Puberty and adolescent sexuality

HIV vulnerabilities and psychosocial health among young transgender women in Lima, Peru: results from a bio-behavioural survey

INTRODUCTION

Peruvian young transgender women (YTW) ages 16-24 years are a critical but understudied group for primary HIV prevention efforts, due to sharp increases in HIV prevalence among TW ages 25 years and older.

METHODS

Between February and July 2022, a cross-sectional quantitative study with YTW ages 16-24 years in Peru (N = 211) was conducted consisting of a bio-behavioural survey accompanied by laboratory-based testing for HIV and sexually transmitted infections (STIs). Bivariate and multivariable Poisson regression models were used to estimate prevalence ratios between socio-demographic and behavioural characteristics and HIV status.

RESULTS

HIV prevalence was 41.5% (95% CI: 33.9-49.4%), recent syphilis acquisition 19.4% (95% CI: 12.7-28.4), chlamydia 6.3% (95% CI: 3.1-11.1) and gonorrhoea 12.3% (95% CI: 7.9-18.7). Almost half (47.9%) reported condomless anal sex in the past 6 months, 50.7% reported sex work in the past 30 days and 13.7% reported accepting more money for condomless sex. There were no significant differences in reported sexual behaviours by HIV status. Only 60.8% of participants reported ever having been tested for HIV, and 25.6% reported a past 6-month STI test. More than two-thirds (67.8%) had not heard of antiretroviral pre-exposure prophylaxis (PrEP) and only 4.7% had taken PrEP in the past month. Current moderate-to-severe psychological distress was endorsed by 20.3%, 10.0% reported attempting suicide in the past 6 months and 85.4% reported alcohol misuse.

CONCLUSIONS

Findings show that the HIV epidemic for YTW in Lima, Peru is situated in the context of widespread social exclusion, including economic vulnerabilities, violence victimization and the mental health sequelae of transphobic stigma that starts early in life. Future research should aim to further understand the intersection of these vulnerabilities. Moreover, there is an urgent necessity to design and evaluate HIV prevention programmes that address the root systems driving HIV vulnerabilities in YTW and that focus on developmentally specific clusters of stigma-related conditions.

Social media use, knowledge, attitudes, and risky sexual behavior of HIV transmission: A survey among boarding school adolescent students in Indonesia

Background

Social media has many positive and negative influences on individuals, especially for adolescents related to HIV. However, little is known about how social media impacts HIV-related outcomes among adolescents in boarding schools.

Objective

This study aims to investigate the social media use, knowledge, attitudes, and sexual behavior at risk of HIV transmission and their relationship with the demographic characteristics of adolescent students at boarding schools.

Methods

This study was school-based and used a cross-sectional design. The questionnaires were used to assess social network site usage, knowledge, attitudes, and risky behavior. Cluster random sampling involved students (n = 214) from three boarding schools in Cirebon City, West Java, Indonesia, in 2022. Chi-square tests and Cramer's V were used to explore correlations between social and demographic factors.

Results

A considerable number of adolescent students exhibited high social media addiction (58.4%), with the majority possessing limited knowledge of HIV transmission (54.7%). Additionally, nearly half displayed a negative attitude towards preventing HIV transmission (47.2%), while only a small fraction engaged in risky behavior (2.8%). Bivariate analysis revealed that social media use was moderately associated with the type of social media application (φc = 0.246, p <0.05). Knowledge of HIV transmission exhibited a moderate correlation with age (φc = 0.331, p <0.05), education level (φc = 0.240, p <0.001), and exposure to information (φc = 0.269, p <0.001). Similarly, attitudes toward HIV prevention demonstrated moderate associations with age (φc = 0.341, p = 0.001), education level (φc = 0.317, p <0.001), and exposure to information (φc = 0.266, p <0.001). Furthermore, risky sexual behavior exhibited a strong association with exposure to pornographic content (φc = 0.730, p <0.001).

Conclusion

The study found a high prevalence of social media usage among adolescents, coupled with low knowledge about HIV, negative attitudes, and risky behavior. Significant relationships were observed between social media use, knowledge, attitudes, and risky sexual behavior related to HIV transmission and demographic characteristics. This study emphasizes the vital role of nurses and healthcare professionals in implementing targeted educational interventions in boarding schools to address gaps in HIV risk knowledge influenced by social media, ultimately improving strategies for adolescents' sexual health.

Sexual Agreement Discussions Among Adolescent Sexual Minority Men in the USA

Nearly two-thirds of new HIV infections are attributed to primary partners, necessitating a greater understanding of relationship context of HIV transmission among sexual minority men. Sexual agreements, which are the explicit decisions couples make about sexual behaviors allowed inside and outside of their relationship, have been primarily studied among adult sexual minority men. Little work has sought to understand how adolescent sexual minority men utilize and navigate sexual agreement conversations. In this qualitative study, we explored adolescent sexual minority men's motivations for having these conversations, how they define different types of agreements (e.g., monogamous, non-monogamous), and the topics most commonly discussed in their conversations. We conducted thematic analysis of in-depth interviews with 30 partnered, HIV-negative, adolescent sexual minority men ages 15-19 years. Participants reported similar reasons, definitions, and desires for creating sexual agreements as those reported in the adult literature. Novel to this population was the influence of stigma and heterosexism on the participants' choice of sexual agreement type. Like adult sexual minority men, participants used sexual agreement conversations to respond to life events; however, the adolescents in our sample, when talking with their partners, led with the context of developmentally specific events such as leaving for college or attending a school dance. Those with more relationship experience often described having intentional, explicit sexual agreement conversations. Study findings suggest that content focused on sexual agreements is important for HIV prevention interventions designed with adolescent sexual minority men, especially young men who have less relationship experiences.

Emergent Penile Venous Stripping for Treating Adolescent Impotence

INTRODUCTION

Traditional anatomy-based penile venous surgery is deemed inadequate. Based on revolutionary insights into penile vasculature, penile venous stripping (PVS) shows promise in treating adolescent erectile dysfunction (AED). We aimed to report on this novel approach.

METHODS

We conducted a retrospective analysis of 223 individuals under 30 diagnosed with veno-occlusive dysfunction (VOD) between 2009 and 2023. Among them, 83 were diagnosed with AED and divided into the PVS (n = 37) and no-surgery (NS, n = 46) groups. All participants had been dissatisfied with conventional therapeutic options. Dual pharmaco-cavernosography was the primary diagnostic modality. PVS involved stripping the deep dorsal vein and two cavernosal veins after securing each emissary's vein with a 6-0 nylon suture. Erection restoration was accessed using the abridged five-item version of the International Index of Erectile Function (IIEF-5) score system and the erection hardness scale (EHS). Statistical analysis was performed using IBM SPSS 21.0.

RESULTS

There were significant differences (both p < 0.001) between the preoperative and postoperative IIEF-5 scores in the PVS and NS groups (9.8 ± 3.0 vs. 20.4 ± 2.2; 9.9 ± 2.5 vs. 9.5 ± 2.1), as well as in the EHS scores (1.7 ± 0.7 vs. 3.5 ± 0.6 and 1.8 ± 0.5 vs. 1.3 ± 0.4). The satisfaction rate was 87.9% (29/33) in the PVS group and 16.7% (17/41) in the NS group.

CONCLUSIONS

AED can be effectively treated using physiological methods, although larger patient cohorts are needed for validation.

