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Adolescence is a time of great exploration and change. During this time, youth are transitioning both biologically and sexually into adults. Adolescents are also testing the boundaries of self-reliance and making choices about their personal relationships. Not surprisingly, aggressive urges are often driven by peers in pursuit of some form of identity (Masten 2004). Peers can have both positive and negative effects on the wellbeing on youth. Peer groups can provide emotional, physical, and social support to youth during a time of immense change (Parker and Asher 1987; Gest, Graham-Berman, and Hartup 2001). Peers can also model delinquent and risk-taking behaviors that have lasting health, social, and economic consequences throughout the life course. In an effort to understand the role of friendships in adolescent health, social scientists have increasingly focused on adolescent network structures within schools and the role various positions and peer group formations influence behaviors such as alcohol and cigarette use, violent and serious delinquency, and sexual risk-taking. While informative, peer networks studies have yet to adequately address how peer network structures based on immigrant generation and types of marginalized social positions influence health risk behavior engagement among adolescents. In three studies, I address the dearth of research in these areas, using data from the National Longitudinal Study of Adolescent to Adult Health (Add Health). The first study investigates the influence of generational peers on alcohol misuse among immigrant youth. Testing hypotheses derived from sociological theories of generations regarding race/ethnicity, gender, and immigrant generation, findings from this study demonstrate generational ties are inversely related to alcohol misuse for immigrants and these effects depend partly on race/ethnicity and gender. The second study investigates the effects of specific network forms of social isolation on heavy episodic drinking and cigarette use among adolescents. The central finding from this study is that different network-based forms of social isolation had varying effects on alcohol and cigarette use when compared to sociable youth. The final study examines the relationship between types of social isolation and violent delinquency when compared to sociable youth. Deriving hypotheses from general strain theory, I test whether the isolation-violence relationship varies across isolation types when compared to sociable youth. I also test whether other negative experiences and circumstances (strains) tied to adolescence moderate the relationship between isolation types and violent delinquency. Finally, studies indicate a consistent gender gap in criminality. Therefore, I test whether the isolation-violence relationship differs by gender. Findings demonstrate that socially disinterested youth show a greater capacity for violent behavior, but other types of marginalized youth showed no difference in violence when compared to sociable youth. Results also suggest that some types of strain moderate the isolation-violence relationship and that these patterns are gendered.

School plays critical roles in facilitating and inhibiting the safety, development, and well-being of adolescents with T1DM. However, their school-based lived experiences have been under-investigated. This study aimed to explore those experiences for adolescents with T1DM in Taiwan. In conducting the study, Heidegger’s hermeneutic phenomenological approach was used. Fourteen Taiwanese adolescents with T1DM were enrolled between June 2009 and July 2010 through purposive snowball sampling. Data were collected using audio-recorded, semi-structured interviews and analyzed using the hermeneutic circle and West’s (1998) structural analysis steps, supported by qualitative analysis software NVivo 9.0. Reflective journaling, peer debriefing, memo writing, and member checking were performed to enhance the trustworthiness of the findings. Six interrelated themes were identified in the adolescents’ school-based lived experiences. They are (a) the same and different, (b) covert and overt, (c) hyper- and hypoglycemia, (d) independent and dependent, (e) derailing and being on track, and (f) dark clouds and silver lining. In the stressful context of school, the adolescents’ diabetes self-management is challenged. Multiple factors, including unaccepted disease identity; social anxiety and pressure; intrusive, ignorant school personnel and classmates; and transition to independent self-management threaten the adolescents’ health and well-being at school. To optimize diabetes self-management effectiveness, interventions should include the adolescents and their parents, classmates, and school personnel to ease burdens that the adolescents bear. Future interventions should also facilitate the adolescents’ autonomy, self-efficacy, diabetes knowledge and self-management, and capacity to alleviate social pressure. / text

