In this two-manuscript dissertation, framed through queer and minority stress theories, I focus on heteronormative pressures and their impact on sexual identity fluidity and health of lesbian, gay, and bisexual youth and young adults. Heteronormativity, or the expectation to meet heterosexual norms in relationships, may be stressful for lesbian, gay, and bisexual (LGB) youth and be linked to poorer health. In particular, I focus on bisexual young people because bisexual people can enter into either same- or different-gender relationships; these young people could experience pressure from family members and religious communities to conform to heterosexual norms, resulting in sexual identity transitions that could explain health differences between sexual minority groups. In the first manuscript, I conducted life history narratives interviews with 14 racially and ethnically diverse youth and young adults between the ages of 18-24 on how LGB youth make sense of expectations to conform to heterosexual norms and how their experiences vary based on youths’ characteristics. In the second manuscript, I used structural equation modeling analysis of one of the largest community samples of LGB youth and young adults between the ages of 15-21 in the U.S. to examine youths' current and future relationship desires in a broader system of heteronormative expectations and how these expectations operate as mechanisms to influence the mental health of sexual minority youth. Qualitative results from the first manuscript show that for many youth and youth adults, gender and sexuality intersect to influence their experiences of heteronormativity: Gender and sexuality were conflated for gay men who stated that their gender nonconformity meant that family members already knew their sexuality before they came out as gay. Many bisexual women described their experiences being gender conforming in which they struggled to legitimize their sexuality to others because they were feminine. Though gay and lesbian identities were present in discussions of gender, an expression of gender that signaled and was named as bisexuality was fundamentally missing in the interviews. That is, participants did not describe a gender presentation that would indicate someone attracted to more than one gender. Participants consistently considered childbearing, but not marriage, to be highly desirable. Latino participants discussed heteronormativity through the racialized lens of machismo. However, religion was a greater source of pressure to conform to heterosexuality for Latino participants than were racial communities. My quantitative results from the second manuscript showed that gay men, lesbian women, and bisexual men are more likely to desire same-gender marriages later in life compared to bisexual women, who are more likely to desire different-gender marriages. Participants who desired different-gender marriage were more likely to identify as a different sexual identity over time. However, neither relationship desires nor sexual identity transitions related to depressive symptoms. The findings of this manuscript suggest that initial transition to a sexual minority identity may be the most vulnerable time for youth. After this initial transition, lesbian, gay, and bisexual youth may be inoculated to stress related to identity transitions, even in the context of heteronormativity. This research informs queer and minority stress theories: Gender, sexuality, and family norms intersect to structure how youth understand heteronormativity and predicts whether youth maintain their sexual identity, but such norms might not be stressors that influence health after youth first identify as LGB.

Master of Science / Department of Journalism and Mass Communications / Nancy Muturi / Cigarette smoking is one of the leading causes of preventable deaths in the U.S. and a global public health concern. The health effects have been severe among the youth. Smoking among the youth has been attributed to media. Movie in particular, is perhaps the most successful advertising on cigarette. Research shows that greater exposure to smoking in movies predicts increased likelihood of trying smoking. The purpose of this experimental study was to explore the relationships of smoking exposure in movies and young adults’ attitude, intention, and risk perception toward smoking. The theory of reasoned action (TRA) and the Attitude Accessibility Concept served were used in the study. The experiment was conducted at 70 Kansas State University students and examined the extent to which young adults’ memory/experience on smoking are triggered by watching smoking scenes; and whether young adults had different reactions based on the level of dosages of onscreen smoking. The results showed that the relationship of onscreen smoking and young adults’ memory/experience on smoking is not significant, as well as the relationship of media exposure and young adults’ attitude to smoke. However, the study found that nonsmokers contain considerable anti-smoking attitude and significant risk perception to smoke. The anti-smoking attitude is highly associated with the risk perception. The study presented theoretical implications, which includes the proposal to incorporate risk perception in the model of TRA, made recommendations to future anti-smoking campaigns targeted on young adults, and suggested areas of further research.