School Connectedness and Risk for Sexual Intercourse and Nonconsensual Sex in Adolescence

The CDC reports that 30% of high school students have engaged in sexual intercourse. Evidence suggests biological, personal, peer, societal, and family variables affect when a child will initiate sex. The school environment plays an important role in a child's development. Evidence suggests that greater attachment to the school community can modify sexual risk-taking activity in adolescents. Future of Families and Child Wellbeing Study (FFCWS) comprises a cohort of approximately 4,700 families of children born in the U.S. between 1998-2000, over-sampled for non-marital births in large U.S. cities. Adolescents (N = 3,444 of 4,663 eligible) completed the wave six teen survey at approximately age 15. School connectedness was self-reported with four items measuring inclusiveness, closeness, happiness, and safety felt by the adolescent in their school environment. Sexual intercourse and nonconsensual sex were self-reported by the adolescent. Hierarchical regression analyses were conducted examining sexual intercourse, nonconsensual sex, risk factors, and school connectedness. In this sample of adolescents (48% female, 49% Black, 25% Hispanic, ages 14-19), school connectedness appears to reduce boys' risk of nonconsensual sex (OR = 0.29, p < 0.01), and reduce girls' risk of engaging in sexual intercourse (OR = 0.55, p < 0.01). Findings suggest gender differences in the association between school connectedness and sexual practices in adolescents. School connectedness may confer protection for boys' risk of nonconsensual sex, and for girls' risk of engaging in sexual intercourse. Further exploration of the relationship between school connectedness may allow for recommendations into preventative measures for teenage sexual behaviors.

Associations between externalizing behavior problems and risky sexual behaviors in adolescence: Attachment as a mediator

INTRODUCTION

Risky sexual behaviors in adolescence are associated with negative health and psychological functioning outcomes. Although the association between behavior problems and risky sexual behaviors is well established, addressing these problems requires understanding the mechanisms that help explain this association. Adolescent attachment, while related to risky sexual behavior, has not been extensively explored as an outcome of childhood externalizing problems. The two objectives of this study were to explore the links between parental and peer attachment and risky sexual behaviors and to examine the mediating effect of attachment on the links between behavior problems and risky sexual behaviors.

METHODS

Five hundred and ninety-eight French-Canadian adolescents (46.2% girls), Mage at T1 = 13.23; Mage at T2 = 14.28; Mage at T3 = 17.35) participated in this longitudinal study.

RESULTS

The quality of parental attachment at T2 was significantly and negatively associated with risky sexual behaviors 3 years later, at T3. More specifically, a lower quality parental attachment relationship was associated with having nonexclusive partners as well as with inconsistent condom use. Finally, parental attachment (T2) was a significant mediator between behavior problems (T1) and risky sexual behaviors (T3), but only for younger adolescents.

CONCLUSIONS

Findings suggest that in addition to behavior problems in adolescence, the quality of parental attachment relationships may help in understanding risky sexual behaviors in adolescence.

How Does Sexual Subjectivity Vary on the Basis of Gender and Sexual Orientation? Validation of the Short Sexual Subjectivity Inventory (SSSI-11) in Cisgender, Heterosexual and Sexual and Gender Minority Adolescents

Through sexual exploration, adolescents learn that they are sexual beings with choices, desires, and are deserving of pleasure, which corresponds to sexual subjectivity. However, the two measures of this construct (i.e., Female Sexual Subjectivity Inventory and Male Sexual Subjectivity Inventory) have not been validated with younger adolescents and have different items for boys and girls (with no scale available for gender diverse individuals), limiting gender comparisons. This study examined (1) the factor structure of the adapted Short Sexual Subjectivity Inventory-11 items (SSSI-11) in a large sample of young cisgender, heterosexual and sexual and gender minority adolescents, (2) measurement invariance across language (English and French), gender, and sexual orientation, (3) validity with sexuality-related outcomes, and (4) one-year temporal stability. Results of a confirmatory factor analysis among 2001 adolescents (Mage = 15.5 years, SD = 0.60) revealed a multidimensional factor structure. The SSSI-11, in both English and French, showed adequate reliability and one-year temporal stability, and was invariant across genders, sexual orientations, and languages. Girls had lower scores on the entitlement to self-pleasure and self-efficacy in achieving pleasure factors, and higher scores on the entitlement to pleasure from a partner factor. No significant differences were observed on the basis of language or between heterosexual and sexual minority adolescents. The SSSI-11 correlated positively with sexuality-related variables. Findings support the strong psychometric properties of the SSSI-11, rendering it of considerable use in clinical, education, and research applications.

Experiences of adolescents using sexual health services on Reunion Island: protocol for a qualitative phenomenological study

INTRODUCTION

Adolescence and early adulthood are often critical periods of sexual development. The discovery of sexual intercourse can lead to sexual risk-taking which may impact the incidence of sexually transmitted infections (STIs) and unwanted pregnancies. Despite available sexual health services on Reunion Island, sexual health indicators for adolescents are very poor showing a high number of teenage pregnancies and abortions, low use of contraception and an upsurge of STIs. In contrast, this French region is equipped with many services and resources that enable young adults to make informed sexual health choices. This study protocol describes the methodology to describe adolescent experiences of using sexual health services on Reunion Island.

METHODS AND ANALYSIS

A monocentric descriptive qualitative study using a phenomenological approach will be conducted from December 2022 to August 2023 and will be based on face-to-face semistructured interviews with participants aged 15-19 years and residing on Reunion Island. Recruitment will be distributed at various educational institutions and sexual health centres and will be facilitated by the 'snowball' and 'word-of-mouth' effect. Data analysis will be independently carried out by three investigators to increase reliability. An interpretative phenomenological analysis will be performed.

ETHICS AND DISSEMINATION

Ethics approval was obtained from the Ethics Committee of the Hospital Center University De Bordeaux (CER-BDX-2022-55). Data generated do not fall within the field of biological or medical knowledge nor into the category of Research Involving the Human Person as defined in Articles L. 1121-1 and R. 1121-1 of the Public Health Code in France. All participants will receive information about the study in verbal and written forms and will give their oral consent before enrolment. Results will be published in a peer-reviewed journal as well as presented and disseminated at the Regional Health Agency of Reunion Island, conferences and in meetings with school directors.

Description of HIV risk behavior among adolescent female sex workers: Findings from the nationwide cross-sectional integrated biological and behavioral surveillance (IBBS) 2014-15 survey for HIV in India

Introduction

Adolescent female sex workers are at high risk of acquiring human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) infection. There was paucity of information regarding their sexual practices. The main objective of this study was to study the sexual behavior, condom use practices, and physical and sexual violence experienced by adolescent female sex workers (FSWs).

Materials and Methods

This study was a secondary data analysis of the data collected during the nationwide IBBS 2014-15 survey. All adolescent FSWs aged 15 to 19 years were included in the analysis. The primary outcome variable was HIV serostatus, and independent variables included sexual behavior and condom use practices and socio-demographic variables. Descriptive analyses were performed to estimate the prevalence of independent variables. Ethical approval of the original IBBS study was obtained by the Ethics Committee of National AIDS Control Organization.

Results

A total of 948 adolescent FSWs were included in the final analysis. The prevalence of HIV in adolescent FSWs was 1.2% [95% confidence interval, 0.1-1.9%]. The mean age [standard deviation (SD)] of FSWs was 18.2 (0.9) years. The mean (SD) age at first sexual intercourse was 15.6 (1.7) years, and the mean (SD) age of starting sex work was 16.6 (1.5) years. The majority of the FSWs (94%) had used condom during the last sexual intercourse with a commercial partner, and about one-thirds (66%) had consistently used condom with a commercial partner. About a quarter (26%) of the FSWs had anal intercourse with a commercial partner in the last 1 month. About one in five FSWs (21%) had experienced physical violence in the last 1 year.

Conclusion

Almost one-third of FSWs had high-risk sexual behavior like multiple clients, anal intercourse, inconsistent condom use, and so on. These behaviors in turn increase their vulnerability to HIV infection.

Substance Use, Sexual Agreements, and Sexual Risk Behaviors Among Adolescent Sexual Minority Males (Aged 13-17) in the United States

PURPOSE

Despite the fact that adolescence represents a distinct developmental period wherein dating and sexual relationships are emergent, much of what is known about substance use, sexual agreements, and sexual risk behaviors among adolescent sexual minority males (ASMM) is extrapolated from research on adults. This study tested associations between substance use and sexual risk behaviors among ASMM and examined whether relationship status and sexual agreements moderated these associations.

