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.

Sexually transmitted diseases have reached epidemic proportions, especially among African Americans. However, African American women have emerged as being one of the hardest hit groups by the most fatal of sexually transmitted diseases - the Human Immunodeficiency Virus (HIV) and the Acquired Immune Deficiency Syndrome (AIDS). Although there has been much speculation regarding contributing risk factors specific to this group, previous research has focused mostly on low-income, uneducated or drug-addicted individuals. Still, these factors do not account for the infection rates among educated, non-addicted and financially stable women. In this study, psychological variables of self-efficacy and locus of control were explored study as potential risk factors in sexual decision making for African American women enrolled at two Midwestern universities. Locus of control was a significant predictor of normative beliefs regarding safer sex practices, while self-efficacy was not found to be a significant predictor for sexual decision-making. However, there was a significant interaction between self-efficacy and locus of control in relation to participants' intentions to practice safer sex. The results and implications for counseling, counselor education, research and prevention are discussed.

This study utilized a is a two-phase mixed methods design to examine partner-based expectations and perceptions of factors that affecting condom use among African American women recruited at a sexually transmitted infection (STI) clinic. Phase One utilized qualitative methods to analyze interviews from 25 unmarried, African American women between ages 18--26. Interviews explored the following two research questions: (1) How do young adult African American women conceptualize relationships as illustrated by their expectations of their partner and their expectations of themselves in the relationship? (2) What messages do women recall receiving from their family members about sexual opportunities, intercourse, consequences of sex, love, marriage and premarital sex? Data analysis revealed partner-based expectations that included expectations of trust/honesty, respect from partners, stability of partner's behaviors, interest in women's well-being, partner's ability to be self-reliant, and specific behavioral expectations (e.g., communication, family commitment). Some expectations linked to women's ideas about their sexual health. Women's self-expectations included being emotionally supportive, committed, honest, domestic and independent. Familial messages focused on what to expect from partners, who women should be in relationships, messages stressing respect for and from others, messages emphasizing how to prevent negative outcomes of sex and messages warning about consequences of sexual engagement. Findings related to women's HIV/AIDS prevention behavior included responsibility for their own sexual safety, commitment to assessing partner's history, incorrect education regarding sexual safety, and relationship factors affecting condom use. Findings from interviews were used to develop items for the Relationship Expectation Measure (REM), which tested and used as a mediator for Phase Two Hypotheses. Phase Two of the research tested for the association between family process factors, communication and closeness, relationship expectations and sexual health outcomes. Hierchical Linear regression models were used to test associated hypotheses. Findings did not support the association between family process variables, relationship expectations and sexual health outcomes. Findings from this study illuminate the need for further understanding the degree to which different aspects of expectations and familial processes affect women's history of sexual behavior and partner-based expectations. Inconsistencies between what women expect and accept from partners are also discussed.

<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

This study examined the relationship between family functioning, as conceptualized by the FACES III instrument, and adolescents’ comfort and frequency communicating about sex, communicating and asserting personal boundaries, and sexual decision making. Quantitative data was collected from 154 Grade 9 students in the North Eastern Nova Scotia region. Gender, family structure, and sexual activity variables were explored. Findings showed that adolescents from balanced families scored higher on sexual decision making, were more comfortable communicating about sex, and communicated more frequently about sex to friends and parents. Females from more adaptive families scored higher on sexual decision making and sexually active adolescents were more comfortable talking about sex and their personal sexual boundaries but spent significantly less time thinking about the consequences of their choices, gathering information, and discussing it with others. Findings help understand adolescent sexual behaviour which is vital for promotion of positive sexual health across the life span. / Family Ecology and Practice

This qualitative grounded study explores power dynamics and its influence on sexual decision-making amongst college-age African American women. The film All of Us was shown to eighteen African American women to understand how they perceive power dynamics and sexual decision-making. Taking place at Georgia State University‟s main campus in Atlanta, focus groups and one on one interviews were implemented. Much of the research being conducted theorize that the risk factors regarding HIV infection are related to risky sexual decision-making and lack of consistent condom use; however this study concluded that there is a relationship between sexual decision-making and gendered power dynamics.

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