Master of Science / Family Studies and Human Services / Farrell J. Webb / Relationship and risk factors of infidelity within intimate and romantic relationships were examined using the Relationship and Risk factors influencing Infidelity Model (RRIM). It is based in part on Sternberg’s (1998) theoretical construct known as the triangular theory of love. Relationship factors included demographics, and relationship, development, strengths, and dynamics. Risk factors included sexual compatibility, and relationship problems. Data gleaned from Wave IV of the National Longitudinal Study of Adolescent Health (Add Health) measured a subsample of approximately 1,000 respondents (n = 939) young adults from 24 to 32 years of age (M = 28.64, SD = 1.79, Mdn = 28.61) and was designed to test the accuracy of the RRIM. Hierarchical logistic regression was used to explicate the relationships found across the elements within the RRIM. The overall results revealed that the RRIM correctly classified that 72.2% of the men and 78.8% of women were not likely to commit infidelity. The final results revealed that the level of commitment, the feeling of love, and the frequency of sex within the relationship were statistically significantly likely to influence infidelity between both men and women. Meanwhile, education and believing that one’s relationship would be permanent were statistically significantly likely to influence infidelity for women, but not for men. Although these results are encouraging, limitations were found within the RRIM and problems generated from using the Add Health must be acknowledged as several measures were not reliable. Future investigations should focus on how role models within young adults immediate and external environment influence their participation in committing infidelity.

The purpose of this study was to examine the claim that 70 to 90% of youth ministry graduates from conservative Southern Baptist churches leave the church after high school graduation. In order to accomplish this goal, the researcher compared current levels of church involvement among young adults with their youth ministry commitment levels to look for significant relationships between the two and to obtain a valid retention statistic. The research design for this study was essentially quantitative. Young adults who graduated high school prior to the year 2008 from twelve Southern Baptist churches were surveyed to gather data regarding their previous youth ministry commitments and current levels of church involvement. Survey data was compiled, coded, and analyzed using a series of Chi-Square tests and t-tests to determine the statistical significance between these two categories. An overall retention rate of 88% was observed for all levels of youth ministry commitment, and over 70% of the survey respondents reported that they never dropped out of church between the ages of 18 and 22. Keywords . Retention, Youth Ministry Commitment, Drop Out, Church Involvement / This item is only available to students and faculty of the Southern Baptist Theological Seminary. If you are not associated with SBTS, this dissertation may be purchased from <a href="http://disexpress.umi.com/dxweb">http://disexpress.umi.com/dxweb</a> or downloaded through ProQuest's Dissertation and Theses database if your institution subscribes to that service.

<p>Sexual risk behavior among young adults is a serious public health concern; 50% will contract a sexually transmitted infection (STI) before the age of 25. The current study collected self-report personality and sexual history data, as well as neuroimaging, experimental behavioral (e.g., real-time hypothetical sexual decision making data), and self-report sexual arousal data from 120 heterosexual young adults ages 18-26. In addition, longitudinal changes in self-reported sexual behavior were collected from a subset (n = 70) of the participants. The primary aims of the study were (1) to predict differences in self-report sexual behavior and hypothetical sexual decision-making (in response to sexually explicit audio-visual cues) as a function of ventral striatum (VS) and amygdala activity, (2) test whether the association between sexual behavior/decision-making and brain function is moderated by gender, self-reported sexual arousal, and/or trait-level personality factors (i.e., self-control, impulsivity, and sensation seeking) and (3) to examine how the main effects of neural function and interaction effects predict sexual risk behavior over time. Our hypotheses were mostly supported across the sexual behavior and decision-making outcome variables, such that neural risk phenotypes (heightened reward-related ventral striatum activity coupled with decreased threat-related amygdala activity) were associated with greater lifetime sexual partners at baseline measured and over time (longitudinal analyses). Impulsivity moderated the relationship between neural function and self-reported number of sexual partners at baseline and follow up measures, as well as experimental condom use decision-making. Sexual arousal and sensation seeking moderated the relationship between neural function and baseline and follow up self-reports of number of sexual partners. Finally, unique gender differences were observed in the relationship between threat and reward-related neural reactivity and self-reported sexual risk behavior. The results of this study provide initial evidence for the potential role for neurobiological approaches to understanding sexual decision-making and risk behavior. With continued research, establishing biomarkers for sexual risk behavior could help inform the development of novel and more effective individually tailored sexual health prevention and intervention efforts.</p> / Dissertation

Regular physical activity (PA) participation and fruit and vegetable (FV) consumption confers numerous positive health outcomes for cancer survivors, including prevention of cancer recurrence, second primary cancers, and other non-communicable chronic diseases. Rural-living young adult cancer survivors (YAs) possess unique barriers and concerns that influence their ability to participate in traditional face-to-face behaviour change interventions. Few researchers have explored alternative means for delivering behaviour change interventions grounded in theory utilizing a mixed-methods approach to assess processes of change and behavioural outcomes. To fill this gap and provide recommendations for future interventions and services focused on positive health behaviours in this population, the objective of the research presented in this thesis was to explore the feasibility and acceptability of a 12-week theory-based telehealth behaviour change intervention aiming to improve PA and FV consumption using a single-arm, mixed methods pilot trial. Over a 7-month period, 14 YAs self-referred. Of these 14, 5 were eligible and consented to participate with 3 completing the study. Retention to the study was 73% and adherence to the health coaching program ranged from 66.67-100% with a 40% attrition rate. Inquiry into the acceptability of the intervention offered insight into participants experiences, which was summarized within five themes: (1) the more time the better, (2) the human factor, (3) supporting access, (4) influencing the basic psychological needs, and (5) finding motivation. Collectively, the findings suggest the methods used require minor modifications before being deemed feasible despite the general acceptability of the intervention. Importantly, they highlight the necessity of more expansive recruitment strategies and a need to explore participants’ underlying intentions for participating in behaviour change interventions. Further, recommendations are made based on the findings to improve this style of intervention, including testing stepped down models of support because it may help some YAs maintain behaviour change post-intervention.

