Sexual health risk-taking behaviour is typically initiated during adolescence and continues throughout teenage years and early adulthood at higher levels than at other life stages. For some groups (e.g. deprived and vulnerable populations) the risks can be greater still. Risk behaviours in early youth are related to increased rates of risk-taking and the adoption of multiple risk behaviours in early adulthood. Prevention interventions implemented early on are shown to be most effective at preventing or reducing the poor health outcomes associated with risk-behaviours. Policies and prevention interventions are informed by current data showing patterns of risk behaviour, identification of emerging behaviour, factors associated with these behaviours and evidence of intervention prevention effectiveness. This submission presents a linking commentary which summarises and critiques a series of peer reviewed publications, supported by additional publications, all of which were carried out during my employment at Liverpool John Moores University. Studies have identified key factors affecting sexual development and associated behaviour; associations between sexual and other behaviours, such as alcohol behaviours; and the relationship between social and well-being factors and sexual behaviours in adolescents and young people. Studies also evaluate public health initiatives and review public health evidence of intervention effectiveness. These studies have contributed to understanding sexual development and its impact on behaviours during the life course; have highlighted the health service and education needs of young people; and have identified effective interventions and intervention components to inform national guidance, public health policy and intervention development.

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Since June of 2013, Plan B and its generics have been available over-the-counter without age restriction nationwide. Even so, pharmacy-based economic, physical, and staff-associated barriers still exist, potentially leading adolescent customers to fail to obtain emergency contraception (EC) in a sufficiently timely manner to prevent pregnancy. This study explores these pharmacy-based barriers to EC in the state of Kentucky focusing on comparisons of urban and non-urban pharmacies and chain and private pharmacies. Using a secret-shopper survey technique, the researcher called 220 Kentucky pharmacies acting as a 15-year-old girl seeking information about EC. Among other findings, a logistic regression analysis revealed that private pharmacies were 97% less likely to carry EC compared to chain pharmacies (OR= .027; p

Parent-teen sex conversations reduce Black adolescents’ HIV/STI risk. Nationally, most studies about Black teens’ sexual risk behaviors omit Afro-Caribbean groups whom are disproportionately burdened by HIV/STIs. Therefore, this exploratory study guided by the PEN-3 model (a) characterized the nature, perceptions, enablers, and nurturers of sexuality conversations between Haitian and Jamaican parents and adolescents and (b) explained the relationship between sexuality conversations and adolescent sexual activity. Using narrative inquiry, 6 Haitian and 8 Jamaican mother-teen dyads’ and triads’ (N=31) experiences were used to characterize the nature, perceptions, enablers, and nurturers of parent-teen sex conversations. Thematic content analysis generated common themes. In phase two, Black adolescents (African American, Haitian, and Jamaican) N=157, completed a validated 52-item questionnaire. Scales included ASAI; measuring recent pre-coital and coital activities; FSCQ measuring families’ orientation towards sex-conversations, and PTSRC-III measuring sexual topics discussed with each parent. Linear and logistic regression determined the relationship between parent-teen sex conversations and teens’ sexual activity. Mothers’ mean age was (41.85±5.50) and teens’ mean age was (16±1.31). Qualitative findings suggest that Afro-Caribbean mothers’ limited childhood and adolescent sex conversations and outcomes of those interactions shaped mothers’ existing attitudes, beliefs, and behaviors about sexual topics, and hindered their ability to discuss sex with their teens. Dyads believed modifying parents’ approach, improving parents’ sexual health knowledge, and increasing families’ comfort with sex- conversations would improve sexual discussions. Survey participants’ mean age was (16±1.49) and mean age of penile-vaginal/anal sexual debut was (14.95±1.71). Twenty percent of sexually active teens had their first parent-teen sex conversation after penile-vaginal/anal sexual debut, p=.01, and 27% after penile-oral/vaginal-oral sexual debut, p=.001. Haitians had lower comfort with family-sex conversations than African Americans, p=.03 and Jamaicans, p=.004. African American teens’ higher comfort for family-sex conversations was predictive of delayed penile-vaginal/anal sexual debut, p=.009 and virginity, OR=1.5, 95% CI [1.154, 1.866]. Teens who never spoke to their fathers about protection from HIV/STI were four times more likely OR= 4.41, 95% CI [1.466, 13.30] to not use condoms. In summary, culturally-responsive, family focused interventions are needed to equip Afro-Caribbean parents for sex conversations with their teens in order to reduce teens’ sexual risk.

Student voice could improve the effectiveness of sex education curricula, student input, however, is generally limited or totally absent in sex education development. This dissertation explores student content preferences in sex education curricula and how school officials can incorporate student feedback to ensure content is relevant, relatable, and reliable. Results also show that adolescents are in favor of receiving social media-delivered sex education from local health departments. To build an adolescent following and greater awareness about SNS accounts that disseminate sex education, participants suggested LHDs 1) inform intended audiences about products by building offline connections 2) use promotions to create awareness 3) emphasize price during giveaways, publicize free services and 4) use the right people to motivate others to follow accounts.

This thesis aims to investigate the influence of parental styles on an adolescent's ability to access and receive sexual health services, regardless of the existing policies that may or may not require parental consent. Through stratified sampling, participants who lived in different parts of Sweden during their adolescence were interviewed. The Parental Power Assertion theory has been used to identify the parental styles used by the interviewees’ parents under their adolescence. Additionally, the Self-Determination Theory has been used to determine their level of autonomy during their adolescence. The data collected indicated that parenting styles have a significant impact on an adolescent's autonomy, particularly in relation to their sexual health decisions. The findings show that parental styles play an important role in shaping an adolescent's autonomy in making their own sexual health decisions.

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