Sexual education, gender ideology, and youth sexual empowerment

Effectiveness of a Comprehensive School-Based Sex Education Program for Young Adolescents in the Netherlands

Most sexual education programs traditionally focused on providing sexual information regarding the risks of sex. However, current studies on sexual behavior in youth show a need for truly comprehensive sex education approaches with a sex-positive focus on sexuality, that effectively improve sexual competence. Therefore, in the current study the effectiveness of "Love is…", a four lesson school-based program based on the Sexual Interactional Competence model and Attitude-Social-Influence-Self-Efficacy-model was studied. A cluster-randomized controlled trial on the effectiveness of "Love is…" was conducted in 2018-2020. The sample consisted of 1160 adolescents in grades 8 and 9 from nine schools in the Netherlands. The sample was 48% female, 34% Dutch/Caucasian, 41% none-religious and 50% higher educated. They were randomized at class level into a program group [n = 32 classes; 567 students (Mage = 13.74 (SD = 0.74))] and a control group [n = 31 classes; 593 students (Mage = 13.86 (SD = 0.73))]. Results showed that "Love is…" increased sexual knowledge, that adolescents in the program group showed less cyber victim blaming attitudes and increased in communications skills after the program. In conclusion, the current study shows that "Love is…" was effective not only on the knowledge level, but also regarding sexual attitudes and competences. However, due to the developmental process of sexuality, there is a necessity to continue lessons in following grades through booster sessions by reinforcing competences as communicating comfortably about sexuality.On 12 November 2019 the study design and hypotheses were registered in the Dutch Trial Registration, number NL8150. ( https://onderzoekmetmensen.nl/nl/trial/26676 ).

Attitudes toward Help-Seeking for Sexual Problems among College Women

Prior research has indicated that 65-70% of college age women have experienced at least one sexual problem. Sexual problems are associated with higher rates of depression, anxiety, and relationship distress; however, few college age women seek professional help for sexual difficulties. The present study used the Theory of Planned Behavior to explore how adherence to traditional feminine norms and self-stigma are associated with intention to seek professional psychological help for a sexual difficulty. Results of structural equation modeling analysis demonstrated approximate fit in a sample of 259 college women. The structural model indicated that self-stigma and stronger endorsement of specific feminine gender norms (i.e., romantic relationship, sexual fidelity, sweet and nice) were found to be associated with less intention to seek help for a sexual problem. We discuss future research directions and implications for clinical services.

What shapes attitudes on gender roles among adolescents in Bangladesh

Background

In Bangladesh, large gender differentials exist in outcomes in almost all spheres of life, stemming from conservative norms and attitudes around gender. Adolescence is a crucial period for social-emotional learning that can shape gender norms and attitudes.

Objective

The aim of the paper is to investigate the extent to which adolescents hold egalitarian attitudes toward gender roles, and to examine the factors that influence egalitarian gender attitudes.

Methods

The paper uses data from a nationally representative sample survey of 7,800 unmarried girls and 5,523 unmarried boys ages 15–19 years. Adolescents were considered to have egalitarian attitudes on gender role if they disagreed with all the following four unequal gender role statements with regards to socio-economic participation, while respondents who agreed with any one of the four statements were considered to have non-egalitarian attitudes: (1) It is important that sons have more education than daughters, (2) Outdoor games are only for boys, not girls, (3) Household chores are for women only, not for men, even if the woman works outside the home, and (4) Women should not be allowed to work outside the home. Multivariable linear probability regression analysis was implemented to identify the factors shaping attitudes on gender roles.

Results

Unmarried girls and boys differ hugely in their views on gender roles regarding socio economic participation-girls were much more egalitarian than boys (58 vs. 19%). The multivariate linear probability model results show girls and boys who completed at least grade 10 were 31% points and 15% points more likely to have egalitarian views on gender roles respectively, compared to girls and boys with primary or less education. Having strong connection with parents is associated with having egalitarian views on gender roles among girls but not boys. Adolescents' individual attitude on gender role is highly associated with the views of their community peers for both girls and boys. Girls and boys who had participated in adolescent programs were 6–7% points more likely to have egalitarian attitude than those who were not exposed to these programs. Egalitarian views were also significantly higher, by 5% points among girls and 6% points among boys, who were members of social organizations compared to those who were not. Watching television had positive influence on egalitarian attitudes among girls but not among boys. To create a more egalitarian society, both men and women need to hold progressive attitudes toward gender roles. The interventions must be multilevel, influencing adolescents at the personal, interpersonal, communal, and societal levels.

