Sexualiteten är en naturlig del av livet som varje individ utforskar och lär sig att förhålla sig till. Det sexuella utforskandet kan även innebära en risk både för den fysiska och/eller psykiska hälsan. Riskerna kan till exempel vara sökande efter bekräftelse, närhet eller status, men kan även vara att visa upp sig, dela utmanande bilder eller utbytande av sexuella tjänster mot ersättning. Sexualiteten kan även bli ett verktyg för att dominera, förtrycka eller kränka andra människor. Socialiseringsprocessen, alltså det sociala samspel som sker mellan barnet och deras familj beskrivs som grunden för hur barnet själv utvecklar sina egenskaper samt hur hen i sin tur integrerar med sin omgivning. I studien undersöks kommunikationen mellan föräldrar och barnet upplevs och huruvida det finns samband med att barnet utsätter sig själv eller andra för sexuella riskbeteenden. Studien uppmärksammar även på skillnaderna mellan könen i hur kommunikationen upplevs och vad som korrelerar med sexuellt riskbeteende. Studien är en kvantitativ analys där urvalet består av ungdomar som går i årskurs 9 (N=1357). Data är insamlad av det pågående longitudinella programmet LoRDIA (Longitudinal Research on Development In Adolescence). Studiens resultat indikerar att det finns statistiska signifikanta samband mellan ungdomar som pratar med sina föräldrar och inte uppvisar sexuella riskbeteenden. Resultaten visade även att tjejer uppvisade högre frekvens av sexuella riskbeteende.  Det föreligger även en signifikant skillnad mellan hur tjejer och killar upplever kommunikationen till vårdnadshavare och att tjejer har en högre tendens av att påverkas av vårdnadshavarnas regler och överkontroll till skillnad från killar. / Sexuality is a natural part of life which every individual explores and must learn how relate to. The sexual exploration may also cause a risk both to physical but also to the mental health. The risks may, for example, be unfavourable searching for confirmation, proximity or status, but may also be to share intimate images or exchange sexual favours for economical compensations. Sexuality can become a tool to dominate, oppress and/or offend other people. The socialization process, that is, the social interaction that takes place between the child and their family is described as the base for how the child develops his/her own characteristic and how they integrate with their surroundings. This study examines at how communication between parents and child looks and is experienced, whether there is any connection with how the child exposes themselves and/or others to sexual risk behaviours and if there is any difference between the sexes. The study is a quantitative analysis in which the sample consists of young people who are in 9th grade (N=1357). The data is collected by the ongoing longitudinal program LoRDIA (Longitudinal Research on Development In Adolescence). This study indicates that there is a statistically significant relationship between youths who communicate with their parents and shows less sexual risk behaviours. The results also demonstrate that girls show a higher frequency of sexual risk behaviour. There is also a significant difference between how girls and boys experience the communication to custodians and that girls have a higher tendency to be affected by the custodians' rules and control than what boys do. / LoRDIA

The overall aim of the present thesis is to contribute to the knowledge in young people´s experiences, thoughts and norms regarding sexually transmitted infections (STI) and sexual risk-taking. The specific aims are two-fold. The first aim is to explain and understand young Swedish men and women´s lived experience of an STI, in this case genital warts (I, II). The second is to explain and understand the values and attitudes of young men and women to sexual risk-taking (III) in relation to perceptions of gender (IV).   The theoretical perspectives are a reflective lifeworld approach, hermeneutic and gender perspectives. The thesis is based on individual interviews (I, II) and focus groups (III, IV).  The results show that a young person infected by an STI, will experience encounters at different levels. A person with an STI is forced to meet him/herself and their own prejudices. Loss of innocence is highly significant and symbolic for women, while other person´s attitudes are more important for men (I, II). Also, being a disease carrier is of great significance, which has an impact on their views of future meaningful relationships (II).      Sexual risk-taking, such as it was expressed in the focus groups with young people, revealed a pattern that is described as a ‘game’. In that game, a dialogue might feel more intimate than intercourse. These teenagers often view their one night stand partners as objects, as opposed to love relationships where they are viewed as subjects, i.e. persons to be cared for. Engaging in sexual risk-taking often starts at a club where these teenagers pretend that they are spontaneous (III). This game is further illuminated in a secondary analysis with a gender perspective. There are frequent misunderstandings between young men and women that are based on gender constructions, which derive from lack of communication. Hence, they have to take part in a balancing act while shaping their sexual identity and trying to maintain their self-esteem. For these young women, this also concerns not getting a bad reputation. In this act of balance, it is difficult to discuss sexuality and how to protect one’s sexual health (IV). The discussion emphasizes that a professional caring dialogue with young people about STI: s and sexual-risk taking must have reference in the young person´s own reality. Thus, professional health care workers who meet a young person infected with an STI appear to face a challenging task. This involves helping reduce anxiety by defusing the situation, and at the same time to make the person understand the importance of using a condom in order to prevent STI: s.

