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Background: Adolescent loneliness and poor mental health represent dual public health concerns. Yet, associations between loneliness and mental health, and critically, how these associations vary in school settings are less understood. Aims: Framed by social-ecological theory, we aimed to identify key predictors of adolescent mental health and examine school-level variation in the relationship between loneliness and mental health. Sample: Cross-sectional data on adolescents from the 2018 wave of the Health Behaviour in School-aged Children study (HBSC) in Scotland were used (N = 5286). Methods: Mental health was measured as a composite variable containing items assessing nervousness, irritability, sleep difficulties and feeling low. Loneliness was measured via a single item assessing how often adolescents felt 'left out'. Multilevel models were used to identify social-ecological predictors of mental health, associations with loneliness and between-school variation. Results: Loneliness, as well as demographic, social and school factors, was found to be associated with mental health. Mental health varied across schools, with the between-school difference greater among adolescents with high levels of loneliness. Additionally, the negative effect of loneliness on mental health was stronger in schools with lower average mental health scores. Conclusions: The findings suggest that schools can play an important role in shaping adolescent mental health. Our study uniquely identifies that school-based interventions targeting mental health may be especially necessary among lonely adolescents, and programmes aimed at tackling loneliness may be more beneficial in schools with poorer mental health.

Objective: Due to high prevalence rates of sexual assault among college-aged women and the benefits of disclosure (e.g., emotional well-being), it remains important to consider barriers to disclosure. The current paper aimed to examine if barriers to disclosure may be more salient to sorority women. Participants: We examined differences in rates of hypothetical willingness to formally disclose (N = 693) and actual formal/informal disclosure (N = 584) as well as mental health as a function of Greek-life status among college women. Method: Two separate online surveys were administered (October, 2016; January, 2017), respectively. Results: Findings suggest no significant differences in rates of hypothetical or actual formal/informal disclosure as a function of Greek-life status; however, Greek-life members reported lower mental health. Conclusion: Findings from the current studies suggest that institutional factors (e.g., campus climate) may serve as a barrier to disclosure. Limitations and future directions in this important area are discussed.

Objective: Most studies on agreeing to unwanted sex have assessed sexual encounters between people who have had sex before. Thus, we examined instances of sexual compliance with a novel sexual partner. Participants: A probability sample of college students at a university in the Midwest United States (N = 7,112). Methods: Participants completed an online survey based on measures from the National Survey of Sexual Health and Behavior. Results: Only 2.5% (n = 179) agreed to unwanted sexual activity at their most recent sexual encounter. People who were sexually compliant with a novel sexual partner frequently did so due to their own alcohol intoxication. Further, sexual compliance with novel sexual partners was less frequently associated with affectionate sexual behaviors or orgasm. Conclusions: Our initial findings regarding the effect of sexual precedent on sexual compliance warrant further research on instances when people agree to sex they don't want with novel partners.

Objective: Undergraduate women are more likely to comply with unwanted sexual behavior if they have experienced sexual coercion from their partner. We investigated whether the severity and frequency of sexual coercion was associated with sexual compliance. Participants: A sample of 195 female university students in committed relationships. Methods: Participants completed an online survey about sexually coercive experiences in their relationship and hypothetical sexual compliance. Results: We found that undergraduate women exposed to more frequent mild sexual coercion from their current partner predicted they would be more compliant with hypothetical sexual coercion from that partner--both mild and severe. Conclusion: There may be a precedent for sexual compliance in some sexually coercive relationships; this precedent seems to be gradually set. Prevention programs should emphasize that even the mildest forms of sexual coercion can potentially have negative implications for a relationship.

Objective: College students may not view sexual consent communication while under the influence of substances (i.e., alcohol and drugs) as problematic if media models the co-occurrence of these behaviors. The purpose of this study was to assess the types of consent cues used by characters who are and are not under the influence of substances in mainstream films. Method: Four researchers inductively analyzed popular mainstream films (N = 50). Films were assessed for substance use and consent communication cues. Results: Characters using substances were depicted using implicit verbal and explicit nonverbal consent cues more than characters who had not used substances. Conclusion: Films may perpetuate cultural narratives that substance use can be part of the consent process and that consent is communicated differently when people have used substances. Prevention programs could include media literacy to address misleading messages college students may internalize about substance use and sexual consent communication.

