Made available in DSpace on 2015-12-06T23:47:43Z (GMT). No. of bitstreams: 0 Previous issue date: 2008 / A Orientação Sexual constitui-se na atualidade um tema transversal devendo permear todo o currículo escolar, num processo de intervenção pedagógica com o objetivo de transmitir informações e problematizar questões relacionadas à sexualidade. O professor é a peça chave para execução e sucesso desta intervenção, portanto, este estudo teve como objetivos identificar o conhecimento e a prática dos mesmos em relação à orientação sexual, bem como conhecer a opinião dos professores sobre o momento (Quando) e a maneira (Como) de iniciar as atividades de orientação sexual na escola. Trata-se de uma pesquisa descritivoexploratório, realizada em quatro escolas estaduais de ensino fundamental e médio do município de Embu das Artes, SP. A amostra foi constituída por 130 professores também participantes do Projeto de Extensão Universitária Corporalidade e Promoção da Saúde. A coleta de dados foi realizada em dois momentos distintos, sendo o primeiro por meio de um questionário, e o segundo, pela técnica de Grupo Focal. Os resultados apontam que os professores deste estudo consideram importante a orientação sexual, pois a escola mostra-se importante não somente para transmissão de informações, mas também para promover reflexão sobre essas questões e mudanças de conceitos e comportamentos sexuais, complementando a educação sexual recebida da família. Os professores reconhecem sua falta de preparo para a função não somente teórica e metodológica, mas também nas questões pessoais com suas áreas de interdição sobre o aspecto sexual. Soma-se, ainda, a falta de recursos materiais e de tempo para preparo das aulas, o que compromete o desenvolvimento do trabalho de orientação sexual na escola. Para eles, a orientação sexual deveria ter início desde o ingresso da criança na escola, ou seja, desde a 1ª série, em um processo contínuo e gradativo. Usando de linguagem apropriada para cada idade, respeitando o nível de maturidade da criança para absorção das informações transmitidas. A 5ª série foi apontada como a fase indicada para o aprofundamento das questões sobre sexualidade, pelo aumento da curiosidade dos alunos sobre o tema e por terem maior maturidade para discussão dos assuntos. Apesar de se considerarem despreparados para o desenvolvimento das atividades de orientação sexual, a maioria dos professores aborda o tema em sala de aula. As atividades sugeridas são: uso de dinâmicas e brincadeiras com auxílio de recursos áudio-visuais, através da leitura de textos e de discussões baseadas nas perguntas feitas pelos próprios alunos. Aproveitam, ainda, as situações do cotidiano escolar ou social trazidas pela mídia para suscitar discussões. Os docentes consideram-se aptos a discutirem todos os assuntos relacionados à sexualidade, porém, declaram ter mais habilidade para discussão de temas com enfoque biológico como Doenças Sexualmente Transmissíveis, gravidez, conhecimento sobre o corpo e métodos contraceptivos. Conclui-se que os professores precisam ser capacitados para conduzir os alunos em um processo contínuo e gradativo de aquisição de conhecimentos e de instrumentos que transformem este conhecimento em mudanças de comportamento. Desta forma, um desenvolvimento saudável da sexualidade deles, livre de riscos físicos, psíquicos e sociais poderá ser garantido. / Sexual Education is currently constituted of a transversal topic that should span the whole school curriculum, in a pedagogic intervention process aiming at providing information and addressing issues related to sexuality. The teacher is a key part in the accomplishment of this intervention, and should be prepared for the function. Therefore, this study aimed at identifying teachers' knowledge and practice concerning Sexual Education, as well as to know their opinion about the time (when) and manner (how) the Sexual Orientation should be started as a school activity. A descriptive-exploratory research was carried out in four state-run elementary and high schools in the municipality of Embu das Artes, SP. The sample was composed by 130 teachers who also took part in the Corporality and Health Promotion University Project. Data were collected at two distinct moments, firstly through a questionnaire, and then through the Focal Group technique. Results demonstrated that teachers consider Sexual Education at school to be important. To them, the school seems important not only to spread information, but also to promote reflection upon these issues and to promote changes of sexual behaviors and concepts. Thus, the school enhances the sexual education received from the family. Teachers acknowledge their lack of prepare for the function, which includes not only theoretical and methodological