The optimal model to support adolescent sexual health is the concurrent use of hormonal birth control and condoms. This dual protection approach prioritizes protection against unplanned pregnancy as well as sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV). In order to explore individual, interpersonal and structural factors that influence adolescent protection use, multivariate Chi-squared Automatic Interaction Detector (CHAID) analysis was completed with a national sample of adolescents (n=2320) from the 2002 Canadian Youth, Sexual Health, and HIV/AIDS Study. CHAID is a decision tree method which assesses interactions between significant independent variables to optimize prediction of the dependent variable (i.e. safer-sex protection method). Among adolescent females, the following factors were associated with dual protection use: high condom intentions; having lived with both biological parents; having accessed a medical professional or media as the primary source of HIV/AIDS information; having utilized a medical professional as the primary source of sexual health information; having never had unwanted sex; having not consumed alcohol and/or drugs before sex; frequent sexual activity; having identified a medical professional as the primary source of STD advice; having been tested for STDs; and having supported the importance of talking about condoms with a partner. Among adolescent males, dual protection was associated with: high condom intentions; frequent sexual activity; the belief that both partners are responsible for condom use; having been born in Canada; having noted uncertain or high levels of religiosity; having been older than 14 at first sexual intercourse; having been able to speak with their father about sex; having accessed a medical professional or media as the primary source of HIV/AIDS information; and having reported a peer group that did not use tobacco. The results indicate that structural factors, in concert with individual and interpersonal factors, play a vital role in understanding adolescent safer-sex practices. Policy and practice implications include revisions to sexual health curricula, sexual health service accessibility for all adolescents, and targeted prevention programming for adolescents at highest risk. Further research into the sexual health of male adolescents and the influence of structural factors on sexual health among diverse samples should be prioritized.

The optimal model to support adolescent sexual health is the concurrent use of hormonal birth control and condoms. This dual protection approach prioritizes protection against unplanned pregnancy as well as sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV). In order to explore individual, interpersonal and structural factors that influence adolescent protection use, multivariate Chi-squared Automatic Interaction Detector (CHAID) analysis was completed with a national sample of adolescents (n=2320) from the 2002 Canadian Youth, Sexual Health, and HIV/AIDS Study. CHAID is a decision tree method which assesses interactions between significant independent variables to optimize prediction of the dependent variable (i.e. safer-sex protection method). Among adolescent females, the following factors were associated with dual protection use: high condom intentions; having lived with both biological parents; having accessed a medical professional or media as the primary source of HIV/AIDS information; having utilized a medical professional as the primary source of sexual health information; having never had unwanted sex; having not consumed alcohol and/or drugs before sex; frequent sexual activity; having identified a medical professional as the primary source of STD advice; having been tested for STDs; and having supported the importance of talking about condoms with a partner. Among adolescent males, dual protection was associated with: high condom intentions; frequent sexual activity; the belief that both partners are responsible for condom use; having been born in Canada; having noted uncertain or high levels of religiosity; having been older than 14 at first sexual intercourse; having been able to speak with their father about sex; having accessed a medical professional or media as the primary source of HIV/AIDS information; and having reported a peer group that did not use tobacco. The results indicate that structural factors, in concert with individual and interpersonal factors, play a vital role in understanding adolescent safer-sex practices. Policy and practice implications include revisions to sexual health curricula, sexual health service accessibility for all adolescents, and targeted prevention programming for adolescents at highest risk. Further research into the sexual health of male adolescents and the influence of structural factors on sexual health among diverse samples should be prioritized.

Building upon feminist and sexual health research, this dissertation shows how the positioning of women in various discourses as somehow ‘lacking’ actually constrains what researchers are able to hear in their sexual stories. Using interviews with 26 heterosexually active young women, I seek to upset traditional approaches to understanding young women’s sexual stories and theorizing heterosexuality. To analyze the interviews, I first employ a Foucauldian-inspired discourse analysis that focuses on the power that circulates through discourses and our positioning within them. Our positioning in various discourses both enables and limits various courses of action, understandings and experiences. This power of discourse is illustrated by an emergent hybrid discourse that is apparent in young women’s sexual narratives. I discuss what I call the ‘competent feminine sexuality’ discourse and show how this discourse smoothes over contradictions between liberal and gendered discourses. Secondly, I show how psychoanalytic insights allow us to explore the processes of subjectification by which young women constitute themselves as (hetero)sexual women. Specifically, this dissertation explores processes of abjection, disavowal and ambivalence in participants’ narratives. In conclusion, the dissertation outlines the practical implications for sexual health education in Canada.

Despite a number of public health initiatives targeting the sexual health of teenagers, teen pregnancy and STD rates in the U.S. remain exceptionally high. Although schools and peers are common sources of information for teens, research suggests that parents serve as one of the primary sources of sexual health information for adolescents. Many studies have focused on the content of parent-adolescent communication about sex, but more needs to be known about how such communication varies by adolescent gender and across different kinds of families. In this study, regression analysis assessed mother and adolescent In-Home interview data from Wave I of the Adolescent Health dataset (n = 20,745). Findings indicate that family structure and maternal education are somewhat predictive of the communication outcomes, yet adolescent gender remains the most significant factor in communication between mothers and adolescents. In short, mothers communicate more about sexual health with girls than boys, and this gender gap does not vary considerably across family structures or socioeconomic statuses based on maternal education. / text

Background: Adolescents are among those at most risk for acquiring sexually transmitted infections. Despite numerous strategies to increase STI knowledge, teens are not being reached as well by traditional preventative efforts. Texting is the preferred method of communication for adolescents who send and receive over 3417 text messages per month. Purpose: To examine the experiences of text messaging among urban adolescents and to explore their views on the potential for text messaging within adolescent sexual health services. Methods: Four focus groups were conducted with 21 adolescents in two community agencies in an urban setting. Results: Four themes emerged from the data: 1) connection to others and to self; 2) exerting control; 3) adolescents are generally receptive to texting in sexual health; 4) need to feel safe. Conclusions: Findings suggest ways in which health care organizations can adopt text messaging services and interventions to better serve adolescents’ needs.