Influence of Selected Sociodemographic and Cultural Factors on the Age of Sexual Initiation of Students from Polish Universities

Sexuality is the one of the most important parts of human life. The aim of our study was to identify the factors influencing the onset and age of sexual initiation in students and drawing attention to the need to improve access to sexual education in Polish schools at a sufficiently high level. An original questionnaire with 31 questions was used for the study. Data were collected using the Google Forms tool. A total of 7528 students participated in the study and 5824 underwent sexual initiation. The mean age at sexual initiation was 18.1 years. Logistic regression analysis was performed to show factors influencing the onset of sexual activity, while linear regression analysis was used for factors influencing the age of sexual initiation. Religion, drug use, smoking, alcohol consumption, type of housing, and conversations with parents about contraception or sex affect the onset of sexual activity. The age of sexual initiation is affected by religion, the age of the first viewing of pornography, quality of life, the size of the city of residence, smoking and drug use.

Is empowerment in sexual health measurable? A scoping review of definitions and measurement indicators

The concept of empowerment in sexual health is widely used in health promotion. This scoping review aims to identify how it is defined and measured. PubMed, Sage Journals, PsycInfo and the Web of Science are data sources. The inclusion criteria for studies were as follows: (1) an analysis of empowerment in sexual health, (2) quantitative evaluation and (3) publication in a peer-reviewed journal in French or English since January 1996. Data were extracted using a summary table of the definitions and indicators of empowerment in sexual health. Of the 2181 articles found, 29 met the inclusion criteria. Only 4 studies on 29 clearly defined empowerment in sexual health. Five dimensions emerged from the indicators used in the 29 studies in relation to sexual empowerment (social participation, participation in decision making, power to act, sexual health knowledge and gender norms), with two types of indicators: indicators unspecific to sexual health, which can be viewed as empowerment basic skills, and indicators specific to sexual health. Most studies concerned women and focused on individual empowerment, with a lack of measure of collective and structural levels of empowerment. Despite great heterogeneity in the definitions and indicators used, a set of core indicators emerged: participation in decision making, sexual negotiation power and sexual communication skills, knowledge and use of contraceptive methods, and HIV and sexually transmitted infections risk perception. This set could be systematically used in each study based on sexual empowerment concept, completed by supplementary indicators considering the specific context.

A structural equation modeling of reproductive health promoting behaviors among female adolescents in the Philippines

AIMS

Integrated reproductive health promoting behaviors, including safe sexual intercourse, preventing sexually transmitted diseases, sexual responsibility, and genital health management, are essential for adolescents in developing countries. The Philippines is currently facing several reproductive health threats. The aim of this study was to identify factors affecting reproductive health promoting behaviors based on a theoretical model using structural equation modeling.

METHODS

In this cross-sectional study and a structural equation modeling, a total of 227 female adolescents in the Philippines participated in a self-reported questionnaire survey.

RESULTS

The results indicated that reproductive health knowledge (β = .14, p = .033), attitudes regarding reproductive health behaviors (β = .31, p = .027), and reproductive health self-efficacy (β = .31, p = .002) influenced participants' reproductive health promoting behaviors. Social norms (β = .31, p = .021) influenced reproductive health self-efficacy and indirectly influenced reproductive health promoting behaviors. Attitude toward gender roles (β = .20, p = .020) was associated with reproductive health knowledge.

CONCLUSIONS

This study confirmed the direct effect of reproductive health knowledge, attitudes regarding reproductive behaviors, and reproductive health self-efficacy, as well as the indirect effect of social norms, on reproductive health promoting behaviors using structural equation modeling.

Integrating Sexual Pleasure for Quality & Inclusive Comprehensive Sexuality Education

The lack of inclusion of sexual pleasure in comprehensive sexuality education (CSE) could be detrimental to sexual development, misses opportunities for inclusive education, and may have a long-term impact on sexual well-being. The WAS' Declaration on Sexual Pleasure provides the opportunity to advocate for pleasure as an indispensable part of CSE. Specifically, the inclusion of pleasure in CSE will positively impact six outcomes: traditional risk-reduction, cultivating healthy relationships, celebration of sexual diversity, exercise of sexual rights, empowerment, and consent, and prevention of gender-based sexual violence. Messages of sexual pleasure are crucial for sexuality education to be comprehensive, effective, and inclusive.

Attitudes of three generations of women toward gender roles

PURPOSE

This study was conducted to investigate the attitudes of three generations of women regarding gender roles.