aspects, but also personal issues regarding their own sexual restraints. In addition to that is the lack of material resources and time for class preparation, what impairs the development of Sexual Education tasks at school. In their opinion, Sexual Education should start at the moment children are admitted to school, that is, in the first grade, in a continuous and gradual process, by using appropriate language for each age, and respecting the child’s maturity level to absorb the provided information. The fifth grade was pointed out as the appropriate age for in-depth education of sexuality-related issues because of the increase in curiosity for the topic, and also for having more maturity to discuss the topics. Despite the teachers feel unprepared for the development of Sexual Education activities at school, the most of them approach the insertion of the issue in the classroom. The activities suggested by them are: group dynamics and plays with audiovisual resources, readings, and discussions based on questions asked by the students themselves. They also use daily school and social life brought by the media to raise discussions. Teachers considered themselves able to discuss all the issues related to sexuality, however, reporting more ability to discuss topics of biological scope such as Sexually-Transmitted Diseases/AIDS, pregnancy, knowledge about the human body and contraceptive methods. It was concluded that teachers need to be properly instructed to lead students into a continuous and gradual process of knowledge acquisition and proper tools that turn this knowledge in behavior changes. Thus, a healthy development of sexuality, without physical, psychic and social risks can be assured. / BV UNIFESP: Teses e dissertações

Esta dissertação enfoca o tema a partir da análise de narrativas de jovens (homens e mulheres, entre 18 e 24 anos), residentes em três capitais brasileiras (Rio de Janeiro, Porto Alegre e Salvador), acerca de experiências envolvendo sexo por constrangimento ou forçado. Os relatos são examinados à luz de uma produção internacional que discute a questão da coerção sexual. Os dados analisados correspondem a uma sub-amostra de 46 entrevistas com jovens pertencentes a camadas médias e populares, selecionadas do conjunto de 123 entrevistas que integraram a fase qualitativa da pesquisa GRAVAD (Gravidez na Adolescência: Estudo Multicêntrico sobre Jovens, Sexualidade e Reprodução no Brasil). A leitura do material empírico buscou situar os episódios narrados nas biografias individuais e refletir sobre as representações dos sujeitos sobre gênero e sexualidade e os aspectos dessas trajetórias capazes de conduzir a um entendimento de tais eventos. Moças e rapazes relataram distintas experiências de sexo contra vontade, que variavam de acordo com o contexto e o tipo de coerção utilizada e/ou sofrida. As dinâmicas das relações entre os gêneros revelam que, na negociação sexual, consentimento e desejo nem sempre andam juntos. Em determinadas condições, certos modos de constrangimento são tidos como constitutivos dos jogos de sedução. A análise das narrativas evidencia o caráter relacional e contextual das interações afetivo-sexuais entre os gêneros e do que pode ser qualificado como violência. Tal conclusão, conduziu ao questionamento acerca da positividade atribuída a certas atitudes e comportamentos sexuais categorizados como violentos por diversos estudos dedicados ao tema. / This dissertation presents the (reported) experiences concerned to sex imposed by pressure or by use of force of young men and woman (from the age of 18 to 24 years old), who live in three Brazilian capitals (Rio de Janeiro, Porto Alegre and Salvador). The reports are examined in the light of an international production discussing the subject of sexual coercion. The data corresponds to a sub-sample from 46 interviews with youngsters of middle-class and lower classes, selected from a group of 123 interviews concerning the qualitative data of GRAVAD research (Teenage Pregnancy: A Multi-centered Study about Youth, Sexuality and Reproduction in Brazil). Young men and women related different experiences of forced sex, which vary according to the context and the kind of coercion used and/or suffered. The dynamics of gender relations reveal that, in terms of sexual negotiation, agreement and desire are not always together. Under certain circumstances, some forms of coercion are taken as part of the seduction interaction. The analysis of the narratives clarifies the relational and contextual character of the affective and sexual interactions between genders and what can be qualified as violence. Such conclusion lead to the questioning of the positivism attributed to some sexual conducts categorized as violent by many studies dedicated to the theme.

