"It's like all of his attention is on you": A mixed methods examination of attachment, supportive nonparental youth-adult relationships, and self-esteem during adolescence.

The purpose of this mixed methods study was to examine the relationship between attachment, supportive nonparental youth-adult relationships, and self-esteem during adolescence. First, in a quantitative path analysis, we found that perceived social support from nonparental adults partially mediated the relationship between adolescent attachment and self-esteem. In our follow-up mixed methods analysis, we analyzed youth reflections of support experienced in relationships with significant non-parental adults (VIPs). As compared to youth with positive attachment models, youth with negative attachment models reported fewer instances of emotional support but more instances of validation support. The youth with negative attachment models described (1) the importance of trust and (2) receiving emotional support specific to their needs. In instances of validation support, these youth described how their VIPs (1) provided them with honest and realistic feedback, (2) challenged their negative thinking and (3) created opportunities for them to recognize and showcase their strengths. Our findings underscore the importance of considering youths' individual attributes in the context of their ongoing relationships in order to gain a more nuanced understanding of the role and dynamics of supportive nonparental youth-adult relationships in youths' lives.

"They're hoping we can stop it": Student leadership in sexual violence intervention and response at West Point.

This study identified risks and opportunities in peer leadership approaches to sexual violence intervention and response. Constructivist grounded theory was used to analyze semistructured interviews with 24 cadets, including a bystander intervention scenario. With regard to bystander intervention, cadets adhered to gendered assumptions that blocked action, drew upon community values to plan intervention, and thus prepared in ways that reinforced gender biases. With regard to incident response, cadets struggled with cynicism regarding their role in addressing sexual assault, but wanted incidents to be reported despite victim blaming and lack of supports, and responded from their feelings instead of skillfully acting on their values. This study explicates opportunities for leveraging community values in service of intervention and response while illustrating risks of rape myths and gender biases. Addressing inaccurate assumptions and reinforcing positive values could better prepare cadets and other undergraduate students for leadership.

Sexual and Gender Minority Adolescents' Views On HIV Research Participation and Parental Permission: A Mixed-Methods Study.

CONTEXT: Sexual and gender minority adolescents are underrepresented in HIV research, partly because institutional review boards (IRBs) are reluctant to waive parental permission requirements for these studies. Understanding teenagers' perspectives on parental permission and the risks and benefits of participating in HIV research is critical to informing evidence-based IRB decisions. METHODS: Data from 74 sexual and gender minority adolescents aged 14-17 who participated in an online focus group in 2015 were used to examine perspectives on the risks and benefits of participation in a hypothetical HIV surveillance study and the need for parental permission and adequate protections. Data were analyzed thematically; mixed methods analyses examined whether concerns about parental permission differed by whether teenagers were out to their parents. RESULTS: Most adolescents, especially those who were not out to their parents, would be unwilling to participate in an HIV study if parental permission were required. Perceived benefits of participation included overcoming barriers to HIV testing and contributing to the health of sexual and gender minority youth. Few risks of participation were identified. Adolescents suggested steps that researchers could take to facilitate informed decision making about research participation and ensure minors' safety in the absence of parental permission; these included incorporating multimedia presentations into the consent process and explaining researchers' motivations for conducting the study. CONCLUSIONS: Respondents believed that the benefits of HIV surveillance research outweighed the risks. Requiring parental permission may exclude many sexual and gender minority teenagers from taking part in HIV research, especially if they are not out.

"I Won't Out Myself Just to Do a Survey": Sexual and Gender Minority Adolescents' Perspectives on the Risks and Benefits of Sex Research.

Sexual and gender minority (SGM) adolescents under age 18 are underrepresented in sexual health research. Exclusion of SGM minors from these studies has resulted in a lack of knowledge about the risks and benefits youth experience from sexual health research participation. Institutional Review Boards' (IRB) overprotective stances toward research risks and requirements for guardian consent for SGM research are significant barriers to participation, though few have investigated SGM youth's perspectives on these topics. This study aimed to empirically inform decisions about guardian consent for sexuality survey studies involving SGM youth. A total of 74 SGM youth aged 14-17 completed an online survey of sexual behavior and SGM identity, and a new measure that compared the discomfort of sexual health survey completion to everyday events and exemplars of minimal risk research (e.g., behavioral observation). Youth described survey benefits and drawbacks and perspectives on guardian permission during an online focus group. Participants felt about the same as or more comfortable completing the survey compared to other research procedures, and indicated that direct and indirect participation benefits outweighed concerns about privacy and emotional discomfort. Most would not have participated if guardian permission was required, citing negative parental attitudes about adolescent sexuality and SGM issues and not being "out" about their SGM identity. Findings suggest that sexual health survey studies meet minimal risk criteria, are appropriate for SGM youth, and that recruitment would not be possible without waivers of guardian consent. Decreasing barriers to research participation would dramatically improve our understanding of sexual health among SGM youth.

"Make Sure You're Not Getting Yourself in Trouble:" Building Sexual Relationships and Preventing Sexual Violence at the U.S. Military Academy at West Point.

Sexual violence continues to present a problem on college campuses nationwide and among members of the U.S. military. This study attended to patterns of response in how students (cadets) at the U.S. Military Academy (West Point) discussed sexual and romantic relationships, both potential and actual, in order to examine how, if at all, they enact their sexuality-related values. Constructivist grounded theory was used to analyze semistructured interviews with three male and three female cadets from each of the 4 years of the undergraduate program, in which they are intended to become "leaders of character" who will serve as Army officers. Findings indicated limitations in cadets' access to developing and implementing sexuality-related skills within this context. Cadets' fear and distrust erected barriers to their pursuing their desires; the ways in which cadets avoided getting in trouble for sexual harassment or sexual assault shifted responsibility from a potential perpetrator onto a potential victim; and cadets were caught in dilemmas regarding romantic relationships as sources of both emotional support and social stigma. These findings have implications for promoting gender equity and for preventing sexual violence at this institution and at others like it, including both university campuses and other military settings.