In the USA, universities have recently developed policies and programmes on sexual consent education. But waiting until students enroll in higher education may be too late to begin this work. To examine the extent that K-12 health education standards promote sexual consent education, we conducted a pilot study and found that only two of eighteen states explicitly mentioned sexual consent in their health education standards. Using a small sample (n = 4 states), we then identified four themes as making implicit reference to sexual consent: communication skills, decision making, personal space and interpersonal relationships. Finally, in a robust sample (n = 18 states), we conducted a content analysis of published standards regarding these themes related to sexual consent. Our analysis suggests that sexual consent is likely not discussed in sex education at K-12 schools. We recommend the more explicit inclusion of sexual consent in health education curricula via the identified themes that already exist in most or all standards, emphasising the importance of teaching young people about the nuances of sexual consent and its communication before they become sexually active.

Objective: Our objectives were to measure reporting differences between sexual behavior data from daily diary and retrospective estimates and to assess the utility of using smartphones to collect sexual behavior data from a college student population. Participants: Eighty-six participants (68 women, 18 men) completed the study. Methods: For 30 days during the Spring 2017 semester, participants received prompts to participate in daily diaries about their previous day's sexual behavior on their smartphones. Participants then retrospectively reported their past 30 days of sexual behavior and provided feedback on the process of receiving daily diaries on their smartphones. Results: We found that college students overreported their sexual behavior on the retrospective survey compared to their daily diary reports (ps < 0.001; Cohen's ds = 1.51). Participants provided positive and constructive feedback. Conclusions: Using smartphones to administer daily diaries is a promising technique for obtaining reliable sexual behavior data from college students.

In response to evidence that one in five college women are sexually assaulted, institutions of higher education have started adopting affirmative consent policies. Affirmative consent must be voluntarily and explicitly communicated--verbally or nonverbally. A recently published article highlighted barriers to the success of affirmative consent initiatives at the intrapersonal level. To extend this discussion, we identified barriers at each level of the Social Ecological Model. In our commentary, we discuss social determinants that are particularly relevant for campus sexual assault. There are elements in young people's micro-, meso-, exo-, and macrosystems that hinder their adoption of affirmative consent practices. We focus on gender as an aspect of the macrosystem that is a formidable barrier to the success of affirmative consent initiatives, influencing each of the other levels. Finally, we discuss how sexuality education might begin to address the social determinants of sexual assault.

People’s beliefs about sexual consent can have far-reaching consequences, from forming opinions about a sexual assault case while serving as a juror to attending to a partner’s verbal and nonverbal consent cues during a sexual encounter. In this study, we examined the extent to which sexism, attitudes towards sexual consent, and sexual consent norms predict perceptions of risk related to sexual consent communication, or more specifically, the absence of sexual consent communication. Undergraduate students (N = 217) participated in an online survey study. Results revealed that participants’ attitudes towards sexual consent mediated the relationship between sexism and perceived risk. That is, people with sexist beliefs were less likely to evaluate sexual consent behaviours in a positive way, and in turn, these negative evaluations of sexual consent were associated with lower risk perceptions. [ABSTRACT FROM AUTHOR]

We examined associations between recent contraceptive use and first-sex behaviors (early initiation, substance use, contraceptive use) among adolescents in Scotland. We used data from the Health Behavior in School-aged Children study. Controlling for early initiation and substance use, girls and boys who used contraceptives at first sex were 7.5 and 12.3 times more likely to use contraceptives at most recent sexual intercourse than adolescents who did not (p <.001). We also present preliminary evidence on contraceptive use of Scottish adolescents in 2022. Experiences during adolescents' first sex may have lasting implications for later sexual behavior. [ABSTRACT FROM AUTHOR]

