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During the past two decades there has been much research conducted on the relationship between the risky sexual behavior practices and substance use among U.S. adolescents. This body of research has documented the fact that substance use and not using condoms are the most important indicators associated with the risk of becoming infected with sexually transmitted diseases (STD) both among adolescents and adults (Florida Department of Public Health, 2004; Malow, Devieux, Jennings, & Lucenko, 2001; McCoy & Inciardi, 1995). Data from those reports and studies indicate that adolescents and adults who use a condom regularly and appropriately are 20 times less likely to contract an STD than those who do not (Pinkerton & Abramson, 1997). However, less empirical evidence exists about the factors that influence adolescent use of condoms, particularly among adolescents who are detained due to their criminal lifestyle. Researchers have found both a high prevalence of STD in addition to early onset of sexual activity without protection among some adolescent groups such as the detainees (D'angelo & DiClemente, 1996) and that adolescents tend to underestimate their risks of acquiring the human immunodeficiency virus (HIV) (Magura, Shapiro, & Kang, 1994). Many adolescents will experiment with alcohol and other drugs. This behavior may compromise their judgment and increase their chances of engaging in risky sex (Rotheram-Borus, 2000). Hence the need for research that investigates the influence that substance use, risky sexual attitudes, knowledge about the transmission of HIV, and both peer and parental approval of condom use have on the use of condoms among both female and male adolescent detainees. Lastly, it is important for additional research to be conducted because adolescent detainees have been identified as being at high risk of becoming infected with an STD (Malow, Rosemberg, & Devieux, 2006). The purpose of this study was to examine the relationship among adolescent substance use, gender, sexual risk attitude, attitude about personal use of condoms, knowledge associated with the transmission of HIV, peer and family approval of condom use, history of sexually transmitted diseases (STD) and the level of condom use in a sample of adolescents housed in a correctional institution. Further details of the explanatory variables, the control variables and their expected relationships can be found in the review of the Literature in Chapter 2. Also, more information about the separate analysis of the research questions is detailed in the Methods section in Chapter 3. Based on the literature detailed in Chapter 2 (e.g., Malow et al., 2006), the current study’s researcher anticipated that adolescents’ higher levels of illicit drug use would be related to higher levels of sexual risk behaviors, as measured by lower levels of condom use, than their counterparts who used no drugs. Similarly, it was hypothesized that positive attitudes toward condom use and higher levels of HIV risk knowledge would be associated with a lower level of risky sexual behaviors along with a higher level of condom use skill. It was further hypothesized that the level of approval perceived from parents and peers regarding condom use was going to be related to adolescents’ safe sex behavior (i.e., condom use). Therefore, it was expected that participants’ perception of a high level of approval to use condoms from peers and parents would be a statistically significant variable in helping explain the condom use within this sample of adolescent detainees.

The primary purpose of this research was to examine the relationship between individualism and attitudes toward four types of sexual behavior, specifically adolescent sex, premarital sex, extramarital sex, and homosexual sexual behavior. A secondary purpose was to add to the conceptual and methodological discussions of individualism. In the United States these behaviors are becoming more common and attitudes generally more accepting. What remains unclear and under theorized is why? I address this question from the frame of the intersection of sexuality studies with the study of deviance as these behaviors have been considered to fit normative, absolutists, statistical and/or reactive definitions of deviance. This research was informed by Hawdon's recent general model of deviant behavior. In brief, one of Hawdon's contributions to the study of deviance is his addition of the cultural value of individualism as an explanatory variable related to cross-cultural rates of drug use. The primary research question that guided this research was: Is individualism related to attitudes toward adolescent sex, premarital sex, extramarital sex, and homosexual sexual behavior? Utilizing data from the General Social Survey, this question was examined using a variety of conceptualizations of individualism to test the relationship between individualism and attitudes toward the various sexual behaviors for five time periods--1998, 2000, 2002, 2004, and 2006. Three major hypotheses were posed regarding the relationship between individualism and attitudes toward perceived sexual deviance. The analysis did not support the hypotheses. Reasons for this lack of support for the theoretical perspective were discussed. / Ph. D.