On a routine and daily basis, women are exposed to sexually objectifying experiences, which result in a number of harmful psychosocial outcomes (Fredrickson & Roberts, 1997). Five-hundred and forty-sex women attending a large, Southeastern university participated in this study that investigated a conceptual model of how childhood sexual abuse (CSA) contributes to sexual risk behaviors (SRBs) via self-objectification (S0). In order to assess the causal relationships among variables, measured variable path analyses were conducted in order to test two theoretical models. The following instruments were used in this investigation: the Sexual Abuse Subscale of the Childhood Trauma Questionnaire (a measure assessing experiences of childhood sexual abuse [Bernstein, Stein, Newcomb, Walker, Pogge, Ahluvia et al., 2003]); the Body Surveillance Subscale of the Objectified Body Consciousness Scale (a measure assessing self-objectification [McKinley & Hyde, 1996]); the Body Shame Subscale of the Objectified Body Consciousness Scale (a measure assessing body shame [McKinley & Hyde, 1996]); the Toronto Alexithymia Scale-20 (assesses alexithymic symptoms, or difficulty identifying, describing, and expressing one’s emotions [Bagby, Parker, & Taylor, 1994]), the Contraceptive Self-Efficacy Scale (assesses overall sexual self-efficacy, such as the ability to insist upon sexual protection [Levinson, 1986]), and the Sexual Risk Survey (assesses risky sexual practices [Turkchik & Garske, 2009]). Results revealed that the data fit the second model better than the first. Specifically, data revealed that CSA directly predicted SRBs and was not mediated via SO, but was partially mediated by alexithymia and body shame. That is, CSA predicted increased alexithymia and body shame. Increased alexithymia predicted SRBs, whereas body shame decreased SRBs. Results also revealed that alexithymia and body shame mediated the relationship between SO and SRBs. Specifically, self-objectification led to increased alexithymia and body shame, and alexithymia increased SRBs while body shame decreased SRBs. Last, results revealed that body shame fully mediated the relationship between both CSA and SO and sexual self-efficacy. Pathways were significant at the p < .05 level.

Understanding the development of adolescent sexual risk behavior is complicated by the co-occurrence of sexual risk with substance use and delinquency, conceptualized as “problem behavior syndrome,” with common causes and influences underlying all three problem behaviors (Jessor & Jessor, 1977). Explaining the development of sexual risk becomes even more complex given the changing patterns of adaptation and maladaptation over the course of adolescence (Sroufe & Rutter, 1984). Research also suggests that multiple pathways may forecast adolescent engagement in sexual risk behavior, underscoring the ideas of equifinality and multifinality in developmental psychopathology (Cicchetti & Rogosh, 1996). To understand the diverse nature of sexual risk taking, researchers must identify these pathways and disentangle co-occurring problem behaviors from sexual risk. Revealing the course of sexual risk taking and the early risk and protective processes through which problem behavior develops allows researchers to identify the developmental periods that would be most amenable to intervention efforts (Rolf et al., 1990). Using data from the National Longitudinal Survey of Youth (NLSY79), this study aimed to disentangle problem behavior syndrome by identifying the unique developmental pathways of adolescent sexual risk, alcohol use and delinquency. This study also investigated how early adolescent processes of risk and protection were associated with the growth of these risk behaviors during adolescence. Using a developmental psychopathology and resilience framework, risk trajectories were measured with adolescents aged 15 to 24, and antecedents were measured with early adolescents ages 10 to 14 (N= 1778). Using Latent Class Growth Analyses (LCGA), joint trajectory analyses revealed five distinct adolescent risk taking groups: high sex and alcohol, moderate problem behavior, problem behavior, alcohol-only, and alcohol and delinquency experimentation. Early adolescent externalizing problems were particularly important in understanding adolescent risk group membership. The co-occurrence between sexual risk and alcohol use, the diversity of problem behavior syndrome, and potential intervention and prevention efforts are discussed.