Thesis advisor: Kevin J. Mahoney / Thesis advisor: Ce Shen / For young adults with disabilities, who face barriers in achieving markers of adulthood, a service gap has been identified during the transition to adulthood. Preliminary qualitative evidence suggests that participant-directed home and community-based services (PD-HCBS), which can be easily modified to meet an individual’s needs, might aid these young adults as they transition into adulthood and provide an option to fill the service gap. However, research was needed to determine if young adults are significantly affected by having the option to develop an individualized spending plan and manage their own budget. In this study, secondary data analysis was employed in evaluating the effectiveness of the Cash and Counseling budget authority model of PD-HCBS for young adults aged 18 to 35 with long-term care disabilities and eligible for Medicaid who were enrolled in the Cash and Counseling Demonstration and Evaluation randomized control trial (n = 831). Using a theoretical framework based on the developmental life stage of young adulthood, theories of self-determination and consumer direction, and past research on PD-HCBS, I examined young adults’ outcomes on community involvement, satisfaction ratings, unmet needs for assistance, and health status compared to peers through self-reports or through proxy respondents. Multivariate logistic regression results showed that Cash and Counseling significantly increased the likelihood of young adults attending school or college at a preferred level, being very satisfied with when care was received, care arrangement, transportation, help around the house and community, personal care, and getting along with paid attendants, and having fewer unmet needs with health care at home and with transportation than controls receiving agency-based care. Bivariate logistic regression models also showed Cash and Counseling members were significantly more likely to attend activities at a preferred level, be very satisfied with life, and have lower likelihoods of unmet personal care needs. These findings support the effectiveness of the Cash and Counseling model with young adults with disabilities and as an option to help fill the service gap for this population. Future research and intervention could address how other influential factors identified affect outcomes and test PD-HCBS during different aspects of the transition to adulthood. / Thesis (PhD) — Boston College, 2016. / Submitted to: Boston College. Graduate School of Social Work. / Discipline: Social Work.

Background This report examined the association and relationship between Migration, Gender and STIs among young adults in Lesotho. To achieve this, the first objective was to understand the historical trans-boundary relationship between Lesotho and South Africa and how it contributed to STIs among young adults in Lesotho. The report then described the relationship between migration and having had any STIs among young adults in Lesotho. After multivariate analysis the association, between gender and having had any STIs among young adults in Lesotho was explored for understanding. Methodology For data analysis, secondary data from the 2009 Lesotho Demographic Health Survey (LDHS) were used. The LDHS is a cross-sectional study, designed to provide estimates of health and demographic indicators at the national level, for urban-rural areas and for each of the ten districts in Lesotho. The sample size used for this report was N=6,270. The statistical methods employed for data analysis were descriptive analysis, to establish the distribution of young adult migrant groups, according to STIs, demographic, socioeconomic and sexual practices. A Chi-square test was done to test for association. And a multivariate analysis was done using the forward selection process, to examine the relationships between STIs, migration, gender and significant variables. Results Migration status was found to have an insignificant (p=0.237) association with STIs. On the other hand, after considering migration status and gender at multivariate level, migration status, specifically urban-non migrants, were found to have a significant (p<0.05) relationship with having had any STIs. Gender was found to have an insignificant (p=0.587) association with having had any STIs and an insignificant (p=0.365) relationship with having had any STIs. However at multivariate level being female was found to be 16% protective against having had any STIs. Conclusion The report found that the relationships between migration status and having had any STIs were closely linked to factors related to gender and social and cultural norms pertaining to sexual behaviour. These influences were reflected in the literature and empirical evidence of this research report.