Accompanying materials housed with archival copy. / The purpose of this research was to describe and critically interpret girls' experiences with respect to body image, physical activity and health. The qualitative inquiry included focus group and individual interviews, document analysis and field observations. These methods were used to explore the perceptions of sixty-three girls (grades eight and eleven) and staff from an inner-city high school. Through interpretive data analysis (and constant comparison), the inter-related themes of body image, physical activity and health branched into the sub-themes of societal influences and personal attitudes including: friends, boys, family, school and media. Girls' body images ranged from minor preoccupations to major dissatisfaction with their bodies, while a few girls were happy being themselves. Weak or negative family influences gave way to influences by media, boys and friends. A few girls were very active, whereas others' low levels of participation were attributed to: disinterest in physical activity, intimidation by boys, or perceived lack of opportunity. The girls' perceptions of health incorporated fitness, weight, and eating habits. Girls often used negative qualifiers when describing their weight or body shape. Generally, girls perceived overweight individuals as not taking care of themselves. This research supports the development of gender sensitive physical education programs promoting healthier lifestyles for females.

Thesis (Ph.D.)--University of Wollongong, 2006. / Typescript. Includes bibliographical references: p. 331-353.

Thesis (D. Ed.)--University of Texas at Austin, 1999. / Vita. Includes bibliographical references (leaves 184-203). Available also in a digital version from Dissertation Abstracts.

Secondary analysis of data from the National Longitudinal Study of Adolescent Health is used to examine possible explanatory variables for sexual health outcomes. Linear and logistic regression analyses were conducted to examine the relationship between sexual health outcomes and topical content in sexuality education, controlling for race, biological sex, low socioeconomic status, and religiosity. Results indicated increasing topical content in sexuality education had a positive effect on knowledge acquisition and confidence, but no statistically significant effect on engagement in sexual risk behavior or likelihood of reporting sexual coercion. Control variables were significant predictors and overall model fit was low, indicating topical content in sexuality education is minimally important in creating adolescent sexual behavior. Further exploration of differing aspects of sexuality education is suggested.

The AIM of the study from which the empirical data were obtained for this thesis, was the collection of basic demographic information and selected health related data from a group of adolescents at high-school in Cape Town. 1.2 The OBJECTIVES were Description of the demographic features of the pupils in Standards 8, 9 and 10 at a specific co-educational high school in Cape Town; Determination of the prevalence of smoking, and the attitudes to, and knowledge of the health risks of smoking; Determination of the prevalence of alcohol use, and the attitudes to, and knowledge of the health risks of consuming alcohol; Determination of the prevalence of habit-forming drug use, and the attitudes to, and knowledge of the health risks of using drugs; Determination of the sexual experience of the pupils, attitudes to and knowledge of the health risks of sexual activity, and knowledge of contraception and venereal disease; Examination of whether the above habits correlated within individuals i.e. whether those who smoked were more likely to use drugs or be sexually active, and vice versa.

Accompanying materials housed with archival copy.