Esta dissertação enfoca o tema a partir da análise de narrativas de jovens (homens e mulheres, entre 18 e 24 anos), residentes em três capitais brasileiras (Rio de Janeiro, Porto Alegre e Salvador), acerca de experiências envolvendo sexo por constrangimento ou forçado. Os relatos são examinados à luz de uma produção internacional que discute a questão da coerção sexual. Os dados analisados correspondem a uma sub-amostra de 46 entrevistas com jovens pertencentes a camadas médias e populares, selecionadas do conjunto de 123 entrevistas que integraram a fase qualitativa da pesquisa GRAVAD (Gravidez na Adolescência: Estudo Multicêntrico sobre Jovens, Sexualidade e Reprodução no Brasil). A leitura do material empírico buscou situar os episódios narrados nas biografias individuais e refletir sobre as representações dos sujeitos sobre gênero e sexualidade e os aspectos dessas trajetórias capazes de conduzir a um entendimento de tais eventos. Moças e rapazes relataram distintas experiências de sexo contra vontade, que variavam de acordo com o contexto e o tipo de coerção utilizada e/ou sofrida. As dinâmicas das relações entre os gêneros revelam que, na negociação sexual, consentimento e desejo nem sempre andam juntos. Em determinadas condições, certos modos de constrangimento são tidos como constitutivos dos jogos de sedução. A análise das narrativas evidencia o caráter relacional e contextual das interações afetivo-sexuais entre os gêneros e do que pode ser qualificado como violência. Tal conclusão, conduziu ao questionamento acerca da positividade atribuída a certas atitudes e comportamentos sexuais categorizados como violentos por diversos estudos dedicados ao tema. / This dissertation presents the (reported) experiences concerned to sex imposed by pressure or by use of force of young men and woman (from the age of 18 to 24 years old), who live in three Brazilian capitals (Rio de Janeiro, Porto Alegre and Salvador). The reports are examined in the light of an international production discussing the subject of sexual coercion. The data corresponds to a sub-sample from 46 interviews with youngsters of middle-class and lower classes, selected from a group of 123 interviews concerning the qualitative data of GRAVAD research (Teenage Pregnancy: A Multi-centered Study about Youth, Sexuality and Reproduction in Brazil). Young men and women related different experiences of forced sex, which vary according to the context and the kind of coercion used and/or suffered. The dynamics of gender relations reveal that, in terms of sexual negotiation, agreement and desire are not always together. Under certain circumstances, some forms of coercion are taken as part of the seduction interaction. The analysis of the narratives clarifies the relational and contextual character of the affective and sexual interactions between genders and what can be qualified as violence. Such conclusion lead to the questioning of the positivism attributed to some sexual conducts categorized as violent by many studies dedicated to the theme.

<p>The present study predicted that gender, relationship status, sexual orientation, and sexual debut would have an impact on number of sexual partners, which would then affect self-esteem, sexual satisfaction, and sexual self-efficacy. Through an online survey, participants anonymously responded to statements related to these concepts in order to test relationships among demographics and the number of sexual partners as well as among the number of sexual partners and self-esteem, sexual satisfaction, and sexual self-efficacy. Overall, men were much more influenced by their relationship status and number of sexual partners than women, implying that the men are still affected by the sexual double standard through the praise they receive for having many sexual partners.</p>

This thesis investigates the underlying factors behind sexual risk-taking and non-risk-taking behavior with regard to Sexual Reproductive Health (SRH) among adolescents in Lusaka, Zambia. The Qualitative Approach was used for data collection and analysis and using the theory of Social Construction, the author explains how different contexts and aspects in the Zambian Society, that is Traditional, Socio-economic, Political, etc., influence the sexuality or sexual behavior of young people in Zambia. Hermeneutics was used to interpret the meanings in the texts/transcripts acquired through data collection and from the author’s knowledge and understanding of the Zambian historical and cultural contexts within which the participants of the research were constructed. Max Weber’s Ideal Type concept was also used to explain that each young individual’s sexual behavior is uniquely constructed by societal aspects. It explains how that the discourses of these different aspects of society impact on young people individually causing them to be either Sexually Risk-taking or Non Sexually Risk-taking. Either tendency depends on whether the societal aspect that has most the dominating influence on a given individual's life is a Power factor (causing them to rationally think their way into Non Sexually Risk-taking behavior) or a Risk factor(causing them to rationally think their way into Sexually Risk-taking behavior). The author of this thesis introduces a new Model for Social Construction of Adolescent Sexuality with regard to Risk-taking. She uses it to explain how it is either power factors or risk factors that can have a greater impact on an individual's thinking, causing them to have either sexual risk-taking or non-sexual risk-taking behavior. The author concludes that the extent to which unsafe sex among the Zambian adolescents constitutes a product of interacting and/or main discourses in relation to mainly Traditional aspect risk factors, varies from person to person depending on the strength of given risk factors over any power factors that may be at play in an individual's life.