DESIGNS AND METHODS

In this study, 58 female students, their mothers, and grandmothers participated. Percentages and means, χ² test, Kruskal Wallis test, and multiple regression analysis were used to analyze the data.

FINDINGS

The findings obtained in this study showed that 91.5% of the students, 89.8% of the mothers, and 84.6% of the grandmothers had an egalitarian attitude regarding gender roles. The egalitarian attitudes of students were affected onefold by the attitudes of mothers, whereas grandmothers' attitudes affected the attitudes of students 1.1 times. These two variables explain 48% of the status of having egalitarian attitudes of the students.

PRACTICAL IMPLICATIONS

Students had more traditional attitudes regarding gender roles than their mothers and grandmothers.

Talking to Others About Sexual Assault: A Narrative Analysis of Survivors' Journeys

Previous research suggested the benefits for sexual assault survivors to talk about their trauma and its mental health implications, but it remained unclear what steps sexual assault survivors need to take to be able to have these conversations. To address this gap in the literature, this study aims to explore the journeys of sexual assault survivors with the use of narrative interviews to retain the richness of the data. This study reports the findings of a narrative analysis of the accounts of six female sexual assault survivors aged between 20 and 38. The analysis provides an individual case profile for each participant, the core aspects and tone of each narrative, and a cross-case analysis. The cross-case analysis reveals an overarching theme of "the bumpy journey" within which the individual difficulties encountered are examined. The analysis also reveals the two main factors that motivated the participant to strive to make a difference for other sexual violence survivors and to improve their mental health through talking about their experiences. The implications for services providing continuous and long-term support to sexual assault survivors and clinical practices are discussed.

How does health reproduction education based on gender equality influence knowledge, attitudes, and self-efficacy in adolescents?

Adolescents experience biological and psychological maturity which is characterized by attraction toward the opposite sex and begin experimenting about sexual activity. Culture places men higher than women forming negative views about the functions, roles and positions of women. The purpose of this study was to determine the effect of gender equality-based reproductive health education on improving knowledge, attitudes, and self-efficacy in adolescent girls and boys. The research was a quasi-experimental study using a nonequivalent pretest and posttest with a control group design. This research was conducted in two schools from August 2018 until April 2019. Schools were determined based on preliminary studies with predetermined criteria, School A as the intervention and School B for the control was done without randomization. The purposive sampling method was used to select 135 students. The data were analyzed by paired t-tests and Mann-Whitney tests. After the reproductive health education based on gender equality, the difference in scores between the pretest and posttest in the intervention group compared with the control group in adolescent boys did not show improvement with Knowledge value -0.09 vs -0.5, p=0.878, Attitude value -2.61 vs -1.79, p=0.713, and Self-efficacy value -3.54 vs 2.88, p=0.067. For the adolescent girls the comparison of the scores of the intervention group actually tended to decrease at the posttest while the control group tended to increase, except in the aspect of knowledge with Knowledge value 1.06 vs -0.34, p=0.006, attitude value -6.78 vs 0.91, p=0.000, and self-efficacy value -5.06 vs 1.94, p=0.015. The reproductive health education based on gender equality was only able to increase knowledge in adolescent girls only.

Egalitarian Values and Sexual Behavior-The Role of Country Level Values in Shaping Individual Level Behaviors in Africa, South America and Asia

Objective The aim of this study is to investigate the relationship between country level egalitarian values (broadly speaking emancipatory values/structural gender equality) and sexual behavior among youth. Methods: Comparative individual level data on sexual activity and condom use were collected from the Global School-based Student Health Survey, resulting in a final sample of 23 countries, analyzed utilizing multilevel logistic regression analysis. Results: Egalitarian values were significantly associated with sexual activity and condom use. Conclusions: Egalitarian values have a relationship with adolescents' sexual activity and condom use, and thus contribute to sexual health and well-being in Africa, South America and Asia.

Primary School Teachers' Perspective of Sexual Education in Spain. A Qualitative Study

Sexual education is a part of the teaching-learning process that addresses cognitive, psychological, physical and social aspects of sexuality. The purpose of sexual education is to provide people with knowledge, abilities, attitudes and values that will help them to have good sexual health, well-being and dignity. The objective of this study was to explore the perspective of primary school teachers regarding Sexual Education in school. A descriptive qualitative study was designed based on content thematic analysis. Fifteen open-ended interviews with primary school teachers were carried out, followed by inductive data analysis using ATLAS.ti software. Two key themes emerged from the analysis: "In search of a comprehensive approach to Sexual Education" and "Barriers to Sexual Education in schools: From the lack of training to fear of the families". We conclude that despite the efforts to implement a comprehensive approach to Sexual Education that recognises sexuality as a right, primary school teachers face difficulties in delivering Sexual Education in schools due to a lack of training and the fear that parents will reject their children being spoken to about sexuality.

