abstract: Overview: Transition from the pediatric to adult care setting for 'emerging adults' (ages 18- 26) continues to develop as a growing concern in health care. The Adolescent Transition Program teaches chronically ill 'emerging adults' disease self-management skills while promoting a healthy lifestyle. Transferring this knowledge is vital for successful health care outcomes. Unfortunately, patients who have been transferred to the adult care setting, report that they felt lost in the system due to lack of communication between care teams, inadequate support systems, and insufficient disease management knowledge. To address these gaps, the design of the physical environment must adapt to these challenges while also meeting the needs of various chronic illnesses. Methodology: Design thinking or human-centered design was utilized as the vehicle to discover unmet 'emerging adult' and adolescent health clinician needs. Ethnographic research methods involved observations at adolescent health clinics and in learning environments outside of the healthcare setting as well as interviews with 5 outpatient adolescent clinicians. A survey was also conducted with 16 'emerging adults' to understand how they learn. Lastly, a literature review explored the history of the adolescent, adolescent development, adolescence and chronic illness, and The Adolescent Transition Program. Results: Findings revealed that physical environment must be conducive to meet a variety of clinical and education activities such as chronic disease management, support adolescent development, and should be more human-centered. The space should transform to the patient education or clinical activity rather than the activity transforming to the space. Five design recommendations were suggested to ensure that the outpatient clinic supported both clinician and 'emerging adults' needs. / Dissertation/Thesis / M.S.D. Design 2014

Introduction: Emerging adults (young people age 18 to 29) are increasingly using the Internet to seek sex partners, with over 30% having tried an online or mobile dating site. As more emerging adults use dating and sex-seeking websites (DSP) for their love and sexual pursuits, it is imperative to understand how DSPs contribute to HIV/STI risk. Objectives: The objectives of this research were accomplished by pursuing the following specific aims: Aim 1. To systematically review and quantitatively synthesize evidence from published findings to determine the association between condom use and meeting venue (online and offline). Aim 2. To determine whether condom use behaviors during the first sexual interaction among heterosexual emerging adults vary depending on the venue in which participants met their partners in the past six months. Aim 3. To describe how the Information Motivation Behavioral (IMB) Skills Model applies to the relationship between condom use and meeting venue. Methods: This mixed methods study identified sexual risk behaviors of emerging adults. Men and women—recruited via social networking, classified ad and dating and sex-seeking websites— who met a heterosexual partner on a DSP and/or in-person in the past six months completed a survey about behavioral, communication and relationship factors that influence condom use. Additionally, a subset of people who met partners on DSPs and or offline (i.e., in-person) who completed the survey participated in qualitative interviews designed to explore in-depth factors that influence condom use during the first offline sexual encounter. The Information Motivation Behavioral (IMB) skills model was used to further understand the HIV/STI sexual risk behaviors of emerging adults with sex partners they met on DSP compared to those who met partner’s offline. Results: The findings of this study were that DSP are not associated with greater risks of condomless sex compared to offline meeting venues. The qualitative findings suggest that emerging adults have an attitude that condoms are to be used in new sexual relationships. However, whenever emerging adults do not have condoms available, they are less likely to use a condom. Conclusion: Although the findings of this study suggest that there is no statistical difference in condomless sex by venue, DSPs are an important place for public health messaging about condom use for the prevention of HIV/STIs, and unintended pregnancy. DSPs can help achieve some of the objectives set by Healthy Campus 2020, Healthy People 2020, and the National HIV/AIDS Strategy. In addition to targeting DSPs, it is important to continue sexual health promotion efforts in offline meeting venues.

