Search

We examined the association between sexual orientation and human papillomavirus (HPV)-related risky sexual behaviors among high school students in the U.S. We used the 2015 Youth Risk Behavior Survey, a three-stage cluster sample, nationally representative, cross-sectional study. Participants were sexually active students (Grades 9–12) in public, private, and Catholic schools in 50 states and the District of Columbia (n = 5,958). Sexual orientation dimensions were: sexual self-identity (heterosexual, gay, lesbian, bisexual, and not sure) and sex of sexual contacts. HPV-associated risky sexual risk behaviors selected a priori were early sexual debut (≤ 12 or ≥ 13 years old) and number of lifetime partners (≥ 2 or ≥ 4). Separate multiple logistic regression analyses estimated association between sexual orientation and sex of sexual contacts, and HPV-associated risky sexual behaviors. Among the 5,958 high school students, a quarter had ≥ 4, and two-thirds had ≥ 2 sexual partners. Students who self-identified as bisexual (aOR = 2.43, 99% CI 1.19–4.98) or "not sure" (aOR = 4.56, 99% CI 2.54–8.17) were more likely to have sexual debut before 13 years. Similarly, students whose sexual contacts were adolescent females who had sex with females and males were more likely to have sexual debut before they turned 13 years of age (aOR = 3.46, 99% CI 1.83–6.48), or had ≥ 4 sexual partners (aOR = 2.66, 99% CI 1.74–4.08), or had ≥ 2 sexual partners (aOR = 3.09, 99% CI 1.91–5.00). In conclusion, HPV-associated risky sexual behavior is prevalent among high school students, especially sexual minorities. Interventions tailored to this population could increase HPV vaccine uptake and prevent future HPV-associated cancers and other negative outcomes. [ABSTRACT FROM AUTHOR]

This study evaluated the feasibility, acceptability, and preliminary efficacy of a 45-minute interactive, online sexual health program for adolescents, called Health Education and Relationship Training (HEART). The program was originally developed and evaluated among adolescent girls (HEART for Girls); the current project describes and evaluates a new version of the program that was adapted for boys and girls. Participants were 226 high school students (mean age = 16.3; 58% girls; 46% White; 79% heterosexual). Students were randomized to HEART or an attention-matched control and assessed at pre-test and immediate post-test. Overall, the program was feasible to administer in a school setting and youth found the program highly acceptable (83% liked the program, 87% learned new things, and 93% would use program content in the future). At post-test, students who completed HEART demonstrated improvements on every outcome we examined: sexual communication intentions, condom use intentions, HIV/STD knowledge, condom attitudes, condom norms, self-efficacy to practice safer sex, and sexual assertiveness compared to control participants (effect size ds =.23 to 1.27). Interactions by gender and sexual orientation revealed the program was equally acceptable and worked equally well for boys and girls and for heterosexual and sexual minority youth. We propose several avenues to further adapt and tailor HEART given its promise in promoting adolescent sexual health. [ABSTRACT FROM AUTHOR]

Sexting is receiving substantial scholarly attention and is now considered commonplace in adolescence. Little is known, however, about the normative contexts and the development of adolescent sexting behavior, including the initiation of sexting in relation to other sexual behaviors. In this study, we used growth mixture modeling to identify classes of onset trajectories for sexual behaviors across high school. Participants included 429 high school students (54% female) who completed annual assessments of sexual behavior over a three-year period. We identified four distinct classes: postponement (9%) with no behaviors other than hand-holding and kissing initiated by Grade 11, gradual onset (44%) with sexting and other sexual behaviors emerging incrementally across high school, continuous onset (32%) with sexting and other sexual behaviors within the first three years of high school, early onset (15%) with initiation of sexting and all other sexual behaviors prior to or by the end of Grade 9. Boys were more likely than girls to be members of the postponement versus gradual onset class, while Black students were more likely than White students to be members of the early versus gradual onset class. Sexting behavior appears to be common in adolescence and co-emerges with genital contact behavior across varying trajectories of sexual development. These findings provide the foundation for contextualizing sexting within normative sexual development. Further, this information can inform efforts to promote sexual health. [ABSTRACT FROM AUTHOR]

