Sexual decision making of Ugandan young adults: findings from national online discussions.

Fifty-one 18-22-year-old Ugandans took part in asynchronous online discussions about sexual decision-making. To increase generalizability and variability of experience, youth were recruited across the country using social media advertising. Participants were stratified into 8 groups by sex and sexual experience (e.g., women who had not had sex). Participants were asked questions such as, "What role do you think [men/women] play in deciding when a couple is going to play sex?" Several themes emerged. Both young men and women articulated social pressures to be abstinent, particularly to avoid STIs and pregnancy moreso than saving oneself for marriage. That said, women noted pressures to be seen as "pure". There also were pressures to have sex: Men were expected to have sex to demonstrate their virility. Women were expected to have sex if they accepted gifts or other commodities from their partners. It seemed that the specter of HIV and other STIs, as well as unwanted pregnancy, served to mitigate these expectations however, resulting in self-efficacy to use condoms among both men and women. Nonetheless, both men and women acknowledged that it could be hard for women to negotiate condoms. Implications for HIV prevention are discussed.

"An escape from the isolation": Youth thoughts about the impact of COVID-19 on adolescent sexual behavior and alcohol use.

INTRODUCTION: The COVID-19 pandemic likely affected adolescent sexual behaviors and alcohol use, although how is not well understood. METHOD: Youth were sampled from the national, online longitudinal Growing up with Media study. They responded via text messaging to open-ended questions about how the COVID-19 pandemic may have impacted the sexual behavior and alcohol use of adolescents. Conventional content analysis summarized open-ended responses. RESULTS: 416 responses were analyzed from 335 participants (aged 15-30, US residents), 81 of whom provided data for both topics. Participants suggested that the pandemic affected some youths' sexual health precautions (increased and varying) and attitudes about sex (positive and negative). They discussed how adolescents met partners during the pandemic, including increased use of online platforms. Participants also suggested researchers investigate sexual risk in the realm of COVID-19 transmission and the practice of "safe sex." Many participants believed adolescents were drinking alcohol more as a result of the pandemic, both alone and with friends; however, others perceived adolescents were drinking less. Participants proposed researchers investigate adolescent drinking habits during the pandemic, as well as how this compares to before the pandemic and the type and quantity of alcohol consumed. CONCLUSIONS: Young people believe adolescent sexual relationships and drinking behaviors changed due to the pandemic, though how varied. Future research could examine the contexts and individual differences that shape these varying behaviors. Overall, this study highlights the importance of directly asking youth about their pandemic experiences and the diversity of views on how the pandemic has influenced adolescent behavior.

Sexual Fluidity in Identity and Behavior Among Cisgender Youth: Findings from the Longitudinal Growing up with Media Study.

OBJECTIVES: To examine fluidity in sexual orientation identity and behavior among cisgender youth. STUDY DESIGN: Data were analyzed from 5 survey waves of the longitudinal US Growing Up with Media Study (2010-2019). Participants were 989 cisgender youth, aged 13-20 years at baseline, who completed online surveys assessing sexual orientation identity and behavior (gender of sexual partners). Amount of change (mobility) and patterns of change across waves were assessed for identity and behavior. RESULTS: Consistently heterosexual was the most common sexual orientation identity (89%-97% for boys, 80%-90% for girls), followed by gay (3%) for boys, and bisexual (8%) for girls. Sexual minority identities increased (3%-11% for boys, 10%-20% for girls) over time, same-gender sexual behavior also increased. Girls had more identity mobility than boys; no gender difference was found for behavior mobility. Movement from heterosexual to a sexual minority identity occurred for 9% of girls and 6% of boys; movement from different-gender sexual behavior to same-gender sexual behavior occurred for 2% of girls and boys. CONCLUSIONS: Findings highlight the need to assess multiple dimensions and patterns of change of youth sexual orientation in research and clinical care. Recognizing and creating space for conversations about changes in sexual identity and behavior over time will help providers accurately and effectively address the health needs of all patients.

