Adolescent Attachment Profiles Are Associated With Mental Health and Risk-Taking Behavior

This person-oriented study aimed to identify adolescents’ hierarchical attachment profiles with parents and peers, and to analyze associations between the profiles and adolescent psychosocial adjustment. Participants were 449 Finnish 17–19-year-olds reporting their attachments to mother, father, best friend, and romantic partner and details on mental health (internalizing symptoms, inattention/hyperactivity, and anger control problems) and risk-taking behavior (substance use and sexual risk-taking). Attachment was measured with Experiences in Close Relationships – Relationship Structures (ECR-RS); internalizing, inattention/hyperactivity, and anger control problems with Self-Report of Personality — Adolescent (SRP—A) of the Behavior Assessment System for Children, third edition (BASC-3); substance use with the Consumption scale of the Alcohol Use Disorders Identification Test (AUDIT-C) and items from the Finnish School Health Promotion Study; and sexual risk-taking behavior with the Cognitive Appraisal of Risky Events (CARE). Latent profile analysis identified five attachment profiles: “All secure” (39%), “All insecure” (11%), “Parents insecure – Peers secure” (21%), “Parents secure – Friend insecure” (10%), and “Parents secure – Partner insecure” (19%). “All insecure” adolescents showed the highest and “All secure” adolescents the lowest levels of mental health problems and substance use. Further, parental attachment security seemed to specifically prevent substance use and anger control problems, while peer attachment security prevented internalizing problems. Our findings help both understand the organization of attachment hierarchies in adolescence and refine the role of specific attachment relationships in psychosocial adjustment, which can be important for clinical interventions in adolescence.

The role of food security in increasing adolescent girls’ agency towards sexual risk taking: qualitative findings from an income generating agricultural intervention in southwestern Kenya

Background Food insecurity is an important underlying driver of HIV risk and vulnerability among adolescents in sub-Saharan Africa. In this region, adolescents account for 80% of all new HIV infections. The primary purpose of this analysis is to understand perceived mechanisms for how a multisectoral agricultural intervention influenced sexual risk taking among HIV-affected adolescents in southwestern Kenya. Methods We conducted semi-structured, individual interviews with 34 adolescent-caregiver dyads who were participants in Adolescent Shamba Maisha (NCT03741634), a sub-study of adolescent girls and caregivers with a household member participating in the Shamba Maisha trial (NCT01548599), a multi-sectoral agricultural and microfinance intervention. Interviews were audiotaped, transcribed, translated, and analyzed using framework and interpretive description analysis methods. Results Adolescents receiving the Shamba Maisha intervention described no longer needing to engage in transactional sex or have multiple concurrent sexual partners as a way to meet their basic needs, including food. Key mechanisms for these effects include greater sexual agency among adolescent girls, and increased confidence and self-efficacy in overcoming existing reciprocity norms and sexual relationship power inequity; as well as staying in school. The intervention also increased caregiver confidence in talking about adolescent sexual reproductive health issues. In contrast, driven primarily by the need for food and basic needs, girls in the control arms described engaging in transactional sex, having multiple sexual partners, being unable to focus in school, getting pregnant or becoming HIV infected. Conclusion These findings emphasize the need to address food insecurity as a part of structural interventions targeting adolescent HIV risk in low-resource countries. We recommend that future interventions build upon the Shamba Maisha model by combining sustainable agricultural production, with household level interventions that deliberately target gender norms that contribute to unequal power dynamics.

Sexual Risk-Taking in Adolescents; a Narrative Review

A review of recent literature on sexual activity in adolescents revealed a prevalence range of 6-65 % in different countries that may relate to sampling different age groups as well as various types of sexual activity. Many risk factors have been researched including parental factors (e.g. parent risk behavior), peer variables (e.g. peer pressure), religiosity (e.g. spiritual intelligence), mood (e.g. depression), health-related behavior (e.g. sexting), substance use (e.g. marijuana) and physiological markers (e.g. activation of various areas of the brain on fMRI scans). The few interventions have included motivational interviewing by clinician or computer and classroom education and condom distribution. Limitations of this literature include a paucity of longitudinal studies and intervention research.