Sexual orientation is a multidimensional construct which is increasingly recognized as an important demographic characteristic in population health research. For this study, weighted Youth Risk Behavior Survey data were pooled across 47 jurisdictions biennially from 2005 to 2015, resulting in a national sample of 98 jurisdiction-years (344,815 students). Respondents were a median of 15.5 years, 49.9% male, and 48.8% White. Sexual identity and behavior trends from 2005 to 2015 were assessed with logistic regression analysis. Overall, 13.9% of females and 7.0% of males identified as lesbian, gay, bisexual (LGB), or not sure, while 9.1% of females and 4.2% of males indicated both same-and-different-sex behavior or same-sex behavior. In total, 17.0% of female and 8.5% of male youth reported non-heterosexual (LGB or not sure) sexual identity, same-sex sexual behavior, or both. LGB youth were approximately twice as likely as other youth to report lifetime sexual behavior. White and Asian youth were less likely to report non-heterosexual identity and/or have engaged in same-sex sexual behaviors than youth of other races/ethnicities. Prevalence of non-heterosexual identities increased over time for both sexes, but only female youth reported significantly more same-sex behavior over time. This is the first study to simultaneously assess adolescent sexual identity and behavior over time within a national dataset. These findings are critical for understanding the sexual health needs of adolescents and for informing sexual health policy and practice. [ABSTRACT FROM AUTHOR]

Survey data from 1,071 high school students in a large southern city indicated that high school sports participants were more likely to be sexually active than were nonparticipants. This result was true for both males (66% vs. 52%) and females (52% vs. 36%) and was independent of the sport in which the adolescent participated. This finding suggests that high school teams may provide an opportunity for reaching teenagers in need of sex education counseling. [ABSTRACT FROM AUTHOR]

Adolescent dating violence may lead to adverse health behaviors. We examined associations between sexual teen dating violence victimization (TDVV) and sexual risk behaviors among U.S. high school students using 2013 and 2015 National Youth Risk Behavior Survey data (combined n = 29,346). Sex-stratified logistic regression models were used to estimate these associations among students who had dated or gone out with someone during the past 12 months (n = 20,093). Among these students, 10.5% experienced sexual TDVV. Sexual TDVV was positively associated with sexual intercourse before age 13, four or more lifetime sexual partners, current sexual activity, alcohol or drug use before last sexual intercourse, and no pregnancy prevention during last sexual intercourse. Given significant findings among both sexes, it is valuable for dating violence prevention efforts to target both female and male students. [ABSTRACT FROM AUTHOR]

This study examined condom use intentions among adolescent boys in relation to the constructs of the Theory of Planned Behavior (TPB): attitude toward the behavior (ATB), subjective norm (SN), and perceived behavioral control (PBC). The potential moderating effects of sexual orientation and gender characteristic (masculine/feminine) were also explored. Anonymous survey data were collected from 929 students enrolled in a boys’ senior high school in Taiwan (response rate: 89.9%). Multivariate logistic regression analyses found higher condom use intentions linked to more positive ATB (adjusted odds ratio [AOR] = 8.09) and supportive SN (AOR = 2.73), as well as high PBC under facilitating conditions (AOR = 2.04). Notably, nonheterosexual boys perceiving supportive SN (AOR = 0.23) or high support for condom use from teachers and health educators (AOR = 0.10 and 0.26, respectively) had lower condom use intentions than their heterosexual peers. By contrast, relatively feminine boys perceiving supportive SN (AOR = 2.06) or high support from close friends (AOR = 2.18) had higher condom use intentions than their masculine counterparts. In conclusion, ATB and SN were strongly linked to condom use intentions; PBC was significant only under facilitating conditions. Sexual orientation and gender characteristic had important moderating effects. These empirical findings could inform tailored health education programs to increase condom use intentions in the male student population. [ABSTRACT FROM AUTHOR]