Minor Consent Laws for Sexually Transmitted Infection and Human Immunodeficiency Virus Services in the United States: A Comprehensive, Longitudinal Survey of US State Laws.

Objectives. To assess changes in minor consent laws for sexually transmitted infection (STI) and HIV testing, treatment, and prevention services in all 50 US states and the District of Columbia from 1900 to 2021. Methods. We coded laws into minor consent for (1) health care generally; (2) STI testing, treatment, and prevention; (3) HIV testing, treatment, and prevention; and (4) pre- or postexposure prophylaxis for HIV prevention. We also coded confidentiality protections and required conditions (e.g., threshold clinician judgments). Results. The largest increase in states allowing minors to consent to STI services occurred during the 1960s and 1970s. By 2021, minors could consent independently to STI and HIV testing and treatment in all 50 states plus DC, STI prevention services in 32 jurisdictions, and HIV prevention services in 33 jurisdictions. Confidentiality protections for minors are rare. Prerequisites are common. Conclusions. Although the number of states allowing minors to consent independently to STI and HIV services has increased considerably, these laws have substantial limitations, including high complexity, prerequisites requiring clinician judgments, and neglect of confidentiality concerns. (Am J Public Health. 2023;113(4):397-407. https://doi.org/10.2105/AJPH.2022.307199).

Subgroup Analyses of Girl2Girl, a Text Messaging-Based Teen Pregnancy Prevention Program for Sexual Minority Girls: Results from a National RCT.

This study aims to investigate whether Girl2Girl, a text messaging-based pregnancy prevention program for cisgender LGB+ girls, had different effects on subgroups based on age, sexual identity, and experience with penile-vaginal sex. A total of 948 girls, 14-18 years old, were recruited nationally via social media and enrolled over the telephone. Once they completed the baseline, they were randomized to either Girl2Girl or an attention-matched control program that discussed "healthy lifestyle" topics (e.g., self-esteem). Both programs were 5 months long: Girls received daily messages for 8 weeks, and then went through a "latent" period of 3 months, and finished with a 1-week review. Outcome measures included condom-protected sex, uptake of other types of birth control, abstinence, and pregnancy. Measures were collected at baseline; 3-month, 6-month, 9-month, and 12-month post-intervention end, which was 17 months after enrollment. Effect modification was examined using longitudinal mixed effects models. Overall, results suggested significant moderating effects of age, (f2 = .12), sexual identity (f2 < .14), and sexual experience (f2 = .11) on rates of condom use and use of other contraception. Although there were no significant moderating effects on pregnancy, abstinence, or intentions to use condoms, use birth control, or be abstinent, (p's > .16), patterns of effects were in the same direction as for significant findings. For example, at 9-month post-intervention, among those who identified as bisexual, the incidence rate of protected sex events was 39% higher for intervention vs. control (IRR = 1.39, 95% CI: 1.06-2.70), adjusting for baseline rate of condom use and sexual experience. Similarly, at 12 months, among bisexual participants, intervention participants had a significantly higher IRR of condom-protected sexual events (IRR = 2.65, 95% CI: 1.31-5.34). There were also higher odds of uptake of birth control use other than condoms for intervention vs. control at 6- (OR = 1.10, 95% CI: 1.01-1.77), 9 m (OR = 1.11, 95% CI: 1.07-1.89), and 12-month (OR = 1.13, 95% CI: 1.07-1.78) follow-up. Girl2Girl appears to be particularly effective for older adolescents, bisexual girls, and those who have already had penile-vaginal sex. No one single approach is going to affect teen pregnancy. Instead, it is more likely that different intervention content and delivery methods will be more accessible and salient to some but not other youth. Understanding for whom the intervention works is just as important as understanding for whom the intervention does not, as this can inform opportunities for future intervention development.Clinical Trial Registration: ClinicalTrials.gov ID# NCT03029962.

