Peer pressure and web-based peer learning: an exploratory case study.

This study explores whether and how peer pressure influenced students' participation in web-based peer learning (WPL). Fifteen students enrolled in a university reading course were followed over the course of one semester, and interviews with them along with the researcher's observational notes on their learning activities were qualitatively analyzed. Peer pressure slowly and steadily occurred during the students' WPL, with the students feeling differently about it at different levels. All of the students became somewhat used to it later in the semester. The peer pressure was mainly influenced by technological factors (e.g., the openness of the web platform) and non-technological factors (e.g., the academic gaps between students), along with other accompanying reasons (e.g., self-motivation for looking academically decent). The study concludes that students' experiences of peer pressure in relation to WPL involved a gradual process, had multiple causes, and ultimately positively impacted the students, although in the process, peer pressure exerted either negative or positive power on the students.

Associations between sexting motivations and consequences among adolescent girls.

INTRODUCTION: Approximately 15% of adolescent girls in the United States have engaged in sexting. Although sexting frequency is similar across genders, adolescent girls report more negative consequences. To date, the majority of sexting research focuses on demographic and behavioral predictors of sexting frequency or onset and there is limited research on the associations between different sexting motivations and consequences. This cross-sectional study draws upon approach-avoidance motivation theory to examine how different sexting motivations serve as risk and protective factors related to negative sexting consequences and which motivations promote more positive experiences. METHOD: A sample of 200 cisgender girls, 14-18 years, diverse with respect to race/ethnicity and geographical region, who had sexted a male recipient in the past year completed an online survey. RESULTS: Regression analyses indicated that avoidance motivations sexting in response to peer pressure and popularity and sexting in response to male coercion were risk factors for negative sexting consequences. Sexual subjectivity (sexual body-esteem, entitlement to sexual pleasure, and sexual self-reflection) was a protective factor against negative sexting consequences and, along with sexting for sexual or romantic reasons, an approach motivation, was associated with experiencing more positive sexting consequences. CONCLUSION: These findings support previous recommendations that schools incorporate ways to counter pressured sexting into existing cyberbullying or dating violence curricula and also align with a positive sexual development framework that acknowledges the importance of consensual and healthy sexual experiences during adolescence that minimize risks and vulnerabilities.

[School-based alcohol prevention with virtual reality]. / Schulische Alkoholprävention mittels Virtual Reality.

Risky alcohol consumption among adolescents continues to be of high public health relevance in Germany. Therefore, preventive measures should promote the skills of adolescents to deal with alcohol and peer pressure. Interactive and gender-sensitive primary prevention programs in schools have a great potential to reach the target group and to increase the effectiveness of interventions. Digital tools such as virtual simulations may help with this process.Virtual reality (VR) enables the experience of risk situations in a safe environment. Internationally, there are currently two VR alcohol prevention programs for adolescents. Their co-creation with the target group was a core element, and comprehensive research on the usability and subjective effectiveness has already been published. Conventional effectiveness evaluations such as randomized controlled trials, however, have limitations with interactive formats. Alternative and complementary evaluation approaches are needed in the future. Furthermore, the potential of tailoring VR to recipients has to be examined. In this context, a gender-sensitive design is both an opportunity and a challenge.Further research is needed to study possibilities to use VR in alcohol prevention in adolescents in Germany.

A Social-Ecological Approach to Understanding Adolescent Sexting Behavior.

This study examined the extent to which active and passive sexting behaviors are associated with family-, school-, peer-, and romantic-level variables. Young people (N = 3,322; 49.1% female, 48.3% male, 2.6% other) aged 11 to 15 years old (M = 12.84, SD = 0.89) took part, and all attended mainstream secondary schools in Scotland. Participants completed self-report measures of school connectedness, parental love and support, perceived susceptibility to peer- and romantic-pressure (e.g., to display behaviors just to impress others), and their involvement in active and passive sexting. The importance of both school- and family-level factors was evident, though perceived romantic-pressure had the largest effect. However, neither school- nor family-level variables were moderated by either perceived romantic-pressure or perceived peer-pressure. Efforts to reduce sexting or increase its safety should primarily seek to tackle young people's ability to respond effectively to romantic-pressure. It may also be helpful to develop school connectedness and to help families provide support that is constructive and not intrusive.