BACKGROUND:In Eastern and Southern Africa (ESA), adolescent girls’ and young women’s (AGYW, aged 15-24 years) disproportionate HIV risk is fueled by age-disparate sex (partners >5 years older). Older men typically acquire HIV from same-aged partners; they then transmit HIV to AGYW, who then transmit HIV to older men as they age, creating a cycle of transmission. Adolescent boys and young men (ABYM, aged 15-24 years) have lower HIV incidence rates, and their risk starts increasing around age 20 due to same-aged partners and age-disparate sex. Developing ABYM’s preventative behaviors may proximally and distally reduce their and AGYW’s HIV risk. HIV risk perception (HIV RP) is a theoretical motivator for initiating and using risk-reduction strategies. However, this relationship remains temporally and empirically equivocal in AGYW and ABYM, who are in a developmentally and socially dynamic stage of life. To increase and improve HIV risk-reduction strategies among AGYW and ABYM in ESA, this dissertation aimed to elucidate temporal trends, determinants, and effects of HIV RP. METHODS:This dissertation employed three aims to examine 1) longitudinal HIV RP literature, 2) HIV RP trajectories and predictors, and 3) HIV RP’s association with health outcomes. Secondary analyses used data collected (2010 [T1], 2011 [T2], 2012 [T3]) from the control arm (714 AGYW, 635 ABYM) of a school-based trial in KwaZulu-Natal, South Africa. Aim 1 evaluated longitudinal quantitative studies examining HIV RP among AGYW and ABYM in ESA. A scoping review synthesized data from peer-reviewed articles published between 1995-2022 to elucidate studies’ geo-spatial distributions, temporal data patterns, sample characteristics, and HIV RP definitions, analytic findings, and theoretical underpinnings. A proposed HIV RP conceptual framework was created by synthesizing findings and theories. Aim 2 described gender-specific patterns and determined predictors of HIV RP in AGYW and ABYM. Trajectories were created based on cumulative reports of high HIV RP. After, these trajectories were characterized using sociodemographic, knowledge, attitudinal/perceptual, biological, experiential, and behavioral factors. Using models stratified by ever-sex status, overall predictive analyses explored factors prospectively associated with high HIV RP. Aim 3 tested the hypothesis that high HIV RP increased chances of HIV testing and decreased cumulative acquisition of HIV/HSV-2. Directed acyclic graphs identified potential confounders using current literature. Predictive analyses estimated high HIV RP’s gender-specific confounder-adjusted association with HIV testing and HIV/HSV-2 incidence over 1-year periods. RESULTS:In Aim 1, synthesis of 38 longitudinal studies offered limited insights on AGYW’s and ABYM’s HIV RP due to geographic homogeneity, abundance of intervention-related studies, and minimal reporting of RP definitions and HIV status. Most (~75%) studies analyzed data collected before 2015, highlighting the evidence gap of HIV RP in current epidemic conditions or prevention options. Studies assessed AGYW when their risk is peaking and provided little detail on pre-risk periods; ABYM were rarely included in analyses. Elevated HIV RP was mostly positively associated with AGYW’s self-initiated outcomes, but HIV RP’s formulation was understudied. Aim 2 found HIV RP was temporally dynamic, as most (60% AGYW, 65% ABYM) changed their level of HIV RP at least once. AGYW’s and ABYM’s Persistent (high HIV RP at all timepoints) trajectories were primarily differentiated by negative prevention attitudes. While sexual risk behaviors were relatively high in AGYW’s and ABYM’s Persistent trajectories, HSV-2 and becoming/getting others pregnant increased in lower RP trajectories, implying potential contradictions between actual and perceived risk. Analyses showed sociodemographic factors (grade repetition, mother-led households) mostly predicted high HIV RP in AGYW, while prevention attitudes differentially (i.e., attitudes and associations largely shifted from negative to positive over time) affected ABYM’s high HIV RP. Behaviors (transactional sex, not knowing partners’ status, older partners, alcohol use [ABYM only]) predicted high HIV RP in both groups. Aim 3 highlighted that age, grade, financial insecurity, HIV/pregnancy-related knowledge, attitudes, perceptions, experiences, and service-seeking and risk-taking behaviors potentially confounded relationships between HIV RP and outcomes (HIV testing, HIV/HSV-2 acquisition). AGYW with high HIV RP at T1 were more likely to HIV test (aRR=1.48 [1.12-1.95]) and acquire HIV/HSV-2 (aRR=1.83 [1.03-3.25]) by T2, associations that did not persist in T2-T3’s analyses. There were no significant associations between any factor and HIV RP in ABYM. CONCLUSION:This dissertation highlights the temporal and associative complexities of HIV RP among AGYW and ABYM in ESA. HIV RP in these groups was variable and primarily predicted by sociodemographic (AGYW), attitudinal (ABYM), and behavioral factors, elucidating need and opportunities for multi-level, age- and risk-appropriate interventions. Structural insecurities and age- and gender-driven power differentials may inhibit AGYW’s prevention behaviors. For both groups, earlier intervention would reach AGYW before their risk escalates and reinforce and/or instill ABYM with potentially lasting assets. Additional high-quality, detailed studies are needed to combat the current evidentiary dearth, optimize prevention interventions, and increase the likelihood of ending HIV/AIDS by 2030.