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Introduction The diversity in self-identified lesbian and bisexual women's sexual interactions necessitates better understanding of how and when they integrate personal lubricant into different experiences. However, little is known about lesbian and bisexual women's lifetime lubricant use, particularly at the population level. Aims The aim of this study was to examine the prevalence and characteristics of lubricant use among adult lesbian and bisexual women in the United States. Methods Data were drawn from a subset of lesbian and bisexual participants who participated in the 2012 National Survey of Sexual Health and Behavior, an online questionnaire administered to a nationally representative probability sample of U. S. adults ages 18 and older. Main Outcome Measures We examined socio-demographic characteristics, recent and lifetime lubricant use, lubricant use in associated with specific sexual behaviors and condom use, frequency of use, motivations for use, as well as perception of lubricant when used. Results A majority of lesbian- (60.1%) and bisexual-identified (77.1%) women reported ever using lubricant; 25.7% of lesbian women and 32.7% of bisexual women used it in the last 30 days. Across most age groups, lubricant was commonly used during partnered sexual play, partnered sexual intercourse, or when a vibrator/dildo was used. Lesbian and bisexual women reported using lubricants to increase arousal/sexual pleasure/desire, to make sex more fun, or to increase physical comfort during sex. Conclusions Lubricant use is identified as a part of lesbian and bisexual women's sexual experience across the life span, as a part of both solo and partnered experiences. As part of evolving sexual health assessments, clinicians and health educators may find value in integrating lubricant-focused conversation with their lesbian and bisexual patients and clients, particularly. Hensel DJ, Schick V, Herbenick D, Dodge B, Reece M, Sanders SA, and Fortenberry JD. Lifetime lubricant use among a nationally representative sample of lesbian- and bisexual-identified women in the United States. J Sex Med 2015;12:1257-1266. [ABSTRACT FROM AUTHOR]

Purpose For young women, new sexual experiences normatively increase after puberty and coincide with extensive changes to brain regions governing self-regulation of risk behavior. These neurodevelopmental changes could leave some young women vulnerable for negative sexual outcomes, including sexually transmitted infection and unintended pregnancy. We evaluated the feasibility of using functional neuroimaging to understand the sexual decision making of adolescent women. Methods Adolescent women (N = 14; 14–15 years) completed enrollment interviews, a neuroimaging task gauging neural activation to appetitive stimuli, and 30 days of prospective diaries following the scan characterizing daily affect and sexual behaviors. Descriptive and inferential statistics assessed the association between imaging and behavioral data. Results Young women were highly compliant with neuroimaging and diary protocol. Neural activity in a cognitive-affective network, including prefrontal and anterior cingulate regions, was significantly greater during low-risk decisions. Compared with other decisions, high-risk sexual decisions elicited greater activity in the anterior cingulate, and low-risk sexual decision elicited greater activity in regions of the visual cortex. Young women's sexual decision ratings were linked to their sexual history characteristics and daily self-reports of sexual emotions and behaviors. Conclusions It is feasible to recruit and retain a cohort of female participants to perform a functional magnetic resonance imaging task focused on making decisions about sex, on the basis of varying levels of hypothetical sexual risk, and to complete longitudinal prospective diaries following this task. Preliminary evidence suggests that risk level differentially impacts brain activity related to sexual decision making in these women, which may be related to past and future sexual behaviors. [ABSTRACT FROM AUTHOR]