Recovering from an Epidemic of Teen Pregnancy: The Role of Rural Faith Leaders in Building Community Resilience

This study explores the role of faith leaders and congregations in preventing teen pregnancy and enhancing overall health. Seventeen faith-based leaders responded to an invitation to participate. Participants were recruited from two counties within Oklahoma, based on desired community characteristics. Findings were directly related to: (1) the vulnerability of rural communities to negative health outcomes; (2) resiliency of rural faith communities to address health issues; and (3) the adaptive capacity of rural faith leaders and their communities to decrease teen pregnancy and maximize community health. Culturally relevant public health programming is necessary to engage this at risk population; however, it requires engaging faith leaders in efforts to build congregation-based and community-based capacity.

Understanding Adolescents' Attitudes Toward Affirmative Consent

A clear understanding of sexual consent is important for sexual violence prevention. To date, most research has focused on how college students understand and negotiate consent. Although adolescence is a critical period for the development of sexual attitudes, identity, and intimate relationships, the perspectives of high school-aged youth have been largely absent from the consent literature. The current study investigated adolescents' attitudes toward affirmative consent in a sample of 226 high school students (58% female; 46% White, 24% Black, 25% Hispanic) from the southeastern U.S., as well as associations between affirmative consent attitudes and gender, gender role beliefs, and sexual activity status. Additionally, we tested whether gender role beliefs were a mediator between gender and affirmative consent attitudes. Overall, adolescents reported supportive attitudes toward affirmative consent. On average, girls and adolescents with more egalitarian gender role beliefs had more positive attitudes toward affirmative consent than boys and those with less egalitarian gender role beliefs, though no differences by sexual activity status were found. Gender role beliefs mediated the relationship between gender and attitudes toward affirmative consent. The results suggest that adolescents are generally supportive of affirmative consent practices, although some important group differences emerged.

An Exploration of Factors That Influence Enactment of Affirmative Consent Behaviors

Affirmative sexual consent, which is ongoing, continuous, and clearly communicated, appears to be highly inconsistent with the way in which individuals actually negotiate their sexual interactions. The current qualitative research proposes an Information-Motivation-Behavioral Skills (IMB) model of sexual consent behavior and elicits, from young, sexually active informants, elements of information, motivation, and behavioral skills that appear to be necessary for engaging in affirmative consent behaviors. Eleven focus groups were conducted (N = 48 participants), which were semi-structured and guided by questions to tap into information, motivation, and behavioral skills aspects of ascertaining and expressing affirmative sexual consent. Two themes related to Information emerged from the data: (1) consent should be verbal, clear, and ongoing, and (2) consent should be natural and free-flowing. Two themes related to motivation were discussed: (1) affirmative consent is awkward, and (2) explicitly asking for consent can be good, but ascertaining consent indirectly is more comfortable. One theme related to behavioral skills was discussed: (1) social and personal factors influence how easy or hard it is to explicitly discuss consent to sexual activity. Understanding factors that influence affirmative sexual consent is an essential step toward developing interventions to promote consensual sexual interactions and explicit sexual communication.

'It is our duty:' Understanding Parents' Perspectives on Reproductive and Sexual Health Education

South Carolina ranks 16^th in the USA for highest rates of teenage pregnancy. The South Carolina Comprehensive Health Education Act (CHEA) does not require medically accurate, unbiased, culturally appropriate materials, and varies greatly in compliance and implementation. This study aimed to better understand parents' perspectives in one county in South Carolina regarding reproductive and sexual health education. A total of 484 parents responded to a qualitative questionnaire, collectively representing 798 students. Researchers conducted a thematic analysis to organise data. Main themes identified include comprehensive reproductive and sexual health education as a duty; dispelling the myth of abstinence-only education; and the value of comprehensive reproductive and sexual health education. Parents described teaching reproductive sexual health education in public schools as a 'duty.' Furthermore, parents rejected the idea that abstinence-only education is effective and believed reproductive and sexual health education should be taught without the influence of religion. Parents valued inclusive reproductive and sexual health education, covering a robust set of topics. Findings from the study provide evidence for the need to update current reproductive and sexual health education materials and legislation to meet parental demands and reduce youth sexual and reproductive health disparities.