<strong>Background:</strong> Sub-Saharan Africa is home to 85% of the world's HIV-positive adolescents: an estimated 1.3-2.2 million 10-19 year olds. Adolescents living with HIV face multiple sexual and reproductive health risks: unwanted pregnancies and the risk of mother-to-child-transmission, risk of infecting partners, co-infection with other STIs, and the rising but undocumented risk of re-infection by potentially resistant HI-virus strains. Using contraception, especially condoms, is particularly challenging for all adolescents. It is even more difficult for HIV-positive adolescents due to HIV-related factors such as learning their HIV-positive status, withholding or disclosing their HIV-status to sexual partners, and accessing services in the home, clinics, and schools. This thesis aims to understand which factors shape sexual risk-taking among HIV-positive adolescents to inform the development of interventions that promote safe sexual practices in this population. <strong>Methodology:</strong> This thesis applies a socio-ecological model to investigate factors associated with sexual risk-taking among HIV-positive adolescents. It consists of three stand-alone papers: a systematic review and two quantitative papers based on a cross-sectional epidemiological and aetiological study of unprotected sex among HIV-positive adolescents and community controls in South Africa. Paper 1 is a systematic review of rates, correlates, and interventions to reduce sexual risk-taking among HIV-positive adolescents and youth in sub-Saharan Africa. Paper 2 looks at associations between HIV-status knowledge and disclosure and protective sexual practices in the cross-sectional study sample. Paper 3 explores the relationship between various social protection provisions and unprotected sex among HIV-positive adolescents. The candidate co-developed and conducted a community-traced study of adolescents in the Eastern Cape, in South Africa: 1,060 HIV-positive adolescents and 467 community controls. HIV-positive 10-19 year old adolescents were recruited from 53 government facilities in a health sub-district with antenatal HIV prevalence of over 30%. 90.1% of the eligible sample was traced, with only 4.1% refusing to take part. Community controls were neighbouring or co-habiting 10-19 year old adolescents, 92% of whom agreed to take part. Voluntary informed consent was obtained from adolescents and caregivers in the language of their choice: English or Xhosa. Questionnaires were administered by trained research assistants using mobile devices (tablets) with adolescent-friendly graphic content to ensure participant interest and reduce participant burden through skip-patterns. The systematic review (Paper 1) included studies located through electronic databases and grey literature. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed. Quantitative studies reporting on HIV-positive participants (10-24 year old) included data on at least one of eight outcomes (early sexual debut, inconsistent condom use, older sexual partner, transactional sex, multiple sexual partners, sex while intoxicated, sexually transmitted infections, and pregnancy). Only studies conducted in sub-Saharan Africa were included. The candidate and a second author independently piloted all processes, screened studies, extracted data independently, and resolved any discrepancies. Due to variance in reported rates and correlates, no meta-analyses was conducted. The systematic review informed the analyses conducted for the two quantitative papers. Analyses for Papers 2 and 3 used condom use at last sexual encounter (dichotomised either as safe sex/abstinence or unprotected sex) as the outcome, controlling for a series of covariates. Analyses used SPSS 22 and STATA 11. For each paper, the hypothesised factors