Addressing sexual health behaviour during emerging adulthood: a critical review of the literature

Risk Factors for Non-Consensual Sexting Among Adolescents and Emerging Adults: An Extension of the Routine Activity Theory Perspective

Adolescence and emerging adulthood are developmental phases in which the exploration of one's own sexuality takes on a high priority, which can increase the risk of risky sexual behavior. Due to technological advances, (non-consensual) sexting has increased among young people and has become an integral part of their sexual socialization. Therefore, the main objective of this study was to examine non-consensual sexting (both victimization and perpetration) among adolescents and emerging adults and to identify potential risk factors associated with non-consensual sexting using routine activity theory. The sample consisted of a total of 3514 adolescents aged 10-17 years (43% males; 57% females) and 3674 emerging adults aged 18-25 years (23% males; 77% females) from Bosnia and Herzegovina and Croatia. The results showed that both male adolescents and emerging adults were at higher risk for experiencing non-consensual sexting victimization. Personal factors such as gender, age, social bond, and routine cell phone activity predicted the risk of becoming a victim of non-consensual sexting in adolescents. For emerging adults, gender, social connection to friends, and routine cell phone use predicted the risk of becoming a victim of non-consensual sexting. Relationship status and routine cell phone activity predicted the forwarding of other sexts for both age groups. According to international scientific research and the findings of this particular study, we can conclude that the study of personal factors and routine variables helps understand non-consensual sexting among youth but is also essential in planning educational resources and preventive activities.

Need for Sexual, Reproductive, and Mental Health Promotion Among Diverse College Students in a COVID-19 Era

In 2020, the COVID-19 pandemic forced unprecedented disruptions in higher education operations. While the adverse mental health effects experienced by college students due to these changes are well documented, less is known about the impact on their sexual and reproductive health (SRH), and the reciprocal relationships between SRH and mental health among adolescents and emerging adults. This position paper reviews existing literature on the effects of the COVID-19 pandemic on SRH, sexual violence, unintended pregnancy, sexually transmitted illness and human immunodeficiency virus rates and highlights issues specific to college-aged males, females, racial/ethnic and sexual minorities, and individuals with disabilities. The need to conceptualize SRH as an integral component of normal development, overall health, and well-being in the context of COVID-19 is discussed. The need to prioritize the design and implementation of developmentally appropriate, evidence-based SRH interventions specifically targeting college students is identified. Furthermore, an intergenerational approach to SRH that includes parents/caregivers and/or college faculty and staff (e.g., coaches, trainers) could facilitate comprehensive SRH prevention programming that enhances sexual violence prevention training programs currently mandated by many colleges. Policies and programs designed to mitigate adverse pandemic-related exacerbations in negative SRH outcomes are urgently needed and should be included in mainstream clinical psychology, not only focused on preventing unwanted outcomes but also in promoting rewarding interpersonal relationships and overall well-being. Recommendations for clinical psychologists and mental health researchers are made.

Increasing reproductive health services through Family PACT participation among California community college student health centers

OBJECTIVE

Community college students engage in more risky sexual behavior compared to their four-year counterparts, yet have access to fewer reproductive health services. The study's purpose was to examine whether California Community College student health centers' participation in Family PACT, a state publicly-funded family planning program, increased reproductive health services to community colleges students.

PARTICIPANTS

California community college student health centers.

METHODS

Bivariate analyses of student health centers with and without Family PACT participation and qualitative analysis of five participating campuses.

RESULTS

Among the 60 colleges in the study, 25 student health centers participated in the Family PACT program. Family PACT campuses reported greater provision of sexual and reproductive health services and higher levels of staffing and revenue.

CONCLUSIONS

Key benefits of Family PACT participation among community colleges include expansion of sexual and reproductive health services to an underserved population and increased student health centers' financial sustainability.

'Taking Care': A qualitative study of emerging adult-aged women's sexual and reproductive health definitions

OBJECTIVE

Emerging adult-aged (EA;18-25 years) women have disproportionately high rates of unintended pregnancy and sexually transmitted infections compared to other women of reproductive age. Little is known about how EA women define and prioritize various aspects of sexual and reproductive health. The purpose of this study was to identify EA women determined definitions of sexual and reproductive health.

METHODS

Between September 2019 and September 2020, 13 women were interviewed about their sexual and reproductive health. Interview transcripts were used to conduct qualitative content analysis.