Acceptability of Texting 4 Relapse Prevention, Text Messaging-Based Relapse Prevention Program for People With Schizophrenia and Schizoaffective Disorder.

ABSTRACT: We report process outcomes of the pilot randomized controlled trial of Texting 4 Relapse Prevention (T4RP), a text messaging-based relapse prevention program for people with schizophrenia or schizoaffective disorder (SAD). Forty people were randomized to either the intervention or treatment as usual control group at a 2:1 ratio. Process indicators were collected at 6 months post enrollment.Over 90% of patients agreed or strongly agreed that the text messages were easy to understand, easy to answer, positive, and helped them feel supported. Patient acceptability was positively associated with recovery (ß = 0.29, p = <0.001) and patient-provider communication scores (ß = 1.04, p < 0.001), and negatively associated with symptoms of the disorder (ß = -0.27, p = 0.07). Acceptability was similar by diagnosis (ß, SAD diagnosis = 0.40, p = 0.90) and age (ß = 0.05, p = 0.67). Findings suggest that a text messaging intervention aimed at preventing relapse is feasible and perceived as beneficial in individuals with schizophrenia and SAD. Future research might include a targeted study of T4RP within the context of hospital discharge when people with schizophrenia/SAD are at highest risk of relapse.

Voices of Youth and Emerging Adults on Suicide Prevention: Experiences and Expectations.

Self-directed violence (SDV) is a significant public health issue for adolescents and emerging adults, and yet youth exposure to prevention messaging and youth perspectives on SDV prevention needs are understudied. The current study sought to better understand the ways in which a national sample of youth and emerging adults were exposed to suicide prevention programs or conversations. A sample of 1031 young people ages 13-23 were recruited nationally through social media. Survey questions asked about SDV prevention exposure. Open-ended questions asked youth to suggest additional information they desired about SDV. A majority of participants (87%) reported that they had received prevention exposure from at least one source (i.e., family, online, attending a talk, or formal program) with few differences by demographic characteristics. However, sexual and gender minority (SGM) youth reported accessing more SDV prevention information online compared to other youth. Overall, youth had many ideas about what additional information they needed, including how to help someone at risk for SDV and how to access information about mental health. While the majority of youth are receiving some SDV prevention messages, there is variation in how they get this information, and survey participants still felt they were missing important information. Findings highlight the need to resource more comprehensive SDV prevention for youth and young adults.

A Pilot RCT Evaluating InThistoGether, an mHealth HIV Prevention Program for Ugandan Youth.

Despite data suggesting that older adolescence is an important period of risk for HIV acquisition in Uganda, tailored HIV prevention programming is lacking. To address this gap, we developed and tested nationally, InThistoGether (ITG), a text messaging-based HIV prevention program for 18-22 year-old Ugandan youth. To assess feasibility and acceptability, and preliminary indications of behavior change, a randomized controlled trial was conducted with 202 youth. Participants were assigned either to ITG or an attention-matched control group that promoted general health (e.g., self-esteem). They were recruited between December 2017 and April 2018 on Facebook and Instagram, and enrolled over the telephone. Between 5-10 text messages were sent daily for seven weeks. Twelve weeks later, the intervention ended with a one-week 'booster' that reviewed the main program topics. Measures were assessed at baseline and intervention end, 5 months post-randomization. Results suggest that ITG is feasible: The retention rate was 83%. Ratings for the content and program features met acceptability thresholds; program experience ratings were mixed. ITG also was associated with significantly higher rates of condom-protected sex (aIRR = 1.68, p < 0.001) and odds of HIV testing (aOR = 2.41, p = 0.03) compared to the control group. The odds of abstinence were similar by experimental arm however (aOR = 1.08, p = 0.86). Together, these data suggest reason for optimism that older adolescent Ugandans are willing to engage in an intensive, text messaging-based HIV prevention programming. Given its wide reach and low cost, text messaging should be better utilized as an intervention delivery tool in low-income settings like Uganda. Findings also suggest that ITG may be associated with behavior change in the short-term. (Trial registration: ClinicalTrials.gov ID# NCT02729337).