A violência sexual é um problema de saúde pública que afeta boa parte da população mundial. Seu estudo, entretanto, é marcado por dificildades conceptuais, legais, epidemiológicas e metodológicas. Dentre os diversos modos de se entender e examinar a violência sexual, as atitudes são comumente investigadas, sobretudo com o emprego de escalas Likert. Contudo, o escalonamento psicofísico pelos métodos de Thurstone possui características típicas de escalas intervalares que lhe conferem vantagens em relação às escalas ordinais. O principal objetivo da presente pesquisa foi construir uma escala de distâncias psicológicas de descritores sexuais para cada grupo experimental através do Caso V da Lei do Julgamento Comparativo de Thurstone. 132 participantes, divididos em três grupos controle, sobreviventes (mulheres vítimas de violência sexual) e reeducandos (homens agressores sexuais) avaliaram oito termos sexuais (cócegas, cheiro, toque, beijo, nudez, agarrar, esfregar e gemer) pelo método de escolha forçada de julgamento de pares. A cada par de termos sexuais apresentado aleatoriamente, os sujeitos deviam escolher aquele com o maior conteúdo sexual. Resultados indicaram que os descritores toque, cheiro e cócegas foram constantemente julgados com os menores conteúdos sexuais entre os três grupos, enquanto beijo e gemer foram os que mais alteraram de ordem entre os grupos. Literatura sobre aspectos linguísticos dos estímulos utilizados não foi suficiente para explicar a escolha de uma palavra em detrimento de outra, reforçando-se a ideia de que os julgamentos foram diferenciais de acordo com as variáveis e o grupo ao qual os participantes pertenciam. Dessa maneira, homens julgaram os descritores com valores próximos, deixando a escala com menor amplitude, o que indica baixa discriminação e necessidade de menos conteúdo sexual para que as palavras fossem percebidas sexualmente. Reeducandos apresentaram o mesmo padrão de resultados, mas de maneira acentuada. Mulheres, por outro lado, tiveram boa discriminação dos termos sexuais e apresentaram maior amplitude na escala. Para as sobreviventes, o padrão de resultados foi o mesmo das mulheres, com poucas variações. As diferenças encontradas entre grupos podem ser decorrentes de atitudes sexuais e em relação à violência sexual e do modo como mulheres e homens processam informação sexual, sendo atravessadas por questões sociais de gênero / Sexual violence is a public health problem that affects a portion of the world population. Its study, yet, is marked by conceptual, legal, epidemiological, theoretical and methodological difficulties. Among the various ways of understanding and examining sexual violence, attitudes are commonly investigated, mainly by employing Likert scales. However, psychophysical scaling by Thurstones methods possess characteristics typical of interval scales, which gives it advantages over ordinal scales. The major goal of the present research was to build a scale of psychological distances of sexual descriptors for each experimental group through the Case V of Thurstones Law of Comparative Judgment. One hundred and thirty two participants, divided in three groups control, survivors (female victims of sexual violence) and inmates (male sex offenders) evaluated eight sexual words (tickle, smell, touch, kiss, nude, grab, rub, and moan) by the forced choice method of pairwise judgment. To each word pair was presented randomly, subjects were asked to choose the one with the higher sexual content. Results indicated that the descriptor touch, smell, and tickle were constantly judge as having the lowest sexual content amongst the three groups. Literature abou linguistic aspects of the used stimuli was nou sufficient to explain the choice of one word over another, reinforcing the idea that the judgments were differential according to the variables and the group to which the participant belonged. Thus, men judged the descriptors as having similar values, making the scales amplitude smaller, which indicates lower discrimination and the need for less sexual content for the words to be perceived sexually. Inmates showed the same pattern of results, but in a accentuated manner. Women, on the other hand, had good discrimation of the sexual descriptors and exhibited higher scale amplitude. For the survivors, the pattern of results was the same as for the women, with few variations. The found differences between groups may be due to attitudes toward sexuality and sexual violence, and to the way women and men process sexual information, being permeated by gender social issues