How men and women learn about sex: multi-generational perspectives on insufficient preparedness and prevailing gender norms in Scotland

Attitudes towards sexual health and relationships are learned from a young age, and there is an ongoing need for innovative and comprehensive approaches to sex education that keep pace with rapidly changing contexts of people's lives. We used thematic analysis of data from two qualitative studies in Scotland to explore learning contexts from a multi-generational perspective, as well as the influence of different socio-cultural factors on provision, access to and experience of sex education. The importance, but inadequacy, of school as a source of learning, was a persistent theme over time. Participants' strategies to address perceived gaps in knowledge included experience, conversations, vicarious and online learning. Gender and age differences emerged, with younger participants more likely to go online for information, and prevailing gender norms shaping attitudes and behaviours across both study groups. Participants who identified as gay, lesbian or bisexual described feeling particularly unprepared for sex and relationships due to the narrow, heteronormative content received. Although schools continue to be a common source of information, it appears that they fail to equip young people for their post-school sexual life-course. We recommend the mandatory provision of comprehensive, positive, inclusive and skills-based learning to improve people's chances of forming and building healthy, positive relationships across the lifespan.

Health care providers' perceptions of family planning and contraception education for adolescents in Kampala, Uganda - A qualitative study

OBJECTIVES

Unsafe abortions are a reproductive health problem in low-income countries, but can be prevented by decreasing unintended pregnancies. The objective was to describe health care providers' (HCPs) perceptions of family planning and contraception education for adolescents in Kampala, Uganda.

STUDY DESIGN

A qualitative study with a semi-structured interview guide was used for individual face-to-face interviews. Eight participants from two different Non-governmental organisations were interviewed. Qualitative content analysis was used to analyse the data.

RESULTS

Data analysis resulted in three main categories of HCP perceptions: counseling, education and availability; peer-educators and community leaders; and stigma, inequality and myths. The providers emphasized the importance to discuss and eradicate the myths and misconceptions among adolescents regarding family planning methods by giving information, preferably at early ages. Peer-educators and community leaders were the most successful methods for accessing and involving the community. Approaches mentioned for reaching out to adolescents included involving parents, using social media, and offering education in schools. Furthermore, the providers highlighted to involve the males in family planning.

CONCLUSIONS

Health care providers emphasized the importance to discuss and eradicate the myths and misconceptions among adolescents regarding different family planning methods by education in school and information in sexual and reproductive health.

Affirmative sexual consent? Direct and unambiguous consent is rarely included in discussions of recent sexual interactions

Sexual activity typically follows an implicit sexual script or a normative sequence of behaviours that are involved in a sexual interaction. It is unclear whether or how affirmative sexual consent is incorporated in individual sexual scripts and interactions. The current research explores how sexual consent may be expressed and verified as part of individuals’ sexual interactions. Undergraduate participants from an Ontario university ( N = 92; 58 males, 34 females) completed a series of open-ended questions that asked them to describe their sexual experiences with a new and long-term partner from beginning to end. Analysis of presence of consent-related behaviours in participants’ accounts were assessed on the basis of a priori themes and extensions of these themes. Thematic analyses identified the following themes: 1) Sex proceeding with escalating intensity of nonverbal sexual behaviour, 2) Passive behaviours that do not indicate unwillingness to have sex, 3) Indirect verbal communication of interest in sex, 4) Indications that sex “just happened,” 5) Descriptions of the context in which sex occurred, and 6) Direct discussions relevant to sexual consent. Results indicated that direct discussion of sexual consent was exceedingly rare and that most sexual interactions included indirect, veiled, and coded behaviours that require inference of sexual consent or non-consent. Consent-related themes varied as a function of both participant gender (male versus female) and nature of relationship (new versus long-term). The findings of this study have implications for sexual health education, sexual assault prevention interventions, and public policy development.

Sexism and sexual risk behavior in adolescents: Gender differences

Background/Objective: This study examines whether there are differences in the maintenance of ambivalent sexist beliefs on the basis of gender and sexual experience in adolescents. The study also investigates whether the sexist beliefs themselves are linked to sexual risk behaviors. Method: A representative sample of 2,703 Spanish adolescents was carried out in public and private secondary schools, with an age range of 14 to 20 years old (M = 15.89; SD = 1.29). Results: Males maintain more hostile, benevolent and ambivalent sexist beliefs compared to females. Sexual experience (both coital and non-coital) is linked to a greater degree of hostile and benevolent sexist beliefs, but only within the male group. In males, greater benevolent sexism is linked to vaginal sex initiation at an earlier age, while greater hostile sexism is linked to a lower proportion of condom use. In females, greater hostile sexism is linked to a greater number of sex partners. Conclusions: It is necessary to include specific actions on sexist beliefs in programs for the prevention of sexually transmitted infections and HIV.

