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Few studies have investigated the sexual development of populations with low cognitive abilities in the United States. This article examines the relationship between cognitive ability and various sexual experiences from adolescence (ages 12 to 18) to early adulthood (ages 28 to 34). Data were from 13,845 respondents interviewed at Waves I and IV of the National Longitudinal Study of Adolescent to Adult Health (Add Health), a probability sample of adolescents in the United States followed from adolescence to adulthood. Adjusted logistic regression models were used to study relationships between cognitive ability, approximated by the Add Health Picture Vocabulary Test (AHPVT), and experiences of vaginal, oral, and anal sex. After controlling for biological sex, age, race/ethnicity, and socioeconomic status (SES), individuals in the lowest cognitive ability group had significantly lower odds of experiencing each type of sex than those in the average ability group. Although individuals in the highest cognitive ability group had significantly lower odds of experiencing vaginal intercourse than those in the average ability group, this association did not remain significant when analyses were stratified by biological sex. These differences in experiences have implications for future health and warrant further study to understand policy implications for sexual health services and education. [ABSTRACT FROM AUTHOR]

Purpose: Both substance use and depression are common in adolescence and often comorbid. Past research has produced conflicting results on whether there is a temporal relationship and if so, in which direction it operates and how it may vary by sex. The purpose of this paper is to explore the longitudinal, potentially bidirectional, relationships between high-frequency substance use and depressive symptoms from adolescence into young adulthood for males and females.Methods: Using data from the National Longitudinal Study of Adolescent to Adult Health we investigated longitudinal associations between high frequency substance use (alcohol, cigarettes, and marijuana) and depressive symptoms. The linear mixed effects models were stratified by sex and used a lagged measure of the dependent variable to test temporal relationships. A random intercept was used for respondent ID.Results: Increases in depressive symptoms were significantly associated with a later increase of about a half day in marijuana use frequency for males and nearly a two day increase in smoking frequency for females. Conversely, increases in smoking frequency were significantly associated with approximately a 0.6-point increase for females and 0.4-point increase for males in depressive symptoms at a later wave.Conclusions: Results indicate a bidirectional relationship between smoking and depressive symptoms for females. For males, there was evidence supporting self-medication with marijuana and for smoking being associated with later increases in depressive symptoms. Results inform how substance use and depression screening, prevention and treatment efforts should be paired and targeted for males and females. [ABSTRACT FROM AUTHOR]

The aim of this study is to assess whether the Government of Kenya's Cash Transfer for Orphans and Vulnerable Children (Kenya CT-OVC) can reduce the risk of HIV among young people by postponing sexual debut. The program provides an unconditional transfer of US$20 per month directly to the main caregiver in the household. An evaluation of the program was implemented in 2007–2009 in seven districts. Fourteen Locations were randomly assigned to receive the program and fourteen were assigned to a control arm. A sample of households was enrolled in the evaluation in 2007. We revisited these households in 2011 and collected information on sexual activity among individuals between 15–25 years of age. We used logistic regression, adjusted for the respondent's age, sex and relationship to caregiver, the age, sex and schooling of the caregiver and whether or not the household lived in Nairobi at baseline, to compare rates of sexual debut among young people living in program households with those living in control households who had not yet entered the program. Our results, adjusted for these covariates, show that the program reduced the odds of sexual debut by 31 percent. There were no statistically significant effects on secondary outcomes of behavioral risk such as condom use, number of partners and transactional sex. Since the CT-OVC provides cash to the caregiver and not to the child, and there are no explicit conditions associated with receipt, these impacts are indirect, and may have been achieved by keeping young people in school. Our results suggest that large-scale national social cash transfer programs with poverty alleviation objectives may have potential positive spillover benefits in terms of reducing HIV risk among young people in Eastern and Southern Africa. [ABSTRACT FROM AUTHOR]

The objective of this study is to examine the association between physical and sexual violence exposure and somatic symptoms among female adolescents. We studied a nationally representative sample of 8,531 females, aged 11–21 years, who participated in the 1994–1995 Wave I of the National Longitudinal Study of Adolescent Health (Add Health). Female adolescents were asked how often they had experienced 16 specific somatic symptoms during the past 12 months. Two summary categorical measures were constructed based on tertiles of the distributions for the entire female sample: (a) total number of different types of symptoms experienced, and (b) number of frequent (once a week or more often) different symptoms experienced. Groups were mutually exclusive. We examined associations between adolescents’ violence exposure and somatic symptoms using multinomial logistic regression analyses. About 5 % of adolescent females reported both sexual and non-sexual violence, 3 % reported sexual violence only, 36 % reported non-sexual violence only, and 57 % reported no violence. Adolescents who experienced both sexual and non-sexual violence were the most likely to report many different symptoms and to experience very frequent or chronic symptoms. Likelihood of high symptomatology was next highest among adolescents who experienced sexual violence only, followed by females who experienced non-sexual violence only. Findings support an exposure–response association between violence exposure and somatic symptoms, suggesting that symptoms can be markers of victimization. Treating symptoms alone, without addressing the potential violence experienced, may not adequately improve adolescents’ somatic complaints and well-being. [ABSTRACT FROM AUTHOR]

This article describes the design and phenotype and genotype data available for sibling pairs with varying genetic relatedness in the National Longitudinal Study of Adolescent Health (Add Health). Add Health is a nationally representative longitudinal study of over 20,000 adolescents in the United States in 1994–1995 who have been followed for 15 years into adulthood. The Add Health design included oversamples of more than 3,000 pairs of individuals with varying genetic resemblance, ranging from monozygotic twins, dizygotic twins, full siblings, half siblings, and unrelated siblings who were raised in the same household. Add Health sibling pairs are therefore nationally representative and followed longitudinally from early adolescence into adulthood with four in-home interviews during the period 1994–2009. Add Health has collected rich longitudinal social, behavioral, environmental, and biological data, as well as buccal cell DNA from all sample members, including sibling pairs. Add Health has an enlightened dissemination policy and to date has released phenotype and genotype data to more than 10,000 researchers in the scientific community. [ABSTRACT FROM AUTHOR]