METHODS

Cross-sectional online survey data were collected from 2,892 HIV negative ASMM aged 13-17 years between November 2017 and March 2020. All were sexually active with male partners and not on pre-exposure prophylaxis. A multigroup hurdle model predicted the occurrence and frequency of condomless anal sex (CAS) with casual partners.

RESULTS

Non-monogamous ASMM were more likely to use illicit drugs and more likely to have CAS with casual partners compared with single ASMM and those in monogamous relationships. Among ASMM who had CAS at least once, those in relationships (both monogamous and nonmonogamous) had CAS more frequently than single ASMM. Binge drinking (odds ratio (OR) = 1.47, p < .001), cannabis (OR = 1.30, p < .001), and illicit drug use (including prescription drug misuse) (OR = 1.77, p < .001) were associated with the occurrence of CAS with casual partners but only binge drinking (rate ratio (RR) = 1.23, p = .027) and illicit drugs (RR = 1.75, p < .001) were associated with its frequency.

DISCUSSION

While results aligned with adult studies in many respects, unlike adult sexual minority males, these findings suggest partnered ASMM-particularly those in nonmonogamous relationships-were at highest risk of substance use and associated sexual HIV transmission risk.

A life course health development model of HIV vulnerabilities and resiliencies in young transgender women in Peru

BACKGROUND

Globally transgender women (TW) are at heightened vulnerability for HIV infection. In Lima Peru, sharp increases in HIV prevalence are seen among TW ages 25 years and older highlighting the need for early HIV prevention efforts for young TW. This study conducted in-depth qualitative interviews to elucidate the social and developmental contexts of HIV vulnerability for young TW in Lima Peru.

METHODS

Between November 2019 and February 2020, young TW ages 16-24 years (n = 21) in Lima Peru were purposively sampled using in-person (e.g., face-to-face outreach) and online (e.g., social media, networking websites) social network-based methods. Interviews were conducted in Spanish and a rapid qualitative analysis was conducted using a modified immersion crystallization methodology to identify themes.

RESULTS

Five themes emerged, informing the conceptualization of a Life Course Health Development Model of HIV Vulnerabilities and Resiliencies: (1) interpersonal contexts (family, school, partners, sexual debut, trans mothers); (2) structural vulnerabilities (poverty, educational constraints, migration, hostile environments, sex work, police violence); (3) concomitant mental health and psychosocial factors (discrimination, violence, depression, suicidality, substance use, life hopes/dreams/future expectations); (4) gender affirmation processes (gender identity development, hormones, surgery, legal name/gender marker change); (5) HIV prevention and treatment barriers (PrEP uptake, HIV care, condom use, risk reduction).

CONCLUSIONS

Young TW experience formidable developmental challenges associated with transphobia, violence, and pre-maturely facing accelerated milestones. Developmentally and culturally appropriate interventions to mitigate HIV vulnerability in Peru are needed, including those that consider co-occurring stigma-related conditions in adolescence and young adulthood.

Sexual development in ADHD and internet pornography consumption

Development of sexual identity during adolescence is a major process of transition in individual life which in cases of ADHD specifically interacts with other ontogenetic, pathological and psychosocial conditions. According to recent findings growing consumption of internet pornography mainly in male ADHD population is closely related to compulsive sexual behavior and hypersexuality. Recent findings also indicate that consumption of internet pornography in ADHD individuals and other sexual activities may serve as a mood-altering "self-medication" which may help to cope with stressful events and decrease depression and anxiety. Taken together recent findings indicate that internet pornography consumption mainly in ADHD individuals is closely related to stressful experiences, anxiety, depression and identity problems in partnerships which significantly increase their vulnerability to the so-called "problematic pornography use" and other forms of addictive sexual behavior. From this developmental perspective "problematic pornography use" in ADHD individuals represents significant epidemiological problem which requires further research mainly with focus on clinical diagnostics and treatment.

Application of ADAPT-ITT: adapting an evidence-based HIV/STI mother-daughter prevention intervention for Black male caregivers and girls

BACKGROUND

Black girls are disproportionately impacted by HIV and sexually transmitted infections (STIs), underscoring the urgent need for innovative strategies to enhance the adoption and maintenance of HIV/STI prevention efforts. Historically, Black male caregivers have been left out of girls' programming, and little guidance exists to inform intervention development for Black girls and their male caregivers. Engaging Black male caregivers in Black girls' sexual and reproductive health may reduce sexual risk-taking and improve the sustainability of preventative behaviors.

OBJECTIVE

This paper describes the formative phases, processes, and methods used to adapt an evidence-based mother-daughter sexual and reproductive health intervention for Black girls 9-18 years old and their male caregivers.

METHODS

We used the ADAPT-ITT model to tailor IMARA for Black girls and their male caregivers. Diverse qualitative methods (interviews, focus groups, and theater testing) were used throughout the adaption process.

RESULTS

Findings support using the ADAPT-ITT model to tailor an evidence-based HIV/STI intervention for Black girls and their Black male caregivers. Findings highlight the importance of community engagement and the use of qualitative methods to demonstrate the acceptability and feasibility of the adapted intervention. Key lessons learned are reviewed.

CONCLUSIONS

Adapting evidence-based interventions to incorporate Black girls and their Black male caregivers should be driven by a relevant theoretical framework that aligns with the target population(s). Adapting the intervention in partnership with the community has been shown to improve acceptability and feasibility as it is responsive to community needs. Using a systematic process like the ADAPT-ITT model will ensure that the new program is ready for efficacy trials.

The influence of minority stress-related experiences on mental wellbeing for trans/gender-diverse and cisgender youth: a comparative longitudinal analysis

Trans and gender-diverse (TGD) adolescents are likely to experience poorer mental health and wellbeing than their cisgender peers. Minority stress theory has developed as a possible explanation for some of this disadvantage: factors such as increased bullying and discrimination lead to excess stress and reduced wellbeing. However, the evidence base remains limited. This study drew on secondary data analysis of the #BeeWell longitudinal cohort over 2 years (N = 26 042, aged 12-13 at time one, T1). We report two unregistered hypotheses relating to T1 (autumn 2021) data which was available at the time of stage-one submission: H1, mean differences in T1 wellbeing; H2, mean differences in T1 minority-related stressors. These are followed by two registered hypotheses relating to T2 (autumn 2022) data: H3, replication of T1 mean differences in T2 wellbeing; H4, predictions were made about the strength of the association between T1 minority-related stressors, controlling for sexuality and T2 wellbeing across T1 gender identity groups. At both time points cis-females, TGD and those who preferred not to say their gender had lower wellbeing than cis-males (CM), with the largest effect evident for the TGD group. TGD adolescents also showed the largest disadvantage (mean difference) compared with CM for minority stressors. Counter to H4 and minority stress theory, gender was not found to moderate the effect of minority stressors on later wellbeing. Our findings highlight the vulnerability of the TGD group in terms of wellbeing and minority stressors and are discussed with relevance for policy and future research.

The Role of the Strong Black Woman in Black Female Sexual Development

Black girls and women are disproportionately impacted by sexual health disparities, including an increased risk of HIV and sexually transmitted infections (STI). Early sexual development among Black females heightens their risk of HIV/STI. Utilizing the Becoming a Sexual Black Woman (SBW) framework, this study sought to understand how early sexual development and stereotype messages may underpin HIV/STI risk, building on and furthering the discussion of the consequences of the SBW schema. To better understand this phenomenon, we conducted a secondary thematic data analysis from two previously completed grounded theory studies with Black girls and women ranging in age from 11 to 62 (N = 40). Findings revealed that Black women have been socialized to be strong and independent and yet are highly vulnerable to HIV/STI. This clash between Black girl's and women's ideals of strength and heightened vulnerability to HIV/STI presents a paradox that may help explain disparities in HIV/STI risk. Four themes emerged among both Black girls and women: complex construction of the SBW schema, burden and consequences of strength, pressure to be strong, and being strong and sexual. Findings also highlight how becoming both a strong and sexual Black woman occurs over the life course and is inherent to Black female sexual development. We discuss the implications of these findings for parents, healthcare providers, educators, and researchers with the aim to improve sexual health outcomes for Black females across the life course.