Social inequalities are at the heart of disparities in sexual health outcomes among African American and Latino/a adolescents living in the United States. Schools are typically the largest and primary context in youth development. School characteristics such as peer and teacher discrimination and school performance were examined to determine whether such characteristics predict sexual behavior in adolescents of color. This study utilized a representative sample of high school age students to assess sexual risk behavior. Findings indicate that there was a clear disparity in sexually transmitted infection diagnoses. School characteristics such as teacher discrimination and Grade Point Average were significant predictors to sexual risky behaviors among adolescents of color. The study adds to the literature in examining contextual factors that are associated with adolescent sexual risk behavior, and findings provide implications for future prevention work. [ABSTRACT FROM PUBLISHER]

The implications of teen sexting for healthy development continue to concern parents, academics, and the general public. Using a probability sample of high school students (N = 1,208) aged 12-18, the prevalence of sexting, associations with sexting, and associations between sexing and sexual activity were assessed. Seventeen percent both sent and received sexts, and 24% only received sexts. Sending and receiving sexts were positively associated with each other and both behaviors were associated with having peers who sext. Lifetime reports of sexual intercourse, anal sex, oral sex, and recent unprotected sex were positively associated with reports of texting 300 or more times per day, only receiving sexts, and both sending and receiving sexts. [ABSTRACT FROM AUTHOR]

As in other parts of sub-Saharan Africa, youth in Kenya report low rates of condom use. Although several studies have explored reasons for the low condom use among Kenyan youth, not many have established linkages between lack of use and normative beliefs and attitudes around condoms. Using the Theory of Planned Behavior (TPB), this article examined whether beliefs and attitudes around condoms influenced intentions and actual condom use. Data for the study were restricted to 1453 sexually active youth during the last school break. Path analysis was used to examine the relationship between the TPB constructs and condom use among Kenyan youth. Results indicated a direct relationship between attitudes and condom use for male respondents and an indirect relationship between these two variables for females. Both males and females who expressed greater intentions to use condoms were significantly more likely to report they used condoms consistently. Also, male and female youth with higher perceived behavioral control were significantly more likely to have used condoms consistently. Males with friends who used condoms were significantly more likely to use condoms consistently. The findings suggest the importance of examining young people's attitudes toward condoms-in particular, those deeply rooted in misconceptions that serve to discourage safer sexual behaviors. [ABSTRACT FROM AUTHOR]

This article describes the experiences of teenagers who engaged in sexual activities on school grounds and their need for social work support. The findings were derived from qualitative research done as part of one of a Master's study and was based on ten semi-structured interviews with high school learners in Gauteng province. Findings indicate that sexual activities are either planned or happen spontaneously in various school areas and during different periods. A variety of factors influence teenagers' decision to have sex at school. The participants, who were aware of the consequences of their behaviour identified a need for social work intervention at schools. [ABSTRACT FROM AUTHOR]

Studies have shown links between educational outcomes such as letter grades, test scores, or other measures of academic achievement, and health-related behaviors (1-4). However, as reported in a 2013 systematic review, many of these studies have used samples that are not nationally representative, and quite a few studies are now at least 2 decades old (1). To update the relevant data, CDC analyzed results from the 2015 national Youth Risk Behavior Survey (YRBS), a biennial, cross-sectional, school-based survey measuring health-related behaviors among U.S. students in grades 9-12. Analyses assessed relationships between academic achievement (i.e., self-reported letter grades in school) and 30 health-related behaviors (categorized as dietary behaviors, physical activity, sedentary behaviors, substance use, sexual risk behaviors, violence-related behaviors, and suicide-related behaviors) that contribute to leading causes of morbidity and mortality among adolescents in the United States (5). Logistic regression models controlling for sex, race/ethnicity, and grade in school found that students who earned mostly A's, mostly B's, or mostly C's had statistically significantly higher prevalence estimates for most protective health-related behaviors and significantly lower prevalence estimates for most health-related risk behaviors than did students with mostly D's/F's. These findings highlight the link between health-related behaviors and education outcomes, suggesting that education and public health professionals can find their respective education and health improvement goals to be mutually beneficial. Education and public health professionals might benefit from collaborating to achieve both improved education and health outcomes for youths. [ABSTRACT FROM AUTHOR]

