. Improved awareness of health literacy issues among adolescents with IBD is needed among health care providers and health care systems.

Influences of social norms and context on sexual decision making among adolescent women

INTRODUCTION

The aim of this study was to explore women's decisions to initiate and continue sexual activity in late adolescence.

METHODS

Narrative inquiry was the qualitative methodology used to research the perceptions of factors that influence the sexual decision making of women in late adolescence. Single interviews were conducted with 10 late-adolescence women between the ages of 18 and 22. Both purposive and snowball sampling were used, and recruitment ended when data saturation was achieved.

RESULTS

The main findings that emerged as the story contained 3 distinct and influential components: the influence of social context provided the introduction to the story, perceptions of the expected social norm for sex and relationships formed the plot, and the narratives concluded with a discussion of how these adolescents' decision-making processes evolved in the years since coital debut.

DISCUSSION

The results of this study provide evidence that adolescent sexual decision making is a multifaceted process with many layers of influence that reflect the complex world adolescents must navigate as they make decisions about their sexual behaviors. Detailed assessment of adolescent sexual activity and anticipatory guidance by health care providers will lay the foundation for risk reduction behavior and safer sexual encounters.

A cognitive analysis of college students' explanations for engaging in unprotected sexual intercourse

Young adults, including college students, engage in high levels of unprotected sexual activity despite relatively high rates of HIV/STI and pregnancy-related knowledge. Little is known about the cognitive strategies that young people use to explain this inconsistency. The current study examined young people's explanations for engaging in unprotected sexual activity in their committed relationships. A total of 63 young adults (32 women and 31 men) completed daily diaries over a 3-week period, providing a total of 1,284 daily reports tracking their condom use and non-use during intercourse. Diary collection was followed by in-depth interviews designed to explore participants' decision-making regarding their participation in sexual intercourse unprotected against infection or unwanted pregnancy. Less than a quarter of the sample used condoms or oral contraceptives consistently. Participants primarily viewed condoms as a means of preventing pregnancy; few described disease prevention as a main motivation for their use. Analysis of the cognitions underlying explanations for condom and contraception non-use were classified as (1) general biased risk evaluation, (2) biased evidence evaluation, (3) endorsement of poor alternatives, (4) focus on spurious justifications, (5) dismissing risk, and (6) ignoring risk. Prevention interventions should incorporate methods to challenge young people to acknowledge personal risk and commit themselves to taking steps to reduce this risk.

Parents, peers, and sexual values influence sexual behavior during the transition to college

Several decades of research have identified the contributions of psychosocial influences on adolescent and young adult sexual behavior; however, few studies have examined parental and peer influence and sexual values during the transition from high school to college. The current study tested the influence of sexual values and perceived awareness and caring (PAC), or beliefs about how much parents and peers know and care about students' behavior, on sexual behavior during this transitional period. Using data from a longitudinal study, generalized estimating equations and the generalized linear model were used to examine the associations among sexual values, parental and peer PAC, and sexual behavior, both cross-sectionally and longitudinally. Participants (N = 1,847; 61% female) completed web-based surveys the summer before college matriculation and at the end of the first semester in college. Results indicated that individuals with high levels of both parental and peer PAC engaged in less frequent sexual behaviors and that PAC moderated the effect of sexual values on sexual behaviors. Furthermore, both PAC variables decreased during the transition from high school to college, and high school sexual values, parental PAC, and their interaction predicted the number of sexual partners during the first semester of college. Only sexual values and high school unsafe sexual behaviors predicted unsafe sexual behavior in college. Findings suggest that complex associations exist among perceived awareness and caring, sexual values, and sexual behaviors, and that the transition from high school to college may be an ideal time for safer-sex interventions.

Computer-delivered, parent-involvement intervention to prevent substance use among adolescent girls

OBJECTIVE

To test a computer-delivered program for preventing substance use among adolescent girls.

METHODS

Randomly, 916 girls aged 12.76+/-1.0 years and their mothers were assigned to an intervention arm or to a test-only control arm. Intervention-arm dyads engaged in exercises to improve the mother-daughter relationship, build girls' substance use prevention skills, and reduce associated risk factors. Study outcomes were girls' and mothers' substance use and mediator variables related to girls' substance use risk and protective factors. The study was conducted between September 2006 and February 2009 with participants from greater New York City, including southern Connecticut and eastern New Jersey.

RESULTS

At 2-year follow-up and relative to control-arm girls, intervention-arm girls reported lower relevant risk factors and higher protective factors as well as less past 30-day use of alcohol (p<0.006), marijuana (p<0.016), illicit prescription drugs (p<0.03), and inhalants (p<0.024). Intervention-arm mothers showed more positive 2-year outcomes than control-arm mothers on variables linked with reduced risks of substance use among their daughters, and mothers reported lower rates of weekly alcohol consumption (p<0.0001).

CONCLUSIONS

A computer-delivered prevention program for adolescent girls and their mothers was effective in changing girls' risk and protective factors and girls' and mothers' substance use behavior.

Truths and myths that influence the sexual decision-making process among young multiethnic college women

In the United States, half of all new human immunodeficiency virus (HIV) cases are among 13- to 24-year-old women. Heterosexual contact is the primary route of transmission (73%). Young African Americans account for 56% of reported HIV cases. In an earlier study, S. T. Roberts and B. L. Kennedy (2006) studied sexual decision making among 100 young multiethnic college women (YMCW). Participants reported high condom use intention (84%) but inconsistent condom use (64%). Participants perceived their risk of acquiring HIV and sexually transmitted diseases (STDs) as low; however, their actual risk was assessed as high. YMCW reported that alcohol and drugs impaired their judgment to practice safer sex. The YMCW concurrently reported that alcohol and drugs were a routine part of their sexual experiences. The current study examined a group of YMCW to elucidate the reasons that the knowledge of safer-sex practices was not put into practice. The authors sought insight into the lived experiences of YMCW's sexual behavioral choices. The qualitative study recruited 15 participants. Focus groups were conducted, and quantitative HIV and STD knowledge questionnaires were administered. The YMCW verbalized high knowledge of HIV, STDs, and safer-sex practices. The questionnaire scores evidenced significant knowledge deficit in these same categories. Themes emerged from the narrative date. Two beliefs or myths explained why women engaged in sex without a condom. The first belief was that YMCW were not in control of their sexual behavior when "being in the moment." The second belief was "not remembering what happened" secondary to alcohol use. The women reported that the myths were culturally accepted in their peer group; however, the YMCW knew that the myths were untrue. The YMCW expressed a strong desire for someone to teach them "real information" on sexuality as this information was missing in their health education courses.

Gender and dating relationship status moderate the association between alcohol use and sex-related alcohol expectancies

Young adulthood can be a period where the development of intimacy and dating relationships coincide with alcohol experimentation. The current study was designed to examine how dating relationship status is associated with drinking behavior. Additionally, although the relationship between sex-related alcohol expectancies and drinking has been established, the current study extends this research by investigating how gender and dating relationship status moderate the association between these expectancies and drinking behavior. A sample of 1932 college students who were single and not actively dating, single and actively dating, or in a steady relationship were included in the analyses. Results revealed that males and females who were actively dating drank significantly more drinks per week than those not dating and those in a relationship. In addition, the association between sex-related alcohol expectancies and drinking behavior was moderated by gender and relationship status. Men with high sex-related alcohol expectancies appeared to be at equal similar risk for greater drinking regardless of relationship status. However, there appears to be unique drinking risk for actively dating women with high sex-related alcohol expectancies.