Developing an Inclusive Model of Young Heterosexual and Sexual Minority Women's Sexual Decision-Making.

Efforts to improve sexual health outcomes among young cisgender women require in-depth understanding of how women with diverse sexual identities make decisions about their sexual health. We conducted semi-structured interviews with 31 young cisgender women with diverse sexual identities and histories (age range 18-29 (M = 23.32); 81% White; 29% bisexual, 26% heterosexual, 16% lesbian, 13% queer, 10% pansexual, 3% gay, 3% demisexual) about their decision-making surrounding sexual risk reduction. By conducting thematic analysis, we found that, regardless of partner sex or gender, women adapted sexual health strategies based on how much commitment, trust, and communication existed in their relationships. Because heteronormative structural influences limited access to information and safer sex options, women had to rely on trust and communication more with other women and partners with vaginas, compared to men and partners with penises. Women did not consider safer sex strategies with partners with vaginas (e.g. hand washing) risk-reduction techniques; instead, they considered them general hygiene or a way to take care of a partner. We propose that an inclusive model of young women's sexual decision-making should: (a) highlight the influence of relationships; (b) frame prevention in terms of overall health instead of pregnancy and STIs; and (c) acknowledge that structural factors, such as heteronormativity and sex-negativity, constrain women's decisions.

Queering Cisgender LGB+ Women's Sexual Health Scripts.

The invisibility of lesbian, gay, and bisexual (LGB+) women in sexual health research is of particular concern when it comes to understanding and supporting their sexual health practices. We conducted a qualitative secondary analysis of sexual health decision-making interviews among 22 LGB+ cisgender women who ranged in age from 20 to 26 (M = 23.1 years, SD = 1.8 years). Participants were mostly bisexual (n = 9), White (n = 13), and all reported at least some college education. Results showed that LGB+ women both reify and push against heteronormativity in their sexual partnerships. By queering definitions of "sex" beyond heterosexual intercourse, leaning into trust as a foundation of new sexual partnerships, and promoting accessible and realistic hygienic strategies for STI prevention, LGB+ women queer, or reimagine, new sexual scripts. These results highlight the need for relationship and sexual health scholars to direct focus toward the promotion of holistic sexual and relationship education and research which reflects LGB+ women's various sexual desires, goals and needs. Understanding LGB+ women's sexual scripts and health outcomes will ensure that this population continues to be validated and supported by clinicians, researchers, and educators.

Dating and friendships in adolescence: Variation across same-sex and other-sex romantic partners.

This research examined associations between dating and number of friends for rural adolescents with same-sex and other-sex dating partners using longitudinal sociometric data (N = 2826; 55% female, 87% White, mean age = 14 at baseline). In multilevel models assessing within-person change, boys gained female friends when they were in same-sex romantic relationships, compared to when they were single. In contrast, girls in same-sex relationships lost female friends and gained male friends. Adolescents in other-sex romantic relationships gained same-sex friends compared to when they were single. Results advance understanding of adolescent social and sexual development, suggesting that sexual minority adolescents find allies when dating but may struggle to maintain same-sex friendships.

Religiosity, sexual behaviors, sexual motivations, and gender: A three-year longitudinal study.

Longitudinal data are critical for examining associations of religiosity with sexual behaviors and motivations during college. We use hierarchical linear modeling on five semesters of data from a diverse sample of college students (N = 735) to examine within- and between-person associations between religious service attendance and importance of religion and sexual behaviors and motivations for and against sex and consider gender as a moderator. Between-person religiosity was associated with sexual behaviors and motivations whereas within-person religiosity was not. Students' sexual motivations co-varied across semesters with their religious service attendance and importance of religion. Our results indicated more restrictive associations between religiosity and sexual motivations for women than for men.

Talking to My Partners About PrEP: Factors Associated with PrEP-Related Communication in a Longitudinal US Study of Sexual Minority Men Living with HIV.

Treatment as prevention and pre-exposure prophylaxis (PrEP) have reduced HIV transmission among sexual minority men (SMM). However, little is known about PrEP-related communication in serodiscordant partnerships. In 2015-2016, 965 US SMM living with HIV (Mage = 39; 63% White, 19% Black, 18% Latinx) enrolled in a year-long longitudinal study with surveys every 3 months (2,850 surveys). Multilevel models explored factors associated with PrEP-related communication with HIV-negative partners. Most participants (77%) reported PrEP-related communication. Participants were more likely to discuss PrEP during periods with more sexual partners, AOR = 2.89, p < .001, and group sex, AOR = 1.99, p = .001. Those with more partners on average, ß = 0.48, p < .001, and those engaging in other drug use more frequently, ß = 0.11, p = .002, were more likely to discuss PrEP. PrEP-related communication was more common for men who disclosed their HIV status, ß = 0.22, p < .001, and who had undetectable viral loads, ß = 0.25, p = .007. Communication was also more common for those with higher incomes, ß = 0.12, p = .02, and from larger cities, ß = 0.07, p = .048, and less common for Black participants, ß = - 0.29, p = .003, and older participants, ß = - 0.18, p < .001. PrEP-related communication increased over the course of the study, AOR = 1.16, p= .02. PrEP can confer additional HIV prevention benefits within serodiscordant partnerships, and future research should continue to explore the role PrEP plays in these partnerships.