Building upon feminist and sexual health research, this dissertation shows how the positioning of women in various discourses as somehow ‘lacking’ actually constrains what researchers are able to hear in their sexual stories. Using interviews with 26 heterosexually active young women, I seek to upset traditional approaches to understanding young women’s sexual stories and theorizing heterosexuality. To analyze the interviews, I first employ a Foucauldian-inspired discourse analysis that focuses on the power that circulates through discourses and our positioning within them. Our positioning in various discourses both enables and limits various courses of action, understandings and experiences. This power of discourse is illustrated by an emergent hybrid discourse that is apparent in young women’s sexual narratives. I discuss what I call the ‘competent feminine sexuality’ discourse and show how this discourse smoothes over contradictions between liberal and gendered discourses. Secondly, I show how psychoanalytic insights allow us to explore the processes of subjectification by which young women constitute themselves as (hetero)sexual women. Specifically, this dissertation explores processes of abjection, disavowal and ambivalence in participants’ narratives. In conclusion, the dissertation outlines the practical implications for sexual health education in Canada.

Background: Adolescents are among those at most risk for acquiring sexually transmitted infections. Despite numerous strategies to increase STI knowledge, teens are not being reached as well by traditional preventative efforts. Texting is the preferred method of communication for adolescents who send and receive over 3417 text messages per month. Purpose: To examine the experiences of text messaging among urban adolescents and to explore their views on the potential for text messaging within adolescent sexual health services. Methods: Four focus groups were conducted with 21 adolescents in two community agencies in an urban setting. Results: Four themes emerged from the data: 1) connection to others and to self; 2) exerting control; 3) adolescents are generally receptive to texting in sexual health; 4) need to feel safe. Conclusions: Findings suggest ways in which health care organizations can adopt text messaging services and interventions to better serve adolescents’ needs.

The purpose of this qualitative exploratory descriptive study was to arrive at an increased understanding of the factors influencing access to sexual and reproductive health services by rural Manitoban adolescents. Focus groups and individual interviews were held with 23 health care providers who provide sexual and reproductive health services to adolescents. The descriptive findings of this study revealed that a number of barriers for adolescents exist, which include: transportation difficulties, system barriers, and fear of lack of confidentiality. Recommendations included: creating health services that are adolescent-friendly: evening hours, remaining open during lunch-hour, and locating a clinic near a high school; increasing nurses scope of practice; encouraging multi-disciplinary referrals; improving relationships between public health nurses and the school division; and advocacy for adolescents’ to receive comprehensive sexual health information in school.

The purpose of this qualitative exploratory descriptive study was to arrive at an increased understanding of the factors influencing access to sexual and reproductive health services by rural Manitoban adolescents. Focus groups and individual interviews were held with 23 health care providers who provide sexual and reproductive health services to adolescents. The descriptive findings of this study revealed that a number of barriers for adolescents exist, which include: transportation difficulties, system barriers, and fear of lack of confidentiality. Recommendations included: creating health services that are adolescent-friendly: evening hours, remaining open during lunch-hour, and locating a clinic near a high school; increasing nurses scope of practice; encouraging multi-disciplinary referrals; improving relationships between public health nurses and the school division; and advocacy for adolescents’ to receive comprehensive sexual health information in school.

Doctor of Philosophy (PhD) / ABSTRACT This thesis reports on a study which explored the sexual health needs of men and teenage boys with a moderate to profound intellectual disability. Qualitative in design, this study was exploratory in nature as it sought to develop theoretical knowledge in male sexual health as a broad concept as opposed to testing a theory or hypothesis related to sexual health. Literature on sexuality and intellectual disability was reviewed in addition to male-specific literature on intellectual disability. In addition, mainstream literature on sexuality, sexual health, masculinity and men’s health was also reviewed. The literature review highlighted that the intellectual disability specific literature had largely ignored mainstream literature and had failed to acknowledge emerging work in men’s health and masculinities. Moreover, the literature identified a problematised focus toward sexual matters and males with an intellectual disability. The topic of enquiry was explored via an ethnomethodological design. Data consisted of interviews with 17 paid support staff, over 100 hours participant observation in community group homes, and triangulated with relevant artefacts from the field. The constant comparative method was used to analyse the data. Participants described the notion of men and teenage boys with a moderate to profound intellectual disability as being Conditionally Sexual. Conditionally Sexual was framed by three interconnected themes: 1) sexual development, 2) conditionally masculine, and 3) gendered service delivery. Through consideration of the implications to theory, practice, research, and policy, a propositional framework for a masculine health environment has been outlined. This framework is based on a salutogenic notion of male sexual health and the development of a healthy masculinity.