Summary: Objectives: Longitudinal examinations of associations between daily stress, diurnal cortisol concentrations, and physiological parameters in population-based studies are needed. This study evaluates issues related to consent, collection, and protocol adherence for a low-burden saliva collection protocol. Methods: In the 2007 pretest (n =193) for Wave IV of the National Longitudinal Study of Adolescent Health (Add Health) a three-sample, one-day, unsupervised saliva collection protocol was pilot tested. Embedded experiments allowed for examination of adherence and effects of monetary incentives. Results: Although most (97%) study participants consented to collection, only about 80% actually mailed back samples. Use of a time-stamping TrackCap allowed comparison of self-reported and stamp-recorded collection times. Of returned samples, self-report of collection time was missing for about a quarter, and only about one in three respondents (of those for whom adherence was calculable) fully adhered to the collection protocol, indicating significant potential for bias. Consent, return, and protocol adherence were unrelated to key sociodemographic characteristics, and did not improve with higher monetary incentives or knowledge of being monitored. Conclusions: Despite the relatively low-burden collection protocol and use of multiple strategies thought to improve collection and protocol adherence, response and adherence were poor, leading to a decision to drop cortisol measurement from the Wave IV Add Health protocol. Large field studies should carefully evaluate the feasibility of collection and protocol adherence for unsupervised collection protocols before implementing costly, and potentially unusable, biological measurements. [Copyright &y& Elsevier]

Although developmental theory predicts that adolescent romantic relationships have important benefits, empirical evidence suggests that they may also carry substantial psychosocial risk. This study uses data from 4,948 respondents (50% female) in Wave I and Wave II of the National Longitudinal Study of Adolescent Health to examine the association between involvement with an older romantic partner and depressive symptoms during adolescence. Ordinary least squares regression models compared Wave II depressive symptoms among respondents with older partners (defined as an age difference of 2 or more years) to respondents with same-age or younger partners, controlling for baseline depressive symptoms and sociodemographic characteristics. Ten percent of females and two percent of males reported having an older romantic partner at Wave II. Among females only, involvement with an older romantic partner was associated with a modest but significant increase in depressive symptoms between waves. This association was largely mediated by increases in substance use. Findings suggest that involvement with an older male partner during adolescence may increase the risk of poor emotional outcomes among females. [ABSTRACT FROM AUTHOR]

Although low socioeconomic status has been positively associated with adult partner violence, its relationship to adolescent dating violence remains unclear. Further, few studies have examined the relationship between contextual disadvantage and adolescent dating violence, or the interactive influences of family and contextual disadvantage. Guided by social disorganization theory, relative deprivation theory, and gendered resource theory, we analyzed data from the U.S. National Longitudinal Study of Adolescent Health (1994–1996) to explore how family and school disadvantage relate to dating violence victimization. Psychological and minor physical victimization were self-reported by adolescents in up to six heterosexual romantic or sexual relationships. Family and school disadvantage were based on a principal component analysis of socioeconomic indicators reported by adolescents and parents. In weighted multilevel random effects models, between-school variability in dating violence victimization was proportionately small but substantive: 10% for male victimization and 5% for female victimization. In bivariate analyses, family disadvantage was positively related to victimization for both males and females; however, school disadvantage was only related to males'' physical victimization. In models adjusted for race/ethnicity, relative age within the school, and mean school age, neither family nor school disadvantage remained related to males'' victimization. For females, family disadvantage remained significantly positively associated with victimization, but was modified by school disadvantage: family disadvantage was more strongly associated with dating violence victimization in more advantaged schools. Findings support gendered resource theory, and suggest that status differentials between females and their school context may increase their vulnerability to dating violence victimization. [Copyright &y& Elsevier]

The association between sexual debut timing and depressive symptomatology in adolescence and emerging adulthood was examined using data from Waves I, II and III of the National Longitudinal Study of Adolescent Health. Respondents who reported never having sexual intercourse at Wave I and were 18–22 years of age at Wave III were included ( n = 5,061). Twenty percent of respondents experienced early (

CONTEXT: Although sexual debut has been negatively associated with adolescent educational performance and aspirations, it is not clear whether such relationships continue beyond adolescence. METHODS: Initiation of postsecondary education by young adulthood was assessed among 3,965 participants in the National Longitudinal Study of Adolescent Health who had not experienced sexual intercourse at baseline. Associations between age at sexual debut and educational progress were examined in bivariate and multivariable Poisson regression analyses. RESULTS: Most respondents experienced sexual debut during adolescence: 15% before age 16 (early) and 53% at ages 16–18 (typical). Sixty-five percent of respondents initiated postsecondary education by early adulthood; however, the proportion was significantly lower among those who had had an early (49%) or typical sexual debut (63%) than among those who debuted late (78%). In unadjusted analyses, early and typical debut were associated with a reduced likelihood of initiation of postsecondary education for both females (relative risk ratios, 0.6 and 0.8, respectively) and males (0.7 and 0.8). However, in adjusted analyses, the associations were attenuated for females (0.8 and 0.9) and were at best marginally significant for males. Childbearing was a significant mediator of this relationship. CONCLUSIONS: Adolescent sexual debut appears to be modestly negatively associated with early adult postsecondary education initiation, particularly for females. Targeting mediators of the sexual debut–education relationship, such as early childbearing, could lead to effective interventions. [ABSTRACT FROM AUTHOR]