Prospective Associations Between Pornography Viewing and Sexual Aggression Among Adolescents.

Adolescence is a critical period for sexuality development; this study examined prospective associations between pornography use and sexual aggression using a longitudinal study of middle and high school students surveyed five times across 3 years (mean age = 13.7 years at baseline; 53.2% female; 76.5% White; 21.0% Native American; 88.9% heterosexual). Across waves, 15.7%-29.0% of adolescents had viewed pornography in the past 6 months. Results indicated significant, reciprocal associations between pornography and sexual harassment perpetration that were stronger for male adolescents, and some significant associations between pornography use and subsequent sexual assault perpetration. Findings underscore the need to consider multiple theories of the link between pornography viewing and aggression and need for media literacy sexual education beginning in middle school.

Adolescent Sexual Development: A Family Perspective.

Adolescent sexual development is informed by individual, relational, generational, institutional, and cultural perspectives. Families matter: they are the social institution at the intersection of adolescent development and broader social systems, charged with the responsibility for rearing children and adolescents to adulthood. This narrative review maps insights from family theory and research onto adolescent sexual development research. Our purpose is to inform sexuality researchers from diverse fields about how family perspectives can enrich understanding of adolescent sexual development. We present the critical, intersectional theoretical framework guiding this review as consisting of three meta-themes for understanding families through an examination of family structure, process, and context. Then, we apply those meta-themes to current research on adolescent sexual development by selectively organizing our review around the contexts of family structural diversity and family relational complexity, demonstrating that both the structure and the process components are embedded within the intersectional and cultural contexts that shape and are shaped by families. Our review demonstrates that diverse, intersectional family structures and transitions may affect adolescent sexual development by influencing family processes, particularly around sexual communication. We conclude with implications of using family perspectives for future inquiry related to adolescent sexual development.

Short-Term Consequences of Sex: Contextual Predictors and Change Across College.

Although sexual experiences are normative by young adulthood, individuals continue to explore and develop their sexual behaviors and cognitions across the college years. Thus, perceived consequences of sexual experiences may change. Similarly, characteristics of sexual experiences such as partner type, alcohol use, and sexual behavior type predict perceived consequences, and these associations may change over time. In this study, we addressed links between characteristics of sexual experiences (casual vs. committed partner, heavy alcohol use on sex days, and kissing/touching only vs. oral/penetrative sex) and short-term perceived consequences of sexual experiences (physical satisfaction, emotional intimacy, not satisfied, guilt, not ready), using daily data collected longitudinally across seven college semesters. We also examined whether perceived consequences of sex change across college and whether within-person daily associations between sexual experience characteristics and perceived consequences of sex change across college. An ethnically and racially diverse sample of traditionally aged first year university students (N = 566; 54% female; 98% heterosexual) completed online surveys, yielding 8,838 daily reports about sexual behaviors. Multilevel models indicated that partner type, heavy alcohol use, and sexual behavior type predicted within-person differences in perceived consequences of sex. Interactions between characteristics of sexual experiences and college semester indicated that differences in perceived consequences of sexual experiences with casual versus committed partners lessened over time. The likelihood of reporting physical satisfaction and guilt after only kissing/touching (but not oral/penetrative sex) decreased across college semesters. Findings inform understanding of normative sexual development by demonstrating that perceived consequences and their predictors change across time.

Emotional Outcomes of Casual Sexual Relationships and Experiences: A Systematic Review.