This article aimed to analyze two cases of sexual abuse against girls, one with three years old and another with six years old, which was perpetrated by their progenitors, and examined by a psychosocial team of a South Brazilian Forum. In both cases the mothers had a family history of incestuous sexual abuse, were living alone with their daughters and the proper disclosure of the abuse committed against the girls only happened after the guard reversal. The fathers showed a passive behavior against the ex-wives and they were still sexually attached to them. With regard to the sexual violence, they had trouble believing it had been perpetrated by the mothers. It was also observed the difficulty of specialized services (police stations) to receive and register the complaint / Este artículo tuvo como objetivo analizar dos casos de abuso sexual contra niñas, una con 3 y la otra con 6 años de edad, cometidos por sus progenitoras, y que fueron periciados por el equipo psicosocial de un Foro del sur de Brasil. En ambos casos las madres abusivas tenían una historia familiar de abuso sexual incestuoso y vivían solas con sus hijas, la revelación del abuso ocurrió solamente después de la reversión de guardia. Los padres de las niñas tenían un comportamiento pasivo en relación a las ex mujeres, aun siendo sexualmente unidos a ellas. En relación a la violencia sexual, los padres tenían problemas para creer lo que había sido perpetrado por ellas. Se observó también la dificultad de servicios especializados (comisarías de policía) para recibir y registrar la denuncia. / Este artigo teve como objetivo analisar dois casos de abuso sexual contra meninas, uma com 3 e a outra com 6 anos de idade, cometidos por suas genitoras, que foram periciados por equipe psicossocial de um Fórum do Sul do Brasil. Em ambos os casos as mães abusivas tinham uma historia familiar de abuso sexual incestuoso e viviam sozinhas com as filhas e a revelação do abuso ocorreu somente depois da reversão de guarda. Os pais das meninas apresentavam comportamento passivo em relação as ex mulheres ainda estando sexualmente ligados a elas. Em relação a violência sexual, eles tinham dificuldade em acreditar que havia sido perpetrada por elas. Se observou ainda a dificuldade dos serviços especializados (delegacias de policia) de receber e registrar a queixa.

Made available in DSpace on 2015-07-22T20:49:16Z (GMT). No. of bitstreams: 0 Previous issue date: 2011-03-30 / O presente trabalho pretende, por meio da abordagem qualitativa e do estudo de caso, analisar as narrativas de pediatras da atenção básica básica de saúde do município do Embu e de um ambulatório de especialidades do município de São Paulo, com o objetivo de apreender como esses profissionais lidam com a questão do abuso sexual infantil. Para a coleta de dados, foram utilizadas as técnicas de observação não participante, entrevistas gravadas com roteiro semiestruturado e registro em diário de campo. A partir das entrevistas gravadas, foram construídas narrativas, analisadas segundo a orientação de Pope (2009), o que resultou na construção dos eixos empíricos, a saber: a) os pediatras frente à situação de abuso sexual; b) ambiguidade ante a notificação; c) necessidade de encontrar marcas físicas e d) a questão do vínculo com o paciente e com a instituição. Os resultados mostraram que o abuso sexual infantil provoca nos profissionais reações emocionais que prejudicam a objetividade diagnóstica. Por outro lado, apontam que o vínculo com o paciente ajuda a conhecê-lo melhor, permitindo suspeitar de maus-tratos, apesar de a maioria insistir na necessidade de encontrar sinais físicos de abuso. Em que pese o treinamento em matéria do abuso sexual, pelo qual a maioria dos profissionais passa, persiste o entendimento de que a notificação de suspeita de abuso poderá gerar problemas, tanto pessoais quanto profissionais. Resta apontar, enquanto perdurar a ineficácia da lei, e considerando os cuidados demandados quando a criança entra no serviço de saúde, a importância para a sensibilização do papel protetivo exercido por esses profissionais, no momento em que não perdem a oportunidade de notificação dos casos suspeitos ou diagnosticados, considerando sua co-responsabilidade pela continuidade ou não da violência sofrida pela criança. / This research intends to analyze, through a qualitative approach and a case study, the narratives of Pediatricians from the basic health care service of Embu County and one specialized clinic in Sao Paulo County, with the purpose of learning how these professionals deal with the question of child sexual abuse. The data collection was made through non-participative observation techniques, semi-structured recorded interviews and registrations in a field notebook. The data were presented through the construction of narratives from the analysis of the recorded interviews following the orientation of Pope et al. (2009), which resulted in the construction of empiric axels, to be noted: a) the pediatricians facing the sexual abuse situation; b) ambiguity upon the notification; c) the necessity for finding physical signs and d) the question of ties with the patient and with the institution. The results show that sexual child abuse brings out emotional reactions in the professionals which harm the diagnostic objectiveness. On the other hand, they point out that bonding with patients