Sexual Health and Relationship Abuse Interventions in Pediatric Primary Care: A Systematic Review

PURPOSE

Supporting adolescents in developing healthy relationships and promoting sexual and reproductive health (SRH) is an important responsibility of pediatric primary care providers. Less is known about evidence-based interventions in pediatric settings focused on healthy relationships and SRH.

METHODS

We conducted a systematic review to describe SRH and healthy relationship/adolescent relationship abuse (ARA) interventions for pediatric primary care over the past 20 years. Eligible articles were original research on an SRH-focused or ARA-focused intervention, conducted in-person within pediatric primary care or school-based health centers specifically for middle or high school-aged adolescents. Data abstracted from included articles included intervention description, content, delivery, evaluation design, and effectiveness of primary outcomes. Heterogeneous outcomes and evidence levels made conducting a meta-analysis infeasible.

RESULTS

Nineteen studies described 17 interventions targeting a variety of SRH and ARA topics (e.g., sexually transmitted infections, contraception, ARA). Interventions largely focused on screening/counseling adolescents (89%). Interventions generally were reported as being effective in changing adolescent health or practice-level outcomes.

DISCUSSION

This review provides preliminary evidence that SRH and ARA interventions in pediatric primary care settings can be effective in promoting adolescent health. Future work should consider ARA-specific prevention interventions, including parents in interventions, and strategies for implementation, dissemination, and scaling.

Sleep Deprivation and Insomnia in Adolescence: Implications for Mental Health

Sleep changes significantly throughout the human lifespan. Physiological modifications in sleep regulation, in common with many mammals (especially in the circadian rhythms), predispose adolescents to sleep loss until early adulthood. Adolescents are one-sixth of all human beings and are at high risk for mental diseases (particularly mood disorders) and self-injury. This has been attributed to the incredible number of changes occurring in a limited time window that encompasses rapid biological and psychosocial modifications, which predispose teens to at-risk behaviors. Adolescents’ sleep patterns have been investigated as a biunivocal cause for potential damaging conditions, in which insufficient sleep may be both a cause and a consequence of mental health problems. The recent COVID-19 pandemic in particular has made a detrimental contribution to many adolescents’ mental health and sleep quality. In this review, we aim to summarize the knowledge in the field and to explore implications for adolescents’ (and future adults’) mental and physical health, as well as to outline potential strategies of prevention.

Differences in the sexual health information parents/guardians give their adolescent sexual minority sons by outness

Introduction

Parents and guardians are a potentially valuable source of sexual health information for adolescent sexual minority males (ASMM). The current study examines what sexual health topics ASMM report discussing with a parent/guardian and whether topics differ by outness about sexual attraction to other males.

Methods

ASMM (N=154; ages 14-17) in the United States completed the baseline of an online sexual health intervention pilot in 2020. They reported which of twelve sexual health topics they discussed with a parent/guardian and if they had disclosed their sexual attraction to other males. Associations between topics discussed and outness to a parent/guardian were examined with Firth logistic regression.

Results

Eighty-eight (57%) participants reported being out to a parent/guardian. Six sexual health topics were significantly more likely to be discussed if participants were out. The three categories with the largest differences by outness were how to: discuss with a partner what they would not like to do sexually (aOR = 7.0, 95% CI: 2.0-24.6), use condoms (aOR = 5.9, 95% CI: 2.3-15.1), and prevent HIV/AIDS (aOR = 3.5, 95% CI = 1.4-8.7).

Conclusions

Interventions on parental/guardian provision of sexual health information are needed to ensure ASMM receive relevant sexual health knowledge.

Association between Family Environment and Adolescents' Sexual Adaptability: Based on the Latent Profile Analysis of Personality Traits

Sexual adaptation plays an important role in psychosexual health. Our study aimed to investigate the relationship between the family environment and sexual adaptability among adolescents with different personality traits. A cross-sectional study was conducted in Shanghai and Shanxi province. A total of 1106 participants aged 14-19 was surveyed in 2019, including 519 boys and 587 girls. Univariate analyses and mixed regression models were performed to assess the association. Girls had a significantly lower average score of sexual self-adaptation compared to boys (4.01 ± 0.77 vs. 4.32 ± 0.64, p < 0.001). We found that the family environment did not impact boys' sexual adaptation in different personality groups. For girls in a balanced group, expressiveness factors improved their sexual adaptability (p < 0.05), intellectual-cultural orientation and organization promoted social adaptability (p < 0.05) and active-recreational orientation and control decreased their social adaptability (p < 0.05). In the high-neuroticism group, cohesion facilitated sexual control (p < 0.05), while conflict and organization reduced sexual control ability, and active-recreational orientation decreased sexual adaptation (p < 0.05). No factors associated with the family environment were found to influence sexual adaptability in groups with low neuroticism and high ratings in other personality factors. Compared with boys, girls demonstrated lower sexual self-adaptability, and their overall sexual adaptability was more susceptible to the family environment.

Individual-, Interpersonal- and Institutional-Level Factors Associated with HIV Stigma Among Youth in Kenya

HIV stigma remains a barrier in achieving optimal HIV treatment. We studied the prevalence and predictors of HIV stigma among adolescents and youth with HIV (AYWHIV) ages 15-24 years in Western Kenya. Of 1011 AYWHIV, 69% were female with a median age of 18 years. Most (59%) attended adolescent clinic days, and 40% attended support groups. One-quarter (27%) had experienced physical, 18% emotional, and 7% sexual violence. The majority of AYWHIV (88%) reported disclosure concerns, 48% reported perceived community stigma, 36% experienced, and 24% internalized stigma. Compared to AYWHIV attending adolescent clinics, those in general/adult clinics had higher internalized stigma. Similarly, having dropped out of school was associated with higher internalized stigma. AYWHIV in sexual relationships had higher experienced stigma and disclosure concerns. Lastly, exposure to violence was associated with higher experienced, internalized, perceived community stigma and disclosure concerns. These risk factors can be targeted when developing stigma-prevention interventions.

Pornography use among adolescents and the role of primary care

Given the increase in pornography use among adolescents over the years, we discuss the impact of its use on sexual health development as well as the role of primary care providers (PCPs) in assessing use and providing sexual health education. While pornography use is often viewed negatively, it is important to develop unbiased understanding of the use in order to provide non-judgemental, adolescent-focused and educational care. As PCPs are often the first point of contact when adolescents experience medical and behavioural health concerns, it is essential for them to be equipped to screen for pornography use effectively, create a confidential and comfortable environment to talk about pornography use and sexuality, and be informed of ways to promote open discussion between youth and parents. In addition to PCP involvement, parental collaboration, knowledge and comfortability with discussing pornography use with their child are powerful tools in understanding and navigating pornography use in this population. This special communication seeks to provide an objective view of adolescents' pornography use, guidelines for screening of pornography use and ways to facilitate conversations about the use between adolescents and caregivers.

A Validation Study of the Global Measure of Sexual Satisfaction in Sexually Active Adolescents

Positive views of adolescents' sexuality have only begun to garner interest in the last two decades. Despite great strides in this emerging area, progress is limited by the paucity of valid and reliable measures among this population. The goal of this study was to validate the widely used adult five-item Global Measure of Sexual Satisfaction (GMSEX) in a large sample of sexually active adolescents. A total of 1,036 adolescents (516 girls, 49.8%) aged between 14 and 17 years (M_age = 14.62; SD = 0.66) were recruited to investigate the reliability and validity of the GMSEX. The GMSEX yielded strong psychometric properties in adolescents, including factor structure, measurement invariance, and reliability. Results showed that the scale works similarly for boys and girls as well as for heterosexual, cisgender, and sexual minority adolescents. The GMSEX is a short, reliable, and valid measure of sexual satisfaction that can be used in future studies focusing on adolescents' sexuality and relationships.

