How Emotional Shifts Effect Youth Perceptions of Opioid Risk and Efficacy: Testing a Know the Truth Campaign Narrative.

Integrating the extended parallel process model (EPPM) and the emotional flow hypothesis, we tested the persuasive effect of emotional shifts during exposure to a Know the Truth anti-opioid campaign narrative in a sample of middle-school students (n = 480). Testing two emotional flow sequences (threat to efficacy and efficacy to threat) of the Know the Truth narrative against a static (threat-only) emotional condition, we found that youth exposed to any emotional flow narrative reported higher levels of hope and lower levels of fear than those exposed to a threat-only narrative. We also found that a threat to efficacy narrative elicited higher levels of self-efficacy than an efficacy to threat emotional flow condition, suggesting that the emotional sequence influences self-efficacy, a well-established predictor of health behavior change. We conclude that the traditional threat to efficacy emotional flow may be superior to its inverse (efficacy to threat) when communicating with young people about opioid addiction. Implications for message design are discussed.

Social self-efficacy and sexual communication among adolescents in the United States: a cross-sectional study.

Background Sexual communication between partners is associated with safer sex behaviours, including condom use among adolescents. Several studies have found a relationship between negative psychological constructs (e.g. depression, anxiety) and poor sexual communication; however, scant research exists regarding positive psychological constructs and their potential to promote effective sexual communication among adolescents. This study examined the association between a positive construct, social self-efficacy - a person's belief in their ability to successfully manage social relationships - and three components of sexual communication: sexual assertiveness, self-efficacy for communication, and frequency of sexual communication with dating partners. METHODS: Data were collected in a cross-sectional survey from 222 high school girls in a rural school district in the south-eastern United States (Mage = 15.2; 38% White, 29% Latina, 24% Black; 50% were in a dating relationship in the past 3 months). Variables were measured with Likert-type scales. Bivariate correlation and regression analyses were conducted. RESULTS: Social self-efficacy was significantly positively associated with sexual assertiveness and sexual communication self-efficacy for all girls, and there was a positive trend in the relationship between social self-efficacy and communication frequency among the subsample of girls who had a dating partner. The significant relationship with sexual assertiveness (ß = 0.22, s.e. = 0.07, P = 0.001) and sexual communication self-efficacy (ß = 0.17, s.e. = 0.04, P = 0.013) remained when controlling for sexual activity status. CONCLUSIONS: Strengthening social self-efficacy may enhance girls' sexual communication and assertiveness skills. Future studies are needed to confirm the causal and temporal nature of these associations.

Preliminary Evaluation of a Prescription Opioid Misuse Prevention Program Among Rural Middle School Students.

Adolescent opioid misuse, addiction, and overdose have emerged as national health crises. Nearly 17% of high school students have misused prescription opioids. The purpose of this study was to evaluate the reach and acceptability of a widely-used prescription opioid misuse prevention program, This Is (Not) About Drugs© (TINAD), and its preliminary efficacy at improving opioid misuse knowledge, opioid misuse attitudes, self-efficacy to avoid opioid misuse, and intentions to misuse opioids. Participants were 576 7th grade students (Mage = 11.8; 51% boys; 39% Hispanic, 31% White, 20% Black) from a rural county in the southeastern U.S. All participants received the TINAD program and completed pretest and immediate posttest assessments. The program was school-based and implemented in collaboration with school teachers and administrators. Over 91% of all eligible students in the school district participated in the TINAD program. Most participants found the program acceptable-over 83% of students liked the program. Approximately 9% of participants reported prior misuse of prescription opioids. After participating in TINAD, students self-reported higher knowledge and self-efficacy as well as safer attitudes. However, there was no change in intentions to misuse opioids in the future. Effects of the program were consistent across gender, socioeconomic status, race/ethnicity, and previous opioid misuse. TINAD is acceptable and shows promise for improving opioid-related cognitions. However, more rigorous experimental and longitudinal research is needed to understand whether TINAD reduces opioid misuse over time. Given the limited research on adolescent opioid misuse prevention, this study lays the ground work for future randomized control trials.

Popular peer norms and adolescent sexting behavior.