Casual sexual relationships and experiences (CSREs) are common and emotionally significant occurrences. Given the uncommitted, often emotionally complicated nature of CSREs, researchers have asked whether these experiences may have positive and/or negative emotional consequences. We reviewed 71 quantitative articles examining emotional outcomes of CSREs, including subjective emotional reactions (e.g., excitement, regret) and emotional health (e.g., depression, self-esteem). Overall, people evaluated their CSREs more positively than negatively. In contrast, CSREs were associated with short-term declines in emotional health in most studies examining changes in emotional health within a year of CSRE involvement. Emotional outcomes of CSREs differed across people and situations. Women and individuals with less permissive attitudes toward CSREs experienced worse emotional outcomes of CSREs. Alcohol use prior to CSREs, not being sexually satisfied, and not knowing a partner well were also associated with worse emotional outcomes. These findings suggest directions for prevention/intervention related to CSREs. For example, skill-building related to sexual decision-making may help individuals decide whether, and under what circumstances, CSREs are likely to result in positive or negative emotional outcomes. In addition, the limitations of extant research suggest directions for future inquiry (e.g., examining whether verbal and nonverbal consent practices predict emotional outcomes of CSREs).

Tailored HIV Pre-exposure Prophylaxis (PrEP) Intervention Needs from a Latent Class Analysis Among U.S. Healthcare Providers.

Interventions are needed to expand HIV pre-exposure prophylaxis (PrEP) prescribing practices among healthcare providers, but research classifying providers to determine tailored intervention needs is lacking. Providers reported demographics, factors related to HIV treatment and prevention experience, and PrEP-related factors such as knowledge and community protection beliefs via online survey. Latent class analysis grouped providers with similar patterns of HIV prevention- and treatment-related care and tested for associations with demographics and PrEP-related factors. Three distinct classes of providers emerged: (1) PrEP naïve, (2) PrEP aware, and (3) PrEP prescribers. Providers with lower community protection beliefs and staff capacity were more likely to be classified as PrEP naïve compared to aware (ps < 0.05). Providers with concerns about PrEP-related tasks and staff capacity were more likely to be classified as PrEP aware compared to prescribers (ps < 0.05). PrEP-naïve providers could benefit from continuing education, whereas PrEP-aware providers might benefit from capacity building and prescribing optimization interventions.

RESUMEN: Se necesitan intervenciones para expandir los hábitos de prescripción de la profilaxis de pre-exposición al VIH (PrEP) entre los proveedores de atención médica, pero faltan investigaciones que categoricen a los proveedores para identificar necesidades que requieran intervención personalizada. A través de una encuesta en línea, proveedores de salud reportaron sus datos demográficos, los factores relacionados con la experiencia en el tratamiento y la prevención del VIH y los factores relacionados con la PrEP, como el conocimiento y las creencias de protección de la comunidad. Se aplicó un análisis de clases latentes para agrupar a los proveedores con patrones similares de atención de la prevención y el tratamiento del VIH y se evaluó la asociación de estos con factores demográficos y factores relacionados con la PrEP. Surgieron tres clases de proveedores: (1) ingenuos de la PrEP, (2) conscientes de la PrEP y (3) prescriptores de la PrEP. Los proveedores con creencias de protección de la comunidad y capacidad del personal más bajos tuvieron más probabilidad de ser clasificados como ingenuos de la PrEP en comparación con los proveedores conscientes de la PrEP (ps <0.05). Los proveedores con preocupaciones sobre las tareas relacionadas con la PrEP y la capacidad del personal tuvieron mas probabilidad de ser clasificados como conscientes de la PrEP en comparación con los prescriptores de la PrEP (ps <0.05). Los proveedores ingenuos de la PrEP podrían beneficiarse de la educación continua, mientras que los proveedores conscientes de la PrEP podrían beneficiarse de intervenciones para el desarrollo de capacidades y optimización de los hábitos de prescripción.

Developing an inclusive Safe Dates program for sexual and gender minority adolescents: A pilot study.

INTRODUCTION: Despite the prevalence and negative consequences of dating violence among sexual and gender minority (SGM) adolescents, few prevention programs address dating violence for these groups. We describe the adaptation of the evidence-based Safe Dates dating violence prevention program to be inclusive of SGM adolescents and the outcome of a pilot trial of the expanded curriculum implemented in mixed settings serving both SGM and cisgender, heterosexual youth. METHODS: Following a published framework of curriculum adaptation, we gathered information on SGM adolescents' needs and adapted Safe Dates materials to address SGM-specific risk factors for, and manifestations of, dating violence. We piloted the adapted program in 11 US schools and organizations serving SGM and cisgender, heterosexual youth (N = 156). The average age of participants was 15.11 years (SD = 2.76) at baseline. Participants were diverse with respect to race/ethnicity (26% Black/African American, 24% Hispanic/Latino, 21% White, 7% American Indian/Native Alaskan, 5% Asian/Pacific Islander), gender (56% female), and SGM status (35% SGM). Multi-level models measured change in scores on a written measure of dating violence knowledge from pre-test to post-test. RESULTS: Dating violence knowledge increased significantly. Improvements did not differ by gender (female-identified versus not female-identified) or SGM status. CONCLUSIONS: Results support initial feasibility and efficacy of dating violence prevention programs that include both SGM and cisgender, heterosexual adolescents. The program normalizes diverse SGM identities and encourages participation of youth who are questioning or choosing not to disclose their gender or sexual identities. Larger-scale research should examine effects on dating violence experiences.