In the last 8 years, several studies have documented that many adolescents acknowledge having exchanged sexually explicit cell phone pictures of themselves, a behavior termed sexting. Differences across studies in how sexting was defined, recruitment strategies, and cohort have resulted in sometimes significant differences in as basic a metric as what percentage of adolescents have sent, received, or forwarded such sexts. The psychosocial and even legal risks associated with sexting by minors are significantly serious that accurate estimates of its prevalence, including over time, are important to ascertain. In the present study, students (N = 656) from a single private high school were surveyed regarding their participation in sexting. Students at this same school were similarly surveyed four years earlier. In this second survey, reported rates of sending (males 15.8%; females 13.6%) and receiving (males 40.5%; females 30.6%) sexually explicit cell phone pictures (revealing genitals or buttocks of either sex or female breasts) were generally similar to those reported at the same school 4 years earlier. Rates of forwarding sexts (males 12.2%; females 7.6%) were much lower than those previously acknowledged at this school. Correlates of sexting in this study were similar to those reported previously. Overall, our findings suggest that sexting by adolescents (with the exception of forwarding) remains a fairly common behavior, despite its risks. [ABSTRACT FROM AUTHOR]

During the high school years, most young people in the United States receive school-based sexuality education, but there is little research on what they want to know about sex and sexuality but may be afraid to ask. This study is a content analysis of anonymous questions about sex (N= 645) asked by ninth-grade students from the greater Los Angeles area. A sample of predominantly lower-income and Latino/a students submitted anonymous questions before participating in sexuality education. Results show that young people are eager to understand how to use birth control and prevent pregnancy, have misinformation about sex and sexuality, and are misinformed on many topics. Results are discussed in light of what educators and others can do to help young people develop a safe, healthy sex life. [ABSTRACT FROM PUBLISHER]

Risk and protective processes are integrated developmental processes that directly or indirectly affect behavioral outcomes. A better understanding of these processes is needed, in order to gauge their contribution to sexual risk behaviors. This retrospective cross-sectional study modeled the ecodevelopmental chain of relationships to examine the social contexts of African-American (AA) adolescents associated with sexually transmitted disease (STD)- and HIV-risk behaviors. We used data from 1,619 AA adolescents with an average age of 16±1.8 years obtained from the first wave of the National Longitudinal Study of Adolescent Health for this study. Confirmatory factor analysis followed by structural equation modeling was conducted to identify the latent constructs that reflect the social-interactional components of the ecodevelopmental theory. Among contextual factors, findings indicated that a feeling of love from father, school, religion, and parent attitudes toward adolescent sexual behavior were all factors that played significant roles in the sexual behavior of AA adolescents. AA adolescents who reported feeling love from their father, feeling a strong negative attitude from their parents toward having sex at a very young age, and having a strong bond with school personnel were associated with better health statuses. The level of parents' involvement in their children's lives was reflected in the adolescents' feeling of love from parents and moderated by their socioeconomic status. Being male, attaining increased age, and being a sexual minority were associated with higher likelihood of exhibiting risky sexual behavior. In contrast, higher socioeconomic status and fathers' level of involvement were indirectly associated with reduced STD/HIV-related sexual risk behavior. In conclusion, our findings suggest that interventions aimed at maximal protection against STD/HIV-related risk behavior among AA adolescents should adopt both self- and context-based strategies that promote positive functioning in the family, school, and peer microsystems. [ABSTRACT FROM AUTHOR]

Introduction and Aims: This study examines the association of alcohol and polydrug use with risky sexual behaviour in adolescents under 16 years of age and if this association differs by gender.Design and Methods: The sample consisted of 5412 secondary school students under 16 years of age from Victoria, Australia. Participants completed an anonymous and confidential survey during class time. The key measures were having had sex before legal age of consent (16 years), unprotected sex before 16 (no condom) and latent-class derived alcohol and polydrug use variables based on alcohol, tobacco, cannabis, inhalants and other illegal drug use in the past month.Results: There were 7.52% and 2.55% of adolescents who reported having sex and having unprotected sex before 16 years of age, respectively. After adjusting for antisocial behaviours, peers' drug use and family and school risk factors, girls were less likely to have unprotected sex (odds ratio = 0.31, P = 0.003). However, the interaction of being female and polydrug use (odds ratio = 4.52, P = 0.004) was significant, indicating that girls who engaged in polydrug use were at higher risk of having unprotected sex. For boys, the effect of polydrug use was non-significant (odds ratio = 1.44, P = 0.310). Discussion and Conclusions For girls, polydrug use was significantly associated with unprotected sex after adjusting for a range of risk factors, and this relationship was non-significant for boys. Future prevention programs for adolescent risky sexual behaviour and polydrug use might benefit from a tailored approach to gender differences. [Chan GCK, Kelly AB, Hides L, Quinn C, Williams JW. Does gender moderate the relationship between polydrug use and sexual risk-taking among Australian secondary school students under 16 years of age? Drug Alcohol Rev 2016;35:750-754]. [ABSTRACT FROM AUTHOR]