This study explored the relationship between the social organization of neighborhoods including informal social control and social cohesion and a current bacterial sexually transmitted infection (STI) among adolescents and young adults in one U.S. urban setting. Data for the current study were collected from April 2004 to April 2007 in a cross-sectional household study. The target population included English-speaking, sexually-active persons between the ages of 15 and 24 years who resided in 486 neighborhoods. The study sample included 599 participants from 63 neighborhoods. A current bacterial STI was defined as diagnosis of a chlamydia and/or gonorrhea infection at the time of study participation. Participants reported on informal social control (i.e. scale comprised of 9 items) and social cohesion (i.e. scale comprised of 5 items) in their neighborhood. In a series of weighted multilevel logistic regression models stratified by gender, greater informal social control was significantly associated with a decreased odds of a current bacterial STI among females (AOR 0.53, 95% CI 0.34, 0.84) after controlling for individual social support and other factors. The association, while in a similar direction, was not significant for males (AOR 0.73, 95% CI 0.48, 1.12). Social cohesion was not significantly associated with a current bacterial STI among females (OR 0.85, 95% CI 0.61, 1.19) and separately, males (OR 0.98, 95% CI 0.67, 1.44). Greater individual social support was associated with an almost seven-fold increase in the odds of a bacterial STI among males (AOR 6.85, 95% CI 1.99, 23.53), a finding which is in contrast to our hypotheses. The findings suggest that neighborhood social organizational factors such as informal social control have an independent relationship with sexual health among U.S. urban youth. The causality of the relationship remains to be determined. [ABSTRACT FROM AUTHOR]

Perspectives on sexual health clearly articulate the value of sexual well-being to the control and prevention of adverse sexual outcomes. Young women's emerging romantic/sexual partners factor prominently into strategies to cultivate and maintain sexual health as they help cultivate the development of skills needed to control if, when, and how sex happens. As such, public health agencies recognize that these skills are important enhancement to existing prevention programs as they can be leveraged to help young women reduce sexual risk taking. Using romantic/sexual partner-specific data collected from adolescent women (N=375; 14 to 17 years), we empirically examined the influence of sexual health on several STI-associated behaviors, including the frequency of vaginal sex, condom use, substance use prior to sex, and sexual coercion. Our data provide evidence for the idea that dimensions of sexual health work collectively to re- duce sexual risk behaviors, both with single partners or with multiple partners. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: Sexual health refers a state of lifespan well-being related to sexuality. Among young people, sexual health has multiple dimensions, including the positive developmental contributions of sexuality, as well as the acquisition of skills pertinent to avoiding adverse sexual outcomes such as unintended pregnancy and sexually transmitted infections (STIs). Existing efforts to understand sexual health, however, have yet to empirically operationalize a multi-dimensional model of sexual health and to evaluate its association to different sexual/prevention behaviors. Methods: Sexual health dimensions and sexual/prevention behaviors were drawn from a larger longitudinal cohort study of sexual relationships among adolescent women (N = 387, 14–17 years). Second order latent variable modeling (AMOS/19.0) evaluated the relationship between sexual health and dimensions and analyzed the effect of sexual health to sexual/prevention outcomes. Results: All first order latent variables were significant indicators of sexual health (β: 0.192 – 0.874, all p < .001). Greater sexual health was significantly associated with sexual abstinence, as well as with more frequent non-coital and vaginal sex, condom use at last sex, a higher proportion of condom-protected events, use of hormonal or other methods of pregnancy control and absence of STI. All models showed good fit. Conclusions: Sexual health is an empirically coherent structure, in which the totality of its dimensions is significantly linked to a wide range of outcomes, including sexual abstinence, condom use and absence of STI. This means that, regardless of a young person''s experiences, sexual health is an important construct for promoting positive sexual development and for primary prevention. [Copyright &y& Elsevier]

Abstract: Developing a sexual self-concept is an important developmental task of adolescence; however, little empirical evidence describes this development, nor how these changes are related to development in sexual behavior. Using longitudinal cohort data from adolescent women, we invoked latent growth curve analysis to: (1) examine reciprocal development in sexual self-concept (sexual openness, sexual esteem and sexual anxiety) over a four year time frame; (2) describe the relationship of these trajectories with changes in sexual behavior. We found significant transactional effects between these dimensions and behavior: sexual self-concept evolved during adolescence in a manner consistent with less reserve, less anxiety and greater personal comfort with sexuality and sexual behavior. Moreover, we found that sexual self-concept results from sexual behavior, as well as regulates future behavior. [Copyright &y& Elsevier]