Little evidence is available about the utility of web-based health education for students in low resource settings. This paper reports results from an evaluation of the TeenWeb project, a multi-year, web-based health education intervention implemented in two urban settings: Nairobi, Kenya (N =1178 school students) and Rio de Janeiro, Brazil (N =714 school students). A quasi-experimental, school-based pre-test/post-test design was implemented at each study site to determine if easy access to web-based reproductive health information, combined with intellectual “priming” about reproductive health topics, would result in improved knowledge and attitudes about topics such as condom use, access to HIV testing, emergency contraception and abortion laws. Students in web-access schools completed one web-based module approximately every 6–8 weeks, and in return, had access to the Internet for at least 30min after completing each module. Although students were encouraged to access project-supplied web-based health information, freedom of web navigation was an incentive, so they could choose to access other Internet content instead. Most measures showed statistically significant differences between students in “web” and “comparison” conditions at post-test, but only about half of the differences were in the hypothesized direction. Results of an embedded experiment employing more directed feedback tripled the likelihood of correctly reporting the duration of emergency contraception effectiveness. Review of URL logs suggests that the modest results were due to inadequate exposure to educational materials. Future intervention should focus on teen's purposeful searching for health information when they are in personal circumstances of unmet health needs. [Copyright &y& Elsevier]

CONTEXT: Sexual relationships in young adulthood may have important ramifications for individuals’ physical and emotional well-being. Nonetheless, representative information about young adults’ sexual activities in long-term relationships and the emotional context of such relationships is rare. METHODS: A subsample of 6,421 participants in Wave 3 of the National Longitudinal Study of Adolescent Health (18–26-year-olds) who were in a sexual relationship of at least three months’ duration were selected for analysis. Multiple logistic regression models were used to explore the relationship between love and various sexual activities. RESULTS: Eighty percent of respondents had engaged in cunnilingus and fellatio as well as vaginal intercourse in their current relationship; this group included 22% who also had engaged in anal sex. Compared with their peers who reported that they and their partner did not love each other a lot, both males and females who reported mutually loving relationships had significantly higher odds of having given oral sex (odds ratios, 3.9 and 2.6, respectively) and having received oral sex (1.8 and 3.3); males in mutually loving relationships also had elevated odds of having had anal sex (3.1). CONCLUSIONS: Most young adult couples in long-term relationships engage in a variety of sexual practices with loving partners; the direction of causality in this association and its implications for relationship building require exploration. Furthermore, programs and interventions that address health and well-being during emerging adulthood should cover issues relevant to a broad range of sexual activities, including oral and anal sex. [ABSTRACT FROM AUTHOR]

This article describes the design and data availability for samples of genetic pairs in the National Longitudinal Study of Adolescent Health (Add Health). Add Health provides unique samples of genetic pairs that are nationally representative and followed longitudinally from early adolescence into young adulthood with 3 in-home interviews and a 4th interview planned for 2007 to 2008. The design of Add Health included an embedded genetic sample of more than 3000 pairs of individuals with varying genetic resemblance, including monozygotic twins, dizygotic twins, full siblings, half siblings, and unrelated siblings who were raised in the same household. Add Health has collected rich longitudinal social, behavioral, and environmental survey data, as well as buccal cell DNA from a subsample of the genetic sample (N = 2612). Add Health has an enlightened dissemination policy and to date has released phenotype and genotype data to more than 3000 researchers in the scientific community. [ABSTRACT FROM AUTHOR]

This study explores students' narratives and discourses about adolescent pregnancy and abortion elicited via internet-based open-ended questions posed in response to a cartoon vignette. We report on content analysis of recommendations and strategies for how to manage the unplanned pregnancy of a fictional young couple and in their own personal lives. The responses of 614 young people were analysed. Strategies vary widely. They include giving birth, adoption, running away, abortion, denial, and postponement until discovery. Young people were also queried about unplanned pregnancy resolution among their peers. Discourse analysis reveals competing social scripts on abortion. Florid condemnation of abortion acts in the hypothetical cases contrasts with more frank and sober description of peers' real life abortion behaviour. Students' language is compared with that found in official curricula. The rhetorical devices, moralizing social scripts and dubious health claims about abortion in students' online narratives mirror the tenor and content of their academic curricula as well as Kenyan media presentation of the issue. The need for factual information, dispassionate dialogue and improved contraceptive access is considerable. [ABSTRACT FROM AUTHOR]

This chapter discusses biological contributions to adolescent female sexual development and, based on a developmental systems framework, suggests future research directions. [ABSTRACT FROM AUTHOR]

Romantic relationships constitute an important, but understudied, developmental context for accommodation to pubertal change. Using a nationally representative sample of 5,487 black, white, and Hispanic adolescent females, this study examined associations among body mass index, current romantic involvement, and dieting. For each one point increase in body mass-index (BMI), the probability of having a romantic relationship decreased by 6%. Further, involvement in a nonsexual romantic relationship—but not involvement in a sexual romantic relationship—was associated with a significant increase in the likelihood of dieting. Associations between relationship type and dieting did not vary by age, socioeconomic status, or race, but were stronger at higher BMIs. These findings confirm that weight has implications for romantic involvement, which is highly valued by adolescent girls, and that romantic relationships, in turn, are important contexts in which to consider psychological and behavioral accommodation to the physical changes of puberty. [ABSTRACT FROM AUTHOR]

CONTEXT: Sexual and substance use behaviors covary in adolescence. Prevalence of HIV and other sexually transmitted diseases (STDs) differs according to race and gender, yet few studies have systematically investigated risk behavior patterns by subgroup, particularly with nationally representative data. METHODS: A priori considerations and K-means cluster analysis were used to group 13,998 non-Hispanic black and white participants in the National Longitudinal Study of Adolescent Health, Wave 1, according to self-reported substance use and sexual behavior. Multinomial logit analyses examined racial and gender differences by cluster. RESULTS: Among 16 clusters, the two defined by the lowest risk behaviors (sexual abstinence and little or no substance use) comprised 47% of adolescents; fewer than 1% in these groups reported ever having received an STD diagnosis. The next largest cluster--characterized by sexual activity (on average, with one lifetime partner) and infrequent substance use--contained 15% of participants but nearly one-third of adolescent with STDs. Blacks were more likely than whites to be in this group. Black males also were more likely than white males to be in three small clusters characterized by high-risk sexual behaviors (i.e., having had sex with a male or with at least 14 partners, or for drugs or money). Black females generally were the least likely to be in high-risk behavior clusters but the most likely to report STDs. CONCLUSIONS: Adolescents' risk behavior patterns vary by race and gender, and do not necessarily correlate with their STD prevalence. Further investigation of adolescents' partners and sexual networks is needed. [ABSTRACT FROM AUTHOR]