Interventions to reduce risk for sexually transmitted infections in adolescents: A meta-analysis of trials, 2008-2016

BACKGROUND

Numerous studies have evaluated the efficacy of interventions to reduce risk for sexually transmitted infections in adolescents in recent years, but their global effects remain unknown since 2008, the last date of a comprehensive review of prior studies.

AIMS

This study aims at evaluating the efficacy of interventions to promote sexual health, reduce STIs and unplanned pregnancies targeted to adolescents available after 2008; and analyzing the moderators of their global efficacy.

METHODS

We searched electronic databases and manual searches of some journals focused on STIs in May 2016. The studies evaluated the efficacy of interventions to reduce sexual risk in adolescents (age range: 11-19) anywhere in the world. Effect size of the relevant outcomes for sexual risk was calculated for every study. Analyses incorporated random-effect assumptions for each outcome. The homogeneity in the results was examined with the I2 statistic and its associated 95% confident interval.

RESULTS

Data from 63 studies (59,795 participants) were analyzed for behavioral and non-behavioral outcomes. In the short term, interventions had a positive impact in sexual health-related knowledge (Hedges'g = 1.01), attitudes (g = 0.29), self-efficacy toward condom use (g = 0.22), intention to refuse sex (g = 0.56), condom use intention (g = 0.46), and condom use (g = 0.38). In the medium term, positive effects observed at the short-term were maintained, although effect size significantly decreased in all variables. In the long term, interventions improved condom use (g = 0.47). Moderators of the efficacy are discussed.

CONCLUSIONS

Sexual health promotion interventions are effective to promote sexual health through increasing condom use. Effects on non-behavioral variables tend to decrease over time, while condom use increased in the long-term. Interventions should focus on the long-term efficacy, especially in behavioral and biological measures.

Which girls, which boys? The intersectional risk for depression by race and ethnicity, and gender in the U.S

We sought to conduct the first systematic review of studies applying an intersectional lens to assessing risk and protective factors for depression in minority adolescents in the United States. Twenty-five studies were identified which investigated the role of racial and ethnic identity and gender for minority groups and how marginalization may be associated with differential outcomes in depression symptomology. The results showed substantial variability in whether studies intentionally operationalized intersectionality through theoretical frameworks, study design, sampling, and analyses. Studies were rated on a scale of 1 through 5; those with scores of 3 or higher were included in the review. A rating of 5 indicated studies had explicitly used an intersectional theoretical framework, integrating the process of racial/ethnic identity development and gender socialization during adolescence. Three studies met the criteria for 5, one study was rated 4, and 21 studies were rated 3. Attention to experiences with discrimination was common throughout. Overall, the collective findings point to the importance of using an intersectional lens for understanding differential mechanisms for how and why specific adolescent minority youth are at greater risk for reporting depression symptoms, identifying cultural and developmental protective factors, and informing how interventions can effectively target specific mechanisms for prevention and treatment.

A Narrative Engagement Framework to Understand HPV Vaccination Among Latina and Vietnamese Women in a Planned Parenthood Setting

Disparities in cervical cancer and human papillomavirus (HPV) vaccination persist among Vietnamese and Latina women. Through a partnership with Planned Parenthood of Orange and San Bernardino Counties (PPOSBC) in Southern California, we conducted in-depth interviews with young adult Latina ( n = 24) and Vietnamese ( n = 24) women, and PPOSBC staff ( n = 2). We purposively sampled vaccinated women to elicit HPV vaccine decision narratives to uncover rich data on motivators, cultural values, and implicit vaccine attitudes. Unvaccinated women were interviewed to identify barriers. Women were also asked to discuss their observations of men's HPV vaccine attitudes. Narrative engagement theory guided the study privileging the meaning women ascribed to their experiences and conversations related to vaccine decision making. Vaccine decision narratives included (a) mother-daughter narratives, (b) practitioner recommendation of HPV vaccination, (c) independence narratives among Vietnamese women, (d) HPV (un)awareness narratives, and (d) school exposure to HPV knowledge. Barriers to vaccinating included trust in partner HPV status, and family silence and stigma about sexual health. Participants conveyed the importance of including messages aimed at reaching men. Practitioners described insurance barriers to offering same day vaccination at PPOSBC health center visits. Narrative communication theory and methodology address health equity by privileging how Vietnamese and Latina women ascribe meaning to their lived experiences and conversations about HPV vaccination. Identifying authentic and relatable vaccine decision narratives will be necessary to effectively engage Vietnamese and Latina women. These findings will guide the process of adapting an existing National Cancer Institute research-tested HPV vaccine intervention.