Peer conversation about substance (mis)use.

What happens when a friend starts talking about her own substance use and misuse? This article provides the first investigation of how substance use is spontaneously topicalized in naturally occurring conversation. It presents a detailed analysis of a rare video-recorded interaction showing American English-speaking university students talking about their own substance (mis)use in a residential setting. During this conversation, several substance (mis)use informings are disclosed about one participant, and this study elucidates what occasions each disclosure, and how participants respond to each disclosure. This research shows how participants use casual conversation to offer important substance (mis)use information to their friends and cohabitants, tacitly recruiting their surveillance. Analysis also uncovers how an emerging adult peer group enacts informal social control, locally (re-)constituting taken-for-granted social norms and the participants' social relationships, to on the one hand promote alcohol use while, on the other hand endeavouring to prevent one member from engaging in continued pain medication misuse. This article thus illuminates ordinary peer conversation as an important site for continued sociological research on substance (mis)use and prevention.

Peer-pressure and overuse: The effect of a multimodal approach on variation in benzodiazepine prescriptions in a network of public hospitals.

BACKGROUND: The epidemic phenomenon leading to a progressive increase in benzodiazepine prescriptions represents a challenge for healthcare systems. In the hospital setting, indicators of prescription variation and potential of overuse are lacking and are rarely monitored. Inter-hospital monitoring/benchmarking, via peer-pressure, can foster the motivation to change. The aim of this investigation was to analyse whether, the reduction in new benzodiazepine prescriptions obtained thanks to a Choosing Wisely campaign, also contributed to reducing inter-hospital variation. METHODS: Secondary analysis of a multicentre longitudinal intervention in a network of five teaching hospitals in Switzerland. We set out to explore the effect, on inter-hospital benzodiazepine prescription variation, of a continuous monitoring/benchmarking strategy, which was proven effective in reducing the intra-hospital prescription rate. The variance was used to assess inter-hospital variation. To investigate the impact of the intervention a segmented regression analysis of interrupted time series was performed. RESULTS: A total of 36 299 admissions over 42 months were analysed (1 July 2014 to 31 December 2017). Before the intervention a significant constant upward trend in inter-hospital variability was found (+0.901; SE 0.441; P < .05). After the intervention, the variance trend line significantly changed, decreasing by -0.257 (SE 0.005: P < .001) and producing by December 2017, a 27% absolute reduction. CONCLUSIONS: Thanks to a multimodal approach based on monitoring-benchmarking, a significant reduction in inter-hospital benzodiazepine prescription variation was obtained. Aligning to peer strategy is a spontaneous consequence of open benchmarking that can be used to convert a variation-based suspicion of overuse, into an occasion to actively review prescription habits.

Peer pressure and alcohol consumption in adults living in the UK: a systematic qualitative review.

BACKGROUND: Peer pressure to drink alcohol may influence excessive alcohol consumption, which can have adverse impacts on health and wellbeing. While peer pressure to drink alcohol is extensively studied among youth, less examination exists among adults. This systematic review examined qualitative research studies which explored the role and concept of peer pressure within the context of alcohol consumption in adults living in the UK. METHODS: Qualitative studies which explored peer pressure within the context of alcohol consumption or alcohol related behaviours and views in adults (age range approximately 18-52 years) living in the UK were included. Systematic searches conducted in Medline, PsycINFO and Web of Science identified 1462 references, of which 13 studies met inclusion criteria. Thematic analysis was conducted. RESULTS: Five overarching themes were identified. Four of these themes directly address aspects of peer pressure, including: experiences of peer pressure; consequences of peer pressure; strategies to deal with peer pressure; and conditions perceived to affect peer pressure. The fifth overarching theme explains the wider social context influencing peer pressure. Pressure to drink alcohol affects individuals across the life span and can be experienced as overt and aggressive, or subtle and friendly. Those consuming little or no alcohol are more likely to feel overt forms of peer pressure. Some developed strategies to cope with pressure from drinkers. Peer pressure can result in feelings of social isolation, or giving in by consuming alcohol against ones wishes. CONCLUSION: Peer pressure to drink alcohol is a complex and multifaceted phenomenon experienced across adulthood requiring better understanding to support initiatives to decrease the impact of pressure-inducing environments and develop strategies to deal with perceived pressure conditions. TRIAL REGISTRATION: The protocol for this review is registered with PROSPERO ( CRD42019122201 ). Registered 11 February 2019.