Alcohol intoxication may influence how bystanders interpret other people's consent and refusal cues. We examined the effects of alcohol intoxication on participants' perceptions of characters' consent and refusal indicators in a fictional vignette depicting an alcohol-involved sexual encounter. Young adults (n = 119, 52% women) participated in an alcohol administration experiment examining the influence of acute intoxication on bystander perceptions during a vignette depicting a character who is intoxicated and declines a sexual advance from another character, who ignores her refusal and continues to pursue sexual activity. Participants were randomly assigned to an alcohol or non-alcohol condition and then guided through a semi-structured interview in which we asked about the characters' consent and refusal cues. Interviews were analyzed using both inductive and deductive coding. Most participants eventually indicated the encounter was nonconsensual, but approximately 9% of participants described the encounter as entirely consensual and another 42% of participants described the interaction as initially consensual and then nonconsensual. Participants discussed nuanced accounts of consent and refusal cues, including indicators related to alcohol consumption. Disregarding intoxication and gender, participants eventually recognized the situation as nonconsensual and thus potentially risky. However, some participants recognized this risk earlier in the encounter than others. Consequently, bystanders who recognize risk later in a situation may have fewer opportunities to intervene before a situation escalates. We recommend sexual assault prevention educators take a more nuanced approach when discussing consent and refusal indicators, emphasizing contextual factors that may indicate risk. [ABSTRACT FROM AUTHOR]

Researchers have demonstrated associations between use of pornography and sexual objectification of women. We examine whether self-reported preference for degrading pornography moderated the relation between use frequency and sexual objectification of others. Participants were 1,342 heterosexual women and men residing in the United States. In women and men, pornography use frequency was associated with the sexual objectification of others, even after controlling for interest in generally explicit content. In men, interest in degrading pornography content significantly predicted sexual objectification of women. Our results suggest greater pornography use is associated with greater sexual objectification of others, across a variety of content categories. [ABSTRACT FROM AUTHOR]

Substance use can occur prior to nonconsensual and consensual sexual activity and affect how sexual consent is communicated and felt. Yet, researchers' understanding of how substance use relates to these sexual experiences is still developing. Few researchers examine these behaviors among the intersection of sexual minority (SM) identity and gender. The goal of this study was to assess if experiences of nonconsensual and consensual substance-involved sexual activity, consent communication and feelings varied by the intersection of SM identity and identifying as a woman. Participants were recruited from a Prolific Academic panel to complete a survey about their substance use, sexual experiences, and sexual consent. SM persons and SM women reported more nonconsensual and consensual substance involved sexual experiences than heterosexual participants and SM men. Consent communication and feelings did not differ by across groups. Prevention initiatives for substance use and sexual activity may want to take an intersectional approach that addresses why different subgroups are at elevated risk to coalesce these two behaviors. Because consent feelings and communication did not differ by SM identity and gender, consent initiatives should expand their discussion to be inclusive of SM as these initiatives are often presented within a heteronormative framework. [ABSTRACT FROM AUTHOR]

Background Sexual assault is a pervasive problem in the UK, and young women are disproportionately affected. We sought to provide an initial account of sexual consent norms in the UK and whether they differ by gender and age. Method The present study was a secondary analysis of data collected by the Family Planning Association, which conducted an online survey (N  = 2003) to assess experiences with, knowledge of, and attitudes toward consent. The sample represented all regions of the UK and spanned ages 14–55. Results Definitions of sexual consent endorsed by women and older age groups more closely aligned with the tenets of affirmative consent compared with men and younger age groups. Women and older age groups were also more likely to perceive that various nonverbal cues may be used to interpret sexual consent or refusal and were more supportive of people being able to withdraw their sexual consent. Conclusion Maladaptive sexual consent norms seemed to be prevalent among men and young people in the UK, which may contribute to young women's elevated risk of experiencing sexual assault. Our findings support the UK's recent relationships and sex education curriculum that actively promotes healthy sexual consent norms. [ABSTRACT FROM AUTHOR]