Bisexual Invisibility and the Sexual Health Needs of Adolescent Girls.

PURPOSE: The purpose of this study was to analyze bisexual female youth perspectives on their experiences accessing sexual health information and services provided by a doctor, nurse, or counselor. Specifically, we sought to: (1) understand how youth perceptions of providers' attitudes and behaviors affect their seeking and obtaining sexual health information and services; (2) examine how social stigmas within the family context might be associated with barriers to sexual health information and services; and (3) assess school-based sources of sexual health information. METHOD: We utilized a mixed-method study design. Data from bisexual female youth were collected through an online questionnaire and asynchronous online focus groups addressing lesbian, gay, bisexual, and transgender health and HIV prevention. Data were analyzed with descriptive statistics and thematic analysis. RESULTS: Barriers to sexual healthcare included judgmental attitudes and assumptions of patient heterosexuality among healthcare providers, and missed opportunities for HIV and sexually transmitted infections (STI) testing. Bisexual stigma within families was associated with restricted youth openness with providers, suggesting fear of disclosure to parent or guardian. School-based sexual health education was limited by a restrictive focus on abstinence and condoms and the exclusion of STI risk information relevant to sex between women. CONCLUSION: We recommend that practitioners integrate nonjudgmental questions regarding bisexuality into standard contraceptive and sexual health practices involving female youth, including discussion of HIV and STI risk reduction methods. Further support for bisexual health among adolescent girls can come through addressing stigmas of female bisexuality, increasing sensitivity to privacy while engaging parents, and expanding the reach of school-based sexual health education.

Self-Consent for HIV Prevention Research Involving Sexual and Gender Minority Youth: Reducing Barriers Through Evidence-Based Ethics.

This project examined the attitudes of sexual and gender minority youth (SGMY) toward guardian permission for a pre-exposure prophylaxis (PrEP) adherence trial and their preparedness to provide informed, rational, and voluntary self-consent. Sixty sexually active SGMY (ages 14-17) participated in online survey and asynchronous focus group questions after watching a video describing a PrEP adherence study. Youth responses highlighted guardian permission as a significant barrier to research participation, especially for those not "out" to families. Youth demonstrated understanding of research benefits, medical side effects, confidentiality risks, and random assignment and felt comfortable asking questions and declining participation. Reasoning about participation indicated consideration of health risks and benefits, personal sexual behavior, ability to take pills every day, logistics, and post-trial access to PrEP. Results demonstrate youth's ability to self-consent to age- and population-appropriate procedures, and underscore the value of empirical studies for informing institutional review board (IRB) protections of SGMY research participants.

Profiles of problematic behaviors across adolescence: covariations with indicators of positive youth development.

Previous analyses of data from the 4-H Study of Positive Youth Development (PYD) have examined concurrent trajectories of positive development and risk/problem behaviors among adolescents, finding complex and not necessarily inverse relationships among them. In this article, we expand on prior research by employing a person-centered approach to modeling risk behaviors, assessing development from approximately 6th grade through 12th grade among 4,391 adolescents (59.9% female). Latent profiles involving the problematic behaviors of delinquency, depressive symptoms, substance use, sexual activity, disordered eating behaviors, and bullying were then assessed for concurrent relationships with the Five Cs of PYD: Competence, Confidence, Character, Caring, and Connection. We found six latent profiles, based primarily on mental health, aggression, and alcohol use, with significant differences in Confidence levels among many of the profiles, as well as some differences in the four other Cs. We discuss directions for future research and implications for application to youth policies and programs.

The role of ecological assets in positive and problematic developmental trajectories.

Two theoretical perspectives have been proposed to describe, explain, and intervene in adolescent development - prevention science and positive youth development (PYD). An integrative model bridging these two perspectives posits that it is important to assess the extent to which the same, similar, or complementary mechanisms may be responsible for preventing problem behavior and promoting PYD. Therefore, using data from the 4-H Study of PYD, the present study examines the role of assets in the family, school, and neighborhood in differentiating trajectories of goal-optimization and delinquency in a sample of 626 youth (50.9% female) from Grades 5 to 11. The results indicated that collective activity in the family best predicted membership for the five goal-optimization trajectories while school-based assets differentiated the four delinquency trajectories that were identified. The findings suggest that multidimensional approaches may be most effective to promote PYD and prevent problem behaviors.

The role of school engagement in preventing adolescent delinquency and substance use: a survival analysis.

The present study was designed to examine the effects of school engagement on risky behavior in adolescence. Using data from the 4-H Study of Positive Youth Development (PYD), a longitudinal study of U.S. adolescents, discrete-time survival analyses were conducted to assess the effect of behavioral and emotional school engagement on the initiation of drug use and delinquency. The current analyses used seven years of longitudinal data collected from youth and their parents. Results of discrete-time survival analysis indicated that, controlling for demographic variables, higher degrees of behavioral and emotional school engagement predicted a significantly lower risk of substance use and involvement in delinquency. Substance use prevention programs and other health-risk reduction programs should include components (i.e., adolescents' participation in and emotional attachment to school) to capitalize on the protective role of the school context against youth risk behavior.