Understanding Factors that Shape Gender Attitudes in Early Adolescence Globally: A Mixed-Methods Systematic Review

Background

Early adolescence (ages 10–14) is a period of increased expectations for boys and girls to adhere to socially constructed and often stereotypical norms that perpetuate gender inequalities. The endorsement of such gender norms is closely linked to poor adolescent sexual and reproductive and other health-related outcomes yet little is known about the factors that influence young adolescents’ personal gender attitudes.

Objectives

To explore factors that shape gender attitudes in early adolescence across different cultural settings globally.

Methods

A mixed-methods systematic review was conducted of the peer-reviewed literature in 12 databases from 1984–2014. Four reviewers screened the titles and abstracts of articles and reviewed full text articles in duplicate. Data extraction and quality assessments were conducted using standardized templates by study design. Thematic analysis was used to synthesize quantitative and qualitative data organized by the social-ecological framework (individual, interpersonal and community/societal-level factors influencing gender attitudes).

Results

Eighty-two studies (46 quantitative, 31 qualitative, 5 mixed-methods) spanning 29 countries were included. Ninety percent of studies were from North America or Western Europe. The review findings indicate that young adolescents, across cultural settings, commonly express stereotypical or inequitable gender attitudes, and such attitudes appear to vary by individual sociodemographic characteristics (sex, race/ethnicity and immigration, social class, and age). Findings highlight that interpersonal influences (family and peers) are central influences on young adolescents’ construction of gender attitudes, and these gender socialization processes differ for boys and girls. The role of community factors (e.g. media) is less clear though there is some evidence that schools may reinforce stereotypical gender attitudes among young adolescents.

Conclusions

The findings from this review suggest that young adolescents in different cultural settings commonly endorse norms that perpetuate gender inequalities, and that parents and peers are especially central in shaping such attitudes. Programs to promote equitable gender attitudes thus need to move beyond a focus on individuals to target their interpersonal relationships and wider social environments. Such programs need to start early and be tailored to the unique needs of sub-populations of boys and girls. Longitudinal studies, particularly from low-and middle-income countries, are needed to better understand how gender attitudes unfold in adolescence and to identify the key points for intervention.

The Complexities of Sexual Consent Among College Students: A Conceptual and Empirical Review

Headlines publicize controversies about sexual assault among college students, and universities face pressure to revise their sexual consent policies. What can the social science literature contribute to this discussion? In this article, we briefly discuss reasons for the recent upsurge in attention to these issues, the prevalence of sexual assault among college students, and aspects of college life that increase the risk of sexual assault and complicate sexual consent. We then review the conceptual challenges of defining sexual consent and the empirical research on how young people navigate sexual consent in their daily lives, focusing primarily on studies of U.S. and Canadian students. Integrating these conceptual issues and research findings, we discuss implications for consent policies, and we present five principles that could be useful for thinking about consent. Finally, we discuss some of the limitations of the existing research and suggest directions for future research.

The Relationship Between Endorsement of the Sexual Double Standard and Sexual Cognitions and Emotions

Sexual gender norms promoting sexual prowess for men, but sexual modesty for women have been shown to negatively affect sexual and mental health in both men and women. Knowledge about the relationship between gender norms and sexual cognitions and emotions might further the understanding of continued gender-norm conformity. In the present study, we investigated whether and how gendered sexual attitudes are related to (positive and negative) sex-related emotions, via sexual cognitions (autonomy, body esteem, and approach/avoidance motives for sex). A survey was submitted to 293 heterosexually identified, sexually active, Dutch (central and southern regions) 18–25 year-olds. Results from a moderated mediation model (using structural equation modeling) revealed that women, but not men, who more strongly endorsed traditional gender-related sexual attitudes experienced significantly less positive and more negative emotions, as a result of decreased sexual autonomy and sexual body esteem as well as increased avoidance motives for sex. We conclude that, as a result of negative cognitions associated with the endorsement of traditional gender norms, women in particular are at risk of experiencing negative emotional outcomes in the sexual context. We argue that sexual cognitions and emotions deserve explicit attention in sex-positive and gender-transformative sexuality education, which has been proven to be a vital resource for achieving increased gender-equity in sexual and romantic relationships.