Public awareness of sexual assault and initiatives aimed at preventing sexual assault continue to increase over the years. However, whether rates of sexual assault have diminished because of such cultural shifts remains unclear. The purpose of this study was to assess if rates of sexual assault (i.e., forced sex) have changed over the past 18 years for adolescent girls and boys as well as potential differences across racial/ethnic identities. Using nationally representative data from the Youth Risk Behavioral Surveillance Survey from 2001 to 2019, we conducted logistic regressions to assess rates of experiences of forced sex by sex and by sex and racial/ethnic identity, while accounting for grade level. Participants included 135,837 high school students. From 2001 to 2019, rates of forced sex maintained for girls; however, there was a decrease over time for boys. For girls, there were inconsistent differences in rates of forced sex by racial/ethnic identities. However, boys who identified as Black, Hispanic, Multi-Racial, and Other Race/Ethnicity were at higher risk to report forced sex than their White peers, until 2015; only Other Race/Ethnicity was at higher risk in 2019. As girls and boys aged, the risk of forced sex increased. Despite prevention efforts, rates of forced sex did not decrease from 2001 to 2019 for adolescent girls disregarding race/ethnicity, and for racial/ethnic minority boys. That rates of forced sex continue to be high is problematic as experiencing sexual assault at an earlier age is associated with myriad consequences. Further, results suggest current prevention initiatives may be inadequate at addressing risk factors for forced sex, and more broadly, sexual assault. Moving forward, researchers and educators may want to re-evaluate the strategies used to address and measure sexual assault experiences. [ABSTRACT FROM AUTHOR]

Sexual wellbeing is an integral part of a person's overall sense of wellbeing. It is closely linked to physical, sexual, and mental health. Despite this, sexual wellbeing remains underexplored, including among young people (aged 16–24). This review aims to gain a greater understanding of young people's experiences of sexual wellbeing. We will include qualitative research on young people's lived experiences related to sexual wellbeing. We will search PROSPERO, Medline, CINAHL, PsycINFO, and SocINDEX utilising an iterative search approach. If the volume of eligible studies for inclusion is too large to permit in-depth analysis, the team will purposively sample studies to prioritise heterogeneity and richness. The lead author will assess the eligibility of studies, carry out data extraction, and assess the methodological quality of all studies. The wider research team will independently screen papers' title and abstract, extract data, and conduct methodological quality assessments of a subset of papers. Two reviewers will independently assess inclusion of all papers at full text. We will draw on the QuART tool to assess the methodological quality of included studies. We will utilise a thematic synthesis approach to synthesise the data and produce analytical statements. We will apply GRADE-CERQual to evaluate our confidence in each of the synthesis' analytical statements. The team will adopt a reflexive approach throughout all stages of the qualitative evidence synthesis (QES). Research will be written up in line with ENTREQ and PRISMA-S standards. The protocol for this QES was prospectively published in the International Prospective Register of Systematic Reviews (PROPERO) database under registration number CRD42022315593. [ABSTRACT FROM AUTHOR]

Sexual consent refers to people's internal willingness to engage in sexual activity with another person—as well as their external communication of that willingness. Internal and external sexual consent can vary by type of sexual behavior; however, previous research on sexual consent has primarily only assessed "typical" sexual behaviors such as genital touching, oral sex, and vaginal–penile sex without providing further context or acknowledging people's sexual diversity. Therefore, we provided an initial account of people's sexual consent—and lack thereof—for a broader array of sexual behaviors and contexts in which they occur. Using an online cross-sectional survey of participants in the United Kingdom and the United States (N = 658, 50.5% women), we examined event-level internal and external sexual consent for 20 sexual behaviors or contexts. Women reported significantly lower levels of sexual consent feelings than men for 12 of the 20 sexual behaviors and lower levels of active consent communication for 7 of them. Almost a third of participants (31.0%) had experienced at least one of the listed sexual behaviors against their will. Of those, participants on average reported nonconsensual experiences with 3.1 of the 20 types of sexual behavior listed, ranging from 1 to 11. More women reported at least one nonconsensual experience with one of the sexual behaviors assessed compared with men (47.9% versus 22.3%, respectively). We discussed several behavior-specific findings regarding sexual consent and the lack thereof. We also made recommendations for initiatives aimed at promoting healthy sexual consent practices: embrace sexual diversity, emphasize sexual agency, and encourage active consent communication. [ABSTRACT FROM AUTHOR]