Attachment and interpersonal theory suggest a sequential pattern of relationships beginning in the earliest stage of development and progressing to social and eventually romantic relationships. Theoretically, cross-sex experiences have an important role in the progression of interpersonal relationships. Despite the prevalence of these theories about the nature of romantic relationship development, the linkage of cross-sex experience (CSE) to romantic relationships has not been established. Indeed, it is an intuitive assumption, especially within Western society and these theories do not consider socio-cultural factors that may influence CSE and relationship satisfaction. This study addresses the varying contextual factors that may contribute to relationship satisfaction and adjustment, aside from CSE, and is divided into two parts. Study 1, addresses CSE, relationship satisfaction, and adjustment in a unique population, ultra-Orthodox Jews. Among this population, social or romantic CSE is limited and sexes are effectively segregated. Study 2, expanded the study to a larger sample of U.S. college students, to assess the linkage of CSE to romantic relationship satisfaction in a more typical Western population. It included social norm and support variables to address the contextual nature of relationship development and satisfaction. Results demonstrated clear differences in the relation between CSE and relationship satisfaction in the two samples. In the first sample CSE was unrelated to relationship satisfaction; nevertheless, relationship satisfaction was associated with adjustment as it is for more typical populations with greater CSE. These results suggested the importance of specifying how social norms and social support relate to CSE, relationship satisfaction and adjustment. The results from the second sample were consistent with the theoretical framework upon which the social/romantic literature is based. CSE was directly connected to relationship satisfaction. As anticipated, CSE, relationship satisfaction, and adjustment also varied as a function of social norms and support. These findings further validate the influence of socio-cultural factors on relationship satisfaction and adjustment. This study contributes to the romantic relationship literature and broadens our understanding of the complex nature of interpersonal and romantic relationships.

Recent research has proposed a new stage in human development, termed emerging adulthood by Jeffrey Arnett, which is characterized by a prolonged journey to adult roles and responsibilities. This thesis explores the experience of Chinese emerging adults, university students aged 20-25 years using Erikson’s and Levinson’s developmental theories as a theoretical framework. These authors proposed that three major developmental tasks are necessary for the transition to adulthood: separating from family of origin, forming an adult identity and finding the place for the self in the larger society. Qualitative interviews were conducted virtually with 12 Chinese university students to understand their perceptions and lived experience. Qualitative thematic analysis was used to analyze the interview transcripts. The results suggest Chinese emerging adults (a) have a low level of separation from parents; (b) have not formed a clear sense of identity and have not achieved a self-definition in adulthood; and (c) have not made initial commitments to love and work. It is speculated that the Chinese sociocultural context may further postpone its young adults’ independence and autonomy, and this prolonged transition to adulthood is both positive and problematic to Chinese young adults. This study lends support to Arnett’s emerging adulthood theory through its exploration of emerging adulthood in China, where, to date, little research has been done on this subject. It provides rich descriptions of the experience of Chinese emerging adults’ lives and enhances understandings of the role of culture in influencing the emerging adulthood period.

Sexual health is related to sexual experience and the accurate understanding of HIV and STIs modes of transmission, symptoms, and prevention. An examination of the influence of sociocultural factors provides a greater understanding of the determinants of sexual health given that sexual conduct is socially and culturally constructed. Consequently, this study sought to examine the influence of acculturation as it related to identity, behaviours and values, and the effects of religiosity and perceived discrimination in Haitian-Canadian, Franco-Ontarian and Anglo-Canadian emerging adults on their level of sexual experience and knowledge of HIV and STIs. The results indicated that Haitian-Canadians were the least sexually experienced group. Haitian-Canadian women in particular, were less experienced than Franco-Ontarian and Anglo-Canadian young women. The three groups did not differ in their level of knowledge regarding HIV. Yet, Anglo-Canadians were the most knowledgeable regarding STIs, followed by Franco-Ontarians. The level of religiosity experienced by participants was the only significant predictor related to sexual experience for all three groups. More religiosity predicted less sexual experience. Furthermore, greater religiosity also predicted less knowledge of HIV for Franco-Ontarians. These findings suggest that more specific measures regarding sexual norms and values should be used to examine sexual acculturation.