INTRODUCTION: Adolescents misperceive and are heavily influenced by the behavior of their popular peers, yet research has not yet investigated this phenomenon for a relatively new and potentially risky behavior: adolescent sexting. The present study investigates rates of sexting among popular and non-popular adolescents and the association between adolescents' perceptions of popular peers' sexting behavior and their own sexting behavior. METHODS: A school-based sample of 626 adolescents from a rural high school in the Southeastern U.S. (Mage = 17.4, 53.5% female) completed surveys indicating whether they had sent a sext in the past year. Participants also reported on perceptions of popular peers' sexting behavior and completed sociometric nominations of peer status. RESULTS: While 87.4% of adolescents believed the typical popular boy or girl in their class had sent a sext in the past year, only 62.5% of popular adolescents had actually sent a sext. There was no significant difference between rates of sexting among popular and non-popular (54.8%) adolescents. After adjusting for gender and sexual activity status, adolescents who believed that the typical popular peer sent a sext were over ten times more likely to have also sexted in the past year. Among adolescents who believed their popular peers had not sexted, girls were more likely than boys to have sexted themselves; however, this gender difference disappeared among adolescents who believed their popular peers had sexted. CONCLUSIONS: These results underscore the importance of peer status and perceptions of peer norms in adolescents' sexting.

Parental influence on sexual intentions of Black adolescent girls: Examining the role of gendered-racial socialization.

Parents can promote the sexual health of adolescents in a number of well-established ways, such as through sexual communication and parental monitoring. Another unexplored avenue through which parents might influence sexual decision-making among Black girls is gendered-racial socialization-the process through which parents send messages to their Black daughters about what it means to be a Black girl, in part, to improve their self-esteem. In a national, U.S.-based sample of 287 Black girls (Mage = 15.4) and their parents (87.8% female), we examine how two dimensions of gendered-racial socialization (gendered-racial pride socialization; gendered-racial oppression socialization): (a) are related to adolescents' intentions to have early sex and (b) moderate the association of parental communication and monitoring with adolescents' intentions to have early sex. We found Black girls who are exposed to more empowering messages about Black girls and women are less likely to intend to have early sex. Additionally, gendered-racial pride socialization moderated the relationship between parental monitoring and intentions to have sex, such that more monitoring was associated with lower intentions to have early sex among girls low in gendered-racial pride socialization. For girls high in gendered-racial pride socialization, there was no relationship between parental monitoring and sexual intentions. Gendered-racial pride socialization is an important asset in Black families, which can be leveraged to improve the sexual health of Black girls. Future studies are needed to examine the causal, temporal pathways between gendered-racial socialization and sexual health. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Adherence to Pre-Exposure Prophylaxis in Adolescents and Young Adults: A Systematic Review and Meta-Analysis.

This meta-analysis synthesized the proportion of adolescents and young adults (AYAs) who are adherent to pre-exposure prophylaxis (PrEP) and factors moderating adherence. A systematic search was conducted of studies published through May 2020 using PubMed, PsycInfo, Cochrane, EMBASE, and CINAHL. Included studies reported the proportion of AYAs (mean age ≤ 29 years) who were PrEP adherent. PrEP adherence was meta-analyzed using random-effects models. Secondary analyses evaluated potential moderating variables. A total of 41 individual samples, from 29 studies, of 8,679 AYA (weighted average age = 23.8 years) were synthesized. The proportion of AYA who met study-defined thresholds for PrEP adherence was .64 (95% confidence interval .57-.71) across studies. Subgroup analyses revealed that adherence was lower in young cisgender women (.46) than young men who have sex with men (.65) and serodiscordant heterosexual couples (.98). Adherence was higher in studies initiated after 2012 (.70) than earlier studies (.47). No differences based on participant age, country, or strategies to promote adherence were found. Across published studies to date, 64% of AYA demonstrate adequate PrEP adherence. Findings can be used to guide PrEP adherence interventions and also provide directions for future research on PrEP among AYA.

Associations between adolescents' pornography consumption and self-objectification, body comparison, and body shame.

Although prior work indicates an association between idealized media content and adolescents' body-related concerns, such as self-objectification, body comparison, and body shame, few prior studies have examined the role of pornography. Even fewer studies have included adolescent girls, limiting our understanding of potential gender differences. In this brief report, we investigate these associations in a diverse mixed-gender sample of high school students in the Southeastern U.S. (n = 223, ages 15-18, M age = 16.25, 59 % girls) who completed computerized self-report measures. Controlling for demographic covariates and frequency of social media use, we found an association between frequency of pornography consumption in the past year and higher self-objectification and body comparison, but not body shame. No evidence of differences by gender emerged. Results suggest that both boys and girls may be susceptible to pornography-related body concerns, yet these concerns may not include body shame. Future research should examine both risks and benefits of pornography use among adolescents using longitudinal designs, as well as how body-related concerns can be incorporated into pornography literacy interventions.

Gender Differences in Parents' Communication With Their Adolescent Children about Sexual Risk and Sex-Positive Topics.