Release of the hormone cortisol represents a distress response to novel or stressful situations. Individual differences in such reactivity have been conceptualized as representing a relatively enduring, generalizable trait. In this study, cortisol responses to two experimentally manipulated “sexual” and “nonsexual” stressors were used to examine whether stress reactivity is related to sexual and nonsexual risk behavior in young adult males. Analyses were based on 150 males 18 to 25 years old; risk behavior was assessed in confidential, self-administered questionnaires. Analyses indicated that both stressors effectively elicited cortisol increases. Generalized reactivity, defined as a cortisol response to both stressors, was inversely associated with deviance (e.g., theft, substance use) and with two indicators of sexual risk taking (lifetime number of intercourse partners and frequency of condom use). Findings are discussed in terms of cross-situational consistency of stress responses, the utility of stress reactivity for understanding individual differences in risk taking, and the interpretive limitations imposed by study design. [Copyright &y& Elsevier]

Objectives. This report examines (1) the prevalence of psychological and minor physical violence victimization in a nationally representative sample of adolescents and (2) associations between sociodemographic factors and victimization. Methods. Analyses are based on 7500 adolescents who reported exclusively heterosexual romantic relationships in the National Longitudinal Study of Adolescent Health. Items from the Conflict Tactics Scale were used to measure victimization. Associations between victimization patterns and sociodemographic characteristics were assessed with polytomous logistic regression. Results. One third of adolescents reported some type of victimization, and 12% reported physical violence victimization. Although most sociodemographic characteristics were significantly associated with victimization, patterns varied by sex and type of victimization. Conclusions. Psychological and minor physical violence victimization is common in opposite-sex romantic relationships during adolescence. The sex-specific associations between sociodemographic characteristics and patterns of partner violence victimization underscore the importance of pursuing longitudinal, theory-driven investigations of the characteristics and developmental histories of both partners in a couple to advance understanding of this public health problem. (Am J Public Health. 2001;91:1679-1685) [ABSTRACT FROM AUTHOR]

Investigates the implications of differences in body fat in Black and White adolescent girls for dating and sexual activity. Implications of heterosexual activity for dieting and weight concerns; Linking of body fat with lower dating probability.

Strong relationships between one-time serum testosterone (T) measures and sexual activity have been demonstrated in cross-sectional analyses of adolescent males. However, a subsequent longitudinal study of a separate adolescent sample, using semiannual plasma measures, failed to replicate cross-sectional findings. The present study reexamined the relationship between T and sexual activity using more frequently collected measures of salivary T and behavior. Saliva samples and weekly behavior checklists were collected over a 2-year period from the same panel sample of males on which semiannual analyses were based. Saliva samples representing measures approximately every fourth week of study participation were selected for T assay. The association between these monthly salivary T measures and weekly reports of incidents of sexual activity was assessed with repeated measures analyses. Higher levels of salivary T were significantly associated with an increasing hazard of coital initiation, and with more frequent coital and noncoital activity. Within-individual change analyses demonstrated that increases in salivary T were associated with increased sexual activity. Comparisons of models that varied specimen type, schedule of T measurement, and type of behavioral report indicated that all three factors contribute to the varying magnitude of hormone/behavior relationships that are demonstrated. These findings are consistent with a biosocial model of adolescent sexual development that pubertal changes in T are a causal factor in the timing of sexual initiation and the frequency of activity during adolescence. [ABSTRACT FROM AUTHOR]

Explores the hypothesis that repeated questionnaire administration affects sexual behavior. Little support for the hypothesis was found even with a high number of questionnaire administration; Adolescent sexuality; Testing effects; Reactivity; Repeated measures.

A biosocial model of the effects of early adolescent testosterone levels and religiosity on adolescent males' sexual attitudes and activity over a 3-year period was examined. Using panel data for approximately 100 boys who were 12·5/13·0 years old at study entry, significant additive effects of free testosterone and frequency of attendance at religious services were demonstrated on the transition to first intercourse and other aspects of sexual behaviour and attitudes. No interactive effects of the two predictors were found. Boys with higher free testosterone levels at study entry who never or infrequently attended religious services were the most sexually active and had the most permissive attitudes. Boys with lower free testosterone who attended services once a week or more were the least active and reported the least permissive attitudes. For some behaviours, differences between free testosterone/attendance groups increased over time, resulting in substantial behavioural differences by the final round of measurement 3 years later. [ABSTRACT FROM PUBLISHER]

Existing data linking testosterone (T) and aggression in human adult males are surprisingly tenuous. In one of the few studies based on adolescent males, Olweus et al. (1988) demonstrated strong relationships between concurrent measures of T and aggression. However, the conclusions that could be drawn regarding developmental change were limited. Using data from a three‐year panel study of 100 adolescent males (ages 12 to 13 at study entry), we examined whether there are significant relationships between concurrently collected measures of T and self‐ratings of aggression, and whether the dramatic pubertal rise in T predicts subsequent change in aggression ratings. Panel analyses incorporating concurrent, lagged, and change measures found few significant relationships between aggression and T or pubertal development. The general absence of T/aggression relationships is discussed in the context of other empirical findings, the aggression measures used, and prepubertal differentiation on aggression. [ABSTRACT FROM PUBLISHER]

Using data from a 3-year longitudinal study of 100 young adolescent males, radioimmunoassay (RIA) results for testosterone (T) measured in the same plasma and saliva specimens were compared across six laboratories. Correlation coefficients across labs for plasma samples were generally high, ranging from .69 to .96, with most coefficients exceeding .80. However, cross-lab comparability of saliva T values was poor; two of three coefficients were 0. Correlations between specimen types for concurrently collected blood and saliva samples were highly variable, ranging from 0 to 86. The correspondence between plasma and saliva T values was not better when the same lab performed both types of RIAs. The magnitude of relationships between T and pubertal development, as well as between T and several behavior dimensions, also varied by lab, suggesting different conclusions about the presence and strength of hormone-behavior links. [ABSTRACT FROM AUTHOR]

In the article the author reflects on research concerning adolescent sexuality which focuses on healthy sexual development. She believes that adolescent sexuality research should look at sexual health and well-being across the course of life. Research perspectives, populations and content studies are also discussed.