RESUMEN: A pesar de que los datos sugieren que la adolescencia mayor es un período importante de riesgo de contraer el VIH en Uganda, hace falta una programación de prevención del VIH personalizados. Para abordar esta brecha, desarrollamos y probamos a nivel nacional, InThistoGether (ITG), un programa de prevención del VIH basado en mensajes de texto para jóvenes ugandeses de 18 a 22 años. Para evaluar la viabilidad y aceptabilidad, y las indicaciones preliminares del cambio de comportamiento, se realizó un ensayo controlado aleatorio con 202 jóvenes. Los participantes fueron asignados a ITG o a un grupo de control de atención que promovía la salud general (p.ej., la autoestima). Fueron reclutados entre diciembre de 2017 y abril de 2018 en Facebook e Instagram y se inscribieron por teléfono. Se enviaron entre 5 y 10 mensajes de texto diariamente durante siete semanas. Doce semanas después, la intervención terminó con un "refuerzo" de una semana que repasó los principales temas del programa. Las medidas se evaluaron al inicio y al final de la intervención, 5 meses después de la aleatorización. Los resultados sugieren que ITG es factible: la tasa de retención fue 83%. Las calificaciones del contenido y las características del programa alcanzaron los umbrales de aceptabilidad; las calificaciones de experiencia del programa fueron mixtas. La ITG también se asoció con tasas significativamente más altas de relaciones sexuales protegidas con condón (aIRR = 1.68, p < 0.001) y probabilidades de pruebas de VIH (aOR = 2.41, p = 0.03) en comparación con el grupo de control. Sin embargo, las probabilidades de abstinencia fueron similares en el grupo experimental (ORa = 1,08, p = 0,86). Juntos, estos datos sugieren razones para el optimismo de que los adolescentes ugandeses mayores están dispuestos a participar en un programa intensivo de prevención del VIH basado en mensajes de texto. Dado su amplio alcance y bajo costo, los mensajes de texto deberían utilizarse como una herramienta de entrega de intervenciones en lugares de bajos ingresos como Uganda. Los hallazgos también sugieren que ITG puede estar asociada con cambios de comportamiento a corto plazo.

Groups of Sexual Violence Perpetration in a National Sample of Youth 13-25 Years of Age.

Little is known about how specific forms of sexual violence (SV) perpetration group together and how youth transition between these groups over time. Between 2011 and 2016, four waves of data were collected online nationally from 1129 13-25-year-olds. Six forms of SV perpetration were assessed: sexual harassment, online sexual harassment, sexual assault, coercive sex, attempted rape, and rape. We used latent class analysis to examine how different types of SV perpetration behaviors clustered together in each of the four waves. Latent transition analysis was used to examine stability and instability in group membership between the first and fourth waves assessed. Three groups were identified in each of the four waves of data collection: (1) a "non-perpetrators" group, ranging from 69 to 81% (n: 775-912) across waves, (2) a "sexual harassment" group, ranging from 17 to 29% (n: 191-327), and (3) a "multiple perpetration" group that engaged in all types of SV perpetration, ranging from 1 to 3% (n: 12-28). Most youth persisted in their behavior over time, which was true for each of the three groups (ranging between 60 and 72%). Desistence was less common, ranging from 35% of those who transitioned from sexual harassment to non-perpetration to 20% for those who transitioned from multiple perpetration to sexual harassment, and from multiple perpetration to non-perpetration. Escalation was least common, ranging from 2% who transitioned from non-perpetration to multiple perpetration to 26% who transitioned from non-perpetration to sexual harassment. Youth who perpetrate SV are heterogeneous; SV perpetration is not persistent for all youth.

Risk and Protective Factors for Adolescent Relationship Abuse across Different Sexual and Gender Identities.