Patient reported outcome measure domains and tools used among adolescents and young adults with cancer: A scoping review

Adolescent and young adult (AYA) cancer patients and survivors are growing and face with distinct issues from paediatric and older cancer survivors. Hence it is important the issues they encounter are measured using appropriate Patient Reported Outcome Measures (PROMs). We searched PubMed, EMBASE, CINAHL, and PsycINFO for articles including: (1) AYAs (ages 15-39), (2) Malignant neoplasms, and (3) PROMs. This resulted in 3566 unique articles, 523 were included for full text review, of which 175 were included. These studies included 203 distinct tools to measure PROMs across 31 domains. Physical function was most frequently measured domain, followed by social, emotional and mental health. The most commonly used tools were the EORTC QLQ-C30, HADS and SF-36. PROMs used in AYA cancer patients is a complex topic, this comprehensive review serves as a useful reference for researchers, clinicians and health services who want to better understand, and improve, outcomes among their patients.

Association of the consumption of common drinks with early puberty in both sexes

Background

We examined the effect of sugar-sweetened beverages (SSB) and common drink intake on pubertal development in both sexes.

Methods

Data were retrieved from Taiwan Children Health Study, which involved detailed pubertal stage assessments of 2,819 schoolchildren aged 11 years in 2011-2012. Drawings of secondary sexual characteristics and self-reported age at menarche or voice breaking were used to assess pubertal stages. Dietary intake was assessed using a detailed semi-quantitative food frequency questionnaire. Generalized estimating equation modeling was applied to obtain odds ratios (ORs) and 95% confidence intervals (CIs) to represent the effects of each drink on early pubertal development outcomes.

Results

In boys, an one cup/day increment of a SSB was associated with earlier voice breaking (β = -0.12; 95% CI = -0.20, -0.04), whereas consuming yogurt (≥2 cups/day) was a protective factor against early puberty (OR = 0.78; 95% CI = 0.73, 0.83). In girls, SSB consumption was associated with increased risk of early puberty in a dose-response manner, and a similar protective effect of yogurt consumption and fermented probiotic drink (≥2 cups/day) against early puberty was observed (OR = 0.96; 95% CI = 0.94, 0.99). Furthermore, the intake of both total sugar and added sugar within SSBs increased risk of early puberty in girls but not in boys.

Conclusions

Sugar-sweetened beverages were associated with early puberty, and probiotic drinks appeared to mitigate this link. These findings indicate that the gut-brain axis could play a crucial role in sexual maturation.

First Adolescent Romantic and Sexual Experiences in Individuals With Differences of Sex Development/Intersex Conditions

PURPOSE

Adolescence is an important period for sexual development, including sexual debut. The purpose of this study was to assess first romantic and sexual experiences and debut age in individuals with differences of sex development (DSD/intersex) and compare these with age-matched and gender-matched population control values.

METHODS

Questionnaire data on sociodemographic characteristics, romantic and sexual milestones (e.g., masturbation, dating), satisfaction with sexual life and sexual activity at follow-up, self-esteem, and feelings of femininity or masculinity were collected from 976 participants in Europe with a DSD condition. Participants were divided into six diagnostic subgroups based on their diagnostic classification: women with Turner syndrome, congenital adrenal hyperplasia, 46XY-DSD nonvirilized, and 46XY-DSD female partially virilized conditions and men with 46XY-DSD male or Klinefelter syndrome. Age-specific and gender-specific reference values were retrieved from a Dutch population sample.

RESULTS

Individuals with DSD were less likely to reach each of the romantic and sexual milestones compared to their peers without these conditions and they were significantly older when reaching these milestones. Between clinical subgroups, individuals with Klinefelter were significantly older when reaching milestones and in the female groups and individuals with Turner were the least likely to reach milestones. Furthermore, a higher age when reaching several romantic and sexual milestones was correlated with lower self-esteem, lower satisfaction with sexual life, and lower sexual frequency at follow-up.

DISCUSSION

Due to a difference in biopsychosocial context, individuals with DSD often experience a different and/or delayed sexual development during adolescence. Healthcare providers should be aware of these differences in adolescents with DSD and their sexual development to optimize affirmative counseling.

Sex and Sexuality in Autism Spectrum Disorders: A Scoping Review on a Neglected but Fundamental Issue

ASD consists of a set of permanent neurodevelopmental conditions, which are studded with social and communication differences, limited interests, and repetitive behaviors. Individuals with ASD have difficulty reading eye gestures and expressions, and may also have stereotyped or repetitive language, excessive adherence to routines, fixed interests, and rigid thinking. However, sexuality in adolescents and young adults with ASD is still a poorly studied and neglected issue. This review aims to evaluate sexual function and behavior in individuals with ASD to foster a greater understanding of this important, although often overlooked, issue. This review was conducted by searching peer-reviewed articles published between 01 June 2000 and 31 May 2022 using the following databases: PubMed, Embase, Cochrane Database, and Web of Science. A comprehensive search was conducted using the terms: "Autism" OR "ASD" AND "Sexuality" OR "Romantic relation" OR "sexual behavior" AND/OR "sexual awareness". After an accurate revision of 214 full manuscripts, 11 articles satisfied the inclusion/exclusion criteria. This review found that, although individuals with ASD may have sexual functioning, their sexuality is characterized by higher prevalence rates of gender dysphoria and inappropriate sexual behavior. Furthermore, sexual awareness is reduced in this patient population, and the prevalence of other variants of sexual orientation (i.e., homosexuality, asexuality, bisexuality, etc.) is higher in adolescents with ASD than in non-autistic peers. Sexual health and education should be included in the care path of patients with ASD in order to improve their quality of life and avoid/reduce inappropriate and risky behaviors.

Sexual function in Brazilian female adolescents and young adults: a cross-sectional study

OBJECTIVE

The aim of this study was to investigate and compare the sexual function of Brazilian adolescents and young women who were using popular contraceptive methods.

METHODS

This cross-sectional study took place in 2012-2014 in a free family planning clinic of a tertiary teaching hospital in Brazil. Participants were female adolescents (10-19 years) and young adults (20-24 years) who were using barrier (condom) or hormonal contraceptive methods. The Female Sexual Function Index questionnaire was used to assess the sexual function in the last 4 weeks.

RESULTS

A total of 199 women (128 adolescents and 71 young adults) were included. There were no significant differences in the mean total Female Sexual Function Index scores of adolescents and young adults (26.6±5.7 versus 27.6±6.2, respectively, p=0.264). Compared to young adults, adolescents had significantly lower mean scores for orgasm (3.9±1.5 versus 4.4±1.4, p=0.020) and dyspareunia (4.4±1.6 versus 5.2±1.5, p=0.001; lower scores indicate more dyspareunia). There were no significant differences in the proportion of adolescents versus adults classified as being at risk for sexual dysfunction (38.3 versus 42.3%, p=0.651) or at risk of low desire (18.0 versus 21.1%, p=0.579).

CONCLUSION

Nearly 40% of Brazilian female adolescents and young adults are at risk for sexual dysfunctional symptoms and 19% have low desire, without significant differences between the two age groups.

The Effect of Aposematic Signals of Plants on Students’ Perception and Willingness to Protect Them

Degradation of biodiversity is one of the current problems of today, and scientists are increasingly concerned with identifying the key factors influencing people’s willingness to protect (WTP) wild organisms. Using a within-subject design, we investigated the influence of aposematic signals along with the presence or absence of flowers on perceived danger, attractiveness and WTP plants with lower secondary school students (mean age = 13 yrs) in Slovakia (n = 423). Aposematic plants received a higher dangerousness score (mean = 2.62 vs. 2.27), higher attractiveness score (mean = 3.45 vs. 3.32) and lower WTP plants than plants without aposematic signals (mean = 3.27 vs. 3.37). Interaction terms showed that males perceived the aposematic species as more dangerous than females and were more willing to protect species lacking aposematic signals. Females rated aposematic plants as more attractive than non-aposematic plants (mean = 3.82 vs. 3.0). The presence of flowers increased the perceived attractiveness of plants (mean = 3.75 vs. 3.02) and WTP plants (mean = 3.59 vs. 3.05) and decreased perceived dangerousness (mean = 2.70 vs. 2.20). Perceived attractiveness and WTP plants decreased with students’ age. Students with a higher interest in plants rated the attractiveness of the species more positively and were also more willing to protect them regardless of the presence of aposematic signals. We conclude that the presence of aposematic signals does not directly contribute to WTP plants, but conspicuous traits with high aesthetic value, such as flowers, positively enhance WTP in Slovak students.