Peer Pressure and Substance Use in Emerging Adulthood: A Latent Profile Analysis.

Introduction: Peers play an important role in influencing emerging adults' substance use behaviors, however, research on peer pressure has typically not been extended beyond adolescence to include emerging adulthood. Little research has examined the relationships between various peer pressure domains and emerging adult substance use. Methods: This study used quantitative data from 359 emerging adults (aged 18-29 years, M = 25.46 years; 60.8% female; 74.2% White) to explore the associations between different types of peer pressure (e.g. peer pressure to socialize and peer pressure to use substances) and substance use among a diverse sample of emerging adults. Latent profile analysis and path analysis were used for analysis. Results: Three unique profiles of perceived peer pressure emerged (negative peer pressure, positive peer pressure, and no perceived peer pressure). The negative peer pressure group was more likely to engage in binge drinking, lifetime alcohol use and lifetime marijuana use than the no peer pressure group. The positive peer pressure group was less likely to engage in lifetime alcohol or marijuana use compared to the no peer pressure group. Discussion: Findings suggest that peer pressure is associated with emerging adult substance use, in both negative and positive ways. Results of the current study provide the critical groundwork for more sophisticated studies seeking to understand the pathways by which positive and negative peer pressure impact emerging adult behavior.

Adolescent Drivers - Are We Doing Enough?

The minimum eligible driving age in Australia is 15 years 9 months, in the Australian Capital Territory, and 16 years elsewhere in the country. Approval to drive mandates: appropriate age; completing computer-generated testing; and monitored Graduated Licensing Schemes. The National Road Safety Strategy 2011-2020, released by the Australian Transport Council, either has been or is being implemented, including sponsorship of the Australasian College of Road Safety and establishing Cabinet representation for road safety. Factors include: driving ability; developmental factors; personality; demographics; general environment; and driving environment. The Graduated Licensing process has counted driver inexperience, but immaturity and peer pressure remain additional considerations. Complementing Graduated Licensing, parental and respected directives and guidance are essential to minimise negative peer pressure. Specific counselling and other targeted interventions may also assist. Attention Deficit Hyperactivity Disorder or adolescent epilepsy demand appropriate management to facilitate driving in accordance with the AUSTROADS Guidelines. A composite targeted approach is required to deal with adolescent road fatalities and injuries.

The effect of active and passive peer encouragement on adolescent risk-taking.

INTRODUCTION: In this experiment, we investigated the effect of active (pressure) and passive (imitation) peer encouragement on adolescent risk-taking and assessed gender differences. METHOD: The participants performed the Balloon Analogue Risk Task (BART) with the same-sex e-confederate. The experiment consisted of a 2 (passive encouragement: no/yes updates about the number of pumps of the e-confederate) by 2 (active encouragement: no/yes messages received from the e-confederate) by 2 (gender: girls/boys) by 3 (time: baseline/first message or update/second message or update) mixed design. The participants comprised 138 Dutch secondary-school students aged 11-19 years old of whom 46% boys. They were assigned to one of the four conditions: 1. neutral (e-confederate present), 2. passive (two updates received), 3. active (two messages received), or 4. combined (two updates and two messages received). RESULTS: Only a significant main effect of passive peer encouragement and a significant interaction effect of passive peer encouragement*time were shown. The participants exposed to passive peer encouragement took significantly more risk compared to other participants. Moreover, adolescent risk-taking significantly increased after the first and second update compared to baseline (no update). CONCLUSION: The findings suggest that adolescents are more likely to engage in risk-taking because of passive rather than active peer encouragement. Thus, communication through text-based messages in which young people provide information solely about their own risk-taking may be an important aim of prevention and intervention programs.