Little is known about the characteristics and context of adolescent relationship abuse victimization across youth of different sexual and gender minority identities. This study sought to examine this in a national sample of 14-15-year-old youth. The sample comprised 3296 youth who reported having been in a relationship, of which 36% (n = 1197) were exclusively cisgender heterosexual; 41% (n = 1, 349) cisgender sexual minority; and 23% (n = 750) gender minority, the majority of whom were also sexual minority. More than half of all youth who had been in a relationship, dated or hooked up with someone had experienced some form of adolescent relationship abuse victimization. Gender minority youth, in particular transgender boys and non-binary youth assigned female at birth, were more likely to be victims of multiple types of adolescent relationship abuse compared to cisgender youth. Perpetrator gender varied for sexual and gender minorities and was more homogenous for cisgender heterosexual youth. Several factors were associated with adolescent relationship abuse for all youth, although alcohol use, and parental trust and communication emerged as particularly important for sexual and gender minority youth. Overall, findings address multiple gaps in the literature and contribute to the understanding of adolescent relationship abuse across different sexual and gender identities.

A National, Qualitative Study of Sexual Decision Making by Teenage Girls who are Lesbian, Gay, Bisexual, or who have Another Nonheterosexual Identity.

OBJECTIVE: To address the significant dearth of literature that examines how girls who are lesbian, gay, bisexual, or who have another nonheterosexual identity (LGB+) decide when and with whom to have sex; and to explore why inexperienced LGB+ girls might have sex with girls or boys. STUDY DESIGN: We conducted 8 online, asynchronous, bulletin board-style focus groups with 160 adolescent girls 14-18 years of age. The transcripts were analyzed using a thematic analysis of each girls' responses to the questions. Analyses were focused on increasing our understanding of sexual health decision making among LGB+ teenage girls (eg, "What was the reason you had sex for the first time?"). Participants' responses reflected their day-to-day experiences and roles of cisgender LGB+ girls inside a dominant heteronormative social structure. RESULTS: Some LGB+ girls talked about the perception that LGB+ girls were presumed or expected to be hypersexual, and that they did not feel they could be accepted as LGB+ without being sexually active. Developmental aspects of identity were also salient: Girls considered or engaged in sexual encounters as a way of figuring out to whom they were attracted as well as confirming or disconfirming the identity labels they used for themselves. Same-sex encounters could be offered as "proof" that one really was LGB+. Similarly, unsatisfying experiences with guys could serve as evidence that they were not attracted to guys. CONCLUSION: Sexual decision making among LGB+ girls is often driven by aspects of their sexual minority identity.

Iterative Development of In This toGether, the First mHealth HIV Prevention Program for Older Adolescents in Uganda.

In Uganda, HIV prevention programming for older adolescents is noticeably lacking, even though HIV incidence rates increase dramatically from adolescence into young adulthood. Here we describe the development of In This toGether (ITG), the first-of-its-kind, comprehensive text messaging-based HIV prevention program for both sexually active and abstinent 18- to 22-year-old Ugandans. Five iterative development activities are described: (1) conducting focus groups (FGs) to better understand the sexual decision-making of older adolescents across Uganda and to gain 'voice' of older adolescents; (2) the drafting of intervention content based on FG data; (3) testing of the drafted content with two Content Advisory Teams (CATs) that reviewed and provided feedback on the messages; (4) alpha-testing the program among the research team; and (5) beta-testing the intervention and protocol with people in the target population. Participants were recruitment nationally via Facebook and Instagram, and enrolled over the telephone by research staff. Results suggest that men were easier to reach and engage across all intervention development steps. As such, specific efforts to enroll women were made to ensure that feedback from both sexes was taken into account. FG participants said they were interested in learning more about sexual positions, how to prepare for sex, the consequences of unprotected sex, benefits of protected sex, masturbation, and how to be a good sexual partner. In both the FGs (n = 202) and CATs (n = 143) however, some noted that masturbation, oral sex, and anal sex were particularly sensitive topics. These messages were rewritten to address the cultural sensitivity. Feedback from beta test participants (n = 34) suggested that text messaging-based HIV prevention programming that is intense (e.g., 5-11 messages per day) and extends for two months, is both feasible and acceptable. In conclusion, the engagement of older adolescents at each step of the iterative intervention development process increased the likelihood that the final product would resonate with 18- to 22-year-old Ugandan youth across the country. Furthermore, social media appears to be a feasible method for recruiting national samples of Ugandan older adolescents into HIV-focused research.