Objectives. To determine if the Teen Outreach Program (TOP), a youth development and service learning program, can reduce sexual risk-taking behaviors compared with a business as usual or benign counterfactual. Methods. We synthesized results of 5 independent studies conducted in 5 geographically and ethnically diverse locations between 2011 and 2015 with 17 194 middle and high school students. Each study cluster-randomized classes, teachers, or schools to treatment or control groups and included the students enrolled in those clusters at baseline in an intent-to-treat analysis. Multilevel models tested impacts on recent sexual activity, recent unprotected sexual activity, and sexual initiation among the sexually inexperienced at baseline at approximately 1 and 2 years after baseline. Results. Precision-weighted average effect sizes showed nonsignificant reductions of 1 percentage point or less in recent sexual activity (5 studies: -0.6; P = .32), recent unprotected sex (5 studies: -0.2; P = .76), and sexual initiation (4 studies: -1.1; P = .10) after 1 year. Conclusions. There was little evidence of the effectiveness of TOP in reducing sexual risk-taking behaviors. Results underscored the importance of continually evaluating evidence-based programs that have previously been shown to be effective. [ABSTRACT FROM AUTHOR]

The Center for Sex Education recently published the fourth edition ofUnequal Partners: Teaching about Power, Consent, and Healthy Relationships, Volumes 1 and 2. Included here are two lesson plans about sexual consent selected from each volume.1“What does it take … to give sexual consent?” is reprinted from Volume 1; and “Enthusiastic consent: What is it and how do I do it?” is reprinted from Volume 2. [ABSTRACT FROM PUBLISHER]

Young persons aged 13-24 years accounted for an estimated 22% of all new diagnoses of human immunodeficiency virus (HIV) infection in the United States in 2014. Most new HIV diagnoses among youths occur among males who have sex with males (MSM). Among all MSM, young black MSM accounted for the largest number of new HIV diagnoses in 2014 (1). To determine whether the prevalence of HIV-related risk behaviors among black male high school students who had sexual contact with males differed from the prevalence among white and Hispanic male students who had sexual contact with males, potentially contributing to the racial/ethnic disparities in new HIV diagnoses, CDC analyzed data from Youth Risk Behavior Surveys conducted by 17 large urban school districts during 2009-2013. Although other studies have examined HIV-related risk behaviors among MSM (2,3), less is known about MSM aged <18 years. Black male students who had sexual contact with males had a lower or similar prevalence of most HIV-related risk behaviors than did white and Hispanic male students who had sexual contact with males. These findings highlight the need to increase access to effective HIV prevention strategies for all young MSM. [ABSTRACT FROM AUTHOR]

