Advancing Adolescent Sexual and Reproductive Health by Promoting Healthy Relationships

Sexual Concurrency Among Adolescent Women With Multiple Partners: A Daily Diary Study

PURPOSE

Sexual partnerships that overlap in some period of time (i.e., concurrent) are a key factor in sexually transmitted infection (STI) transmission. Research examining concurrency among adolescents typically uses person-level, cross-sectional, and/or retrospective data, obscuring factors that manifest on any given occasion of concurrency. We used sexual diaries to examine: (1) daily prevalence of vaginal sex concurrency when two partners are reported by adolescent women; and (2) individual, relational, and behavioral attributes that impact the likelihood of sex with neither partner, with one partner or the other, or with both partners on any given day.

METHODS

Daily diaries were drawn from a large longitudinal cohort study examining sexual relationships, behaviors, and STIs among adolescent women. Participants contributed 280,844 partner-associated diary entries, of which (27.9%; n = 78,356) indicated multiple partners. All two-partner diary entries were retained for analysis (N = 323; Mage = 17.55; 90% African American). Random intercept mixed-effects multinomial logistic regression was used to evaluate the impact of predictor variables on odds of having sex with one or the other, both, or neither partner.

RESULTS

Most two-partner days (93.5%) involved no sex with either partner. Few reports (.2%) indicated same-day sexual concurrency. Older age, greater partner support, and higher sexual interest increased the likelihood of sex with both partners on the same day.

CONCLUSIONS

Individual, relational, and behavioral factors predict concurrency in ways that challenge assumptions that secondary partnerships constitute negligible relationships. Programs targeting partner concurrency in adolescents may find success tailoring messaging around these findings.

Leveraging a relationship-based sexual health framework for sexual risk prevention in adolescent men in the United States

Background Studies link sexual health to lower sexual risk in adolescent women, yet no empirical literature evaluates these associations in adolescent men.

METHODS

Data were drawn from a longitudinal cohort study of sexual relationships and sexual behaviour among adolescent men (n=72; 14-16 years) in the US. Participants contributed quarterly partner-specific interviews, from which sexual health information and partnered sexual behaviours were drawn. A multidimensional measure of sexual health was constructed and linked to partnered outcomes, including oral-genital, vaginal and anal sex, condom use, partner concurrency and intimate partner violence. Random intercept, mixed-effects linear, ordinal logistic or binary logistic regression were for analyses. Models controlled for participant age, race/ethnicity and relationship length.

RESULTS

Adolescent men contributed 651 unique partner-specific interviews. A higher sexual health score with partners was significantly associated with more frequent oral-genital and vaginal sex, as well as higher condom use, lower partner concurrency and lower received and perpetuated intimate partner violence.

CONCLUSION

Positive sexually related experiences in adolescent men contribute to a core of sexual wellbeing, which in turn is linked to lower levels of sexual risk with partners. The present study data support both developmental and public health applications of sexual health, with attention on promoting healthy sexuality as well as risk reduction. Higher sexual health among adolescent men from the US is associated with more frequent condom use, lower partner concurrency and less frequent intimate partner violence. Young men's exercising the skills associated with healthy sexuality may also reinforce the skills needed to both enjoy sexuality with partners and to avoid adverse sexual outcomes.

Peer sexual harassment predicts African American girls’ psychological distress and sexual experimentation

Peer sexual harassment (PSH) occurs frequently and across contexts during adolescence. The current study examined the relations among PSH in school, psychological distress, sexual experimentation, and sexual risk-taking in a sample of African American middle and high school girls. Results indicate that negative body appraisals mediated the relationship between PSH and psychological distress, suggesting that PSH is one way to operationalize interpersonal sexualization and sexual objectification. PSH was directly associated with sexual experimentation, but the association between PSH and sexual experimentation was not mediated by negative body appraisals. Neither PSH nor negative body appraisals were related to sexual risk-taking. This suggests that frequent exposure to high levels of sexualization and sexual objectification, in the form of PSH, is associated with more psychological distress and sexual experimentation, but not with sexual risk-taking, regardless of how girls feel about their bodies.