Girl2Girl: How to develop a salient pregnancy prevention program for cisgender sexual minority adolescent girls.

INTRODUCTION: Although sexual minority girls are more likely than heterosexual girls to be pregnant during adolescence, programs tailored to their needs are non-existent. Here we describe the iterative development of Girl2Girl, a text messaging-based pregnancy prevention program for cisgender lesbian, gay, bisexual and other sexual minority (LGB+) girls across the United States. METHODS: Four activities are described: 1) 8 online focus groups to gain feedback about intended program components (n = 160), 2) writing the intervention content, 3) 4 online Content Advisory Teams that reviewed and provided feedback on the salience of drafted intervention content (n = 82), and 4) a beta test to confirm program functionality, the feasibility of assessments, and the enrollment protocol (n = 27). Participants were 14-18-year-old cisgender LGB+ girls recruited nationally on social media. Across study activities, between 52% and 70% of participants were 14-16 years of age, 10-22% were Hispanic ethnicity, and 30-44% were minority race. RESULTS: Focus group participants were positive about receiving text messages about sexual health, although privacy was of concern. Thus, better safeguards were built into the enrollment process. Teens in the Content Advisory Teams found the content to be approachable and compelling, although many wanted more gender-inclusive messaging. Messages were updated to not assume people with penises were boys. Between 71 and 86% of participants in the beta test provided weekly feedback, most of which was positive; no one withdrew during the seven-week study period. CONCLUSIONS: This careful step-by-step iterative approach appears to have resulted in a high level of intervention feasibility and acceptability.

Health Indicators of Lesbian, Gay, Bisexual, and Other Sexual Minority (LGB+) Youth Living in Rural Communities.

OBJECTIVE: To investigate whether the intersectionality of being lesbian, gay, bisexual, and other sexual minority youth (LGB+) and living in a rural community may portend worse concurrent health indicators than identifying as heterosexual and/or living in a nonrural community. STUDY DESIGN: Data were collected online between 2010 and 2011 from 5100 13- to-18-year-old youth across the US. Youth were randomly recruited from within the Harris Panel Online and through targeted outreach efforts to LGBT+ youth by a youth-focused nonprofit. The survey questionnaire was self-administered and included measures used in the present study and other measures related to the goal of the Teen Health and Technology study. RESULTS: Living in a rural community was not associated with additional challenges beyond those posed by LGB+ status. Instead, most noted differences in indicators of psychosocial challenge were between LGB+ and heterosexual youth, regardless of rural vs nonrural community living status. For example, sexual minority youth, both male and female, were more likely to have used substances, have depressive symptomatology, have low self-esteem, and report being bullied in the past year compared with both rural and nonrural heterosexual youth. CONCLUSIONS: Findings suggest that LGB+ youth living in rural areas are equally likely to face psychosocial challenges as LGB+ youth living in nonrural areas. Pediatricians and other healthcare providers who work with youth should be mindful of creating LGB+ inclusive environments that can promote self-disclosure by youth who may benefit from additional health services or clinical support for psychosocial challenges.

A Cross-sectional Study Examining the (In)congruency of Sexual Identity, Sexual Behavior, and Romantic Attraction among Adolescents in the US.