Fraternity Membership, Traditional Masculinity Ideologies, and Impersonal Sex: Selection and Socialization Effects.

Fraternity culture perpetuates traditional masculinity ideologies, but little research has considered the process by which men internalize these ideologies. Men may select into fraternities based on preexisting ideologies, or fraternities may have a socializing effect on ideologies. We used two longitudinal datasets to explore selection and socialization effects of fraternity membership on masculinity ideologies (gendered beliefs, gendered traits, and sexual double standard beliefs) and impersonal sex (sexual motives and multiple sex partners) among ethnically and racially diverse college men. Using dataset one (n = 166, M = 18.0 years old fall of first year), we explored the selection and socialization effects of fraternity membership on male role norms, masculine traits, and endorsement of the sexual double standard. Men who more strongly endorsed male role norms about status and the sexual double standard were more likely to join fraternities than other men, indicating selection effects. Using dataset two (n = 256, M = 18.5 years old fall of first year), we explored selection and socialization effects of fraternity membership on sex motives and multiple sex partners. We did not find much evidence for selection or socialization effects on sex motives and multiple sex partners. Our findings may inform intervention efforts for men before and during college.

Peer Acceptance and Sexual Behaviors from Adolescence to Young Adulthood.

Well-liked adolescents are more likely than their peers to engage in sexual behaviors, which may place them at higher risk of negative outcomes such as sexually transmitted infections and unwanted pregnancy. Yet, little is known regarding whether peer acceptance in adolescence predicts sexual outcomes in young adulthood. Understanding developmental links between peer acceptance and sexual outcomes will inform theories of how peers affect health and can help identify targets for health promotion efforts. Using longitudinal sociometric data from 1878 participants in the PROSPER study (54% female, 82% White, mean age = 11.79 at baseline), the present research examined the association of adolescent peer acceptance, reported annually from grades 6-11, with adolescent and young adult sexual outcomes. Well-liked adolescents were more likely to have sexual intercourse by age 16. At age 19, well-liked individuals were more likely to have had sexual intercourse but were less likely to be diagnosed with a sexually transmitted infection. For boys but not girls, peer acceptance was linked to having more past year sexual partners in young adulthood. Adolescent peer acceptance was not associated with other young adult sexual outcomes, such as sex without a condom or casual sex. Overall, well-liked adolescents demonstrated healthy sexual development into young adulthood, despite a higher likelihood of sexual initiation early in adolescence. Findings demonstrate the importance of peer acceptance for healthy development into young adulthood and suggest that well-liked adolescents may be appropriate targets for peer-led sexual health education programs.

Gender Attitudes, Sexual Risk, Intimate Partner Violence, and Coercive Sex Among Adolescent Gang Members.

PURPOSE: Adolescent gang members are at greater risk of poor sexual health outcomes than nongang members. Gang members' beliefs about gender may explain variation in their sexual health outcomes. The purpose of this study was to examine how gangs' and gang members' beliefs about gender are associated with sexual health outcomes, including sexual risk-taking, intimate partner violence, and coercive sex. METHODS: Gang members (N = 281; 46% female; 73% black/African American, 25% Hispanic/Latino, 4% white, age = 14-19 years) from 32 gangs completed surveys. Multilevel models assessed how gang norms and individuals' beliefs about women/girls as romantic partners, gang members, and sexual partners were associated with sexual risk-taking, intimate partner violence, and coercive sex (forced sex and gang rape). RESULTS: Gangs and individual gang members who held more equitable beliefs about girls' role as gang members were at increased risk of experiencing several negative outcomes, including intimate partner violence victimization and perpetration, forced sex victimization, and gang rape victimization. These associations were stronger for gangs with a higher ratio of male members to female members. In contrast, equitable beliefs about women/girls as romantic and sexual partners were protective against intimate partner violence and coercive sex victimization and perpetration. CONCLUSION: Interventions that address gender beliefs among gang members may improve intimate partner violence and coercive sex. These programs may be most effective if they aim to improve equity in sexual and romantic relationships, rather than focusing on respect for female gang members.

Changes in Diverse Sexual and Contraceptive Behaviors Across College.