were entered as independent variables in multivariate logistic regressions controlling for potential confounders. Based on the findings of the systematic review, gender moderation analyses was run entering a 2-way interaction term of gender*correlate in multivariate logistic regressions, controlling for covariates. Marginal effect models explored the effect of combinations of risk/ protective factors. Predicted probabilities for safe sex/ unprotected sex were computed for different two- and three-way combinations of the independent variables, controlling for covariates significantly associated with the outcome. Paper 2 tested the effect of three types of disclosure on protective sexual practices: (i) knowledge of one's own HIV-positive status, (ii) disclosing one's HIV-status to a partner, and (iii) knowing a partner's HIV-status. It compared HIV-positive status aware adolescents (n=794) with the rest of the sample (n=733). Paper 3 investigated associations between nine types of social protection provisions and unprotected sex. In line with UNICEF's definition, social protection was defined as any provision aimed at preventing, reducing and eliminating economic and social vulnerabilities to poverty and deprivation among HIV-positive adolescents. The nine social protection provisions tested by the analyses included ‘cash' and ‘care' factors accessed in the home, school, and community. <strong>Results: Paper 1 – ‘Sexual Risk-Taking among HIV-Positive Adolescents and Youth in Sub-Saharan Africa: A systematic review of prevalence rates, risk factors, and interventions.'</strong> The systematic review (Chapter 4) found that, despite their heightened vulnerabilities and high rates of sexual risk-taking, there is a dearth of evidence on interventions which may help HIV-positive adolescents engage in safe sexual practices. The review included 35 studies, four of which were interventions aiming to reduce sexual risk-taking. The quality of the included studies was low with most studies (k=31) reporting findings from cross-sectional data. HIV-positive adolescents and youth reported high rates of sexual risk-taking, however findings were inconsistent about potential factors associated with sexual risk-taking. Factors consistently associated with sexual risk-taking in multivariate analyses included: food insecurity, living alone, living with a partner, and gender-based violence. No significant associations were reported for: rural residence, informal housing, anxiety, religious guidance, STI prevention knowledge, poor birth outcomes, orphanhood, parental monitoring, having a supportive family, social support, maternal education level, poverty, disclosing one's HIV-status to a partner, time on ART, ART adherence, receiving care at a hospital, opportunistic infections. However, most of the above associations were reported by only one study, therefore further analyses is needed to build the evidence base on potential determinants of sexual risk-taking among HIV-positive adolescents and youth. The included interventions consist of three individual- and group-based psychosocial interventions evaluated in three small-scale trials (n<150) and one large trial of combination interventions for HIV-positive orphaned adolescent girls (n=710). Three of these interventions had positive effects in reducing sexual risk-taking: an individual based 18-session counselling intervention in Uganda, a support group intervention in South Africa, and a combination intervention in Zimbabwe. <strong>Quantitative data analyses of cross-sectional study data:</strong> Overall, adolescents in the full sample (n=1,527) reported high rates of sexual activity (34.9%) and high rates of unprotected sex (22%), with adolescent girls reporting higher rates of unprotected sex than boys (33% vs. 7%).