OBJECTIVE: To examine how sexual identity, romantic attraction, and sexual behavior co-relate for cisgender adolescents. STUDY DESIGN: The Teen Health and Technology survey was a cross-sectional, self-report online survey. More than 5000 youth between 13 and 18 years of age were randomly recruited through Harris Panel OnLine's panel as well as outreach by GLSEN to over-recruit lesbian, gay, bisexual, and other sexual minority youth. Data were collected between 2010 and 2011. Analyses were conducted in 2018 and restricted to cisgender youth. RESULTS: Overall, romantic attraction and sexual behavior most closely mapped each other. The greatest discordance was noted between sexual identity and romantic attraction. For example, 59% of girls and 16% of boys who identified with a nonheterosexual identity reported that at least 1 of their 2 most recent sexual partners was a different gender. Nine percent of heterosexually-identified girls and 3% of heterosexually-identified boys reported romantic attraction to the same sex, and 6% and 7% of heterosexually-identified girls and boys, respectively, reported that at least 1 of their 2 most recent sexual partners was the same gender. CONCLUSIONS: Treating romantic attraction, sexual identity, and sexual behavior as synonymous assumes a unidimensionality that is unsupported by the data. Pediatricians and others working with youth, including researchers, should be mindful not to assume identity on the basis of behavior. Researchers should be clear and purposeful about how they are operationalizing "sexual minority" and how it may affect the composition of their study population. Healthy sexuality and risk reduction programs need to acknowledge that adolescents with a particular sexual identity may have romantic attractions, and even sexual encounters, with people who fall outside of that identity.

Developing Texting for Relapse Prevention: A Scalable mHealth Program for People With Schizophrenia and Schizoaffective Disorder.

Symptom relapse in people with schizophrenia and schizoaffective disorder is common and has a negative impact on the course of illness. Here, we describe the development of Texting for Relapse Prevention, a scalable, cost-effective text messaging relapse prevention program that queries patients' "early warning signs" daily. Results of development focus groups and content advisory teams with 25 patients and 19 providers suggest that patients were enthusiastic about the program and thought that receiving daily messages about their symptoms would help them feel supported. Providers also were positive about the idea but worried that the program might interfere with patient-provider communication if patients thought that the messages were coming from providers. Patients found the content positive and actionable. The program was improved to address this feedback. This iterative development process that included multiple stakeholders ensured that the program is feasible and acceptable to both patients and providers.

Linkages between violence-associated attitudes and psychological, physical, and sexual dating abuse perpetration and victimization among male and female adolescents.

Attitudes about violence and sex in dating relationships were related to psychological, physical, and sexual teen dating abuse perpetration and victimization. Data from Wave 4 of the national, randomly selected, Growing up with Media cohort (n = 876 adolescents aged 14-19 years), collected in 2011, were analyzed. Dating youth perceived more peer pressure to have sex and were more accepting of sex in brief or nonmarital relationships than pre-dating youth. Boys had higher levels of rape-supportive attitudes than girls. Among dating youth, the relative odds of involvement in teen dating abuse as a perpetrator or a victim were generally associated with greater acceptance of relationship violence, perceived peer pressure to have sex, and acceptance of sex in brief and/or nonmarital relationships. Rape-supportive attitudes were not significantly associated with any type of teen dating abuse involvement. Programs aimed at preventing dating abuse might benefit from targeting attitudes associated with sexual activity as well as relationship violence.

Perceptions of middle school youth about school bullying.