Objective: Sex during bleeding is a risk factor for sexually transmitted infection (STI) and other bloodborne viruses, including HIV. We examined daily predictors of adolescent women's male condom use during bleeding-associated vaginal sex.Methods: Adolescent females (N=387; 14-17 years) were recruited from primary care clinics for a longitudinal cohort study of STIs and sexual behaviour. Data were daily partner-specific sexual diaries; generalised estimating equation logistic regression assessed the likelihood of condom use during bleeding-associated vaginal sex.Results: Less than 30% of bleeding-associated vaginal sex events were condom protected. Condom use during these events was less likely with younger age, higher partner support, higher partner negativity or past week bleeding-associated sex with a given partner; condom use was more likely with high individual mood and past week condom use during bleeding-associated vaginal sex with a given partner.Conclusions: Low condom rates during bleeding-associated vaginal sex can increase STI and bloodborne virus risk. Providers should consider integrating partner-specific and behavioural factors when they deliver sexual health messages to young women. [ABSTRACT FROM AUTHOR]

Peer victimization is associated with alcohol use among adolescents. However, few studies have examined the mediating role of depression and anxiety, or differences by race. The current study examined the prospective relationship of peer victimization, depressive and anxiety symptoms, and alcohol use across two timeframes: 9th to 11th grade and 10th to 12th grade among African American and White youth. Two thousand two hundred and two high school youth (57.6% female) who identified as either African American (n = 342, 15.2%) or White (n = 1860, 82.6%) provided data on study variables. Path analysis among the overall sample indicated that anxiety symptoms was a significant mediator for both timeframes, with depressive symptoms mediating the pathway during the 10th to 12th grade timeframe. The findings were most consistent among White youth, with no significant indirect effects observed for African American youth. Thus, addressing depressive and anxiety symptoms may be effective targets to decrease alcohol use risk as a result of peer victimization among White youth. However, further research is needed to better understand risk models for peer victimization exposure on substance use outcomes among racial/ethnic minority youth. [ABSTRACT FROM AUTHOR]

CONTEXT In time, microbicides may provide women with dual prevention against pregnancy and STDs. Although several microbicide dimensions have been evaluated, little is known about women's preferences for contraceptive microbicides and correlates of these preferences. METHODS Acceptability of a hypothetical contraceptive microbicide cream or jelly was examined among a -clinic-based sample of 266 women in Indianapolis from 2004 (when participants were aged 14-22) to 2008. Group conjoint analyses and individual conjoint analyses were used to compare preferences with respect to four microbicide -dimensions: contraceptive ability, efficacy in relation to condoms, timing of use and texture. Pearson's product moment correlations were used to examine the relationship between preferences for a contraceptive microbicide and selected characteristics of the women. RESULTS Overall, the top-rated microbicide dimensions were efficacy in relation to that of condoms and contraceptive ability (importance scores, 40.0 and 35.4 out of 100.0, respectively). When all dimension levels were compared, contraceptive ability was the most strongly preferred (part-worth utility score, 8.9), and lower efficacy than that of -condoms was the least strongly preferred (−11.9). Preference for contraceptive microbicides was positively -associated with current contraceptive use, sexual agency, partner communication, commitment to avoiding pregnancy and -perceived partner agreement about avoiding pregnancy (coefficients, 0.07-0.18). It was negatively associated with current or past nonuse of contraceptives, seeking pregnancy and perceived partner agreement about seeking -pregnancy (−0.08 to −0.14). CONCLUSIONS Microbicides with dual prevention properties may be attractive to young women. Microbicide development and subsequent clinical trials should incorporate contraceptive microbicides. [ABSTRACT FROM AUTHOR]