The Influence of Masculinity on Male Latino Adolescents' Perceptions Regarding Dating Relationships and Dating Violence

In the United States, teen dating violence (TDV) is a concern across ethnic groups. Attitudes and correlates of violence differ by gender, culture, and acculturation. This study used a qualitative interpretive approach. Data were obtained in focus groups with 23 Latino male adolescents. Themes reflected contexts of participants' lives, and definitions and nature of dating relationships and TDV. Participants described the importance of respecting dating partners, the destructive effects of TDV, and the pressure to display masculinity that can lead some young men to perpetrate TDV. These results may advance culturally relevant interventions to promote healthy relationships and prevent dating violence.

Engendering healthy masculinities to prevent sexual violence: Rationale for and design of the Manhood 2.0 trial

Violence against women and girls is an important global health concern. Numerous health organizations highlight engaging men and boys in preventing violence against women as a potentially impactful public health prevention strategy. Adapted from an international setting for use in the US, "Manhood 2.0" is a "gender transformative" program that involves challenging harmful gender and sexuality norms that foster violence against women while promoting bystander intervention (i.e., giving boys skills to interrupt abusive behaviors they witness among peers) to reduce the perpetration of sexual violence (SV) and adolescent relationship abuse (ARA). Manhood 2.0 is being rigorously evaluated in a community-based cluster-randomized trial in 21 lower resource Pittsburgh neighborhoods with 866 adolescent males ages 13-19. The comparison intervention is a job readiness training program which focuses on the skills needed to prepare youth for entering the workforce, including goal setting, accountability, resume building, and interview preparation. This study will provide urgently needed information about the effectiveness of a gender transformative program, which combines healthy sexuality education, gender norms change, and bystander skills to interrupt peers' disrespectful and harmful behaviors to reduce SV/ARA perpetration among adolescent males. In this manuscript, we outline the rationale for and evaluation design of Manhood 2.0. Clinical Trials #: NCT02427061.

Do health promotion messages integrate unintended pregnancy and STI prevention? A content analysis of online information for adolescents and young adults

OBJECTIVE

Recently there have been calls to strengthen integration of unintended pregnancy and sexually transmitted infection (STI) prevention messages, spurred by increasing use of long-acting reversible contraception. To assess the extent to which public health/clinical messages about unintended pregnancy prevention also address STI prevention, we conducted a content analysis of web-based health promotion information for young people.

STUDY DESIGN

Websites identified through a systematic Google search were eligible for inclusion if they were operated by a United States-based organization with a mission related to public health/clinical services and the URL included: 1) original content; 2) about sexual and reproductive health; 3) explicitly for adolescents and/or young adults. Using defined protocols, URLs were screened and content was selected and analyzed thematically.

RESULTS

Many of the 32 eligible websites presented information about pregnancy and STI prevention separately. Concurrent discussion of the two topics was often limited to statements about (1) strategies that can prevent both outcomes (abstinence, condoms only, condoms plus moderately or highly effective contraceptive methods) and (2) contraceptive methods that confer no STI protection. We also identified framing of condom use with moderately or highly effective contraceptive methods for back-up pregnancy prevention but not STI prevention. STI prevention methods in addition to condoms, such as STI/HIV testing, vaccination, or pre-exposure or post-exposure prophylaxis, were typically not addressed with pregnancy prevention information.

CONCLUSIONS

There may be missed opportunities for promoting STI prevention online in the context of increasing awareness of and access to a full range of contraceptive methods.

IMPLICATIONS

Strengthening messages that integrate pregnancy and STI prevention may include: describing STI prevention strategies when noting that birth control methods do not prevent STIs; promoting a full complement of STI prevention strategies; and always connecting condom use to STI prevention, even when promoting condoms for back-up contraception.

The Association Between Sexual Health and Physical, Mental, and Social Health in Adolescent Women

PURPOSE

Developmental models link sexual well-being to physical, mental/emotional, and social well-being, yet little empirical literature evaluates these relationships in adolescents. Better understanding of how and when sexuality complements other aspects of health may yield important points to enhance existing health education and prevention efforts.

METHODS

Data were drawn from a 10-year longitudinal cohort study of sexual relationships and sexual behavior among adolescent women (N = 387; 14-17 years at enrollment). Sexual health data were drawn from quarterly partner-specific interviews and were linked to physical, mental/emotional, and social health information in annual questionnaires. Random intercept, mixed effects linear, ordinal logistic, or binary logistic regression were used to estimate the influence of sexual health on health and well-being outcomes (Stata, v.23, StataCorp, College Station, TX). All models controlled for participant age and race/ethnicity.