INTRODUCTION: Bullying prevention remains a major focus for schools yet prevention programs have yielded limited efficacy. This suggests that efforts to make the programs more salient for youth may result in greater reductions in bullying behavior. METHODS: To inform the development of a text messaging-based bullying prevention program for middle school youth, we conducted two online, asynchronous focus groups with 37 youth in grades 6-8. Youth were recruited across the United States using an online panel. Topics and questions were posted twice-daily across three days; youth responded when convenient. RESULTS: Findings suggested: (a) When asked, many youth provided definitions of bullying that were simliar to the CDC's definition (e.g., differential power). At times, these did not align with their school's definition, however. (b) Youth said those who were 'different', quiet, or unpopular were more likely to be targeted by bullies; (c) Central tenants of bullying prevention programs (e.g., help-seeking, bystander interventions) did not always resonate with youth (e.g., becuase they could be hurt by the bully) although youth did share a range of strategies to manage anger; and (d) Many youth reported that bullying prevention efforts at their school were limited to posters and assemblies. CONCLUSIONS: Asking students about their perspectives of the main tenants of bully prevention programs provides opportunities to craft prevention program content that better speaks to the experiences and concerns that youth have when trying to navigate these difficult situations. Focus groups are also useful in identifying the ways in which youth talk about bullying and other types of peer aggression to guide the 'voice' of the program.

The Effect of a Text Messaging Based HIV Prevention Program on Sexual Minority Male Youths: A National Evaluation of Information, Motivation and Behavioral Skills in a Randomized Controlled Trial of Guy2Guy.

There is a paucity of literature documenting how the constructs of the Information-Motivation-Behavioral Skills (IMB) model are affected by exposure to technology-based HIV prevention programs. Guy2Guy, based on the IMB model, is the first comprehensive HIV prevention program delivered via text messaging and tested nationally among sexual minority adolescent males. Between June and November 2014, 302 14-18 year old gay, bisexual, and/or queer cisgender males were recruited across the US on Facebook and enrolled in a randomized controlled trial testing Guy2Guy versus an attention-matched control program. Among sexually inexperienced youth, those in the intervention were more than three times as likely to be in the "High motivation" group at follow-up as control youth (aOR = 3.13; P value = 0.04). The intervention effect was not significant when examined separately for those who were sexually active. HIV information did not significantly vary by experimental arm at 3 months post-intervention end, nor did behavioral skills for condom use or abstinence vary. The increase in motivation to engage in HIV preventive behavior for adolescent males with no prior sexual experience is promising, highlighting the need to tailor HIV prevention according to past sexual experience. The behavioral skills that were measured may not have reflected those most emphasized in the content (e.g., how to use lubrication to reduce risk and increase pleasure), which may explain the lack of detected intervention impact. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov ID# NCT02113956.

Predicting the Emergence of Sexual Violence in Adolescence.

This study aims to report the epidemiology of sexual violence (SV) perpetration for both female and male youth across a broad age spectrum. Additionally, the etiology of SV perpetration is examined by identifying prior exposures that predict a first SV perpetration. Six waves of data were collected nationally online, between 2006 and 2012, from 1586 youth between 10 and 21 years of age. Five types of SV were assessed: sexual harassment, sexual assault, coercive sex, attempted rape, and rape. To identify how prior exposures may predict the emergence of SV in adolescence, parsimonious lagged multivariable logistic regression models estimated the odds of first perpetrating each of the five types of SV within the context of other variables (e.g., rape attitudes). Average age at first perpetration was between 15 and 16 years of age, depending on SV type. Several characteristics were more commonly reported by perpetrators than non-perpetrators (e.g., alcohol use, other types of SV perpetration and victimization). After adjusting for potentially influential characteristics, prior exposure to parental spousal abuse and current exposure to violent pornography were each strongly associated with the emergence of SV perpetration-attempted rape being the exception for violent pornography. Current aggressive behavior was also significantly implicated in all types of first SV perpetration except rape. Previous victimization of sexual harassment and current victimization of psychological abuse in relationships were additionally predictive of one's first SV perpetration, albeit in various patterns. In this national longitudinal study of different types of SV perpetration among adolescent men and women, findings suggest several malleable factors that need to be targeted, especially scripts of inter-personal violence that are being modeled by abusive parents in youths' homes and also reinforced by violent pornography. The predictive value of victimization for a subsequent first SV perpetration highlights the inter-relatedness of different types of violence involvement. Universal and holistic prevention programming that targets aggressive behaviors and violent scripts in inter-personal relationships is needed well before the age of 15 years.