Measuring sexual assault experiences is considered a methodological challenge in survey research. Researchers can test the validity of sexual assault measures by comparing responses to different, albeit related, measures of sexual assault to determine if they identify similar groups of women. The goal of this study was to compare two measures of sexual assault victimization to determine if women report experiencing sexual assault in both assessments. Cisgender college women (n = 902) completed two separate measures of sexual victimization: the Sexual Coercion Inventory (SCI) and Sexual Experience Survey-Short Form Victimization (SES-SFV). Responses to both measures were coded to identify different sexual assault experiences (i.e., unwanted touching, attempted, and completed oral, vaginal, or anal rape) resulting from verbal coercion, threats of force, and use of force since enrolling in the university. Results suggested the SES-SFV produced higher overall rates of sexual assault experiences than the SCI. Specifically, the SES-SFV elicited more non-consensual sexual experiences resulting from threats and use of force, whereas the SCI elicited more non-consensual sexual experiences resulting from verbal coercion. Findings suggested discrepant responding across the two measures. Development of comprehensive sexual assault measures that fully capture women's victimization experiences is warranted. [ABSTRACT FROM AUTHOR]

Young adults frequently engage in sexual activity after consuming alcohol and, consequently, may try to communicate sexual consent while intoxicated. We aimed to assess how people's drinking behaviors relate to their consent perceptions and communication with their current sexual partners. Using aggregated data from a 30-day daily diary study, young adults (n = 86, 77.9% women, 86% in a monogamous relationship) reported instances of partnered sexual activity and their perceptions of whether that activity was consensual. For each partnered sexual event, participants reported what they said or did to perceive the sexual activity as consensual. Responses were coded as active consent communication (i.e., using verbal or nonverbal cues) or tacit knowledge (i.e., using context to understand consent). During an exit survey, participants retrospectively reported how many days they drank (i.e., typical drinking) during the 30-day study and whether they binge drank. Typical and binge drinking were associated with identifying sexual experiences as consensual. Participants who binge drank relied less on active consent communication and more on context compared with those who did not binge drink. Young adults who binge drink may rely more on tacit knowledge because alcohol impedes their ability to process complex stimuli—such as active consent cues. [ABSTRACT FROM AUTHOR]

Sexual assault victimization (SAV) histories may impede, increase, or have no effect on women's risk recognition. Yet, even though risk recognition is a component of bystander intervention, the effect of SAV on bystander behaviors is understudied. For example, how different SAV histories, such as the severity of the assault and if women were revictimized since entering college, have not been examined with bystander behaviors; we intended to address this gap in the literature. Building on recent work, we also examined the potential interactive effects of alcohol consumption and SAV history in predicting bystander behaviors. College women (n = 560) completed a web-based survey on alcohol consumption, SAV experiences since entering college, and bystander behaviors in alcohol-involved settings. We found that the effect of SAV history on bystander behavior varied based on alcohol consumption. As women's alcohol consumption increased so did their self-reported engagement in bystander behaviors. For non-victims, increased alcohol consumption had a greater positive effect on their bystander behaviors than victims. However, after a certain quantity of alcohol was consumed, both victims and non-victims reported decreased bystander behavior. Finally, alcohol consumption did not interact with severity of SAV or revictimization status in predicting bystander behavior. Findings suggest alcohol consumption may be more influential on bystander behaviors for women with no history of SAV; however, consuming a greater quantity of alcohol is related to a decrease in bystander behavior—regardless of SAV history. Given these findings, more work is needed to explore when and how alcohol impedes, and potentially encourages, bystander behavior. How SAV histories relate to bystander behaviors also warrants further research. [ABSTRACT FROM AUTHOR]

Sexual consent is often conceptualized as an internal willingness to engage in sexual activity, which can be communicated externally to a sexual partner. Internal sexual consent comprises feelings of physical response, safety/comfort, arousal, agreement/want, and readiness; external sexual consent includes communication cues that may be explicit or implicit and verbal or nonverbal. Most previous research on sexual consent has focused on between-person differences; little attention has been devoted to examining the within-person variation of sexual consent across time. We conducted a 28-day experience sampling methodology (ESM) study with a sample of adults (N = 113) to assess fluctuations in internal and external sexual consent across a given person's sexual events. We found that more than 50% and up to 80% of the variance in sexual consent scores could be accounted for by within-person variability. The type of sexual behavior participants engaged in during a sexual event predicted their internal and external consent. Further, internal consent feelings predicted external consent communication. Overall, our findings provided initial evidence regarding the extent that situational contexts are relevant for sexual consent. ESM study designs may be used to further investigate the potential contextual, intrapersonal, and interpersonal factors associated with internal and external sexual consent. [ABSTRACT FROM AUTHOR]