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No. of bitstreams: 1 Dissertação - Aniel de Sarom Negrão Silva.pdf: 1859255 bytes, checksum: 6756009034d321dabee9011e1884e67c (MD5) Previous issue date: 2011-02-02 / CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Adolescence is a phase of life between 10 and 19 years characterized by conflicts and discoveries, At this stage the adolescents begin to live their first sexual experiences and may submit to sexual risk behaviors to STD infection and AIDS. In order to verify the occurrence of sexual risk behaviors among adolescent students in the city of Abaetetuba, we performed a cross sectional observational study in adolescents from 14 to 19 years old from four different Public Schools at High School in order to identify sexual risk behaviors and their possible associations. We performed statistical tests of odds ratio, chi-square test of independence, G test of independence and Correspondence Analysis for the treatment of data. The sample was 603 adolescents formed by 61.03% (368) women and 38.97% (235) men with a mean age of 17.14 years (SD = ± 1.14 years). Sexually active were 49.25% (297), 54.55% (162) men and 45.45% (135) women, 50.75% (306) did not have their first sexual intercourse, 76.14% (233) women and 23.86% (73) men. The average at first sexual intercourse was 15.23 years and sexual initiation was associated with male gender (OR = 2.43, 95% CI 1.51 – 3.91, p= 0.0003). The onset of sexual activity was associated with inconsistent practice of religion (OR = 8.33, 95% CI 3.15 – 22.05, p <0.0001). Condom use at first sexual intercourse was associated with gender, and women had more consistent use at this occasion (OR = 2.04, 95% CI 1.20 – 3.47, p = 0.011); 29.97 % (89) did not use condom at that occasion, 52.81% (47) women and 47.19% (42) men. Family income was associated with sexual initiation (p=0.0113). The multiple sexual partners in the past three months was associated with male gender (p=0.0001), and male gender was statistically significant compared with the categories of "two", "three" and "more than four" with 83%, 78% and 80% respectively. Friends were the main source of information about sex and sexuality; 91.71% (553) have never taken laboratory tests for detection of HIV. There are sexual risk behaviors among adolescents in this study in particular for the males, so it is necessary to implement policies aimed to adolescent sexual health to be promoted by families, schools, religious institutions and public authorities. / A adolescência é uma fase da vida compreendida entre 10 e 19 anos caracterizada pelos conflitos e descobertas. Nessa fase os adolescentes começam a viver suas primeiras experiências sexuais podendo apresentar comportamentos sexuais de risco à infecções por DST/AIDS. Visando identificar comportamentos sexuais de risco e suas possíveis variáveis associadas em adolescentes escolares do município de Abaetetuba, foi realizado um estudo observacional analítico transversal em adolescentes escolares de 14 a 19 anos matriculados no Ensino Médio de quatro escolas da Rede Pública Estadual. Realizaram-se testes estatísticos de “Odds Ratio”, Qui-quadrado de independência, teste G de independência e Análise de Correspondência para o tratamento dos dados. A amostra calculada foi de 603 adolescentes compostos por 61,03% (368) mulheres e 38,97% (235) homens com idade média de 17,14 anos (dp=± 1,14 anos). Já se iniciaram sexualmente 49,25% (297), sendo 54,55% (162) homens e 45,45% (135) mulheres; 50,75% (306) não se iniciaram, sendo 76,14% (233) mulheres e 23,86% (73) homens. A idade média da sexarca foi 15,23 anos e a iniciação sexual precoce esteve associada ao sexo masculino (OR=2,43; IC95%=1,51–3,91; p=0,0003). O início da vida sexual esteve associado à prática inconsistente da religião (OR=8,33; IC95%=3.15–22,05; p<0,0001). O uso do preservativo na primeira relação sexual esteve associado gênero, sendo que mulheres tiveram uso mais consistente nessa ocasião (OR=2,04; IC95% 1,20–3,47; p=0,011); não usaram preservativo 29,97% (89) adolescentes, sendo 52,81% (47) mulheres e 47,19% (42) homens. A renda familiar esteve associada à iniciação sexual (p=0,0113). Os múltiplos parceiros sexuais nos últimos três meses estiveram associados ao sexo masculino (p=0,0001), sendo que este gênero apresentou significância estatística de relação com as categorias “duas”, “três” e “mais de quatro” com 83%, 78% e 80%, respectivamente. A principal fonte de informações sobre sexo e sexualidade foram os amigos e 91,71% (553) nunca fizeram exame de detecção do HIV. Verificam-se comportamentos sexuais de risco entre os adolescentes do estudo, em especial do sexo masculino; assim faz-se necessário a implementação de políticas voltadas à saúde sexual e reprodutiva dos mesmos a serem promovidas pelas famílias, escolas, instituições religiosas e poder público.