The current study examined how multiple dimensions of ethnic-racial identity (ERI) were associated with alcohol use and alcohol use disorder (AUD) symptoms and how these relations varied by individuals’ ethnic-racial group among 1850 diverse emerging adults (M = 18.46, SD = .38). Further, measurement invariance of the Ethnic Identity Scale-Brief (EIS-B) was tested across Latinx, White, Black, Asian, and Multiracial students. Additionally, alternative models were examined that tested whether family factors (i.e., parent education and family history of alcohol problems) moderated the relations between ERI and alcohol problems to further examine nuances in these relations. Results indicated that the EIS-B functioned differently across White students and students of color; therefore, all research questions were tested separately for White students. Findings indicated that there were significant differences by race/ethnicity. ERI affirmation was negatively associated with AUD symptoms for Asian individuals and Black individuals. ERI exploration was positively associated with AUD symptoms among Black individuals. ERI resolution was negatively associated with alcohol use for Latinx individuals and positively associated with alcohol use for Multiracial individuals. For White individuals, ERI exploration was negatively associated with alcohol use and ERI affirmation was negatively associated with AUD symptoms. Regarding the alternative models, parent education was a significant moderator, such that at high parent education, ERI resolution predicted more alcohol use among White students and less AUD symptoms among Minority students. Family history of alcohol problems was not a significant moderator of any relations between ERI dimensions and alcohol problems. Overall, continued research and finding ways to translate findings into interventions with college students that incorporate these nuanced mechanisms underlying alcohol problems is a fruitful and important endeavor.

Sextortion is a phenomenon that has made an impact on the digital technology domain. Sexting is a transmission of sensual messages or performances, provocation, and schemes exhibited through an array of sexual behaviors. The purpose of this cross-sectional study was to examine the psychological effects experienced of sextortion and to uncover the willingness to seek help and report the incident to authorities. Arnett's emerging adulthood theory provided the framework for this study. The sample consisted of N = 27 responders between 18-24 years of age who have engaged in sexting behaviors and may or may not have experienced sextortion. Simple and multiple regressions were performed using convenience samples to test predictor variables, emotional distress, self-esteem, general help-seeking, reasons for calling the police, disclosure expectations, and self-stigma to seek help and outcome variable, sextortion. Statistically significant correlations existed among variables. Overall, the results displayed insignificant effects of the predictor variables on the outcome variable. The effect of sextortion on the difference in the level of emotional distress revealed no significance, F(1, 25) = 1.96, p = .174. The effect of sextortion on self-esteem exhibited no significance, F(1, 25) = .054, p = .818. The effects of sextortion on general help-seeking, reasons for calling the police, disclosure expectations, and self-stigma to seek help collectively uncovered no significance, F(1, 25) = 3.105, p =.109. The sample size used based on the respective predictor variable, presented challenges to achieve significance at acceptable levels. This study provided a foundation for the implementation of mental health services, prevention programs, and support for those who were found to have experienced sextortion.

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<p>  </p> <p>LGBTQIA+ young adults face systemic and interpersonal marginalization and minoritization. These experiences occur not only in offline spaces but also in online contexts. However, online contexts also allow for LGBTQIA+ individuals to access social support that extends and bolsters the support they may receive offline. Previous studies tend to examine the relation between stress and support for LGBTQIA+ individuals using cross-sectional methods, despite the emphasis of previous theories such as minority stress theory on the occurrence of stressors on a daily, cumulative basis. The current study investigated how daily online marginalization stress experiences related to online experiences of social support for LGBTQIA+ young adults. Participants included 177 young adults, ages 18-29 and who identify as part of the LGBTQIA+ community. </p> <p><br></p> <p>Participants completed baseline measures of demographics, lifetime experiences of marginalization stress, social media use and attitudes, perception of online social support, self-esteem, and mental health symptoms. Next, participants were prompted twice daily for 21 days to complete a survey about online marginalization stress experiences, general and LGBTQIA+-specific online social support experiences, and positive and negative affect. Finally, participants completed a follow-up survey measuring internalized stigma, community connectedness, self-esteem, and mental health symptoms. </p> <p><br></p> <p>Results suggested that online marginalization stress was related to daily affect but not to follow-up well-being outcomes. Online marginalization stress was also related to online general social support, but not LGBTQIA+-specific online support. General social support online was related to higher positive affect and lower negative affect, and LGBTQIA+-specific online support was related to higher positive affect, but both types of online social support were generally unrelated to follow-up outcomes. Low marginalization stress and low general social support together were associated with higher internalized stigma and lower self-esteem at follow-up. Differences in these effects generally emerged for individuals with marginalized sexual orientations and less so for individuals with marginalized gender identities. The results of the study suggest that daily online marginalization stress experiences are likely related to online social support, and that online social support is beneficial for daily affect. However, online social support may not be particularly beneficial for ameliorating the effects of online marginalization stress on affect or well-being. </p>