helps better knowing them, thus allowing the detection of foul play, outthought most insist in finding evidence of physical signs of abuse. Despite all the training on sexual abuse which the majority of professionals go through, a common notion persists that when one notifies the suspicion of a case of abuse, it may cause not only personal, but also professional problems. We still point out that while the inefficiency of the law exists and considering the care demanded when a child enters the health care service, the importance of the sensitivity of the protective role exercised by these professionals at the moment they elect not to miss the opportunity of notification of suspicious or detected abuse cases, taking into consideration their co-responsibility for the continuation or not of the violence suffered by such child. / TEDE / BV UNIFESP: Teses e dissertações

Background Relational intimacy is hypothesized to underlie the association between female sexual functioning and various sexual outcomes, and married women and women with sexual dysfunction have been generally absent from prior studies investigating these associations, thus restricting generalizability. Aim To investigate whether relational intimacy mediates sexual outcomes (sexual satisfaction, coital frequency, and sexual distress) in a sample of married women with and without impaired sexual functioning presenting in clinical settings. Methods Using a cross-sectional design, 64 heterosexual married women with (n = 44) and without (n = 20) impaired sexual functioning completed a battery of validated measurements assessing relational intimacy, sexual dysfunction, sexual frequency, satisfaction, and distress. Intimacy measurements were combined using latent factor scores before analysis. Bias-corrected mediation models of the indirect effect were used to test mediation effects. Moderated mediation models examined whether indirect effects were influenced by age and marital duration. Outcomes Patients completed the Female Sexual Function Index, the Couple's Satisfaction Index, the Sexual Satisfaction Scale for Women, the Inclusion of the Other in the Self Scale, and the Miller Social Intimacy Test. Results Mediation models showed that impaired sexual functioning is associated with all sexual outcomes directly and indirectly through relational intimacy. Results were predominantly independent of age and marital duration. Clinical Implications Findings have important treatment implications for modifying interventions to focus on enhancing relational intimacy to improve the sexual functioning of women with impaired sexual functioning. Strengths and Limitations The importance of the role relational intimacy plays in broad sexual outcomes of women with impaired sexual functioning is supported in clinically referred and married women. Latent factor scores to improve estimation of study constructs and the use of contemporary mediation analysis also are strengths. The cross-sectional design precludes any causal conclusions and it is unknown whether the results generalize to male partners, partners within other relationship structures, and non-heterosexual couples. Conclusion Greater relational intimacy mitigates the adverse impact of impaired sexual functioning on sexual behavior and satisfaction in women. Witherow MP, Chandraiah S, Seals SR, et al. Relational Intimacy Mediates Sexual Outcomes Associated With Impaired Sexual Function: Examination in a Clinical Sample. J Sex Med 2017;14:843–851.

Indiana University-Purdue University Indianapolis (IUPUI) / Sexual behaviors in adolescence establish the initial resources an individual carries into sexual relationships in adulthood. Current definitions of sexual resilience in adolescence are defined from a negative, risk-based lens. Resilience theory, more generally defined, considers both internal and external factors that promote adaptation to challenging situations. A direct, capital-based approach to studying adolescent sexual resilience has not been found in the extant literature and I propose that a new, more inclusive definition of sexual resilience in adolescence will be more strongly correlated with sexual health in young adults than the risk-based definition. This study creates mutually exclusive risk-based and capital-based measures of adolescent sexual resilience and examines their associations with sexual health outcomes in young adulthood. The data did not produce significant findings, yet descriptive results provide direction for future research. Research in this area is of critical importance as adolescence and young adulthood are unique life stages that involve significant development in areas that influence health, both short and long term. This research, through a proper resilience lens, will better guide adolescent sexual education to develop internal resources as well as provide adequate external resources for adolescents that promote better sexual health and agency outcomes in adulthood.