RESULTS

Definitions provided by participants were grouped according to three distinct thematic categories, Being Safe, Healthcare as a Tool, and Mind-Body Connection. Being Safe included using condoms and taking steps to prevent sexually transmitted infections. Healthcare as a Tool referred to utilization of healthcare services (e.g., an annual exam) to manage sexual and reproductive health. Mind-Body Connection included acknowledgement of both the physical and mental aspects of sexual and reproductive health, as well as awareness of physical and emotional discomfort related to it. These categories highlight EA women's holistic definitions of sexual and reproductive health.

CONCLUSIONS

Healthcare providers and researchers can use the holistic sexual and reproductive health definitions endorsed by EA women in this study as a starting point for creating and delivering sexual and reproductive healthcare and counseling that is developmentally appropriate and sensitive to population-specific needs.

Sexual Subjectivity in Solo and Partnered Masturbation Experiences Among Emerging Adult Women

This qualitative study aimed to examine the experiences and attitudes toward masturbation among emerging adult women. The study was the first to compare women's solo and partnered masturbation experiences, focusing on how feelings of pleasure, sexual desire, and a sense of empowerment-important markers of women's sexual subjectivity-varied across the two contexts. The sample consisted of 40 women between the ages of 18 and 22 years. The majority of participants identified as Latina (33%) or Black (30%) and were enrolled in community college. Semi-structured interviews about women's masturbation experiences were analyzed using thematic analysis. Women described a multitude of feelings, including pleasure but also awkwardness and guilt. Although women did not describe their masturbation practices as morally wrong, they often alluded to disliking masturbation and preferring it less to partnered sex. Whereas some attitudes and feelings (e.g., awkwardness) arose in the context of both solo and partnered masturbation encounters, others were prevalent only in one (e.g., guilt in the solo encounters). Feelings of pleasure, sexual desire, and empowerment manifested differently in the two contexts. There was more focus on self-knowledge, control, and physical pleasure in the solo encounters and more enjoyment of a partner's desire and intimacy in the partnered encounters. We examine the findings through a feminist lens and consider how race/ethnicity, sexual scripts, and contemporary societal contexts shape women's sexual lives.

Relationship of sexual quality of life and mental well-being in undergraduate women in a Canadian university

As young women transition from adolescence to adulthood, they begin to explore their sexual identities and sexual relationships. The current literature supports the relationship between sexual quality of life (QOL) and mental well-being. However, this relationship has not yet been replicated in undergraduate women. In order to address this gap, the authors assessed the correlation between sexual QOL and mental well-being among a sample of women undergraduate students in Canada. The study design was cross-sectional in nature, and demographic information was collected, along with the completion of validated measures of sexual QOL and mental well-being. A total of 157 individuals participated. After removing those who did not meet inclusion criteria and those with > 90% incomplete responses, 124 valid survey responses remained for analysis. A hierarchical multivariable linear regression was conducted while controlling for age, sexual orientation, exercise, history of nonconsensual sexual contact, household income, and self-perceived health status. Every one-unit increase in sexual QOL was associated with a 0.35 increase in mental well-being (95% CI 0.105–0.428, p = .002). A history of unwanted or nonconsensual sexual activity had a significant negative correlation with mental well-being ( p = .027). The authors’ findings suggest a significant relationship between sexual QOL and mental well-being. There is a strong opportunity for universities to bolster the support services available to students, with a required focus on women with a history of nonconsensual sexual contact.

College Student Experiences Regarding the Impact of the COVID-19 Pandemic on Their Sexual Lives

The COVID 19 pandemic has impacted sexual health in a variety of ways. The purpose of this research was to examine the ways in which college students (attending a university providing primarily online curriculum during fall 2020 and spring 2021 semesters) perceive the pandemic influencing their sexual health and lives. Participants were undergraduate students (N = 66) at a mid-sized Western university recruited during the beginning of the spring 2021 semester. Participants completed an anonymous online survey. A Thematic Analysis of responses to two open-ended questions asking about the impact of the COVID-19 pandemic on their sexual health and lives was conducted. Several important themes were identified during this analysis: (1) Sexual activity and quality, (2) Relationship dynamics, (3) Self-focus, (4) New partners, (5) Sexual healthcare, (6) No change. Findings have implications for promoting sexual health for students during times when the majority of instruction is conducted online.