Abstract The purpose of this study is to describe and to compare the university students’ attitudes (knowledge, feelings and behaviour) towards HIV/AIDS (Human Immune Deficiency Virus/ Acquired Immune Deficiency Syndrome) in Finland and in Kenya and to find explanatory factors associated with the sexual risk behaviour. For educators, managers and experts in health care and education the results will provide an opportunity to deepen their knowledge and awareness of students’ sexual behaviour. These results may also be used for planning an educational programme for youngsters and young adults in order to promote healthy sexual behaviour. This study is focused on the viewpoint of preventive health care and sexual health promotion. The study is a comparative research with quantitative and qualitative methods. The study group consists of 525 first year students (411 Finnish and 114 Kenyan students) of Oulu University of Applied Sciences, Oulu University and the University of Helsinki in Finland and of MOI University in Kenya. The response rate was 87.5%. The results concerning the attitudes towards HIV/AIDS of the students showed that the Finnish and Kenyan students had a good level of knowledge concerning HIV and AIDS. Most of the information had been obtained from TV, campaigns, newspapers, and information packages. The role of the health care professionals was very small in both countries. The most negative attitudes were found towards homosexuality (25.8% of the respondents) and intravenous drugs users (59.5%). The result showed that the level of knowledge did not have an effect on the level of their beliefs and prejudices of the students. It was common for the respondents to be single during their first study year. No influence was found between the students’ knowledge and the number of their sex partners or the frequency of the sexual activity. Almost the same number of students who reported using prevention always or almost always identified both HIV correctly (43.4%) and incorrectly (45.7%). The situation concerning AIDS was similar. The age and the importance of religion of the students had influence on the use of prevention. / Tiivistelmä Tutkimuksen tarkoituksena on kuvata ja verrata kenialaisten ja suomalaisten korkeakouluopiskelijoiden asenteita (tietoja, tunteita ja käyttäytymistä) HIV/AIDSia (Immuunikatovirus/ Hankittu immuunipuutos-oireyhtymä) kohtaan ja löytää seksuaalista riskikäyttäytymistä selittäviä tekijöitä. Terveydenhuollon ja terveysalan hallinnon ja koulutuksen asiantuntijoille tutkimustulokset antavat mahdollisuuden tutustua ja syventää HIV/AIDSia koskevaa tietouttaan ja tietoisuuttaan. Tuloksia voidaan hyödyntää ennaltaehkäisevän terveydenhuollon suunnittelussa ja koulutuksessa edistämään nuorten ja nuorten aikuisten terveellistä seksikäyttäytymistä. Tutkimuksen lähtökohta on ennaltaehkäisevä toiminta ja erityisesti seksuaaliterveyden edistäminen. Tutkimus on vertaileva tutkimus. Aineisto kerättiin strukturoituja ja avoimia kysymyksiä sisältävällä kyselylomakkeella. Tutkimukseen vastasi yhteensä 525 ensimmäisen lukuvuoden korkeakouluopiskelijaa, 411 suomalaista ja 114 kenialaista opiskelijaa. Vastausprosentti oli 87,5 %. Tulokset osoittivat sekä kenialaisilla että suomalaisilla korkeakouluopiskelijoilla olevan hyvät tiedot HIV/AIDSista. Tärkeimpiä opiskelijoiden nimeämiä tietolähteitä olivat TV, kampanjat, sanomalehdet ja informaatiopaketit. Perheen ja terveydenhuoltohenkilöstön rooli tiedon lähteenä oli vähäinen molemmissa maissa. Negatiivisimmat asenteet kohdistuivat homoseksuaalisuutta ja laskimon sisäisiä huumeiden käyttäjiä kohtaan. Kenialaisten opiskelijoiden ennakkoasenteet HIV/AIDSia kohtaan olivat muita opiskelijoita voimakkaammat ja negatiivisemmat. Tulokset osoittivat, että tiedon laadulla ei ollut merkitystä opiskelijoiden ennakkoasenteisiin. Tulokset osoittivat myös, että ensimmäisen vuoden korkeakouluopiskelijoilla ei ole paljon seksisuhteita. Opiskelijoiden HIV/AIDS-tiedoilla ei ollut yhteyttä seksipartnereiden määrään tai seksuaaliseen aktiivisuuteen. Oikealla tai väärällä HIV/AIDS-tiedolla ei ollut vaikutusta ehkäisyn käyttöön. Lähes sama määrä opiskelijoita, jotka kertoivat käyttävänsä ehkäisyä aina tai lähes aina, määritteli HIVin oikein ja väärin. Tilanne oli samanlainen koskien AIDSia. Oikealla tai väärällä HIV/AIDSia koskevalla tiedolla ei ollut myöskään vaikutusta ennakkoasenteiden voimakkuuteen. Tutkimustulosten perusteella HIV/AIDSin ennaltaehkäisyssä ei pelkkä HIV/AIDS tietotason kohottaminen riitä, vaan on syytä käyttää uusia ja monipuolisia lähestymistapoja.

