Hispanic youth living in the U.S. share a disproportionate burden of risk for HIV, other STIs, and teen pregnancies. They also tend to report lower rates of condom use and higher rates of inconsistent condom use than other racial/ethnic groups. Furthermore, immigrant Hispanic adolescents experience a unique burden of sexual risk compared to their non-immigrant counterparts. These negative sexual health outcomes can severely derail the overall health, social mobility, and life opportunities of these adolescents. Social researchers have tried to explain these sexual risk disparities using the concept of immigrant acculturation, which is broadly defined as the process of adopting the cultural values and beliefs of a host society. Immigrant acculturation has been shown to play a key role in shaping youth attitudes and behaviors, including sexual risk behaviors (see Lee & Hahm, 2010). Yet, studies have largely overlooked the contextual components of acculturation that have been proposed in theoretical literature, specifically characteristics of the immigrant's receiving community. Furthermore, studies have not adequately explored the influence of acculturation on two crucial measures of sexual risk: teen pregnancy norms and condom use. Therefore, the current dissertation consists of two unique studies that examine the influence of acculturation, at both the individual and neighborhood level, on Hispanic adolescent teen pregnancy norms and condom use over time. The aim is to fill these important gaps in the literature and expand on earlier explanations of the relationship between cultural, place, and long-term sexual health. Both studies use nationally-representative data from the National Longitudinal Study of Adolescent to Adult Health. Overall, findings suggest an immigrant advantage for both teen pregnancy norms and condom use, although this advantage functions differently for males and females. Furthermore, the studies demonstrate the importance of including contextual measures of acculturation into studies related to Hispanic adolescent sexual health.

Sexual and gender politics inform relational expectations surrounding sexual experiences of Peruvian transgender women (TW) and men who have sex with men (MSM). We used the framework of sexual role strain, or incongruence between preferred sexual role and actual sexual practices, to explore potential conflicts between personally articulated identities and externally defined norms of gender and sexuality and its potential to increase HIV/STI risk. Cross-sectional individual- and dyad-level data from 766 TW and MSM in Lima, Peru were used to assess the partnership contexts within which insertive anal intercourse was practiced despite receptive role preference (receptive role strain), and receptive anal intercourse practiced despite insertive role preference (insertive role strain). Sexual role strain for TW was more common with non-primary partners, while for MSM it occurred more frequently in the context of a primary partnership. Receptive role strain was more prevalent for TW with unknown HIV status (reference: without HIV) or pre-sex drug use (reference: no pre-sex drug use). For homosexual MSM, receptive role strain was more prevalent during condomless anal intercourse (reference: condom-protected) and with receptive or versatile partners (reference: insertive). Among heterosexual or bisexual MSM, insertive role strain was more prevalent with insertive or versatile partners (reference: receptive), and less prevalent with casual partners (reference: primary). Our findings suggest TW and MSM experience different vulnerabilities during sexual role negotiation with different partner-types. Future studies should explore the impact of sexual role strain on condom use agency, HIV/STI risk, and discordances between public and private presentations of gender and sexual orientation. / National Institutes of Health / Revisión por pares

Casual sex culture, also known as hook-up culture, is an experience adversely affecting teens in America. The intent of this study was to test the association between sports participation and sexual risk behaviors among high school males. For the purpose of this study, sports participation, the independent variable, was defined by having played on a sports team in the last 12 months. The sexual risk behaviors, dependent variables, were defined by sexual engagement with multiple partners, drug and alcohol use before intercourse, and sex without condoms. The ecological model provided the theoretical foundation for the study. Secondary analysis of the 2015 Youth Risk Behavioral Surveillance System using logistic regression was employed to test if there was an association between sports participation and sexual risk behaviors in 7,749 high school males. Using regression analysis, a significant association was found between sports participation and abstinence status, number of sexual partners, and drug and alcohol use at last sexual intercourse. As the number of sports teams increased, the number of abstinent participants increased, the number of sexual partners decreased, and the number of participants who used drugs and alcohol at last sexual intercourse decreased. However, there was no association between sports participation and condom use at last sexual intercourse. Recommendations for next steps include using sports programs as a vehicle to influence behavior change. This study aimed to promote social change by improving the understanding of how sports programs benefit individuals, families, and communities from reducing sexual risk behaviors in teen males.