Objective: To compare the Centers for Disease Control and Prevention's (CDC) contraceptive effectiveness poster with a more patient-centered poster on factors affecting the likelihood of using effective contraceptives.Methods: The posters were tested in a randomized controlled trial. Women were eligible if they were aged 18-44 years, could speak and read English, were not pregnant or trying to conceive, and had engaged in vaginal intercourse in the past 3 months. An online survey administered through Amazon Mechanical Turk was used to collect baseline and immediate follow-up data on three primary outcomes: contraceptive knowledge (measured using the Contraceptive Knowledge Assessment), perceived pregnancy risk, and the effectiveness of the contraceptive the woman intended to use in the next year. Subgroup analyses were conducted in women with prior pregnancy scares, low numeracy, and no current contraceptive. Within- and between-group differences were compared for the two randomized groups.Results: From January 26 to February 13, 2018, 2,930 people were screened and 990 randomized. For the primary outcomes, the only significant result was that the patient-centered poster produced a greater improvement in contraceptive knowledge than the CDC poster (P<.001). Relative to baseline, both posters significantly improved contraceptive knowledge (CDC +3.6, patient-centered +6.4 percentage points, P<.001) and a constructed score measuring the effectiveness of the contraceptive that women intended to use in the next year (CDC and patient-centered +3 percentage points, P<.01). This is equivalent to 1-17 of every 100 women who viewed a poster changing their intentions in favor of a more effective contraceptive.Conclusion: This study suggests that both posters educate women about contraception and may reduce unplanned pregnancy risk by improving contraceptive intentions. Of the three primary outcomes, the patient-centered poster performs significantly better than the CDC poster at increasing contraceptive knowledge.Clinical Trial Registration: ClinicalTrials.gov, NCT03372369. [ABSTRACT FROM AUTHOR]

More than 40 years ago, Gilbert Gottlieb and like-minded scholars argued for the philosophical necessity of approaching genetic contributions to development through a multilevel, bidirectional systems perspective. Chamey's target article builds on this heritage in significant ways, offering more recent examples of the interactions of biology and context, as well as die diversity of developmental mechanisms, and reaffirming a way forward for genetic research. A virtual revolution has taken place in our knowledge of environmental influences on gene expression that has not yet seeped into die social sciences in general and the behavioral sciences in particular. Aside from die feared misinterpretation of Lamarckian mechanisms at work, there is an explicit dogma, formulated as such, that does not permit environmental influences on gene activity: the “central dogma of molecular biology,” first enunciated by Crick in 1958. (Gottlieb 1998, p. 792). [ABSTRACT FROM AUTHOR]

Background Emerging research suggests that young adult sexual minorities (identifying as lesbian, gay, or bisexual or engaging in same-sex attractions or behaviors) experience poorer health than their majority counterparts, but many measures of health inequity remain unexamined in population-based research. Purpose To describe a wide range of health status and healthcare access characteristics of sexual minorities in comparison with those of the majority population in a national sample of U.S. young adults. Methods Binary and multinomial logistic regression analyses of Wave IV data (2008) from the National Longitudinal Study of Adolescent Health (participants aged 24–32 years, n =13,088) were conducted. Health measures were self-rated health; diagnosis of any of several physical or mental illnesses or sexually transmitted infections; measured BMI; depression classified from self-reported symptoms; use of antidepressant and anxiolytic medication; uninsured; forgone care; and receipt of physical, dental, and psychological services. Analyses were conducted in 2012–2013. Results Sexual minority women had elevated odds of most adverse health conditions and lower odds of receiving a physical or dental examination. Sexual minority men had elevated odds of fewer adverse health conditions. Conclusions Young adult sexual minorities are at higher risk of poor physical and mental health. The results highlight the multidimensionality of sexual minority status and respond to calls for greater understanding of the health of this population. [ABSTRACT FROM AUTHOR]

CONTEXT Identifying young adult outcomes associated with adolescent sexual behavior, including patterns of first oral, vaginal and anal sex, is critical to promoting healthy sexual development. METHODS Associations between patterns of emerging sexual behavior, defined using latent class analysis, and young adult sexual and reproductive health were examined among 9,441 respondents to Waves 1 (1994-1995), 3 (2001-2002) and 4 (2008) of the National Longitudinal Study of Adolescent Health. Logistic regression analyses examined associations between class membership and young adult outcomes, and tested for interactions by race and ethnicity. RESULTS Compared with respondents who initiated vaginal sex first and reported other sexual behaviors within two years, those who initiated oral and vaginal sex during the same year had similar odds of having had an STD diagnosis ever or in the last year, of having had concurrent sexual partnerships in the last year and of having exchanged sex for money. However, respondents who postponed sexual activity had reduced odds of each outcome (odds ratios, 0.2-0.4); those who initiated vaginal sex and reported only one type of sexual behavior had reduced odds of reporting STD diagnoses and concurrent partnerships (0.4-0.6). Respondents who reported early initiation of sexual activity combined with anal sex experience during adolescence had elevated odds of having had concurrent partnerships (1.6). The data suggest racial and ethnic disparities even when patterns of emerging sexual behavior were the same. CONCLUSIONS Patterns of early sexual behavior considered high-risk may not predict poor sexual and reproductive health in young adulthood. [ABSTRACT FROM AUTHOR]