Understanding Adolescent Sexuality: A Developmental Perspective

Adolescence is a period of transition from childhood to adulthood, during which the individual undergoes significant biological, psychological, and social changes. The development of sexuality, though begins at conception, gets shaped during this period. The changes occurring differ in males and females not just in terms of biopsychosocial organization but sexual behavior and functioning as well. Adolescent sexuality is although highly acknowledged but is quite complex and needs in-depth understanding. Challenges faced by adolescents include being vulnerable to risky sexual behaviors, unprotected sex, nonconsensual sexual interactions, sexually transmitted infections, stigmatization from society, and so on. In developing countries such as India, adolescents deal with additional challenges with higher risk associated with early marriages, unplanned pregnancies, sexual abuse, patriarchy, and insufficient information regarding sexual behavior and risks. This article is an attempt to review the nuances of adolescent sexuality, particularly in developing countries, to ensure appropriate culturally sensitive yet scientifically sound intervention programs.

"Providing Sex Education Is Challenging": Malay Mothers' Experience in Implementing Sex Education to Their Children with Intellectual Disabilities

Sex education (SE) is still a controversial and sensitive topic in Malaysia. Thus, individuals with intellectual disability receive less information about SE formally as Malaysian culture believes that students with disabilities should be shielded from everything connected to sexuality owing to their paucity of maturity and intellectual comprehension of the topic. Due to that reason, non-formal education by the parent is very important to fill that needful gap. This study aimed to explore the experience of mothers on the meanings of sexuality, and implementing sex education for their children with ID. We adopted a phenomenological framework and social cognitive theory to increase understanding of the phenomenon and conducted it using in-depth interviews. Twenty mothers with children aged 10–19 who were diagnosed with mild to moderate ID and/or other cognitive disabilities were involved. Almost all mothers acknowledged the influence of socio-cultural factors and religion on meanings of sexuality and practicing SE. They realized their children’s emerging sexual behavior as they go through the adolescence period. However, how they confronted sexuality and sex education with their vulnerable children was different. Three themes emerged: (1) Sexuality as an erotic experience in life, which enlightens mothers’ views on sexuality, relying mainly on sexual intimacy and sexual being; (2) Perceived their children’s sexual maturity is different, which reflects the mothers’ attitude toward their children’s sexual development; (3) Caution/hesitance in providing sexuality education, which summarizes mothers’ ways of delivering SE, either following physicality or through sociocultural ways. Our findings exemplify the need for strategies to increase parents’ understanding and awareness regarding sexuality and appropriate delivery of SE. To ensure its success, it should be a shared responsibility among all relevant stakeholders.

Social media and body image: Modulating effects of social identities and user characteristics

Social media use and exposure, in particular to highly visual and appearance-focused content, has shown a relationship with poorer body image with small to moderate effect sizes. The aim here was to provide an overview of the theoretical and empirical evidence of the relationships between social media use and body image may vary across individuals. Although evidence exists to support variations in these relationships across different groups, to date, data are scarce and a number of theoretically important groups have largely been overlooked. The available evidence suggests that age may be an important moderating factor of vulnerability to exposure to highly-visual social media content, with younger adolescents most likely to experience negative outcomes. In addition, women and other groups for whom appearance is strongly tied to attractiveness and self-worth may be at heightened risk. Moving forward further research should aim to focus on understanding the relationships between social media use and body image concerns among underrepresented groups, and to expand the focus of to include different aspects of social media use and more sophisticated methodological approaches.

Why do young people engage in dating relationships during early adolescence? An inter-generational qualitative analysis from Blantyre, Malawi

Engagement in dating relationships plays an important role in the health trajectories of young people, particularly during the early adolescent period between ages 10-14. Yet little is known about such relationships among youth in low resource contexts. This study sought to contribute to the literature on this topic by exploring reasons why school-going young people aged 12-14 years engage in dating relationships in Blantyre, Malawi. A thematic analysis was used to code and analyse in-depth interview data from 23 young people and 19 caregivers. Against the backdrop of growing sexual desires and feelings of attraction, participants stressed harassment from boys and coercion from older men, peer pressure, social status attainment, financial deprivation and encouragement during initiation ceremonies as reasons for engaging in dating relationships. Girls were found to be subject to multiple power dynamics-including gender power relations, as well as power dynamics within same-gender peer groups-that influenced their sex and relationship involvement. These findings carry implications for the design and timing of sexual and reproductive health youth programmes in Sub-Saharan Africa and emphasise the need for multi-level interventions to address the multiple influences in young people's dating lives.

Sexuality in Adults With ADHD: Results of an Online Survey

Establishing a secure sexual identity is a major developmental goal of an individual's transition from childhood to adolescence and the years that follow. Attention deficit/hyperactivity disorder (ADHD) as a neurodevelopmental disorder defined by the core symptoms of inattention, hyperactivity, and impulsivity, but also with emotional dysregulation, oppositional behaviors, or disorganization appearing early in life, can affect several areas of an individual's personal and social development, including sexual health. Yet, the scientific knowledge about the relationship between ADHD and sexual functioning is still scarce. Using an anonymous online survey, we compared different sexual behaviors including risky sexual behaviors, hypersexual behaviors, and sexual dysfunctions between 206 individuals with (n = 139) and without (n = 76) ADHD. Individuals with ADHD reported significantly more hypersexual behaviors than non-ADHD individuals, whereas no differences were found concerning risky sexual behaviors or sexual dysfunctions. In women with ADHD, hypersexual behaviors, sexual risk-taking as well as sexual dysfunctions were closely related to symptoms of emotional dysregulation, impulsivity, and oppositional symptoms. In men with ADHD, the associations between ADHD symptomatology and the sexuality-related measures were less clear, however, signs of emotional dysregulation seemed to be relevant as well. Since individuals with ADHD seem to be at an increased risk of some peculiarities in sexual behavior, sexuality-related issues should be routinely addressed during clinical consultations to provide more holistic treatment in order to enhance individual well-being and quality of life.

Understanding the Link Between Adolescent Same-Gender Contact and Unintended Pregnancy: The Role of Early Adversity and Sexual Risk Behavior

Past research suggests an apparent paradox: Women who engage in same-gender sexual behavior show higher rates of unintended pregnancy than women with exclusive other-gender sexual behavior. Such women also have disproportionate rates of early adversity (both harshness, such as abuse or neglect, and unpredictability, such as father absence). We used the Add Health data (N = 5,617 cisgender women) to examine the relative contributions of early adversity, adolescent same-gender sexual behavior, and general sexual risk behavior to women's risks for adult unintended pregnancy. Women who engaged in adolescent same-gender sexual behavior were more likely to report childhood adversity, and both childhood adversity and adolescent same-gender behavior made independent contributions to subsequent rates of unintended pregnancy. The association between adolescent same-gender sexual behavior and adult unintended pregnancy was partially attributable to the fact that women with adolescent same-gender sexual behavior engaged in greater sexual risk behavior more broadly. These findings suggest that same-gender sexual behavior in adolescence may relate to a broader set of sexual risk behaviors that augment future risk for unintended pregnancy, independent of sexual identity. We draw on life history theory to explain this pattern of results and suggest directions for future research.

Sending One's Own Intimate Image: Sexting Among Middle-School Teens

BACKGROUND

There is a gap in the literature regarding data on sexting among youth under the age of 16 whereas the problems related to this practice could affect them more because of their ongoing development. This study aims to determine the prevalence rate and characteristics of sending one's own sexually related image among middle-school teens.