Pilot Randomized Trial of an Expressive Writing Intervention to Reduce Sexual HIV-Transmission Risk and Substance Use Among Emerging Adult Gay and Bisexual Men

This pilot randomized controlled trial evaluated the feasibility, acceptability, and preliminary efficacy of expressive writing to reduce HIV-related sexual risk taking and symptoms of drug dependence among emerging adult gay and bisexual men (EAGBM) through linguistic mechanisms involving use of words associated with cognitive processing (e.g., think, cause), positive emotion (e.g., love, nice), and negative emotion (e.g., hurt, shame). Between 2014 and 2015, EAGBM (n = 78; aged 18-29) completed a baseline survey and were randomized to complete three 15-min expressive writing or equivalent control-group writing sessions and follow-up assessments 2 months post-baseline. EAGBM in the expressive writing condition utilized significantly more positive emotion, negative emotion, and cognitive processing words. Path model results indicated the intervention condition resulted in significant reductions in symptoms of drug dependence and frequency of condomless anal sex (CAS) through paths mediated by positive emotion words, and significant increases in CAS through a path mediated by negative emotion words.

Trends and disparities in urinary BPA concentrations among U.S. emerging adults

BACKGROUND

Emerging adulthood (ages 18-25 years) is a key turning point in the life course characterized by particularly poor eating behaviors (e.g., low in fruits and vegetables, and high in fast food) and weight gain. Emerging adults are also prime consumers of personal care and other consumer products that may result in differential exposures to environmental contaminants, such as Bisphenol A (BPA), compared to adults aged 26+ years. This is of concern given BPA has been associated with adverse health outcomes such as obesity, metabolic disorders, miscarriage, infertility and breast cancer. However, no research has examined exposure to BPA among emerging adults.

OBJECTIVE

To assess trends of exposure to urinary BPA among a representative sample of emerging adults compared to adults aged 26+ years. Secondarily, we aimed to identify differential associations between BPA concentrations and sociodemographic characteristics and BMI by age group.

METHODS

This study uses National Health and Examination Surveys (NHANES) over 2003-2014 to test differences in BPA concentrations comparing emerging adults to adults aged 26+ years. Generalized linear models predicting log BPA by age group and sex, race/ethnicity, education, income, and food security status, and generalized linear models predicting BMI by log BPA, both age group and age as a continuous variable, sex, race/ethnicity, education, income, and food security status were conducted. Interactions with age group (i.e., age group x sex) were examined for the mutually adjusted models. All models controlled for survey year, month, and time of day, and were run with, and without, an adjustment for urinary creatinine.

RESULTS

In models adjusted, and not adjusted, for urinary creatinine, emerging adults had a higher log BPA concentration than adults aged 26+ years (β=0.153, p=0.004; β=0.544, p<0.001), and a significantly steeper decline in BPA concentration between 2003-2004 and 2013-2014 than adults aged 26+ years (ß=-0.051, p=0.002; ß=-0.071, p=0.001). Males' log BPA concentration were lower than that for females when urinary creatinine was included in the model, and higher when urinary creatinine was excluded from the model (ß=-0.188, p<0.001; β=0.203, p<0.001). Higher income was significantly associated with lower log BPA concentration (ß=-0.220, p<0.001; ß=-0.166, p<0.001). A significant interaction between emerging adult age group and food security status was observed, which was associated with higher BPA exposures. Log BPA concentration was associated with BMI only when urinary creatinine was excluded from the models (urinary creatinine included: β=0.031, p=0.747; β=0.022, p=0.815, urinary creatinine excluded: β=0.528, p<0.001; β=0.552, p<0.001).

CONCLUSION

Findings indicate that emerging adults had higher BPA exposures than adults aged 26+ years in 2003-2004, and that emerging adults' exposure level has decreased faster than that of adults aged 26+ years. There were suggestions that the BPA concentration of emerging adults in 2013-2014 was lower than that for adults aged 26+ years, and that BPA exposure is associated with higher BMI. Our results highlight the need for additional research to identify the sources and routes of exposure to BPA and BPA replacements among emerging adults and to better characterize the variability in exposure. Intervention studies are needed to assist emerging adults in limiting their exposure to BPA, and potentially also the BPA alternatives.

University Students' Self-Rated Health and Use of Health Services: A Secondary Analysis

BACKGROUND

University students belonging to various ethnic groups have specific health needs that influence their self-rated health and health service use.

PURPOSE

To examine which determinants of health serve as key predictors of self-rated health and health service use in a sample of ethnically diverse undergraduate students.

METHODS

Data were abstracted from the 2012 Maritime Undergraduate Student Sexual Health Services Survey (N = 10,512). Logistic regression was used to explore the predictors of self-rated health and use of university-based health services according to ethnicity.

