Reorienting adolescent sexual and reproductive health research: reflections from an international conference.

On December 4th 2014, the International Centre for Reproductive Health (ICRH) at Ghent University organized an international conference on adolescent sexual and reproductive health (ASRH) and well-being. This viewpoint highlights two key messages of the conference--(1) ASRH promotion is broadening on different levels and (2) this broadening has important implications for research and interventions--that can guide this research field into the next decade. Adolescent sexuality has long been equated with risk and danger. However, throughout the presentations, it became clear that ASRH and related promotion efforts are broadening on different levels: from risk to well-being, from targeted and individual to comprehensive and structural, from knowledge transfer to innovative tools. However, indicators to measure adolescent sexuality that should accompany this broadening trend, are lacking. While public health related indicators (HIV/STIs, pregnancies) and their behavioral proxies (e.g., condom use, number of partners) are well developed and documented, there is a lack of consensus on indicators for the broader construct of adolescent sexuality, including sexual well-being and aspects of positive sexuality. Furthermore, the debate during the conference clearly indicated that experimental designs may not be the only appropriate study design to measure effectiveness of comprehensive, context-specific and long-term ASRH programmes, and that alternatives need to be identified and applied. Presenters at the conference clearly expressed the need to develop validated tools to measure different sub-constructs of adolescent sexuality and environmental factors. There was a plea to combine (quasi-)experimental effectiveness studies with evaluations of the development and implementation of ASRH promotion initiatives.

Girls' relationship authenticity and self-esteem across adolescence.

Feminist psychologists have long posited that relationship authenticity (i.e., the congruence between what one thinks and feels and what one does and says in relational contexts) is integral to self-esteem and well-being. Guided by a feminist developmental framework, the authors investigated the role of relationship authenticity in promoting girls' self-esteem over the course of adolescence. Latent growth curve modeling was used to test the association between relationship authenticity and self-esteem with data from a 5-year, 3-wave longitudinal study of 183 adolescent girls. Results revealed that both relationship authenticity and self-esteem increased steadily in a linear fashion from the 8th to the 12th grade. Girls who scored high on the measure of relationship authenticity in the 8th grade experienced greater increases in self-esteem over the course of adolescence than girls who scored low on relationship authenticity. Further, girls who increased in authenticity also tended to increase in self-esteem over the course of adolescence. The importance of a feminist developmental framework for identifying and understanding salient dimensions of female adolescence is discussed.

From sex to sexuality: exposing the heterosexual script on primetime network television.

Although it is widely recognized that sexual content pervades television, research rarely examines how television's sexual messages are gendered and occur in a relational context. This study describes the development and implementation of a new coding scheme to evaluate sexual content from a feminist perspective. Merging scripting theory (Gagnon and Simon, 1987) with the theory of compulsory heterosexuality (Rich, 1980), we explicate a heteronormative and dominant sexual script, the Heterosexual Script, and assessed its presence in the 25 primetime television programs viewed most frequently by adolescents. Our codes captured depictions of boys/men and girls/women thinking, feeling, and behaving in relational and sexual encounters in ways that sustain power inequalities between men and women. Male characters most frequently enacted the Heterosexual Script by actively and aggressively pursuing sex. Less frequently but still at high rates were depictions of female characters willingly objectifying themselves and being judged by their sexual conduct.

Interpreting Narratives Within a Cross-National Interdisciplinary Study: A Case Study of a Collaborative Process.