Sexual minority youth, compared to their heterosexual peers, have a disproportionate burden of sexual risks, but it remains unclear whether such inequalities exist across cultures and countries. We used data from eight European countries participating in the 2018 Health Behaviour in School-aged Children (HBSC) study to analyze sexual behavior in representative samples of adolescents aged 14.5–16.5 years (N = 10,583). Overall, 19.1% of the participants reported that they had had sexual intercourse. Compared to their non-minority peers (those exclusively attracted to opposite-gender partners), sexual minority youth – attracted to same- or both-gender partners – were significantly more likely to report having had sexual intercourse and sex before age 14. Those attracted to both-gender partners had similar odds of having had sexual intercourse, but higher odds of not using condoms, or neither condoms nor contraceptive pill use at last intercourse. Those not attracted to anyone had similar odds of having had sexual intercourse but were more likely to report early sex and not using protection at last intercourse. Adjusting for gender, country and family affluence did not substantially change the pattern of results. In interpreting the findings, the onset of puberty, sexual abuse, stigma management and experimentation with sexual identity should be considered. We discuss the practical, clinical and research implications of the findings. [ABSTRACT FROM AUTHOR]

Preliminary evidence indicates that people's sexual consent (i.e., their willingness to engage in sexual activity and communication of that willingness) varies across time and context. Study designs that assess sexual consent at multiple time points (e.g., experience sampling methodology [ESM]) are needed to better understand the within-person variability of sexual consent. However, extant validated measures of sexual consent are not appropriate for ESM studies, which require shorter assessments due to the increased burden this methodology has on participants. As such, the goal of the present study was to develop ESM measures of sexual consent based on items that have previously been validated for use in cross-sectional surveys. We selected items that balanced face validity as evidenced by cognitive interviews (n = 10) and content validity as evidenced by experts' ratings (n = 6). To assess the construct validity and feasibility of these items, we administered the selected ESM measures of sexual consent in a seven-day pilot study (n = 12). The results suggested that the ESM measures developed in the present study were a valid and feasible assessment of people's experience-specific internal consent feelings and external consent communication. We conclude with recommendations for sex researchers interested in ESM. [ABSTRACT FROM AUTHOR]

Sexual consent is a multidimensional construct that requires the participation of all involved in a sexual encounter; however, previous research has almost exclusively relied on one person's perspective. To address this, we collected open- and closed-ended data on sexual consent from 37 dyads in committed sexual relationships (N = 74). We found that relationship length was associated with sexual consent and couples who accurately perceived each other's consent communication cues reported elevated levels of internal consent feelings. Communicating willingness to engage in sexual activity remains important even within committed relationships. Preliminary findings suggest that further investigations of dyadic nuances of sexual consent are warranted. [ABSTRACT FROM AUTHOR]

Bystander interventions for sexual assault promote third-party interference. People who endorse rape myths blame victims more and perpetrators less; consequently, rape myth acceptance (RMA) can impede helping behaviors toward sexual assault victims. Acute alcohol intoxication may exacerbate the effects of RMA on bystander intervention. In this study, we examined the influence of RMA—and potential moderating effect of acute alcohol intoxication—on predictors of bystander intervention. Young adults (N = 128) completed a survey in a lab setting, then consumed either an alcoholic or control beverage, read and listened to a fictional sexual assault scenario, and finally completed a semi-structured interview and postexperiment survey assessing their perceptions of the scenario. Using multivariate analysis of covariance (MANCOVA), we found people with higher RMA blamed the victim more and perpetrator less; they were also less likely to perceive responsibility to intervene for a sexual assault victim. Alcohol intoxication did not exacerbate these effects. That is, alcohol intoxication was not a context in which RMA was expressed more strongly. We recommend bystander programs continue to address RMA, specifically as a barrier to intervening. [ABSTRACT FROM AUTHOR]