The Association Between Admiration of Antisocial Peers and Past 30-Day Opioid Misuse Among Justice-Involved children.

AIM: Prevention of illicit or nonmedical opioid use, called opioid misuse (OM) is a key public health concern that requires research on the factors that influence OM initiation among high-risk populations. Justice-involved children (JIC) have more risk factors and fewer resources. Antisocial peers have been linked to adolescent substance abuse and delinquency. However, the association between the admiration of antisocial peers and OM among JIC has not yet been studied. This study hypothesizes that admiration of antisocial peers will be associated with a higher likelihood of OM among Florida JIC. METHODS: Cross-sectional data on 79,960 JIC from the Florida Department of Juvenile Justice (FLDJJ) were examined. To test the hypothesis, bivariate and multivariate logistic regression analyses were employed. The multivariate models controlled for gender, race, age in 2007, family income, history of mental health, history of depression, and optimism. RESULTS: Nearly 2.7% of the sample met the criteria for past 30-day OM, and over 75% of those current users admired or somewhat admired their antisocial peers. Compare to JIC who did not admire their antisocial peers, those who had some admiration of antisocial peers were 2.39 times more likely to misuse opioids in the past 30-days and those who admired their antisocial peers were 4.40 times more likely to meet the criteria for past 30-day OM. CONCLUSIONS: Cultivating positive peer interactions and providing positive peer role models may help to reduce illicit opioid use among JIC.

Support of adolescents to resist peer pressure and coercion to sexual activity.

AIM: The aim of this study was to explore and describe how peer pressure and coercion to sexual activity manifested among adolescents in a district in South African and how primary healthcare nurses could support them to resist it. BACKGROUND: When adolescents engage in early sexual activity, unplanned pregnancies and sexual transmitted infections become health threats. Notwithstanding the governmental health promotion programmes to improve the sexual health of the youth in South Africa, adolescents are still having unprotected sex and even multiple sex partners. METHODS: A constructivist grounded theory study was done. The initial sample consisted of 10 adolescents and nine professional nurses who were selected from six primary healthcare clinics in the identified district. Constant comparative data collection and analysis were done to identify the initial codes that were theoretically saturated through another round of data collection and analysis involving five participants (four professional nurses and one health educator). FINDINGS: The findings of the study refer to the definition of peer pressure and coercion and the relationship between professional nurses and adolescents. Ways to optimize the relationship in order for nurses to substitute for parental shortcomings in guiding adolescents towards responsible sexual behaviour and to address the adolescents' vulnerability regarding peer pressure were identified. CONCLUSION: Challenging adolescent-nurse interaction incidents were identified that warranted different approaches to build on existing initiatives to improve adolescent-friendly health services. IMPLICATIONS FOR NURSING PRACTICE AND POLICY: Primary healthcare nurses should perform complementary roles to substitute for parents who do not have the skills to guide their adolescent children towards responsible sexual behaviour. Programmes need to be developed to enable nurses to optimize their relationships with adolescents and to deliver services through mobile healthcare units to adolescents where they regular socialize. Management should provide budgets for nurses to use multimedia to interact with adolescents.

A cross-sectional study of depression with comorbid substance use dependency in pregnant adolescents from an informal settlement of Nairobi: drawing implications for treatment and prevention work.