This thesis analyzed if undergraduate students at a Southern university use the term outercourse to describe sexual behaviors that exclude penile-vaginal intercourse. A literature review revealed that no universal definition of outercourse exists and no forward progression toward a more cohesive definition was observed. Furthermore, 22 various sexual behaviors were recognized as possible outercourse behaviors. Following the literature review, a quantitative study with a minor qualitative component was conducted at a large Southern university. For this phase, 426 students responded to a 34-item online survey. After providing basic demographic information, students were asked to select the single term to describe sexual behaviors that do not include penile-vaginal intercourse. Furthermore, students were asked to determine whether or not they would classify 28 various sexual behaviors as outercourse. The respondents were provided space after each behavior to qualify or elaborate upon any uncertainty they had about the classification of a behavior. Frequencies were tabulated for the qualitative responses to each behavior. The number of comments ranged from 2 to 85 and sadomasochistic activity garnered the most comments (85). Frequency statistics were computed for all quantitative variables. Crosstabs were calculated to determine the demographic characteristics of respondents and non-respondents for each behavior. The results revealed that a majority of the respondents were female (67.4%) and heterosexual (95.5%). Respondents preferred the term "fooling around" (63.4%) instead of outercourse (3.4%) to refer to sexual behaviors that exclude penile-vaginal intercourse. The respondents determined ten behaviors to be outercourse, five behaviors to not be outercourse, and 13 behaviors could not be classified due to the lack of a majority response. For each of the sexual behaviors, approximately 25% of the sample did not provide a response. Crosstabs revealed that freshmen students were more likely than their upperclassman counterparts to omit a response to a behavior. In contrast, juniors were most likely to respond to the sexual behavior questions. The findings from this thesis have provided a catalyst for future interdisciplinary research endeavors and practical implications for health educators and medical professionals who work with undergraduate students.

Introduction: African American adolescents have a higher prevalence of risky sexual behavior compared to Hispanic and White adolescents. African American adolescents account for 65% of HIV diagnoses among individuals aged 13 to 24 years (Jackson et al., 2015). The rising rate of new STI and HIV cases remains a public health concern and the need for intervention in target populations is outstanding. The objective of this study is to measure the association between alcohol and other substance use and risky sexual behaviors in African American adolescents in the United States. Methods: Data from the Centers for Disease Control and Prevention’s (CDC) 2015 National Youth Risk Behavior Surveillance Survey (YRBS) was used in this study. SAS 9.3 software package was used for descriptive analysis, univariate logistic regression, and multivariate logistic regression of assessing the relationship between alcohol and drug use with risky sexual behaviors in black adolescents in comparison with white adolescents. Results: When controlling for age, gender, and all other variables, African American adolescents that reported ever consuming alcohol were 2.2 (OR=2.2 95% CI=1.6-3.2 p= <.0001) times more likely to ever had sex, 3.8 (OR=3.8 95% CI= 2.9-4.9 p= <.0001) times more likely to have had sex with 4 or more people in the past 3 months, and 1.3 (OR=1.3 95% CI=0.8-2.1 p= <.0001) times more likely to have had sexual intercourse with at least 4 people in their lifetime. When asked if they ever used marijuana, adolescents that reported at least once were 4.5 (OR=4.5 95% CI= 3.2-6.5 p=<.0001) likely to have engaged in sexual intercourse, 3.8 (OR=3.8 95% CI=2.6-5.5 p= <.0001) times more likely to have had sex with four or more people in the past 3 months, and 6.1 (OR=6.1 95% CI=3.7-10.2 p= <.0001) times more likely to have at least 4 sexual partners in their lifetime. Conclusions: The findings of this study indicate that use of illicit substances does increase risky sexual behaviors in African American Adolescents. Further implications of this study can be utilized in the development of intervention programs. Intervention programs should target African American adolescents that engage in risky sexual behaviors and any substance use.