Researchers have made repeated calls for a better understanding of normative sexuality development during adolescence and young adulthood. We examined how the occurrence of seven penetrative, nonpenetrative, and contraceptive behaviors changed longitudinally across seven waves, and how individual (gender) and contextual (romantic relationship status) factors related to these changes in a sample of college students (N = 730, M age = 18.4 at Semester 1; 51% female; 26% Hispanic/Latino American, 22% Black/African American, 30% Asian American/Pacific Islander, 45% White/European American). Across college, reported kissing, touching, performing and receiving oral sex, and penetrative sex rates increased, and contraception use (any type) and condom use (in particular) rates decreased, demonstrating changes with age independent of young adults' romantic relationship experiences. Rates of all sexual behaviors were higher, and of contraception use lower, when students were in serious romantic relationships. Contraception use decreased more for men than for women, particularly in semesters men were not in serious relationships. Condom use decreased for men, and for women in semesters they were in serious relationships. Findings demonstrate normative trends in sexuality development, as well as suggesting the value of enhanced sexual health promotion programming, with a particular focus on contraceptive behaviors, across college.

Sources of Social Influence on Adolescents' Alcohol Use.

The present research examines social influences on self-reported frequency of drunkenness in a longitudinal sample of 1,439 adolescents (46% female, 90% White, mean age = 14 at baseline) with social network measures from friends, romantic partners, and romantic partners' friends. We build on past research by addressing multiple mechanisms of social influence-peers' frequency of drunkenness, alcohol-related attitudes, and unstructured socializing-across relationship types. Adolescents' drunkenness frequency increased when their friends' and partners' friends' drunkenness frequency increased and when their romantic partners' positive alcohol-related attitudes increased. Furthermore, the association between unstructured socializing and frequency of drunkenness was stronger for older than younger adolescents. Results advance understanding of the social transmission of alcohol use in adolescence and inform intervention efforts.

The Association Between Sexual Behavior and Affect: Moderating Factors in Young Women.

Sexual behavior is associated with increased positive affect and decreased negative affect. However, contextual variables such as partner type, behavior type, and condom use may moderate these associations. The goal of the present research was to examine these contextual moderators using monthly longitudinal data from a sample of young women. Female first-year college students (N = 477) completed monthly assessments of their sexual behaviors and positive and negative affect. Participants reported more negative affect in months in which they engaged in sexual behavior compared to months in which they did not. This association was moderated by partner type, such that only sexual behavior with casual partners was associated with increased negative affect. Participants reported more positive affect during months with kissing/touching only compared to months without sexual behavior; however, this association did not differ significantly from the association between oral/vaginal sex and positive affect. Condom use did not moderate the association between vaginal sex and positive or negative affect. In this sample of young women transitioning to college, engaging in sexual behavior was generally associated with negative affect; however, changes in affect depended on partner type and sexual behaviors. Findings have implications for sexual health education.

Daily Associations Between Kissing and Affect During the Transition From Adolescence to Young Adulthood.

Kissing during late adolescence and the transition to adulthood is prevalent, relatively frequent, and distinct from many sexual behaviors in that it affords positive consequences with minimal risk. In this study, we examined within-person associations between kissing and day-to-day variation in affect. A racially/ethnically diverse sample of college students (N = 560; 54.1% female) completed up to 14 daily surveys for seven consecutive semesters. On days when students kissed, they reported more positive and less negative affect than on other days, after controlling for a number of known correlates. Findings differed at the semester- and person levels. Findings contribute to a normative developmental understanding of sexual behaviors during adolescence and the transition to adulthood.

Never Been Kissed: Correlates of Lifetime Kissing Status in U.S. University Students.

Kissing a partner occurs relatively early during adolescence. Thus, young adults who have never kissed are off-time from their peers. Substantial exploration in the areas of identity and intimacy occur during this period, and kissing may fulfill both of these functions, addressing autonomy and relatedness motives for sexual behaviors. We examined the prevalence and personal, contextual, and adjustment/health predictors of delayed onset of kissing. An ethnically and racially diverse sample of traditionally aged first year university students (N = 738; 50.7% female) completed online surveys. Only 14.2% of young adults had never kissed a partner on the lips. Compared to their peers who had kissed partners, young adults who had never kissed were more likely to be Asian-American, less likely to be in a romantic relationship, were less extraverted, were more likely to be in the Honors College, and drank alcohol less frequently. In bivariate models but not the multivariate model, young adults who had never kissed were more neurotic, had mothers who were less facilitating of independence, and had lower self-esteem. Findings inform understanding of normative sexuality development, and inform future research on normative and off-time sexual behaviors in young adulthood.