INTRODUCTION: Adolescent pregnancy is a highly prevalent and significant public health problem in Kenya, and mental health needs of pregnant adolescent girls have been overlooked. Nearly, 50% of the world's population comprises children and adolescents and 85% live in lower and middle-income countries. OBJECTIVE: Pregnant adolescents were interviewed to ascertain certain social determinants of mental health such as social support, partner or parent support, and demographic profile and assessed for depression using EPDS and for severity of depression using BDI, and their alcohol abuse assessed using AUDIT. METHODS: A cross-sectional descriptive study using a purposive sample of 212 pregnant adolescents visiting Kangemi Health Centre in Nairobi was conducted. RESULTS: We found that 60.4% had depressive symptoms scores of 8 and above on EPDS, 51.9% were found to have severe depression score on BDI. About 26.9% were currently consuming alcohol. The more severely depressed participants were demonstrating greater alcohol use. Of the 110 pregnant adolescents who were severely depressed, 39 were currently consuming alcohol. We identified several alcohol use disorder factors associated with depression such as living with an alcoholic, ever and current use of alcohol, alcohol-related harm being experienced, being pressured to take alcohol. On our final multivariate logistic regression, we found that being a student (AOR 5.12, 95% CI 1.19-22.0, P = 0.028); low family income (between 5000 and 10,000 shillings) (AOR 0.22, 95% CI 0.09-0.56, P = 0.02); unplanned pregnancy (AOR 3.41, 95% CI 1.19-9.80, P = 0.023); both negative and ambivalent attitudes of the unborn baby's father, respectively (AOR 8.72 95% CI 2.88-26.37 P < 0.001; AOR 4.26 95% CI 1.35-13.45, P = 0.013); early age at sexual debut (AOR 0.70, 95% CI 0.55-0.89, P = 0.003); and ever used any psychoactive substances (AOR 3.21, 95% CI 1.31-7.88, P = 0.011). CONCLUSION AND RECOMMENDATIONS: Alcohol abuse during pregnancy presents a significant public health burden and the associated health risks for the adolescent mother and her baby are enormous. We need to bolster screening for the comorbid disorders such as depression and substance use disorders, particularly alcohol in order to address mental health and psychosocial functioning of adolescents. The underlying adversities and sociocultural challenges need to be better understood and mechanisms that lead to comorbidities require further research. Depression interventions for Kenyan adolescents would need to embed screening, treatment and management of substance abuse.

Experiences of pressure to conform in postgraduate medical education.

BACKGROUND: Perception of pressure to conform prevents learners from actively participating in educational encounters. We expected that residents would report experiencing different amounts of pressure to conform in a variety of educational settings. METHODS: A total of 166 residents completed questionnaires about the frequency of conformity pressure they experience across 14 teaching and clinical settings. We examined many individual characteristics such as their age, sex, international student status, level of education, and tolerance of ambiguity; and situational characteristics such as residency program, type of learning session, status of group members, and type of rotation to determine when conformity pressure is most likely to occur. RESULTS: The majority of participants (89.8%) reported pressure to conform at least sometimes in at least one educational or clinical setting. Residents reported higher rates of conformity during informal, rather than formal, teaching sessions, p < .001. Also, pressure was greater when residents interacted with higher status group members, but not with the same or lower level status members, p < .001. Effect sizes were in the moderate range. CONCLUSIONS: The findings suggest that most residents do report feeling pressure to conform in their residency settings. This result is consistent with observations of medical students, nursing students, and clerks conforming in response to inaccurate information within experimental studies. Perception of pressure is associated with the setting rather than the trainee personal characteristics.

Internet Filtering Technology and Aversive Online Experiences in Adolescents.

OBJECTIVES: To evaluate the effectiveness of Internet filtering tools designed to shield adolescents from aversive experiences online. STUDY DESIGN: A total of 1030 in-home interviews were conducted with early adolescents aged from 12 to 15 years (M = 13.50, SD = 1.18) and their caregivers. Caregivers were asked about their use of Internet filtering and adolescent participants were interviewed about their recent online experiences. RESULTS: Contrary to our hypotheses, policy, and industry advice regarding the assumed benefits of filtering we found convincing evidence that Internet filters were not effective at shielding early adolescents from aversive online experiences. CONCLUSIONS: Preregistered prospective and randomised controlled trials are needed to determine the extent to which Internet filtering technology supports vs thwarts young people online and if their widespread use justifies their financial and informational costs.