METHODS

Data were obtained from a web-based in-school survey conducted between October 2019 and February 2020. The sample comprised 3006 (mean age 13.7; 50.2% males) 10th-grade pupils in the canton of Vaud (Switzerland). Participants were asked "Have you ever sent a sexually related/sexy image of yourself?". Analysis of variance/chi-square tests and multinomial regression analyses were used to compare the groups.

RESULTS

Overall, 93.0% reported never, 3.7% once and 3.3% several times. No gender differences were found. Sending was associated with older age, low academic performance, cyberbullying victimization and reception of unsolicited sexually related images.

CONCLUSIONS

Education and health professionals should be aware that it is necessary to discuss the theme, perhaps with a more global approach including pressure, consent, exchange of nonsexual images, and so on from an early age. The context and reasons for sending remain to be explored, particularly to determine if the pressure is greater at this age.

Female Sexual Function in Twin Pregnancy

Introduction: The incidence of twin pregnancy is estimated at 1 per 80 single pregnancies. As the topic of sexual function among women with multiple pregnancy is insufficiently developed, we believe it is appropriate to raise this subject. Methods: A prospective study was conducted on 100 women during subsequent trimesters of pregnancy. Results: From a group of 100 women, 54 women were primiparous, while 46 women had a history of previous delivery. The mean overall FSFI (female sexual function index) was found to be 24.3 ± 6.1. Mean FSFI was the highest in the first trimester at 25.6. The result decreased successively to 24.8 ± 7 and 22.6 ± 8.4 in the second and third trimesters, respectively. The patient’s place of residence had a crucial impact on their FSFI score. The results were considerably higher for residents of small and medium towns or cities—24.4 ± 3.8 and 25.9 ± 4.9, respectively—while for those living in rural areas, the FSFI reached only 21.7 ± 5.4. Conclusions: The present study shows that the FSFI decreased throughout twin pregnancy. The lowest observed FSFI occurred in the third trimester, while the highest FSFI occurred during the first trimester.

The Impact of COVID-19 Among Black Girls: A Social-Ecological Perspective

Objective

To explore the impact of the COVID-19 pandemic on Black adolescent girls’ physical, psychological, and sexual development.

Methods

Semistructured interviews were conducted with 25 girls (9–18 years old) primarily across the Midwestern United States. Interviews were conducted until theoretical saturation was reached. We conducted a conventional content analysis by reviewing transcripts, coding data, and developing themes.

Results

Utilizing the social-ecological model findings revealed themes related to the individual-, interpersonal-, institutional-, and community-level changes that Black girls experienced during the COVID-19 pandemic.

Conclusions

Black adolescent girls need opportunities to discuss the changes, receive relevant resources, and have spaces to support their physical, psychological, and sexual development. Systems such as families, schools, and clinics should implement programming to facilitate discussions around the impact of COVID-19 on Black girls.

Pathways and Patterns of Entrance into BDSM

Prior limited research on entrance into BDSM divided paths of entry into external or internal factors (Yosta & Hunter, 2012), while research on age at entry into BDSM has not considered variation by BDSM role identity, gender, sexual orientation, and other demographic differences. In this mixed-methods exploratory study, we contribute to this literature by collecting and analyzing qualitative interviews with 96 self-described practitioners of BDSM to more fully describe distinct pathways into BDSM, adding nuance to prior descriptions of entry. We also collected and analyzed surveys with 2,017 self-described practitioners of BDSM to examine patterns of age at entry into BDSM practices and fantasies, and selection into older or younger age at practice and age at fantasy by BDSM role identity, gender, sexual orientation, and other demographic characteristics. Interview respondents told "constructionist sexual stories" describing introductions to BDSM via popular culture including pornography and other media, the Internet, or a sexual partner that awaked an inherent interest, along with "essentialist sexual stories" which described self-discovery solely attributed to an inherent personality characteristic. Survey data revealed that age at fantasy and onset of behavior varied by social-environmental factors. Pathways and patterns into BDSM behavior and fantasies therefore reflect a combination of idiosyncratic interests, exposure to ideas via the media or partners, and stratified social norms and opportunities related to sexual behavior.

Adolescents' Use of Sexually Explicit Internet Material Over the Course of 2019-2020 in the Context of the COVID-19 Pandemic: A Three-wave Panel Study

Recently, sexual health scholars have expressed concerns regarding adolescents' use of sexually explicit internet materials (SEIM) during the COVID-19 pandemic. Therefore, using latent growth curve modeling, the current study explored adolescents' changes in the frequency of SEIM use before, during, and after a strict lockdown period was established in Belgium. Attention was given to individual differences (i.e., gender, gender identity, sexual orientation, pubertal timing, and sensation seeking). A three-wave panel study over a 15-month period among 522 adolescents was used (M_age = 15.36, SD = 1.51, 67.1% girls). In general, SEIM use did not significantly increase over a 15-month period in the context of the COVID-19 pandemic. Only gender predicted a change in SEIM use frequencies with girls showing a greater, increasing change of SEIM use than boys. When addressing why adolescents used SEIM during a strict lockdown period, sexual arousal, stress, and boredom regulation motivations emerged as the most prevalent motivations. Loneliness regulation was the least prominent motivation. Individual differences were found regarding the gratifications sought according to adolescents' gender, pubertal timing, and sensation seeking. The findings offer a response to sexual scholars' worries in terms of adolescents' SEIM use during the COVID-19 pandemic.

The Measurement of Female Early Adolescent Sexual Desire

We used the developmental systems model to deduce a definition of female early adolescent sexual desire. We evaluated a measure of this phenomenon with a secondary analysis of data from a randomized group sexual health intervention trial involving low-income, English-speaking, seventh grade Latinas enrolled in a Miami-Dade County public school (n = 542). As part of this study, girls completed a four-item early adolescent sexual desire (EASD) measure. Study findings supported internal consistency (Cronbach's alpha = .81 to .82) and stability over a 1-month period (r = .74). Developmental sensitivity was supported by a decline in stability over 12- (r = .66) and 24-month periods (r = .56). Validity was supported by correlations with puberty changes, sexual intentions, sexting, and sexual behavior, and hypothesized mean differences associated with dating and preference for shoes culturally associated with female sexual attractiveness (p < .01). Research implications include validation work with other ethnic/racial groups and using the EASD as a starting point for a measurement continuum tracking development of sexual desire across adolescence and into adulthood. Directions for future research also include measuring the development of sexual desire in boys and transgendered youth across adolescence and into adulthood.

The Development and Initial Validation of the Youth Sexual Intention Scale: Indonesian Version

Interventions for the early sexual problem in adolescents require proper measurement of sexual intentions. The adolescent sexual intention scales have been widely used by researchers in the West. However, those scales are not very suitable for adolescents in eastern cultures such as Indonesia. As a religious society, Indonesian people have different sexual expectations from liberal western society. Religious teachings and societal norms shape sexual beliefs that reflect semi-restrictive sexual socialization. Thus, sexual intention measurement that represents the sexual beliefs of the subject under study becomes important. Therefore, this two-steps study aims to develop and validate the Youth Sexual Intention Scale (YSIS). In the first step, qualitative elaboration resulted in 27 themes of adolescent sexual beliefs, which turned into 31 items according to the Theory of Planned Behavior (TPB). In the second step, we selected 396 students using the cluster random sampling technique. We investigated 2 methods of validity, content validity using CVI and construct validity using confirmatory factor analysis (CFA). The content validity examination proved that all scale items had high validity (CVI = .93). Meanwhile, the CFA showed that the data was fit for the model (Chi-square 819,420, P <.001, RMSEA = .056, CFI = .978, TLI = .972). The CFA groups items into 4 dimensions, namely, sexual attitudes, subjective norms, perceived behavioral control, and sexual intentions. The reliability test shows an Alpha coefficient of .854. We conclude that 26-items YSIS is a valid and reliable instrument to measure belief-based youth sexual intentions (15–18 years) in religious culture.