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The aims of this study are threefold. First, the study aims to understand the main reasons that stop 18-24-year-olds from communicating condom use and safer sex. Based on findings supported by empirical studies in the literature and interviews with sexual health researchers in Canada, this study describes how a collaborative serious game integrates the principles of serious games with practices of safer sexual communication and negotiation. Finally, it includes an analysis of how 18- to 24-year-olds report practicing safer sexual communication and negotiation skills through participation in the collaborative serious game and what insights (a) 18-24-year-old participants and (b) sexual health experts share about the game that can inform future design iterations of this game. Forty participants aged 18-24 played the game and reported enhanced communication and language skills, raised awareness and reduced stigma around safer sex communication and condom use. The potential of the game in enhancing the participants' language skills (i.e., learning the language such as words, phrases, expressions) of communication and negotiation showed the highest frequency. Language skills and communications skills together comprised 28.5% of the overall feedback. The second most frequent theme was about the efficiency of the game in normalizing conversations around sex and condom use and removing the awkwardness around such topics. The game seemed to allow participants to practice dialogue and scenarios that extend beyond what they experienced in formal sex education in school. Participants also provided a range of recommendations for the next iteration of the game. To design the serious game, I followed a process of Design-Based Research (DBR) (Anderson & Shattuck, 2012) model and followed the four phases of DBR proposed by Reeves (2006). The study's findings aid other researchers in the field and offer insights to enhance sexual health education. With the increasing STIs in Canada, COVID-19's impact, and young people's reliance on online resources for answers, this research is timely. Moreover, the study contributes to the scarce research on collaborative serious games to improve 18-24-year-olds' sexual communication and negotiation skills. Limitations and implications of the design and of the game, as experienced by participants are discussed.

In the past thirty years, HIV/AIDS (Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome) transformed from a mysteriously lethal disease affecting limited portions of the population to a true global pandemic. Although HIV/AIDS is responsible for the deaths of approximately 30 million people worldwide, prevalence rates are now increasing significantly due to increasing survival rates. However, overall increasing incidence rates now serve as a primary concern for researchers. Avert (2011) suggests that there is a lack of behavioral interventions and prevention programs aimed at decreasing the number of newly affected individuals. This is problematic as it may create not only physical and mental stress upon patients but also a source of financial and resource stress upon service organizations. In Asia, HIV/AIDS is primarily apparent in three high-risk groups: sex workers, men who have sex with men, and intravenous drug users (Avert, 2011). Service organizations target these high-risk groups with prevention programs in order to decrease infection rates and raise general awareness of the disease. This study aims to evaluate two HIV/AIDS prevention program theories(the Sonagachi Project and the 100% Condom Use Program) and the studies that implement them. This proposed evaluation assesses the effectiveness of these HIV/AIDS prevention programs in reducing infection rates and raising awareness of the disease. Due to the widespread use and apparent effectiveness of the 100% Condom Use Program and The Sonagachi Project, this study aims to assess the interventions in lessening HIV infection rates and critique the methods outlined by both. This thesis also employs a systemic review of the literature by using the program theories of The 100% Condom Use Program and The Sonagachi Project.