Prevalence and determinants of risky sexual practice in Ethiopia: Systematic review and Meta-analysis.

BACKGROUND: Risky sexual practice is a major public health problem in Ethiopia. There are various studies on the prevalence and determinants of risky sexual practice in different regions of the country but there is no study which shows the national estimate of risky sexual practices in Ethiopia. Therefore, this review was conducted to estimate the national pooled prevalence of risky sexual practice and its risk factors in Ethiopia. METHODS: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline was followed to review published and unpublished studies in Ethiopia. The databases used were; PubMed, Google Scholar, CINAHL and African Journals Online. Search terms were; risky sexual behavior, risky sexual practice, unprotected sex, multiple sexual partner, early sexual initiation, and/or Ethiopia. Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument was used for critical appraisal. The meta-analysis was conducted using Review Manager software. Descriptive information of studies was presented in narrative form and quantitative results were presented in forest plots. The Cochran Q test and I 2 test statistics were used to test heterogeneity across studies. The pooled estimate prevalence and the odd ratios with 95% confidence intervals were computed by a random effect model. RESULTS: A total of 31 studies with 43,695 participants were included in the meta-analysis. The pooled prevalence of risky sexual practice was 42.80% (95% CI: 35.64%, 49.96%). Being male (OR: 1.69; 95% CI: 1.21, 2.37), substance use (OR: 3.42; 95% CI: 1.41, 8.31), peer pressure (OR: 3.41; 95% CI: 1.69, 6.87) and watching pornography (OR: 3.6; 95% CI: 2.21, 5.86) were factors associated with an increase in risky sexual practices. CONCLUSIONS: The prevalence of risky sexual practices is high in Ethiopia. Being male, substance use, peer pressure and viewing pornographic materials were found to be associated with risky sexual practices. Therefore, life skills training is recommended to reduce peer pressure among individuals. Interventions should be designed to reduce substance use and viewing pornography.

The association of peer pressure and peer affiliation with the health risk behaviors of secondary school students in Hong Kong.

OBJECTIVE: The aim of this study was to explore the relationship between peer pressure and the health risk behaviors of secondary school students. STUDY DESIGN: Cross-sectional study using a self-completed questionnaire. METHODS: Secondary school students in Year 3 were the target population of this study. Information was solicited from students on their perceptions of peer pressure using a questionnaire employing the Peer Pressure Inventory and their involvement in risk behaviors using a modified global school-based student health survey. RESULTS: A total of 840 secondary students from Hong Kong completed the questionnaires. The prevalence of secondary students who had ever smoked was 6.4%, consumed alcohol 39.2%, ever used drugs 0.5%, were sexually active 3.9%, and involved in bullying 20.5%. A higher proportion of secondary students involved in risk behaviors were affiliated with peers who were involved in the same activities: smoking (48.9%), drinking alcohol (86.5%), using drugs (18.2%), engaged in sexual activity (34.5%), and bullying (82.6%). The perception of peer conformity and peer involvement was found to be significantly correlated with the students' health risk behaviors, particularly with regard to smoking, drinking alcohol, and bullying. A logistic regression analysis showed that having friends who are involved in the same risk behaviors is the single most important factor associated with the participation of secondary students in those specific risk behaviors. CONCLUSIONS: The results of this study provided a better understanding of the association between peer pressure and the adoption of health behaviors. The development of effective peer-led prevention programs to reduce the uptake of health risk behaviors should therefore be promoted to prevent adolescents from developing serious health problems.

Impact of peer pressure on accuracy of reporting vital signs: An interprofessional comparison between nursing and medical students.