Given the threat posed by STDs in young adulthood, identifying early predictors of STD risk is a priority. Exposure to childhood maltreatment has been linked to sexual risk behaviors, but its association with STDs is unclear. Associations between maltreatment by parents or other adult caregivers during childhood and adolescence and STD outcomes in young adulthood were examined using data on 8,922 respondents to Waves 1, 3 and 4 of the National Longitudinal Study of Adolescent Health. Four types of maltreatment (sexual abuse, physical abuse, supervision neglect and physical neglect) and two STD outcomes (self-reported recent and test-identified current STD) were assessed. Multivariate logistic regression analyses, stratified by sex, tested for moderators and mediators. Among females, even after adjustment for socioeconomic and demographic characteristics, self-report of a recent STD was positively associated with sexual abuse (odds ratio, 1.8), physical abuse (1.7), physical neglect (2.1) and supervision neglect (1.6). Additionally, a positive association between physical neglect and having a test-identified STD remained significant after further adjustments for exposure to other types of maltreatment and sexual risk behaviors (1.8). Among males, the only association (observed only in an unadjusted model) was between physical neglect and test-identified STD (1.6). Young women who experienced physical neglect as children are at increased risk of test-identified STDs in young adulthood, and exposure to any type of maltreatment is associated with an elevated likelihood of self-reported STDs. Further research is needed to understand the behavioral mechanisms and sexual network characteristics that underlie these associations. [ABSTRACT FROM AUTHOR]

Although most people in developed countries experience sexual initiation during adolescence, little is known about inter-country variability in the psychosocial correlates of early initiation. Population-based samples of 15-year-olds ( n = 6,111, 52% female) who participated in the Health Behaviors in School-Aged Children Study (Finland, Scotland, France and Poland, 1997/1998) or the National Longitudinal Study of Adolescent Health (United States, 1996) self-reported sexual intercourse experience and physical (headaches, trouble sleeping) or psychological (unhappiness, loneliness, sadness, moodiness) symptoms. Analyses were conducted stratified by gender. Sexual initiation prevalence and symptoms scores varied significantly across nations. In adjusted models, sexual initiation was not related to symptoms among boys in any nation, but significantly positively related to symptoms among girls in Poland and the US. Results support variability by gender and nation in the relationship between adolescents’ sexual initiation and physical/psychological symptoms. Empirically investigating specific features of national contexts that generate these differences should be explored further. [ABSTRACT FROM AUTHOR]

Abstract: Medical abortion has the potential to increase the number, cadre and geographic distribution of providers offering safe abortion services in India. This study reports on a sample of family planning providers (263 mid-level providers, 54 obstetrician-gynaecologists and 88 general physicians) from a 2004 survey of health facilities and their staff in Bihar and Jharkhand, India. It identified factors associated with mid-level provider interest in training for early medical abortion provision, and examined whether obstetrician-gynaecologists and general physicians supported non-physicians being trained to provide early medical abortion and what factors influenced their attitudes. Findings demonstrate high levels of mid-level provider interest and reasonable physician support. Among mid-level providers, being male, having a more permissive attitude towards abortion and current provision of abortion using any pharmacological drugs were associated with greater interest in attending training. Mid-level providers based in private health facilities were less likely to show interest. More permissive attitude towards abortion and current medical abortion provision using mifepristone-misoprostol were inversely associated with obstetrician-gynaecologists'' support for non-physician provision of medical abortion. General physicians based in private/other health facilities were less supportive than those in public facilities. Study findings strengthen the case for policymakers to expand the pool of cadres that can legally provide safe abortion care in India. [Copyright &y& Elsevier]

Objective: Previous research shows reduced cervical and breast cancer screening among women with physical disabilities. However, other indicators of reproductive health have been largely ignored. We aimed to compare the reproductive health of young adults in the U.S. with and without physical disabilities in a nationally-representative sample.Methods: Data are from 13,819 respondents aged 18-26 who participated in Waves I (1994-1995) and III (2001-2002) of the National Longitudinal Study of Adolescent Health (Add Health). Using logistic regression, we examined associations between physical disability and multiple reproductive health indicators including sexually transmitted infection (STI) testing, STI diagnosis, receipt of a gynecologic exam, and cervical cancer screening. Analyses were stratified by sex and adjusted for the complex study design.Results: We identified 5.8% of respondents as having a physical disability. In multivariate analyses, females with physical disabilities had lower odds of having a Pap smear in the past 12 months than females without disabilities (OR=0.77; 95% CI: 0.61, 0.97). Physical disability was not associated with other reproductive health indicators among females or males.Conclusion: We found few differences in examined reproductive health indicators of young adults with and without physical disabilities, but findings suggest differences in some screening services that merit additional study. [ABSTRACT FROM AUTHOR]

Objectives: To compare receipt of contraception and method effectiveness in the early postpartum period among women with and without a recent preterm birth (PTB). Methods: We used data from North Carolina birth certificates linked to Medicaid claims. We assessed contraceptive claims with dates of service within 90 days of delivery among a retrospective cohort of women who had a live birth covered by Medicaid between September 2011 and 2012 (n = 58,201). To estimate the odds of receipt of contraception by PTB status (24–36 weeks compared to 37–42 weeks [referent]), we used logistic regression and tested for interaction by parity. To estimate the relationship between PTB and method effectiveness based on the Center for Disease Control and Prevention Levels of Effectiveness of Family Planning Methods (most, moderate and least effective [referent]), we used multinomial logistic regression. Results: Less than half of all women with a live birth covered by Medicaid in North Carolina had a contraceptive claim within 90 days postpartum. Women with a recent PTB had a lower prevalence of contraceptive receipt compared to women with a term birth (45.7% vs. 49.6%). Women who experienced a PTB had a lower odds of receiving contraception. When we stratified by parity, women with a PTB had a lower odds of contraceptive receipt among women with more than two births (0.79, 95% CI 0.74–0.85), but not among women with two births or fewer. One-fourth of women received a most effective method. Women with a preterm birth had a lower odds of receiving a most effective method (0.83, 95% CI 0.77–0.88) compared to women with a term birth. Conclusions for Practice: Contraceptive receipt was low among women with a live birth covered by Medicaid in North Carolina. To optimize contraceptive use among women at risk for subsequent preterm birth, family planning strategies that are responsive to women's priorities and context, including a history of preterm birth, are needed. Significance: Access to free or affordable highly effective contraception is associated with reductions in preterm birth. Self-report data indicate that women with a very preterm birth (PTB) are less likely to use highly or moderately effective contraception postpartum compared to women delivering at later gestational ages. Using Medicaid claims data, we found that less than half of all women with a Medicaid covered delivery in North Carolina in 2011–2012 had a contraceptive claim within 90 days postpartum, and one fourth received a most effective method. Women with a PTB and more than two children were least likely to receive any method. Family planning strategies that are responsive to women's priorities and context, including a history of preterm birth, are needed so that women may access their contraceptive method of choice in the postpartum period. [ABSTRACT FROM AUTHOR]