Bakgrund: Cancer drabbar människor i alla delar av livet, frekvensen ökar bland äldre men även barn och unga drabbas. Unga vuxna är en definition på individer i åldrarna 18-30 år. Detta åldersspann kantas ofta av stora förändringar hos individen. Utbildning, jobb och relationer är faktorer som utvecklar identiteten och denna utveckling kan påverkas av sjukdomen. Bredare kunskaper i av individers erfarenheter kan underlätta sjuksköterskans arbete med att främja hälsa och minska lidande för individerna. Syfte: Beskriva unga vuxnas erfarenheter av att leva med cancer. Metod: litteraturstudie med deskriptiv design utifrån tio kvalitativa- och två kvantitativa vetenskapliga artiklar. Huvudresultat Deltagarna upplevde identitetsförändringar i samband med sjukdomen och dessa förändringar påverkade självbild och livskvalité. Sociala relationer påverkades av sjukdomen, dessa kunde stärkas eller försämras. Socialt stöd var viktigt, både från vårdpersonal och anhöriga. Deltagarna handskades med sjukdomen med hjälp av olika copingstrategier. Inom vården beskrevs ett behov av bättre information och mer kompetent personal. Deltagarna önskade flera förändringar i sjukhusmiljön, dessa innefattade inredning, mer aktiviteter och att vårdas med jämngamla individer. Slutsats Unga vuxnas erfarenheter av cancer tyder på att identitetsproblem ofta uppstår till följd av sjukdomen. Som sjuksköterska är det viktigt att se till patientens och anhörigas behov. Det är viktigt att sjuksköterskor som jobbar med dessa människor har goda kunskaper om sjukdomen och behandling för att kunna ge adekvat vård och information. Sjukhusmiljön dessa människor vårdas i bör anpassas så jämngamla individer vårdas ihop. Professioner omkring sjuksköterskan bör användas flitigt såsom präst, kurator och även stödgrupper. / Background: Cancer affects people in all parts of life, the frequency increases among the elderly, but children and young adults are also affected. Young adults are a definition of individuals aged 18-30. This age range is often lined by major changes in the individual’s life. Education, jobs and relationships are factors that develop the identity and this development can be affected by the disease. Broader knowledge of individuals' experiences can facilitate the nurse's work in promoting health and reducing suffering for the individuals. Purpose: To describe young adults' experiences of living with cancer. Method: Literature study with descriptive design based on ten qualitative- and two quantitative scientific articles. Main Results: Participants experienced identity changes in connection with the disease and these changes affected self-image and quality of life. Social relations were affected by the disease, which could be strengthened or impaired. Social support was important, both from healthcare professionals and relatives. Participants dealt with the disease using various coping strategies. In health care, a need for better information and more competent staff was described. The participants wanted several changes in the hospital environment, these included interior design, more activities and to be cared for with individuals of equal age. Conclusion: Young adults' experiences of cancer indicate that identity problems often arise as a result of the disease. As a nurse, it is important to consider the needs of the patient and the relatives. It is important that nurses who work with these people have good knowledge of the disease and about the treatment to be able to provide adequate care and information. The hospital environment in which these people are cared for should be adapted so that equal-aged individuals are cared for together. Professionals around the nurse should be used extensively, such as priests, counsellors and support groups.

This thesis studies how young adults in today's Swedish Pentecostal congregations describe their beliefs and their congregational life. The thesis applies a theoretic frame of Rational Choice Theory and compares the results with previous research/adjacent studies close to the field. The relevance of this thesis lies in that research on young adults in the Swedish Pentecostal movement is a comparatively unexplored area. The reason to write about young adults in the Swedish Pentecostal movement is rooted in the prospect that this thesis could be a starting point for further studies on young adults in the Swedish Pentecostal movement. The thesis was a qualitative and quantitative multi-method study. The thesis is based on interviews and a questionnaire survey in order to present how young adults in today's Swedish Pentecostal churches describe their beliefs and their congregational life. The thesis identifies some issues that can be raised and investigated in further research on thistopic. Summary of the results The young adults describe that their faith becomes stronger by being part of a Pentecostal congregation. The community of the congregation, both in the smaller and the broader context, confirms the faith which makes their belief stronger. They perceive God as a protector and caretaker, and that God listens to their prayers and cares about them. The subjective part of the faith (the personal relationship with God) they experience as necessary, but they feel that the subjective relationship with God both can be experienced in the church community and solitude. Most of the young adults say they would consider switching the congregation (leave the congregation) if they would not thrive in the congregation or if it would not meet their expectations and needs. The interviews show that the respondents indicate certain preferences that they want to get satisfied and they want to belong to a congregation that can fulfil this. Getting their preferences and needs met is the key to the congregations if they want young adults to stay. The young adults are investing and giving time and commitment to their congregations and want this to generate something back. Most of them thrive in their congregations, but there is room for improvement. Their faith is strong. They are willing to invest in God and then consequently also in their congregations. / <p>Godkännandedatum 2019-06-05</p>