Unlabelled: Background Sexually transmissible infections (STIs) in adolescents are an important heath problem. However, the understanding of STIs among adolescents is poor. Rates of and risk factors for ever having a STI and relationships between ever having a STI and mental health in adolescents was investigated.Methods: Data from the Korea Youth Risk Behaviour Web-based Survey (KYRBS) were used. The KYRBS is an anonymous, self-administered online survey. To achieve a representative sample of Koreans, researchers used a stratification, clustering and multi-stage sampling method. Data from adolescents who had not had sexual intercourse and surveys with missing data concerning sexual experience were excluded. Finally, 31363 participants were included.Results: The rate of ever having a STI was 10.0%. A total of 26.5% of adolescents who have had sexual experience report always using contraceptives, and condoms are the most popular contraceptives (69.0%). Contraceptive method (condom, OR: 0.601, 95% CI: 0.491-0.736) and elementary school sexual debut (elementary school, OR: 1.000, middle school, OR: 0.235, 95% CI: 0.181-0.305; high school, OR: 0.128, 95% CI: 0.094-0.173) were significantly correlated with ever having a STI in the multivariate analysis. Depressed mood (OR: 1.379, 95% CI: 1.130-1.683), suicidal ideation (OR: 1.358, 95% CI: 1.109-1.664) and suicide attempts (OR: 1.382, 95% CI: 1.029-1.856) were significantly associated with ever having a STI after adjusting for potential confounders.Conclusions: STIs are common diseases in adolescents who have sexual experience and are significantly associated with mental health. Development of preventive measures and treatment policies including mental counselling for adolescents with STI are needed. [ABSTRACT FROM AUTHOR]

This cross-sectional study investigated the relationships among self-esteem, social support, and Internet dependence. A sample of young people aged between 15 and 18 years old (M age=16.3yr., SD=0.7; 470 boys, 441 girls) completed measures of the Rosenberg Self-Esteem Scale, the Perceived Social Support Scale, and the Internet Dependence Test. According to the cognitive-behavioral model of problematic Internet use, social support should mediate the relationship between self-esteem and Internet dependence. Furthermore, based on previous research it was predicted that boys would score higher on Internet dependence than women. Support for this model was obtained. Internet dependent students were more likely to be boys. Self-esteem and social support were negatively correlated with Internet dependence. The relationship between self-esteem and Internet dependence was mediated by social support. Although the effect sizes were small, the findings of the present study are of significance in investigating adolescents' Internet dependence. [ABSTRACT FROM AUTHOR]

Objectives. We examined associations between sexual orientation and pregnancy risk among sexually experienced New York City high-school students. Methods. We analyzed data from 2005, 2007, and 2009 New York City Youth Risk Behavior Surveys. We excluded students who had never engaged in sexual intercourse, only had same-gender sexual partners, or had missing data on variables of interest, resulting in a final sample of 4892 female and 4811 male students. We employed multivariable logistic regression to examine pregnancy risk by sexual orientation, measured as self-reported sexual identity and gender of sexual partners, with adjustment for demographics and sexual behaviors. We stratified analyses by gender. Results. Overall, 14.3% of female and 10.8% of male students had experienced a pregnancy. Students who identified as gay, lesbian, or bisexual or reported both male and female sexual partners had higher odds of pregnancy than heterosexual students or students who only had opposite-gender sexual partners. Sexual behaviors accounted for higher odds of pregnancy among female, but only partially accounted for higher odds of pregnancy involvement among male, sexual-minority students. Conclusions. Sexual orientation should be considered in future adolescent pregnancy-prevention efforts, including the design of pregnancy-prevention interventions. [ABSTRACT FROM AUTHOR]

Background: An emerging model for sexuality education is the rights-based approach, which unifies discussions of sexuality, gender norms, and sexual rights to promote the healthy sexual development of adolescents. A rigorous evaluation of a rights-based intervention for a broad population of adolescents in the U.S. has not previously been published. This paper evaluates the immediate effects of the Sexuality Education Initiative (SEI) on hypothesized psychosocial determinants of sexual behavior. Methods: A cluster-randomized trial was conducted with ninth-grade students at 10 high schools in Los Angeles. Classrooms at each school were randomized to receive either a rights-based curriculum or basic sex education (control) curriculum. Surveys were completed by 1,750 students (N = 934 intervention, N = 816 control) at pretest and immediate posttest. Multilevel regression models examined the short-term effects of the intervention on nine psychosocial outcomes, which were hypothesized to be mediators of students' sexual behaviors. Results: Compared with students who received the control curriculum, students receiving the rights-based curriculum demonstrated significantly greater knowledge about sexual health and sexual health services, more positive attitudes about sexual relationship rights, greater communication about sex and relationships with parents, and greater self-efficacy to manage risky situations at immediate posttest. There were no significant differences between the two groups for two outcomes, communication with sexual partners and intentions to use condoms. Conclusions: Participation in the rights-based classroom curriculum resulted in positive, statistically significant effects on seven of nine psychosocial outcomes, relative to a basic sex education curriculum. Longer-term effects on students' sexual behaviors will be tested in subsequent analyses. [ABSTRACT FROM AUTHOR]