A healthy sexual self-concept that captures an understanding of the risky and the positive aspects of sexuality is imperative to life-long well-being. Parents have a unique opportunity to instill knowledge of sexual risk as well as confidence and comfort around sexuality in their adolescents. Although parent-child communication about sexual risk is fairly common, less is known regarding the frequency of parent-child communication about sex-positive topics, such as sexual desire and satisfaction. This study examined the frequency of parents' communication with their children about sexual risk and sex-positive topics among a sample of 901 parents of 13-17-year-old adolescents (parent Mage= 40.61; 71% mothers) from across the U.S. Parents reported on sexual communication with their adolescent children (child Mage = 14.68; 50% daughters). We examined gender differences in communication patterns. Few parents communicated with their adolescents about sex-positive topics. Only 38% discussed sexual satisfaction, 38% discussed different types of sexual practices (e.g., oral sex), and 55% discussed sexual desire. Parents communicate more about sexual risk than sex-positive topics with their adolescents and this discrepancy was largest for mothers of daughters. Fathers of daughters communicate the least about sex-positive topics. Implications for intervention development and future research on sexual communication are discussed.

Association of Sexual Health Interventions With Sexual Health Outcomes in Black Adolescents: A Systematic Review and Meta-analysis.

Importance: Black adolescents are at increased risk of contracting HIV and other sexually transmitted infections (STIs) and experiencing unplanned pregnancy. Although sexual health interventions aimed at decreasing these risks exist, evidence of the association between sexual health interventions and the sexual behavior of black adolescents has not been synthesized to our knowledge. Objective: To examine the associations between sexual health interventions and behavioral, biological, and psychological outcomes. Data Sources: For this systematic review and meta-analysis, a systematic search was conducted of studies published through January 31, 2019, using the PubMed, PsycINFO, and CINAHL databases and relevant review articles. The following key words were used: youth, adolesc* or teen*; sexual health or safe* sex or sexually transmitted disease or sexually transmitted infection or STD or STI or HIV or AIDS or pregnancy or reproductive health or condom* or contracept* or unprotected sex or abstinence; intervention or program or education or prevention or promotion or trial; latino* or latina* or latinx* or minorit* or ethnic* or hispanic or african american* or black* or race or racial or biracial. Study Selection: Studies were included if they included a US-based sample of black adolescents, evaluated a sexual health intervention using experimental or quasi-experimental designs, included a behavioral outcome, and were published in English. Data Extraction and Synthesis: Standardized mean differences and 95% CIs were extracted and meta-analyzed using random-effects models. Main Outcomes and Measures: Behavioral outcomes were abstinence, condom use, and number of sex partners. Biological outcomes were pregnancy and STI contraction. Psychological outcomes were sexual health intentions, knowledge, and self-efficacy. Results: Across 29 studies including 11 918 black adolescents (weighted mean age, 12.43 years), there was a significant weighted mean association of sexual health interventions with improvements in abstinence (Cohen d = 0.14; 95% CI, 0.05-0.24) and condom use (Cohen d = 0.25; 95% CI, 0.11-0.39). No significant mean association of these interventions with number of sex partners, pregnancy, or STI contraction was found. Sexual health interventions were significantly associated with improvements in psychological outcomes: sexual health intentions (Cohen d = 0.17; 95% CI, 0.05-0.30), knowledge (Cohen d = 0.46; 95% CI, 0.30-0.63), and self-efficacy (Cohen d = 0.19; 95% CI, 0.09-0.28). Intervention effect sizes were consistent across factors, such as participant sex and age and intervention dose. Conclusions and Relevance: The findings suggest that sexual health interventions are associated with improvements in sexual well-being among black adolescents. There appears to be a need for wide-scale dissemination of these programs to address racial disparities in sexual health across the US.

Sexual Health Programs for Latinx Adolescents: A Meta-analysis.