Objectives: To refine the Centers for Disease Control and Prevention (CDC)'s contraceptive education poster using patient-centered design.Study Design: We conducted cognitive interviews with 26 women aged 18-44 living in North Carolina who spoke and read English and had ever had sex. We interviewed women about both a CDC and a patient-centered poster in alternating order. Participants were contraceptive users and non-users that we selected purposively to have a range of characteristics that might influence their perspective: age, race/ethnicity, previous births and pregnancies, contraceptive method(s) used in the past three months, pregnancy intentions, and numeracy. The initial response rate for participants was 55%. We used cognitive theory to code interviews for comprehension, relevance, and acceptability, as well as design and overall preference. We structured the 26 interviews into four rounds and revised the patient-centered poster after each round to improve these measures.Results: By the final round, 83% of women preferred the patient-centered poster. The majority of women favored this poster's relevance (86%), and design (100%) and ease of comprehension (86%). Women raised few concerns about the acceptability of the final version of the patient-centered poster. Women identified many issues with both posters that the researchers did not anticipate, highlighting the value of patient-centered design approaches to educational materials.Conclusions: This study refined a patient-centered poster so that its language is clear and it addresses the informational needs of its target audience.Implications: The Centers for Disease Control and Prevention and the Office of Population Affairs recommend that clinicians educate women about contraception. This study developed a poster that could help clinicians follow this recommendation. Before widespread implementation, more research is needed to evaluate the poster's impact on contraceptive knowledge and behaviors. [ABSTRACT FROM AUTHOR]

Orphaned adolescents are a large and vulnerable population in sub-Saharan Africa, at higher risk for HIV than non-orphans. Yet prevention of new infection is critical for adolescents since they are less likely than adults to enter and remain in treatment and are the only age group with rising AIDS death rates. We report process evaluation for a randomized controlled trial (RCT) testing support to stay in school (tuition, uniform, nurse visits) as an HIV prevention strategy for orphaned Kenyan adolescents. The RCT found no intervention effect on HIV/HSV-2 biomarker outcomes. With process evaluation, we examined the extent to which intervention elements were implemented as intended among the intervention group (N = 412) over the 3-year study period (2012-2014), the implementation effects on school enrollment (0-9 terms), and whether more time in school impacted HIV/HSV-2. All analyses examined differences as a whole, and by gender. Findings indicate that school fees and uniforms were fully implemented in 94 and 96% of cases, respectively. On average, participants received 79% of the required nurse visits. Although better implementation of nurse visits predicted more terms in school, a number of terms did not predict the likelihood of HIV/HSV-2 infection. Attending boarding school also increased number of school terms, but reduced the odds of infection for boys only. Four previous RCTs have been conducted in sub-Saharan Africa, and only one found limited evidence of school impact on adolescent HIV/HSV-2 infection. Our findings add further indication that the association between school support and HIV/HSV-2 prevention appears to be weak or under-specified. [ABSTRACT FROM AUTHOR]

Cash transfer programmes have recently emerged as promising interventions for HIV prevention among adolescents in Africa. However, the pathways through which risk reduction occurs are not well understood. We examine data on 1429 adolescents and youth from the Kenya Cash Transfer for Orphans and Vulnerable Children, which has been shown to result in delayed sexual debut among adolescents. We explored three potential mediating pathways: schooling, socio-economic status and psycho-social status. None of these hypothesised mediators greatly altered the main effect. However, school attendance had a larger protective effect on sexual debut among females but was only increased by the programme among males. This gendered pattern of effects may explain why we did not see a mediating effect of the cash transfer through schooling, despite schooling's protective effects against early sexual debut. Results also suggest that cash transfer programmes in Africa can contribute to the reduction of HIV related risk behaviours. [ABSTRACT FROM AUTHOR]

The present study compared the prevalence and variation in high-risk sexual behaviors among four monoracial (i.e., White, African American, Asian, Native American) and four multiracial (i.e., White/African American, White/Asian, White/Native American, African American/Native American) young adults using Wave IV data (2008-2009) from the National Longitudinal Study of Adolescent to Adult Health (N = 9724). Findings indicated differences in the sexual behavior of monoracial and multiracial young adults, but directions of differences varied depending on the monoracial group used as the referent and gender. Among males, White/African Americans had higher risk than Whites; White/Native Americans had higher risk than Native Americans. Otherwise, multiracial groups had lower risk or did not differ from the single-race groups. Among females, White/Native Americans had higher risk than Whites; White/African Americans had higher risk than African Americans. Other comparisons showed no differences or had lower risk among multiracial groups. Variations in high-risk sexual behaviors underscore the need for health research to disaggregate multiracial groups to better understand health behaviors and outcomes in the context of experiences associated with a multiracial background, and to improve prevention strategies. [ABSTRACT FROM AUTHOR]