Although much research has examined correlates of pain during sex, far less research has examined why women have sex despite having pain and why they avoid telling their partner. The purpose of our study was to examine women's reports of painful sex, including location of pain, whether they told their partner, factors associated with not disclosing their pain, and their reasons for not disclosing. We used data from the 2018 National Survey of Sexual Health and Behavior, a probability-based online survey of 2,007 individuals ages 14 to 49 years. We limited our sample to adult women who reported a sexual experience that was painful in the past year (n = 382; 23.2%). The primary outcome in quantitative analyses was whether women told their partner they experienced pain during sex. Associations with social identities and sexual health were explored via logistic regression. Those who did not tell their partner about painful sex were asked why; their accounts were coded and analyzed qualitatively. Women were asked, "To what extent was this sexual experience physically painful for you?" Those who reported any pain were asked, "Did you tell your partner that you were in pain during sex?" and, if applicable, "Why didn't you tell your partner that you were in pain during sex?" Of those reporting pain during sex, most said it was "a little painful" (81.6%) and occurred at the vaginal entrance (31.5%), inside the vagina (34.4%), or at or around the cervix (17.4%). Overall, 51.0% (n = 193/382) told their partner about their pain. Adjusting for age and wantedness, women who reported little or no event-level sexual pleasure had nearly 3-fold greater odds of not telling a partner about painful sex (adjusted odds ratio = 3.24; 95% CI, 1.43–7.37). Normalizing painful sex, considering pain to be inconsequential, prioritizing the partner's enjoyment, and gendered interactional pressures were the predominant themes in women's narratives. Providers should ask about painful sex, if the woman continues intercourse despite pain, and how she feels about this as a means of assessing any sexual and social pressures. Strengths include the use of social theory in nationally representative survey research to examine how contextual factors influence sexual health, but experiences were largely limited to heterosexual interactions. Many women do not discuss painful sex with their partners, lack of pleasure is significantly more likely among this group, and gender norms and cultural scripts are critical to understanding why. Carter A, Ford JV, Luetke M, et al. "Fulfilling His Needs, Not Mine": Reasons for Not Talking About Painful Sex and Associations with Lack of Pleasure in a Nationally Representative Sample of Women in the United States. J Sex Med 2019; 16:1953–1965. [ABSTRACT FROM AUTHOR]

Objective: Peer victimization in school is common, with emerging literature suggesting that it may also increase risk for substance abuse. Yet, little is known about the underlying mechanisms within this risk pathway. The objective of this study is to use a prospective 3-wave design to examine the mediating role of depressive symptomatology on the relationship between peer victimization and substance use, as well as examine if the pathway varies based on gender.Method: 801 youth between 6th and 12th grade completed surveys across three years, which included measures on school peer victimization, depression symptomatology and substance use. Models tested the mediational pathway between victimization, depressive symptoms, and substance use. Models were stratified by gender.Results: Controlling for grade and the effect of each variable across waves, a significant indirect effect of peer victimization on substance use through depressive symptoms was found for females, with a non-significant indirect effect for males.Conclusion: Results suggest that female youth who are victimized by peers engage in substance use behaviors, at least in part, due to increases in depressive symptoms. Given its effect on depression, female victims may therefore benefit from coping skills training that targets emotion regulation and distress tolerance skills in order to combat increased risk for substance use behaviors as a coping response to their victimization. Further research is warranted to better understand the risk pathway for male youth who also experience peer victimization. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to describe the development and implementation of a longitudinal evaluation of a statewide intervention (Title IV-E Waiver Demonstration Program) in a statewide child welfare agency using multiple methods for data collection and analysis. This longitudinal evaluation design was developed using guidelines from the Administration for Children and Families (ACF) regarding outcomes, process and cost. The specific design and data collection procedures were developed over time by the evaluation team in collaboration with the state child welfare agency. Data were collected using electronic surveys with various samples, interviews with regional and executive managers, data downloaded from the state's Management Information System, and regional case evaluations. State child welfare agencies are constantly evaluated by the communities in which they are located. However, these evaluations are typically reactive without positive feedback. In our evaluation of the Title IV-E Waiver Demonstration Project, a trusting partnership developed between the state child welfare agency and our university-based evaluation team, which resulted in more efficient use of data by the child welfare agency and in research by the evaluation team on key issues. [ABSTRACT FROM AUTHOR]