Background: Secondary school students are exposed to risky sexual behaviors that put them at certain risk of negative consequences. The aim of this study was to investigate the sociodemographic factors as predictors of sexual behavior of secondary school students in Lagos State, Nigeria. Materials and Methods: A survey design was used for the study. The data were collected using self-developed structured questionnaire called youth sexual behavior questionnaire, the co-variates collected in the questionnaire were: Gender, age and sociological factors. The instrument had test-retest reliability co-effi cient of 0.78 while purposive sampling technique was used to select the schools and respondents. Totally, 2720 students were randomly selected for the study and inferential statistics of multiple regression, mean, t-test and ANOVA were used to analyze the data. Results: Results indicated that all the three co-variates used in the study were signifi cant. Which shows a signifi cant value for gender, age and sociological factors respectively (t = 6.753, P < 0.05), F(3, 2350) (79.930, P < 0.05) and F(4, 2394) (260.020 P < 0.05). Majority of the students were of the opinion that they engaged in premarital sexual activities despite its attendant consequences. Conclusion: Gender, age and sociological factors could infl uence the sexual behavior of secondary school students in Lagos State signifi cantly; it was also observed that most of these factors negatively infl uence youth's sexual activities. [ABSTRACT FROM AUTHOR]

The United States surpasses other developed nations in teen birthrates and sexually transmitted infections, and Florida youths are disproportionately affected. Projections have placed Florida to have the second largest population of youths in the nation by 2025. The racial and ethnic diversity as well as a growing number of youths in Florida make sexual and reproductive health (SRH) outcomes in this state reflective of the increasing diversity of youths throughout the United States. The purpose of this research was to compare a representative sample of Florida youths and US high school youths sexual behaviors, overall and by gender and race/ethnicity, to identify disparities. Employing 2011 Centers for Disease Control and Prevention Youth Risk Behavior Survey data, outcomes of interest were ever having had sexual intercourse; intercourse before age 13 years (early sex); condom use; oral contraceptive pill (OCP) use; and use of Depo-Provera®, Nuva Ring®, Implanon®, or any intrauterine device (IUD) at last sex. The analysis calculated relative risk and corresponding 95% confidence interval between Florida (N = 6,212) and US youths (N = 15,425) using SAS version 9.3 (SAS Institute, Inc., Cary, NC, USA). There were statistically significant differences in four of five behaviors, all of which were worse for Florida youths compared with US youths (except for condom use). Florida youths were more likely to report early sex and less likely to have used OCPs. Florida youths were less likely to have used Depo-Provera®, Nuva Ring®, Implanon, or any IUD, including differences by grade level and among male, female, Hispanic, and white youths. This study can inform policy and the need to develop strategies for intervention or service provision among Florida youths so resources can be allotted to priority populations. In addition this study, highlights areas of SRH that may be faced by a growing and diverse population of youths in the United States. [ABSTRACT FROM AUTHOR]

Objective This study examined whether cigarette use is associated with sexual orientation among high school students. Methods Data were from a 2012 cross-sectional survey of 5994 students in grades 9, 10 and 12 attending public schools in Atlantic Canada. Multilevel logistic regression analysis was used to examine differences in cigarette use by sexual orientation. Results Lesbian, gay and bisexual adolescents (LGB) reported higher prevalence (22%) of daily cigarette use compared with heterosexuals (11%). Multilevel logistic regression analysis, controlling for standard covariates, found that LGB adolescents were more likely to be daily smokers than non-LGB adolescents (odds ratio 2.00, 95% confidence interval 1.50-2.68). Bisexual adolescents were at least twice more likely to be a smoker compared with heterosexual adolescents. Conclusions Prevalence of cigarette use was significantly higher among LGB adolescent students. Our results join a growing body of evidence indicating that sexual minorities are at heightened risk of tobacco use. Smoking cessation measures that specifically target this group may be beneficial given that there is no one size fits all approach. [ABSTRACT FROM AUTHOR]