Philosophiae Doctor - PhD / The study assessed the linkages between HIV infection and intimate partner violence (IPV) during pregnancy and after HIV status disclosure in a context where HIV testing has become almost mandatory through the provider-initiated counselling and testing approach and non-disclosure of HIV status to sexual partners has been criminalised in many countries including Zimbabwe. The study also explored women’s experiences of and health workers’ perceptions of IPV during pregnancy.

Research has identified a number of putative risk factors that places adolescents at incrementally higher risk for involvement in alcohol and other drug (AOD) use and sexual risk behaviors (SRBs). Such factors include personality characteristics such as sensation-seeking, cognitive factors such as positive expectancies and inhibition conflict as well as peer norm processes. The current study was guided by a conceptual perspective that support the notion that an integrative framework that includes multi-level factors has significant explanatory value for understanding processes associated with the co-occurrence of AOD use and sexual risk behavior outcomes. This study evaluated simultaneously the mediating role of AOD-sex related expectancies and inhibition conflict on antecedents of AOD use and SRBs including sexual sensation-seeking and peer norms for condom use. The sample was drawn from the Enhancing My Personal Options While Evaluating Risk (EMPOWER: Jonathan Tubman, PI), data set (N = 396; aged 12-18 years). Measures used in the study included Sexual Sensation-Seeking Scale, Inhibition Conflict for Condom Use, Risky Sex Scale. All relevant measures had well-documented psychometric properties. A global assessment of alcohol, drug use and sexual risk behaviors was used. Results demonstrated that AOD-sex related expectancies mediated the influence of sexual sensation-seeking on the co-occurrence of alcohol and other drug use and sexual risk behaviors. The evaluation of the integrative model also revealed that sexual sensation-seeking was positively associated with peer norms for condom use. Also, peer norms predicted inhibition conflict among this sample of multi-problem youth. This dissertation research identified mechanisms of risk and protection associated with the co-occurrence of AOD use and SRBs among a multi-problem sample of adolescents receiving treatment for alcohol or drug use and related problems. This study is informative for adolescent-serving programs that address those individual and contextual characteristics that enhance treatment efficacy and effectiveness among adolescents receiving substance use and related problems services.

Objective: To examine the relationship between hope, core self-evaluations, physical function, emotional well-being, health risk behaviors, and academic performance in freshman enrolled in their first year of college. Participants: Freshman (N = 495) attending a large public university in the Northeast completed an online survey between February 1 to February 13, 2017. Methods: Cross sectional descriptive survey. Linear regression, path analysis, and structural equation modeling procedures were performed. Results: Core self-evaluations mediated the relationship between hope and emotional well-being and academic performance. Contrary to the hypotheses, higher hope predicted more sexual risk taking behaviors and alcohol use. Conclusions: Core self-evaluations is an important component of hope theory. Hope Theory is useful for predicting emotional well-being, and academic performance, but not as useful for predicting drug use, alcohol use, and sexual risk taking. Hope and core self evaluations interventions are needed to improve academic performance and emotional well-being in university freshman.