Introduction: Wearable biosensors have the potential to monitor physiological change associated with opioid overdose among people who use drugs.Methods: We enrolled 16 individuals who reported ≥ 4 daily opioid use events within the previous 30 day. Each was assigned a wearable biosensor that measured respiratory rate (RR) and actigraphy every 15 s for 5 days and also completed a daily interview assessing drug use. We describe the volume of RR data collected, how it varied by participant characteristics and drug use over time using repeated measures one-way ANOVA, episodes of acute respiratory depression (≤5 breaths/minute), and self-reported overdose experiences.Results: We captured 1626.4 h of RR data, an average of 21.7 daily hours/participant over follow-up. Individuals with longer injection careers and those engaging in polydrug use captured significantly fewer total hours of respiratory data over follow-up compared to those with shorter injections careers (94.7 vs. 119.9 h, p = 0.04) and injecting fentanyl exclusively (98.7 vs. 119.5 h, p = 0.008), respectively. There were 385 drug use events reported over follow-up. There were no episodes of acute respiratory depression which corresponded with participant reports of overdose experiences.Discussion: Our preliminary findings suggest that using a wearable biosensor to monitor physiological changes associated with opioid use was feasible. However, more sensitive biosensors that facilitate triangulation of multiple physiological data points and larger studies of longer duration are needed. [ABSTRACT FROM AUTHOR]

Introduction: Complete disclosure of childhood genital surgery to patients with congenital adrenal hyperplasia (CAH) is a critical part of CAH care. There are no guidelines or uniform recommendations on the timing and content of surgical disclosure discussions., Objective: Our objective was to describe the experiences and preferences of females with CAH and parents of females with CAH who underwent childhood genital surgery regarding surgical disclosure., Methods: We conducted an anonymous cross-sectional online survey of females with CAH (46XX, ≥16 years [y] old) and parents of females with CAH who underwent genital surgery before age 4y in North America. Participants reported experiences, preferences, and advice about initial ("first time you were told") and complete disclosure ("told all details"). Non-parametric statistics and qualitative analysis were used., Results: Participants included 59 females with CAH (median age: 37y, 92% White, 93% non-Hispanic) and 41 parents (median: 36y, 85% White, 93% non-Hispanic, daughter median: 26y). The 76% of females who received complete disclosure were younger (median age: 33y) and underwent surgery more recently (median decade: 1980s) than the 14% who received only initial disclosure (median: 47y, 1970s) and the 10% who did not receive any disclosure (median: 60y, 1960s, p = 0.0003, Summary Figure). Females reported median ages of initial and complete disclosure as 7-10y and 11-13y, respectively. Disclosure was preferred by 98% of females with initial disclosure by age 14y and complete disclosure by 18y. Parents reported similar findings. Most disclosures were by mothers (initial: 82%, complete: 64%). Doctors were more involved in complete vs. initial disclosures (complete: 47%, initial: 13%, p < 0.001). Qualitative analysis of advice about surgical disclosure revealed 8 themes., Conclusions: Disclosure of childhood genital surgery to women with CAH has increased over time. Although timing of disclosure varied, women preferred disclosure, and that it be initiated before age 14y and completed by age 18y., Competing Interests: Conflict of interest The authors have no conflicts of interest to disclose., (Copyright © 2024 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Purpose: Early sexual onset contributes to poor health outcomes through the life course. We use the social behavioral model to examine the behaviors and attitudes associated with early sexual onset and the intention to delay sex in middle school youth., Methods: Youth in rural communities with high rates of hepatitis C and HIV filled out a survey prior to implementation of an evidence-based sex education program. Participants were asked if they had ever had sex and whether they planned to abstain from sex until the end of high school. We collected demographics, attitudes about abstinence, agency for sexual refusal, parent communication, sexual health knowledge, and history of system involvement. Logistic regression was utilized to examine factors associated with each outcome., Findings: Our sample included 6,799 students, 12.7 years old ± 0.9 and 50.3% female. 5.1% had ever had sex and 73.9% planned to abstain until the end of high school. Early sexual onset was associated with older age, negative attitudes toward abstinence, lower agency for sexual refusal, more frequent parent communication about sex, history of child welfare, and history of juvenile involvement. Planning to abstain until the end of high school was associated with being younger, female, positive attitudes toward abstinence, higher agency for sexual refusal, less communication with parents about sex, more communication with parents about relationships, not having a history of foster involvement, and not having a history of juvenile involvement., Conclusions: Age, agency, and parent communication were all associated with both outcomes. Our findings highlight the importance of early comprehensive, trauma-informed sex education., (© 2024 The Author(s). The Journal of Rural Health published by Wiley Periodicals LLC on behalf of National Rural Health Association.)