Objectives. We examined the impact of preconception acute and chronic stressors on offspring birth weight and racial/ethnic birth weight disparities. Methods. We included birth weights for singleton live first (n = 3512) and second (n = 1901) births to White, Mexican-origin Latina, other-origin Latina, and Black women reported at wave IV of the National Longitudinal Study of Adolescent Health (2007–2008; ages 24–32 years). We generated factor scores for preconception acute and chronic stressors from wave I (1994–1995; ages 11– 19 years) or wave III (2001–2002; ages 18–26 years) for the same cohort of women. Results. Linear regression models indicated that chronic stressors, but not acute stressors, were inversely associated with birth weight for both first and second births (b = –192; 95% confidence interval = –270, –113; and b = –180; 95% confidence interval = –315, –45, respectively), and partially explained the disparities in birth weight between the minority racial/ethnic groups and Whites. Conclusions. Preconception chronic stressors contribute to restricted birth weight and to racial/ethnic birth weight disparities. [ABSTRACT FROM AUTHOR]

Background Internet surveys that draw from traditionally generated samples provide the unique conditions to engage adolescents in exploration of sensitive health topics. Methods We examined awareness of unwanted pregnancy, abortion behaviour, methods, and attitudes toward specific legal indications for abortion via a school-based internet survey among 378 adolescents aged 12-21 years in three Rio de Janeiro public schools. Results Forty-five percent knew peers who had undergone an abortion. Most students (66.0%) did not disclose abortion method knowledge. However, girls (aOR 4.2, 95%CI 2.4-7.2), those who had experienced their sexual debut (aOR1.76, 95%CI 1.1-3.0), and those attending a prestigious magnet school (aOR 2.7 95%CI 1.4-6.3) were more likely to report methods. Most abortion methods (79.3%) reported were ineffective, obsolete, and/or unsafe. Herbs (e.g. marijuana tea), over-the-counter medications, surgical procedures, foreign objects and blunt trauma were reported. Most techniques (85.2%) were perceived to be dangerous, including methods recommended by the World Health Organization. A majority (61.4%) supported Brazil's existing law permitting abortion in the case of rape. There was no association between gender, age, sexual debut, parental education or socioeconomic status and attitudes toward legal abortion. However, students at the magnet school supported twice as many legal indications (2.7, SE.27) suggesting a likely role of peers and/or educators in shaping abortion views. Conclusions Abortion knowledge and attitudes are not driven simply by age, religion or class, but rather a complex interplay that includes both social spaces and gender. Prevention of abortion morbidity and mortality among adolescents requires comprehensive sexuality and reproductive health education that includes factual distinctions between safe and unsafe abortion methods. [ABSTRACT FROM AUTHOR]

CONTEXT Associations between early sexual initiation and parental support and knowledge have not been uniformly tested in multiple European population-based samples. Understanding such associations is important in efforts to discourage females' early sex. METHODS Data were compiled for 7,466 females aged 14-16 who participated in the 2005-2006 Health Behaviors in School-Aged Children survey in nine countries (Austria, Finland, Greece, Hungary, Iceland, Lithuania, Romania, Spain and Ukraine). Univariate, bivariate and multivariable analyses were run with standard error corrections and weights to assess how sexual initiation before age 16 was related to maternal and paternal support and knowledge of daily activities. RESULTS Prevalence of early sexual initiation ranged from 7% (in Romania) to 35% (in Iceland). In bivariate analyses, maternal and paternal support were significantly negatively related to adolescent females' early sexual initiation in most countries. In models with demographic controls, parental support was negatively associated with early sexual initiation (odds ratio, 0.8 for maternal and 0.7 for paternal). After parental knowledge was added, early sexual initiation was no longer associated with parental support, but was negatively associated with maternal and paternal knowledge (0.7 for each). These patterns held across countries. CONCLUSIONS Parental knowledge largely explained negative associations between parental support and early initiation, suggesting either that knowledge is more important than support or that knowledge mediates the association between support and early sex. [ABSTRACT FROM AUTHOR]

This study investigated dopamine receptor genes (DRD2 and DRD4) and maternal sensitivity as predictors of infant respiratory sinus arrhythmia (RSA) and RSA reactivity, purported indices of vagal tone and vagal regulation, in a challenge task at 3, 6, and 12 months in 173 infant-mother dyads. Hierarchical linear modeling (HLM) revealed that at 3 and 6 months, RSA withdrawal in response to maternal separation was greater (suggesting expected physiological regulation) in infants without the DRD2 risk allele than those with the risk allele. At 12 months, infants with the risk allele who were also exposed to maternal sensitivity showed levels of RSA withdrawal comparable to infants who were not at genetic risk. Findings demonstrate the importance of developmental analysis of gene-environment interaction. [ABSTRACT FROM AUTHOR]

Background: Internet surveys that draw from traditionally generated samples provide the unique conditions to engage adolescents in exploration of sensitive health topics.Methods: We examined awareness of unwanted pregnancy, abortion behaviour, methods, and attitudes toward specific legal indications for abortion via a school-based internet survey among 378 adolescents aged 12-21 years in three Rio de Janeiro public schools.Results: Forty-five percent knew peers who had undergone an abortion. Most students (66.0%) did not disclose abortion method knowledge. However, girls (aOR 4.2, 95% CI 2.4-7.2), those who had experienced their sexual debut (aOR1.76, 95% CI 1.1-3.0), and those attending a prestigious magnet school (aOR 2.7 95% CI 1.4-6.3) were more likely to report methods. Most abortion methods (79.3%) reported were ineffective, obsolete, and/or unsafe. Herbs (e.g. marijuana tea), over-the-counter medications, surgical procedures, foreign objects and blunt trauma were reported. Most techniques (85.2%) were perceived to be dangerous, including methods recommended by the World Health Organization. A majority (61.4%) supported Brazil's existing law permitting abortion in the case of rape. There was no association between gender, age, sexual debut, parental education or socioeconomic status and attitudes toward legal abortion. However, students at the magnet school supported twice as many legal indications (2.7, SE.27) suggesting a likely role of peers and/or educators in shaping abortion views.Conclusions: Abortion knowledge and attitudes are not driven simply by age, religion or class, but rather a complex interplay that includes both social spaces and gender. Prevention of abortion morbidity and mortality among adolescents requires comprehensive sexuality and reproductive health education that includes factual distinctions between safe and unsafe abortion methods. [ABSTRACT FROM AUTHOR]