PURPOSE: This article presents a case study of a collaborative process for the analysis of a young girl's narrative on becoming an adolescent in Shanghai. The purpose was to illuminate how interpretation of narratives can be strengthened with a diverse team of researchers. METHODS: Three different researchers, each representing a different discipline and lens for analyzing qualitative data, collaboratively analyzed and interpreted a 12-year-old girl's narrative from Shanghai as part of the Global Early Adolescent Study. Each researcher first analyzed the narrative separately with a written summary that was then analyzed for differences and similarities across the research team, along with further cross-checks of the translations of the recording. RESULTS: Throughout the analysis, we argued that the narrative was a story about gender and power: the gendered nature of socializing a girl, the interpersonal process of a mother, at the behest of a father, to press a daughter to behave in a proper, modest fashion, and the daughter learning the appropriate and proper way for adult woman to comport herself. At the same time, by bridging our interpretations together, we also came to agree that it was a story of a Chinese girl's loss of freedom and capitulation, evident in her resignation to comply with the gender norm that required that she refrain from displaying her body in a certain way at the dinner table. CONCLUSIONS: Recording our collaborative analysis process enabled us to illuminate how researchers who work on cross-national studies can combine forces-of perspectives and of methods-for a compelling approach that provides a more comprehensive analysis of the underlying meanings behind an interview narrative.

Marching to a Different Drummer: A Cross-Cultural Comparison of Young Adolescents Who Challenge Gender Norms.

PURPOSE: Little is known about how gender norms regulate adolescents' lives across different cultural settings. This study aims to illustrate what is considered as violating gender norms for boys and girls in four urban poor sites as well as the consequences that follow the challenging of gender norms. METHODS: Data were collected as part of the Global Early Adolescent Study, a 15-country collaboration to explore gender norms and health in early adolescence. The current study analyzed narrative and in-depth interviews conducted in urban poor sites in two middle-income (Shanghai, China; and New Delhi, India) and two high-income countries (Baltimore, U.S.; and Ghent, Belgium). A total of 238 participants, 59 boys and 70 girls aged 11-13 years old and 109 of their parents/guardians (28 male adults and 81 female adults), were interviewed. A thematic analysis was conducted across sites using Atlas.Ti 7.5 software. RESULTS: Findings revealed that although most perceptions and expressions about gender were regulated by stereotypical norms, there was a growing acceptability for girls to wear boyish clothes and engage in stereotypical masculine activities such as playing soccer/football. However, there was no comparable acceptance of boys engaging in traditional feminine behaviors. Across all sites, challenging gender norms was often found to lead to verbal, physical, and/or psychological retribution. CONCLUSIONS: While it is sometimes acceptable for young adolescents to cross gender boundaries, once it becomes clear that a behavior is socially defined as typical for the other sex, and the adolescent will face more resistance. Researchers, programmers, and clinicians working in the field of adolescent health need not only attend to those who are facing the consequences of challenging prevailing gender norms, but also to address the environment that fosters exclusion and underscores differences.

Gender matters: constructing a model of adolescent sexual health.

This article illustrates the construction of a new model of adolescent sexual health, one that addresses the complex relationships between gender and adolescent sexuality. A review of sexual health models highlights the absence of gender; in contrast, research illuminates the significance of gender. This article describes the process of building a model of sexual health explicitly for girls, guided by feminist research on adolescent girls' sexuality and a "web of theories". It also describes the unanticipated challenges of making a companion model for boys and the ensuing shift from a gender-specific approach to an integrated gendered model of adolescent sexual health. Gender complementarity is defined and forwarded as a way to incorporate gender into a model of adolescent sexual health.

Heterosexual anal intercourse among Black and Latino adolescents and young adults: a poorly understood high-risk behavior.

The purpose of this study was to gain a better understanding of the context of heterosexual anal intercourse (HAI) among adolescents. Black and Latino youth were recruited at an urban college and an inner-city adolescent clinic. Participants completed a sexual behavioral questionnaire and the Sexual Relationship Power Scale (SRPS). A total of 61 young people, all of whom were sexually experienced, completed the survey (53 females; 8 males). Of these respondents, 20% reported engaging in HAI (N = 12), and 50% reported HAI refusal. The Relationship Control subscale scores of the SRPS were significantly inversely correlated with a history of HAI. Those who reported HAI or HAI refusal were invited to participate in an interview; 15 participants were interviewed. Most women found HAI distasteful, though some enjoyed it and instigated it. Most participants did not associate HAI with HIV-infection risk, and few used condoms. Some reported no longer using condoms for vaginal or oral intercourse after not using condoms for HAI and vice versa. The data suggest that there is no sexual script for HAI. HAI appears to be a complex behavior. Conventional views about it, as a way to preserve virginity or prevent pregnancy, may not be adequate. More research is needed to understand this behavior.