CONTEXT: Latinx adolescents are at risk for negative sexual health outcomes, and many interventions have been developed to reduce this risk. OBJECTIVE: In this meta-analysis, we synthesized the literature on sexual health interventions for Latinx adolescents and examined intervention effects on 3 behavioral outcomes (abstinence, condom use, number of sex partners) and 3 psychological outcomes (safer sex knowledge, intentions, self-efficacy). Moderators of intervention success were explored. DATA SOURCES: A systematic search of studies published through January 2019 was conducted by using PubMed, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature databases. STUDY SELECTION: All studies included a US-based sample of Latinx adolescents, evaluated sexual health intervention by using an experimental or quasiexperimental design, included a behavioral outcome, and were in English. DATA EXTRACTION: Standardized mean difference (d) and 95% confidence intervals (CIs) were meta-analyzed by using random-effects models. RESULTS: Effect sizes from 12 studies, sampling 4673 adolescents, were synthesized. Sexual health interventions improved abstinence (d = 0.15, 95% CI: 0.02 to 0.28), condom use (d = 0.44, 95% CI: 0.18 to 0.70), number of sex partners (d = -0.19, 95% CI: -0.37 to -0.001), and sexual health knowledge (d = 0.40, 95% CI: 0.10 to 0.70), compared with control conditions. Effects were consistent across a number of demographic and clinical characteristics, although culturally tailored interventions produced greater change in condom use than nontailored interventions. LIMITATIONS: There was variation across studies in measures of sexual behavior, and some elements of individual study quality were unclear. CONCLUSIONS: Sexual health interventions have a small but significant impact on improving safer sexual behavior among Latinx adolescents. Health educators should consider the importance of cultural tailoring to program success.

Feasibility, Acceptability, and Preliminary Efficacy of a Brief Online Sexual Health Program for Adolescents.

This study evaluated the feasibility, acceptability, and preliminary efficacy of a 45-minute interactive, online sexual health program for adolescents, called Health Education and Relationship Training (HEART). The program was originally developed and evaluated among adolescent girls (HEART for Girls); the current project describes and evaluates a new version of the program that was adapted for boys and girls. Participants were 226 high school students (mean age = 16.3; 58% girls; 46% White; 79% heterosexual). Students were randomized to HEART or an attention-matched control and assessed at pre-test and immediate post-test. Overall, the program was feasible to administer in a school setting and youth found the program highly acceptable (83% liked the program, 87% learned new things, and 93% would use program content in the future). At post-test, students who completed HEART demonstrated improvements on every outcome we examined: sexual communication intentions, condom use intentions, HIV/STD knowledge, condom attitudes, condom norms, self-efficacy to practice safer sex, and sexual assertiveness compared to control participants (effect size ds = .23 to 1.27). Interactions by gender and sexual orientation revealed the program was equally acceptable and worked equally well for boys and girls and for heterosexual and sexual minority youth. We propose several avenues to further adapt and tailor HEART given its promise in promoting adolescent sexual health.

Assessment of Parent-Based Interventions for Adolescent Sexual Health: A Systematic Review and Meta-analysis.

IMPORTANCE: Parent-based sexual health interventions have received considerable attention as one factor that can increase safer sexual behavior among youth; however, to our knowledge, the evidence linking parent-based interventions to youth sexual behaviors has not been empirically synthesized. OBJECTIVE: To examine the association of parent-based sexual health interventions with 3 primary youth outcomes-delayed sexual activity, condom use, and parent-child sexual communication-as well as several secondary outcomes. We also explored potential moderators of intervention effectiveness. DATA SOURCES: A systematic search was conducted of studies published through March 2018 using MEDLINE, PsycINFO, Communication Source, and CINAHL databases and relevant review articles. STUDY SELECTION: Studies were included if they: (1) sampled adolescents (mean age, ≤18 years), (2) included parents in a key intervention component, (3) evaluated program effects with experimental/quasi-experimental designs, (4) included an adolescent-reported behavioral outcome, (5) consisted of a US-based sample, and (6) were published in English. DATA EXTRACTION AND SYNTHESIS: Standardized mean difference (d) and 95% confidence intervals were computed from studies and meta-analyzed using random-effects models. A secondary analysis evaluated potential moderating variables. MAIN OUTCOMES AND MEASURES: The primary outcomes were delayed sexual activity, condom use, and sexual communication. RESULTS: Independent findings from 31 articles reporting on 12 464 adolescents (mean age = 12.3 years) were synthesized. Across studies, there was a significant association of parent-based interventions with improved condom use (d = 0.32; 95% CI, 0.13-0.51; P = .001) and parent-child sexual communication (d = 0.27; 95% CI, 0.19-0.35; P = .001). No significant differences between parent-based interventions and control programs were found for delaying sexual activity (d = -0.06; 95% CI, -0.14 to 0.02; P = .16). The associations for condom use were heterogeneous. Moderation analyses revealed larger associations for interventions that focused on younger, compared with older, adolescents; targeted black or Hispanic youth compared with mixed race/ethnicity samples; targeted parents and teens equally compared with emphasizing parents only; and included a program dose of 10 hours or more compared with a lower dose. CONCLUSIONS AND RELEVANCE: Parent-based sexual health programs can promote safer sex behavior and cognitions in adolescents, although the findings in this analysis were generally modest. Moderation analyses indicated several areas where future programs could place additional attention to improve potential effectiveness.