"Enjoy Your Sexuality, but Do it in Secret": Exploring Undergraduate Women's Reports of Friends' Sexual Communications

In the current study I used mixed methods to explore the messages that undergraduate women (n = 415) reported receiving from their male and female friends regarding sex and romantic relationships. Reports of friends' messages varied widely and entailed both support for and criticism of sexual gatekeeping and sex positivity (e.g., sexual agency) and advice regarding sex and romantic relationships. Four individuals, including the author, developed codes to examine this wide range of responses to sexual expectations and prohibitions and independently and reliably coded the data. Response patterns illustrate that reports of female friends' messages were typically longer and more nuanced than reports of male friends' messages. Sex-positive messages and sexual gatekeeping messages were frequently reported simultaneously, and this pattern of co-occurrence illustrates the tensions between diverse discourses regarding women's sexuality. The diversity in reports of friends' messages challenges popular notions that friends' influences are wholly problematic and highlights a need for more gender-focused sex education curricula.

Unsafe sexual behaviour in domestic and foreign migrant male workers in multinational workplaces in Jordan: occupational-based and behavioural assessment survey

OBJECTIVES

To examine the prevalence of unsafe sexual behaviour, sexually transmitted infection (STI)-related knowledge, health and work-related conditions, and correlates of practising unsafe sex among domestic and foreign male workers in multinational workplaces in Jordan.

DESIGN

Cross-sectional behavioural assessment survey.

SETTING

Multinational workplaces in Jordan.

PARTICIPANTS

230 Jordanian and 480 foreign male workers aged ≥ 18 years who had worked in a Qualified Industrial Zone (QIZ) for 12 months or more.

OUTCOMES

The primary outcome was the prevalence of practising unsafe sex. 'Unsafe sex' was defined as sex with a non-regular sexual partner with inconsistent condom usage.

RESULTS

Overall, 74.3% of workers reported lifetime sexual experience. The proportion of lifetime unsafe sex was similar among domestic (31.8%) and foreign (35.6%) workers. Of those, 59.2% of domestic and 68.1% of foreign workers started practising unsafe sex after joining the QIZ. Rates of lifetime unsafe sex were significantly higher among those who had their sexual debut after joining the QIZ in domestic (aOR, 2.2, 95% CI 1.1 to 4.4) and foreign workers (aOR, 2.4, 95% CI 1.4 to 4.1). Among the domestic workers, being 18-24 years old (aOR, 4.9), unmarried (aOR, 4.8), working in the QIZ for 5-8 years (aOR, 5.0), sometimes/frequently shopped with foreign workers (aOR, 2.1) or were current/ex-alcohol drinkers (aORs, 3.4) were independently significantly associated with higher odds of practising unsafe sex.

CONCLUSIONS

A significant proportion of domestic and foreign male workers had been practising unsafe sex. The findings indicated that not only foreigners but also domestic male workers associating with foreign workers are at high risk of unsafe sex. Tailored interventions to promote safer sex in multinational workplaces in Jordan are needed.

Invited commentary: broadening the evidence for adolescent sexual and reproductive health and education in the United States

Scientific research has made major contributions to adolescent health by providing insights into factors that influence it and by defining ways to improve it. However, US adolescent sexual and reproductive health policies-particularly sexuality health education policies and programs-have not benefited from the full scope of scientific understanding. From 1998 to 2009, federal funding for sexuality education focused almost exclusively on ineffective and scientifically inaccurate abstinence-only-until-marriage (AOUM) programs. Since 2010, the largest source of federal funding for sexual health education has been the "tier 1" funding of the Office of Adolescent Health's Teen Pregnancy Prevention Initiative. To be eligible for such funds, public and private entities must choose from a list of 35 programs that have been designated as "evidence-based" interventions (EBIs), determined based on their effectiveness at preventing teen pregnancies, reducing sexually transmitted infections, or reducing rates of sexual risk behaviors (i.e., sexual activity, contraceptive use, or number of partners). Although the transition from primarily AOUM to EBI is important progress, this definition of evidence is narrow and ignores factors known to play key roles in adolescent sexual and reproductive health. Important bodies of evidence are not treated as part of the essential evidence base, including research on lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) youth; gender; and economic inequalities and health. These bodies of evidence underscore the need for sexual health education to approach adolescent sexuality holistically, to be inclusive of all youth, and to address and mitigate the impact of structural inequities. We provide recommendations to improve US sexual health education and to strengthen the translation of science into programs and policy.