Narratives of desire in mid-age women with and without arousal difficulties.

There is controversy about the nature of women's sexual desire. The aim was to explore narrative descriptions of sexual desire among mid-aged women in hopes of clarifying how women define and experience sexual desire, and how these might differ among women with and without female sexual arousal disorder (FSAD). Mid-aged women without (age: M = 45, n = 12) and with (age: M = 55, n = 10) FSAD took part in in-depth interviews that invited them to share personal stories of sexual desire. Women also completed the Brief Index of Sexual Functioning and the Female Sexual Function Index (FSFI). Women in both groups described sexual desire in genital, non-genital physical, and in cognitive-emotional terms. Although women with FSAD had low ratings of sexual desire on the FSFI, they could recall recent experiences of desire that did not differ from the control group. Women identified a number of triggers of desire including touch, memories, and partner's responses--the latter of which acted as both a trigger and an inhibitor. Women in the control group were more likely to express conflation about the distinction between desire and arousal. Among the different "objects" of women's desire, most women acknowledged emotional connection as most important.

Rethinking the associations between television viewing and adolescent sexuality development: bringing gender into focus.

PURPOSE: To investigate associations between adolescents' television viewing, their sexual behavior, and their perceptions of having power and control in sexual situations (i.e., sexual agency). This study incorporates results from a recent content analysis of television and attends to the different motives for and consequences of girls' and boys' sexual and relational behavior. METHODS: Adolescents (n = 703) aged 11 to 17 years from two public school districts in the Northeastern United States completed surveys assessing their television habits and sexual experiences. Survey data were combined with two content analyses, which assessed the frequency of sexual talk and behavior and the prevalence of gendered messages about sexuality (i.e., the Heterosexual Script) on primetime network television. RESULTS: Adolescents' sexual behavior and feelings of sexual agency were not associated with viewing sexual talk and sexual behavior on television, but were related to viewing the Heterosexual Script, particularly among girls. Girls who saw sexually objectified women and portrayals of men avoiding commitment more often reported less sexual agency. Girls who saw women acting as sexual gatekeepers more often were less sexually experienced and reported more sexual agency. Boys who saw men actively asserting their sexuality more often were less sexually experienced. CONCLUSIONS: The relationship between adolescents' television viewing and sexual experiences depends on the type of sexual messages viewed, the sexual outcome considered, and the gender of the viewer. Parents and practitioners should learn to identify the Heterosexual Script on television and encourage young people to negotiate sexual encounters in safe and positive ways.

To be seen and not heard: femininity ideology and adolescent girls' sexual health.

This study used a feminist developmental framework to test the hypothesis that internalizing conventional ideas about femininity in two domains--inauthenticity in relationships and body objectification--is associated with diminished sexual health among adolescent girls. In this study, sexual health was conceptualized as feelings of sexual self-efficacy (i.e., a girl's conviction that she can act upon her own sexual needs in a relationship) and protection behavior (i.e., from both STIs and unwanted pregnancy). A total of 116 girls (aged 16-19) completed measures of femininity ideology, sexual self-efficacy, sexual experiences, and protection behavior. Results revealed that inauthenticity in relationships and body objectification were associated with poorer sexual self-efficacy and sexual self-efficacy, in turn, predicted less sexual experience and less use of protection. Further, the two components of femininity ideology were associated with different forms of protection. The importance of a feminist developmental framework for identifying and understanding salient dimensions of sexual health for female adolescents is discussed.

Mom, dad, I'm straight: the coming out of gender ideologies in adolescent sexual-identity development.

Little attention has been given to how femininity and masculinity ideologies impact sexual-identity development. Differentiating violations of conventional femininity and masculinity ideologies as part of an overt process of sexual-identity development in sexual-minority adolescents suggested the possibility of a parallel process among heterosexual adolescents. Based on feminist theory and analysis of heterosexual adolescents narratives about relationships, the importance of negotiating femininity and masculinity ideologies as part of sexual-identity development for all adolescents is described.