Thesis advisor: Sandra R. Mott / The purpose of this research was to address the gap in the literature regarding the lack of first hand accounts of the factors that influence adolescent sexual decision making. Using a narrative approach, I asked a cohort of late adolescent participants to tell their stories about the events surrounding their decision to become sexually active, and how this initial decision affected subsequent decision making. The specific research questions that guided the study were: 1) What are late adolescents' perspectives of the factors that influenced their decision to become and remain sexually active? and 2) What is the effect of sexual decision making regarding coital debut on subsequent sexual activity? To accomplish my research aims I used narrative inquiry to elicit rich information, in the adolescents' own words, about what they perceive to be the most salient factors that contributed to their decisions to engage in sexual activity. I recruited a purposive sample of 11 late adolescents between the ages of 18 and 22 years from a series of family planning and sexually transmitted infection (STI) clinics in the Northeastern United States. As their stories unfolded, four main components emerged. These components included the internal and external environmental context, expected social norms, implied sexual consent, and self-reflection and evaluation. The results of this study provide evidence that adolescent sexual decision making is a complex process with multiple layers of influence. Through the stories of my participants, I have constructed a more comprehensive conceptualization of adolescent sexual decision making and related sexual behaviors. This will guide the development of possible interventions to improve health care for this population. These interventions include expanding nursing knowledge to inform the development of theories, practice innovations, research, sexual health education, and policies for addressing adolescents' needs across the continuum of the adolescents' development from childhood to adulthood. / Thesis (PhD) — Boston College, 2009. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

The current mixed methods study utilized an ecological framework to examine public perspectives toward sexual behaviors among long-term care residents with dementia. Analyzing attitudes of the public is an integral component of understanding the entire ecological system that affects the development and overall well-being of a long-term care resident. Attitudes were examined using a multiple segment factorial vignette with a probability sample of 329 respondents from a southern state. Results indicate that attitudes were not statistically affected by sex or the elapsed time since diagnosis, and age, spousal disposition, and degree of intimacy predicted attitudes. A respondent’s education level also predicted attitudes across segments; those who attained higher levels of education were consistently more accepting of sexual behaviors, less likely to expect staff intervention in adulterous relationships, and were supportive of the healthy spouse beginning a new relationship. An ecological perspective provided a framework for guiding and informing future research on the influences of long-term care on sexual development and, in turn, for the development of relevant long-term care policy.

Adolescents' perceptions and behaviors about romantic heterosexual relationships and sexual intercourse were compared among adolescents living with adoptive, bio logical, and stepparent s. Data come from The National Longitudinal Study of Adolescent Health (Add Health). In 1995, over 20,000 adolescents living throughout the United States completed a 90-minute in-home interview that asked numerous questions about romantic relationships and sex ual behaviors. Add Health used a multi-stage cluster design to collect a random sample representative of adolescents attending U.S. schools. Results showed that several demographic characteristics (gender, age, race/ethnicity, parent's education, and number of parents in the household) were associated with adolescents' perceptions and behaviors regarding romantic relationships and sexual intercourse. Descriptive mean comparisons not controlling for any demographic characteristics showed more similarities than differences between adopted and nonadopted adolescents' heterosexual relationship formation and sexual behaviors. A second set of descriptive mean comparisons, controlling for the influences of gender and number of parents in the home, showed more differences than similarities between adopted and nonadopted adolescents living in single-parent families. Adopted females reported many more experiences of rape and/or incest than non adopted females living in two-parent and single-parent families. Multivariate regression analyses controlling for five demographic characteristics found more similarities than differences between adopted and nonadopted adolescents. Most J ifferences that were f0und were small in magnitude. Adopted males reported more ictealism when asked to describe their ideal romantic relationships and more sexual activity when asked to describe their actual romantic relationships than nonadopted males. Adopted females were nearly three-and-a-half times more likely than biological females, and nearly two-and-a-halftimes more likely than stepfamily females to report forced sexual intercourse. Adopted females also reported more negative perceptions about the consequences associated with sexual intercourse than nonadopted females. Findings about mediating concepts theorized to be the link between adopted adolescents' experiences and resultant outcomes were inconclusive. Findings overall showed that adopted and nonadopted adolescents' heterosexual relationship format ion and sexual behaviors were more similar than different. Differences that were found were most frequent among single-parent families and most substantial between adopted and nonadopted females' reports of forced sexual intercourse.

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