Triple site sexually transmitted infection testing as a crucial component of surveillance for men who have sex with men: A prospective cohort study

Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections are common among men who have sex with men (MSM). Many oropharyngeal and anorectal infections remain asymptomatic. We aimed to evaluate triple-site screening following PrEP introduction. We enrolled a prospective cohort study including 210 asymptomatic MSM during 2019–2020, analyzed by groups: HIV positive (HIV+), HIV−uninfected using PrEP (HIV−/PrEP+), or HIV-uninfected not using PrEP (HIV−/PrEP−). A self-administered questionnaire captured demographic information and sexual risk-taking behaviors. CT/NG testing results were compared between study groups and predictors of infection were evaluated. We included 59 HIV+, 70 HIV−/PrEP+, and 81 HIV−/PrEP− subjects. 30% ( n = 62) of participants tested positive for CT/NG. HIV−/PrEP+ group had highest proportion of infections ( n = 33, 47%) followed by HIV−/PrEP− ( n = 16, 22%) and HIV+ ( n=13, 20%; p < .001). Importantly, 98% (80/82) of pharyngeal/anorectal CT/NG infections were missed in genitourinary tract screening alone. PrEP use and previous syphilis infection were the strongest risk factor for CT/NG. Extra-genital asymptomatic CT/NG infections were prevalent among MSM. These data highlight the importance of routine extra-genital CT/NG testing in asymptomatic sexually active MSM. The study describes the consequences for three-site testing lack of implementation in the PrEP era.

Sex Differences in Attitudes Toward Casual Sex: Using STI Contraction Likelihoods to Assess Evolved Mating Strategies

Previous work shows that males are more likely to pursue casual sex if given the opportunity, compared to females, on average. One component of this strategy is risk-taking, and males have been shown to take more risks than females in a variety of contexts. Here, we investigate the extent to which sex differences exist considering casual sexual encounters involving sexually transmitted infections (STIs) using a hypothetical sexual scenario which attempts to circumvent several factors that may contribute to a female’s hesitancy to engage in casual sex encounters. Two hundred and forty-six college students rated their willingness to engage in a satisfying casual sexual encounter with someone judged to be personable as a function of sex, varying STI contraction likelihoods, several STI types, and two levels of hypothetical partner attractiveness. We also assess how individual levels of sociosexuality (as measured by the SOI-R) impact findings. Our findings show that males report higher likelihoods of sexual engagement compared to females in general. This trend continued for lower likelihoods of STI contraction in all four STI types (Cold, Chlamydia, Herpes, HIV), with larger effects shown in the high attractiveness partner condition. For higher STI contraction likelihoods and more severe STI types, along with lower partner attractiveness levels, sex differences shrank. Factoring in participant SOI-R scores attenuated the effects somewhat, although it failed to alter findings substantially with predicted sex differences continuing to exist. These results offer further insight into evolved sex differences in human mating systems and provide an additional framework to test sexual risk-taking among males and females.

Sexual Health in Emerging Adulthood

Sexual health in emerging adulthood encompasses a wide spectrum of medical and mental health functioning and associated behaviors. This chapter addresses aspects of physical sexual health that are of concern to emerging adults, including prevalence rates, determinants, and consequences of sexually transmitted infections, including HIV, and unintended pregnancy among emerging adults. The chapter also discusses sexual dysfunction and its treatment. Whenever possible, the chapter highlights differences in prevalence, risk, and protective factors related to aspects of human diversity, guided by an intersectional approach based on the ADDRESSING framework. Both protective and risky sexual health behaviors and decision making about sexual behavior are discussed, with a focus on the role of substance use in sexual risk taking. The chapter concludes with implications for future research, particularly in the area of prevention.

Effectiveness of Native STAND: A Five-Year Study of a Culturally Relevant Sexual Health Intervention

Culturally relevant interventions have the potential to improve adolescent health and protective factors associated with sexual risk taking. We evaluated the impact of the Native STAND curriculum with American Indian and Alaska Native (AI/AN or Native) high school students living across the U.S. using a pre-post evaluation design. Native STAND is a comprehensive sexual health curriculum for Native high school students that focuses on sexually transmitted infections, HIV/AIDS, and teen pregnancy prevention, while also covering drug and alcohol use, suicide, and dating violence. The curriculum was implemented in 48 AI/AN communities from 2014 to 2019. A significantly higher percentage of youth reported at post-test having a serious conversation about sex with their friends (post 36% vs. pre 28%, p < 0.001), thinking about lessons learned (post 24% vs. pre 7%, p < 0.0001), and sharing lessons learned during the conversation (post 21% vs. pre 4%, p < 0.001). A lower percentage of AI/AN youth reported being bullied in the last year (post 31% vs. pre 37%, p < 0.001). Family social support was moderated by dose, with subscale scores of 3.75 at post-with <27 sessions vs. 3.96 at post-with all 27 sessions (p = 0.02). The results demonstrate the effectiveness of Native STAND when delivered in a variety of settings. Efforts are now underway to update Native STAND for medical accuracy, improve alignment with typical class periods, and promote its use and an effective EBI for AI/AN youth.