RESULTS

Higher sexual health was significantly associated with less frequent nicotine and substance use, lower self-reported depression, lower thrill seeking, higher self-esteem, having fewer friends who use substances, higher religiosity, better social integration, lower frequency of delinquent behavior and crime, and more frequent community group membership. Sexual health was not associated with the number of friends who used cigarettes.

CONCLUSIONS

Positive sexually related experiences in romantic relationships during adolescence may complement physical, mental/emotional, and social health. Addressing specific aspects of healthy sexual development during clinical encounters could dually help primary prevention and health education address other common adolescent health issues.

The Social Environment and Childbearing Expectations: Implications for Strength-Based Sexual Health Interventions for Latino Youth

In the United States, adolescent childbearing is disproportionately higher among Latino youth, a growing population facing substantial social exclusion. Exploring the relationship between the social environment and sexual health outcomes among Latino youth may offer insights into the development of novel interventions. In this study, Latino youth in partnerships were recruited from neighborhood venues in San Francisco and completed in-depth interviews. Youth reported a desire to complete higher education goals prior to starting a family to improve future opportunities and further personal development. Youth stated that social network members, family and partners, were supportive of their individual childbearing expectations. Social environment barriers tied to poverty, immigration status, and gang violence hindered educational attainment. Some differences were noted by gender and immigrant generation. Building on protective social ties and creating avenues in poor, urban neighborhoods for Latino youth to fully access educational opportunities may counter early childbearing and improve sexual health.

Taking Stock of Behavioral Measures of Adolescent Dating Violence

The past 2 decades have witnessed an increase in dating violence awareness and research. As the field evolves, it is critical to examine the definition and measurement of adolescent dating violence. This article summarizes the behavioral measures of adolescent dating violence used in the field. Based on a review of the literature and federally funded studies, we identified 48 different measures. The most commonly used measures were the Conflict Tactics Scale-2, the Safe Dates Scale, and the Conflict in Adolescent Dating Relationship Inventory, which all examine aspects of psychological, physical, and sexual violence. Researchers also adapted or created their own measures. This article concludes with a discussion of developments for consideration as the field moves forward.

Feasibility of functional neuroimaging to understand adolescent women's sexual decision making

PURPOSE

For young women, new sexual experiences normatively increase after puberty and coincide with extensive changes to brain regions governing self-regulation of risk behavior. These neurodevelopmental changes could leave some young women vulnerable for negative sexual outcomes, including sexually transmitted infection and unintended pregnancy. We evaluated the feasibility of using functional neuroimaging to understand the sexual decision making of adolescent women.

METHODS

Adolescent women (N = 14; 14-15 years) completed enrollment interviews, a neuroimaging task gauging neural activation to appetitive stimuli, and 30 days of prospective diaries following the scan characterizing daily affect and sexual behaviors. Descriptive and inferential statistics assessed the association between imaging and behavioral data.

RESULTS

Young women were highly compliant with neuroimaging and diary protocol. Neural activity in a cognitive-affective network, including prefrontal and anterior cingulate regions, was significantly greater during low-risk decisions. Compared with other decisions, high-risk sexual decisions elicited greater activity in the anterior cingulate, and low-risk sexual decision elicited greater activity in regions of the visual cortex. Young women's sexual decision ratings were linked to their sexual history characteristics and daily self-reports of sexual emotions and behaviors.

CONCLUSIONS

It is feasible to recruit and retain a cohort of female participants to perform a functional magnetic resonance imaging task focused on making decisions about sex, on the basis of varying levels of hypothetical sexual risk, and to complete longitudinal prospective diaries following this task. Preliminary evidence suggests that risk level differentially impacts brain activity related to sexual decision making in these women, which may be related to past and future sexual behaviors.

Trust - that's a big one: intimate partnership values among urban Latino youth

Romantic relationships play a central role in young people's social development and sexual health. This paper examines romantic relationship ideals valued by urban Latino youth in San Francisco and their experiences in achieving their ideals in their current relationship. We draw on in-depth interviews with 33 young men and women aged 16-22 years in San Francisco, California. In spite of, or perhaps related to, the prevailing perception that their peers were unfaithful in their relationships, young people in this study identified trust as one of the most important characteristics of a romantic relationship. Trust was related not only to fidelity, but also vulnerability and emotional intimacy. Understanding valued relationship ideals and factors that facilitate and impede their attainment is critical in promoting healthy relationships.