The problem this study addressed involves how college students since the year 2020 in the U.S. have been negotiating romance, dating, and sexual relationships in the unique historical period of the COVID-19 pandemic. Further, this study addressed the problem of needing to determine how the pandemic may have disrupted college students’ intimate sexual experiences—and impacted their mental health, physical health, and experiences of social support. The main purpose was to identify significant predictors of the study outcome variable of a higher rating of self-efficacy for engaging in safer sexual behaviors. An additional purpose of the study was to determine if there were significant differences in students’ mean ratings—when comparing mean scores for 5 time periods (i.e. 1-2018-2019/freshman year before the pandemic; 2-2019-2020/second semester of sophomore year during pandemic; 3-2020-2021/junior year during pandemic; 4-2021-2022/senior year during the pandemic; and, 5-currently, especially the past 3 months)—for physical health, mental health, social support, and level of involvement in romantic, intimate, serious dating, or sexual relationships. Overall, comparisons for time periods found deterioration during the pandemic years with some signs of improvement by the current time period of Spring 2023. Findings showed females had higher self-efficacy to perform safer sexual behaviors, but also that survey respondents who lived independently had higher self-efficacy to perform safer sexual behaviors, those who had a COVID-19 diagnosis in the past two years had higher self-efficacy to perform safer sexual behaviors, and survey respondents whose college did have a sexual assault media campaign had higher self-efficacy to perform safer sexual behaviors. The results of the backwards stepwise regression found that higher self-efficacy to perform safer sexual behaviors was significantly predicted by higher age, higher income, higher BMI, lower social support, higher current romantic involvement, higher exposure to sexual assault information on campus, lower alcohol/drug use during sex, and higher stage of change for engagement in safer sex—as a global mean score capturing four risk reduction behaviors; and, 56.4% of the variance was explained by the model. Implications and recommendations are discussed with a focus on the need for longitudinal studies with a nationally representative sample.

No description available.

No description available.

Background: Young adults ages 18-24 are disproportionally affected by unintended pregnancy and sexually transmitted diseases and infections (STD/I). The best protection against both pregnancy and STD/Is is dual contraceptive use: the concurrent use of a highly effective contraceptive method and a condom. Objectives: This dissertation aims to increase our understanding of the psychosocial constructs associated with contraceptive and condom use. This project: 1) examines differences in contraceptive and STD/I knowledge by sex and race, and its association with method use; 2) determines the association between relationship characteristics and dual use; and 3) uses the Theory of Triadic Influence to examine direct and indirect associations between sociocultural factors, interpersonal factors, biological factors, and dual use. Methods: Young adult college students ages 18-24 (N=4,196) were invited to complete a web-based, cross-sectional, sexual health survey in Fall 2018. Multivariable linear and logistic regression models were run to determine differences in contraceptive knowledge by sex and race and its association with effective method use (N=436), and differences in STD/I knowledge by sex and race and its association with condom use (N=414). Multiple logistic regression models were run to determine the association between relationship characteristics, pregnancy and condom attitudes, demographics, and dual use (N=463). Structural equation modeling (SEM) was used to assess the standardized direct and indirect associations of sociocultural, interpersonal, and biological factors and dual use (N=406). Results: Increased contraceptive knowledge was associated with 1.114 odds increase in effective method use (95% CI: 1.058, 1.172), but no association was found between STD/I knowledge and condom use (aOR=0.970, 95% CI: 0.940, 1.000). Adjusted for all relationship characteristics, one-unit increase in trust was associated with decreased odds of dual use (aOR=0.982; 95% CI 0.966, 0.998). In independent models, having sex with a casual date/acquaintance (aOR=3.149; 95% CI: 1.550-6.397) compared to a romantic partner was associated with increased odds of dual use. The hypothesized SEM measurement model had poor fit and was re-specified. The final model had moderate fit and explained 70% of the variance in overall dual use. Condom attitudes (β = 0.18) and partner commitment (β = -0.22) were significantly associated with dual use through intention. Intention was significantly associated with dual use (β = 0.84). Conclusions: Findings emphasize the influential nature of interpersonal and biological psychosocial constructs on method use behavior. Health programs that address partner influences on STD/I risk perceptions, method use intention, and method use behavior could be beneficial for young adults. / Epidemiology