Healthy sexuality development in adolescence: proposing a competency-based framework to inform programmes and research

Positive aspects of sexuality remain understudied among young people globally, and consensus is lacking on how to conceptualise different aspects of healthy adolescent sexuality development in order to guide programmes, research, and policy. We propose a conceptual framework that draws on theories and literature related to positive youth development, empowerment, human rights, gender, social-ecological and life-course perspectives. The framework highlights six key competencies for healthy adolescent sexuality development: (1) sexual literacy, (2) gender-equal attitudes, (3) respect for human rights and understanding consent, (4) critical reflection skills, (5) coping skills, and (6) interpersonal skills. These competencies have the potential to strengthen or impede adolescents’ sense of sexual wellbeing in relation to both themselves (e.g. body image, self-efficacy) and others (e.g. mutually respectful relationships). Whether adolescents are able to translate competencies into desired actions and achieve a sense of sexual wellbeing depends on the resources available to them, their agency, and on the influence of social-ecological opportunity structures. The framework can provide concrete direction for sexual and reproductive health practitioners and researchers by providing a platform for recognising and operationalising indicators of healthy sexuality development, and serve as a Theory of Change for programmes aiming to improve adolescent sexual and reproductive health and wellbeing. Our assets-based, life-course approach can also be used to make the case to donors and policymakers for why early investments and positive approaches to adolescent sexuality are needed to achieve sexual wellbeing over time.

Pleasure During Adolescents' Most Recent Partnered Sexual Experience: Findings from a U.S. Probability Survey

Compared to studies on sexually transmitted infections and pregnancy prevention, sexual pleasure has received limited attention in the adolescent sexual development literature. In the present study, we used data from 157 adolescents (66 females; 14 to 17 years old), with a partnered sexual experience in the past 12 months to explore adolescents' sexual pleasure. First, we examined adolescents' perceptions of pleasure during their most recent partnered sexual experience. We then used information about those sexual experiences to identify correlates of sexual pleasure. Adolescents' reports of sexual pleasure were mixed. Although 17.8% reported their sexual experience was extremely pleasurable and 36.5% reported it was quite pleasurable, 26.6% indicated moderate pleasure, 13.1% a little pleasure, and 3.3% reported no pleasure. Sexual pleasure was primarily associated with aspects of sexual experiences that reflected socioemotional intimacy and desire. Specifically, cuddling with partners, emotional intimacy, and wantedness were all associated with greater sexual pleasure. Additionally, adolescents found sex more pleasurable when it occurred with a friend, but less pleasurable when it involved genital rubbing. Most sexual behaviors, having experienced orgasm, and the situational context of sexual experiences were not associated with sexual pleasure. Thus, specific sexual behaviors and orgasm may have less impact on sexual pleasure than feelings of emotional intimacy and desire. The diversity of perceived sexual pleasure and its associations with intimacy and desire suggest that, during adolescence, partnered sexual experiences are not primarily motivated by anticipated physical pleasure.

The impact of sexual education and socialization on sexual satisfaction, attitudes, and self-efficacy

This study examined the relation between school-based sexual education and parental messages about sex received in adolescence, and sexual attitudes and experiences in young adulthood. Participants—99 Canadian undergraduate students aged 17–25 years—reported that their sexual education largely focused on traditional topics (e.g., negative health outcomes, physiology, etc.), while social and emotional topics were less likely to be formally covered. Parental sexual socialization that was more comfortable and accepting of teen sexuality was related to more permissive sexual attitudes in young adults, but was unrelated to self-efficacy or sexual satisfaction. When all variables were examined using hierarchical regression, sexual education and parental socialization did not predict sexual satisfaction. However, mediation analysis revealed an indirect effect of sexual self-efficacy on the relation between sexual education and sexual satisfaction. More comprehensive and higher-quality sexual education increased sexual self-efficacy, which was then related to higher sexual satisfaction beyond the role of gender and relationship status. This provides insight into the mechanism by which sexual education in Canada may impact sexual satisfaction. The influence of parental socialization and school-based sexual education are apparent and complementary. Both sources of information and values (parents/school) offered benefits for young adults’ positive sexual attitudes, but school-based education appears to be key. How sexual education is delivered (e.g., if teachers are knowledgeable and comfortable discussing topics) may be even more important than the content itself. These findings suggest that prioritizing teacher training to improve their comfort with delivery of sexual education programming would improve adolescents and young adults’ sexual lives.

Bullying Victimization and Sexual Wellbeing in Sexually Active Heterosexual, Cisgender and Sexual/Gender Minority Adolescents: The Mediating Role of Emotion Regulation

Bullying victimization is prevalent in adolescence and associated with adverse consequences on physical and psychological wellbeing, paricularly in sexual and gender minority youth. However, little is known about its associations with sexual wellbeing and the underlying mechanisms that could explain this association. The present study assessed the associations between bullying victimization and sexual wellbeing (sexual satisfaction, sexual desire/arousal and orgasmic function difficulties, sexual distress) via the mediating role of emotion regulation difficulties, considering potential sexual/gender minority status-based differences. Self-report online surveys were completed by 1036 sexually active (49.7% were girls) high school students (M_age = 14.6 years, SD_age = 0.6). Bullying victimization was directly and negatively associated with sexual desire/arousal difficulties and positively with sexual distress. Higher emotion regulation difficulties mediated the associations between higher bullying victimization and higher orgasmic function difficulties, as well as higher bullying victimization and higher sexual distress. No significant association was observed between bullying victimization and sexual satisfaction. No significant differences were observed between heterosexual, cisgender and sexual and gender minority youth in any of the associations. The findings suggest that bullying victimization is associated with adolescents' sexual wellbeing. The cross-sectional design and small effect sizes support the need for further prospective cohort studies.

Condom application skills and self-efficacy in youth: A systematic review and meta-analysis

Globally, and in the United States (U.S.) specifically, rates of reported sexually transmitted infections (STIs) have been steadily increasing and are especially high among youth aged 13-25 years. Using condoms correctly and consistently is an effective STI prevention measure for sexually active youth, yet public health endeavors tend to focus only on condom use consistency. Directly measuring condom application is challenging and expensive. Alternative tools evaluate this behaviour, but little evidence exists on the appropriateness of these instruments in measuring application skills. This systematic review and meta-analysis examined the association between condom application skills and self-efficacy. We conducted a search of several databases as well as unpublished works. Studies were included if they were in English, examined youth aged 13-25 years, and were available between 1992 and 2019. The authors screened 630 titles and abstracts for initial inclusion criteria. A full-text review of 30 studies was conducted. The authors included 19 studies in the systematic review and 5 studies were included in the meta-analysis. Both a fixed- and random-effects model (Q = .2321, I2 = 0%) yielded a medium-sized statistically non-significant association (r = 0.217) between skills and self-efficacy. Despite the small sample size, findings suggest that skills and self-efficacy may not be as interchangeable as previously assumed when assessing condom application. Implications for future research are discussed.

Social isolation at adolescence: a systematic review on behaviour related to cocaine, amphetamine and nicotine use in rats and mice

Adolescence is known for its high level of risk-taking, and neurobiological alterations during this period may predispose to psychoactive drug initiation and progression into more severe use patterns. Stress is a risk factor for drug consumption, and post-weaning social isolation increases drug self-administration in rodents. This review aimed to provide an overview of the effects of adolescent social isolation on cocaine, amphetamine and nicotine use-related behaviours, highlighting the specific period when animals were submitted to stress and these drugs. We wondered if there was a specific period during adolescence that isolation stress would increase drug use vulnerability. A total of 323 publications from the Scopus, Web of Science and PubMed (Medline) electronic databases were identified using the words "social isolation" and "adolescence" and "drug" or "cocaine" or "amphetamine" or "nicotine", resulting in 24 articles after analyses criteria following the PRISMA statement. The main points raised were social isolation during adolescence increased cocaine self-administration, amphetamine and nicotine locomotor activity. We did not observe a pattern of a specific moment during the adolescent period that could lead to an increased vulnerability to drug use. The precise conditions under which adolescent social stress alters drug use parameters are complex and likely depend on several factors.