The hierarchical relationship between nursing and medicine has long been known, yet its direct influence on procedural tasks has yet to be considered. Drawing on the theory of conformity from social psychology, we suggest that nursing students are likely to report incorrect information in response to subtle social pressures imposed by medical students. Second-year medical and third-year nursing students took vital signs readings from a patient simulator. In a simulation exercise, three actors, posing as medical students, and one nursing student participant all took a total of three rounds of vital signs on a high-fidelity patient simulator. In the first two rounds the three actors individually stated the same correct vital signs values, and on the third round the three actors individually stated the same incorrect vital sign values. This same procedure was repeated with actors posing as nursing students, and one medical student. A two-way analysis of variance (ANOVA) revealed that nursing student participants (M = 2.84; SD = 1.24) reported a higher number of incorrect vital signs than did medical student participants (M = 2.13; SD = 1.07), F (1,100) = 5.51, p = 0.021 (Cohen's d = 0.61). The study indicated that social pressure may prevent nursing students from questioning incorrect information within interprofessional environments, potentially affecting quality of care.

The influence of social norms on the dynamics of vaccinating behaviour for paediatric infectious diseases.

Mathematical models that couple disease dynamics and vaccinating behaviour often assume that the incentive to vaccinate disappears if disease prevalence is zero. Hence, they predict that vaccine refusal should be the rule, and elimination should be difficult or impossible. In reality, countries with non-mandatory vaccination policies have usually been able to maintain elimination or very low incidence of paediatric infectious diseases for long periods of time. Here, we show that including injunctive social norms can reconcile such behaviour-incidence models to observations. Adding social norms to a coupled behaviour-incidence model enables the model to better explain pertussis vaccine uptake and disease dynamics in the UK from 1967 to 2010, in both the vaccine-scare years and the years of high vaccine coverage. The model also illustrates how a vaccine scare can perpetuate suboptimal vaccine coverage long after perceived risk has returned to baseline, pre-vaccine-scare levels. However, at other model parameter values, social norms can perpetuate depressed vaccine coverage during a vaccine scare well beyond the time when the population's baseline vaccine risk perception returns to pre-scare levels. Social norms can strongly suppress vaccine uptake despite frequent outbreaks, as observed in some small communities. Significant portions of the parameter space also exhibit bistability, meaning long-term outcomes depend on the initial conditions. Depending on the context, social norms can either support or hinder immunization goals.

Peer Pressure and Risk-Taking Behaviors Among Adolescent Girls in a Region Impacted by HIV/AIDS in Southwestern Uganda.

PURPOSE: This paper uses data from a 3-arm Cluster Randomized Control Trial, Suubi4Her (N = 1260; 14-17-year-old school-going girls) to (1) assess the relationship between peer pressure and adolescent risk-taking behaviors; and (2) test the mediating effect of peer pressure on an intervention on adolescent risk-taking behaviors. METHODS: Students in the southwestern region of Uganda were assigned to three study arms: control (n = 16 schools, n = 408 students) receiving usual care comprising of sexual and reproductive health curriculum; and two active treatment arms: Treatment 1 (n = 16 schools, n = 471 students) received everything the control arm received plus a savings led intervention. Treatment 2 (n = 15 schools, n = 381 students) received everything the control and treatment arms received plus a family strengthening intervention. We used multilevel models to assess the relationship between peer pressure and risk-taking behaviors. We ran structural equation models for mediation analysis. RESULTS: Using baseline data, we found that direct peer pressure was significantly associated with substance use risk behaviors, (ß = 0.044, 95% CI = 0.008, 0.079). We also found a statistically significant effect of the intervention on acquiring STIs through the mediating effect of sexual risk-taking significant (ß = -0.025, 95% CI: -0.049, -0.001, p = .045) and total indirect (ß = -0.042, 95% CI: -0.081, -0.002, p = .037) effects. Also, there was a significant mediation effect of the intervention on substance use through peer pressure (ß = -0.030, 95% CI: -0.057, -0.002, p = .033). DISCUSSION: Overall, the study points to the role of peer pressure on adolescent girls' risk-taking behaviors; and a need to address peer pressure at an early stage.