RESULTS

Social support (Caucasian: odds ratio (OR) = 1.018; 95% confidence interval (CI) [1.008, 1.028]; African: OR = 1.890; 95% CI [1.022, 1.160]; Other: OR = 1.096; 95% CI [1.023, 1.175]), and depression risk (Caucasian: OR = .899; 95% CI [.844, .914]; Indigenous: OR = .904; 95% CI [.844, .969]; Asian: OR = .894; 95% CI [.839, .953]; Multiracial: OR = .892; 95% CI [.812, .980]) were the most frequent predictors of self-rated health across the different ethnic groups; while year of study (Caucasian: OR = 1.855; 95% CI [1.764, 1.952]; African: OR = 2.979; 95% CI [2.068, 4.291]; Indigenous OR = 1.828; 95% CI [1.371, 2.436]; Asian: OR = 1.457; 95% CI [1.818, 1.797]; Middle Eastern: OR = 1.602; 95% CI [1.088, 2.359]; Other: OR = 1.485; 95% CI [1.093, 2.018]; Multiracial: OR = 2.064; 95% CI [1.533, 2.778]) was found to be the most significant predictor of health service use.

CONCLUSION

Findings from this research shed light on the various factors that impact university students belonging to different ethnic groups, their health, and their access to healthcare that addresses their distinct health needs. Nurses can advocate for the development of health promotion and illness prevention strategies that target the needs of the diverse student population.

Family Religiosity, Parental Monitoring, and Emerging Adults’ Sexual Behavior

The processes through which families play a role in the religious and sexual socialization of children are varied and complex. Few studies have considered the impact of parental or family religiosity on young people’s sexual behaviors, either directly or through influence on adolescents’ own religiosity. This study of college students at a large, public university in the mid-Atlantic uses multidimensional measures to examine the relationships among family religiosity, parental monitoring during adolescence, students’ religiosity, and students’ specific sexual behaviors. Results suggest that greater family religiosity is associated with a decreased likelihood of engaging in certain sex acts, but for students who do engage, family religiosity is not associated with any differences in the timing of sexual onset or in the numbers of partners with whom students engaged. Results also suggest that parental monitoring may mediate the relationship between family religiosity and some sexual risk behavior. Greater individual religiosity is associated with a lower likelihood of having engaged in any sexual activity, and a higher likelihood of condom use for students who have had vaginal sex. This study offers valuable insights into the role that religiosity, at both the family and the individual level, plays in college students’ sexual behavior.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Public health nursing and the issue of trust in campus sexual assault

Public Health Nurses are the largest group of public health practitioners in both local and state health departments across the United States. Essential for the delivery of health services in the community, Public Health Nurses frequently provide care for underserved and vulnerable populations. Among these populations are the victims of campus sexual assault, a growing problem on college and university campuses. Both nationally and internationally, sexual assault has been described as a public health and human rights concern. With the signing of the Senate Bill 967 in California, affirmative consent, known as "yes means yes," requires both parties in a sexual encounter to give voluntary and affirmative consent. Many colleges and universities across the country have adopted similar standards. However, students may choose not to seek health care after an assault at the Student Health Center, preferring to obtain care in community clinics or health departments. Students must be able to be safe on and off campus, and must be able to trust they will be heard by campus authorities and the health care community, and be treated with respect. Public health nurses need to be prepared to work with victims of campus sexual assault and have a solid foundation in the issues surrounding assault, and the needs of the student to trust their caregivers. This paper presents an overview of the vulnerability and risk factors in sexual assault, presents legislation on campus and institutional responsibility, and provides a foundation for Public Health Nurses working with victims of sexual assault.

Anxiety and depression strongly associated with sexual risk behaviors among networks of young men in Dar es Salaam, Tanzania

This study tested the association between mental health scores and sexual risk behaviors among male members of social groups known as "camps" in Dar es Salaam, Tanzania. Anxiety and depression were measured using the HSCL-25 and condom use and sexual partner concurrency were assessed through self-report. A total of 1113 sexually active men with an average age of 27 years were included in the analyses. Higher anxiety and depression scores were significantly associated with both condom use (Anxiety AOR = 0.58, 95% CI: 0.44, 0.77; Depression AOR = 0.60, 95% CI: 0.47, 0.77) and concurrency (Anxiety AOR = 2.32, 95% CI: 1.73, 3.12; Depression AOR = 2.08, 95% CI: 1.60, 2.70). The results of this study provide information salient to the development of effective HIV prevention interventions targeting populations with high burdens of anxiety and depression. The feasibility and effect of integrating mental health promotion activities into HIV prevention interventions should be explored.