Research from various countries consistently reported an advantage of boys over girls in general knowledge and was also suggestive of some overall trends regarding specific domains of general knowledge that were speculated to stem from biologically differentiated interests. However, results were heterogeneous and, as of yet, had not been evaluated meta-analytically. Moreover, previous research drew on overly homogeneous high-school or undergraduate samples whose representativeness appears problematic; mostly, likely moderators, such as school type, student age or parental education, were also not directly investigated or controlled for. We provide a meta-analytical aggregation of available results regarding sex differences in general knowledge and present new data, investigating the psychometric properties of the General Knowledge Test (GKT), on which previous research primarily relied, and explored sex differences in a large and heterogeneous Austrian high-school student sample (N = 1088). The aggregated sex effect in general knowledge was of medium size in previous research, but differences in specific domains were heterogeneous across countries and only modest at best. Large sex differences in our data could be explained to a large part by school-related moderators (school type, school, student age, parental education) and selection processes. Boys had a remaining advantage over girls that was only small in size and that was consistent with the magnitude of sex differences in general intelligence. Analysis of the GKT yielded no evidence of biologically differentiated interests, but of a specific interest in the humanities among girls. In conclusion, previous research likely overestimated sex differences in general knowledge. [ABSTRACT FROM AUTHOR]

This paper reports the attitudes and actions on relationships with the opposite sex of 1,002 Grade 10 and Grade 12 students in New Providence. Girls were more likely than boys to use aggressive behaviours in teen relationships. Some of the behaviours noted in teen relationships informed expectations of marital relationships, such as restricted access to friends of the opposite sex. The students endorsed a number of sex-related stereotypes, such as a man being the head of the household. Both male and female students indicated that it was acceptable for men to control their wives. Participation in aggressive and controlling behaviours by teens points to the need to educate students about how to develop more respectful relationships. [ABSTRACT FROM AUTHOR]

Gender-based violence has serious consequences for the psychological, physical, and sexual well-being of both men and women. Various gender roles, attitudes, and practices in South Africa create an environment that fosters submission and silence in females and hegemony and coercion in males. One of the expressions of this power inequity is a high prevalence of forced sex, which in its turn is associated with higher risk of HIV infection. This study therefore assessed potential gender differences in beliefs about forced sex and in prevalence of reported forced sex among high school students ( N = 764) in KwaZulu-Natal. Results showed that significantly more boys were sexually active (26 %) than girls (12 %) and that boys experienced earlier sexual debut by over a year. Boys also held a more positive view about forced sex than girls since they associated it more often with signs of love, as an appropriate way to satisfy sexual urges, and as acceptable if the girl was financially dependent on the boy. The perception that peers and friends considered forced sex to be an effective way to punish a female partner was also more common among boys. On the other hand, boys were less knowledgeable about the health and legal consequences of forced sex, but no significant differences were found for other sociocognitive items, such as self-efficacy and behavioral intention items. Consequently, health education programs are needed to inform both boys and girls about the risks of forced sex, to convince boys and their friends about its inappropriateness and girls to empower themselves to avoid forced sex. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To identify the sexual and reproductive profile and demand for gynecologic services by high school girls in the city of Rio de Janeiro. Design: Cross-sectional study carried out by administration of a questionnaire filled in by the respondents on their own, given to students at 3 high schools with different socioeconomic profiles: private, state, and federal. The questions covered socio-demographic characteristics, sexual behavior, and demand for gynecologic services. The data were analyzed by the Yates chi-square test and Student t-test, with P < .05. Setting: Three high schools in the city of Rio de Janeiro. Interventions: None. Participants: Female high school students. Main Outcome Measure: Age, race, socioeconomic level, parents’ schooling, and sexual activity. Results: A total of 418 students participated, 122 from a private school, 165 from a state public school, and 131 from a federal public school. The state school students were predominantly black and had the lowest socioeconomic level, with their parents having the fewest average years of schooling. They also reported the most sexual partners, pregnancies, and abortions. Their characteristics differed significantly from those of the private and federal school students, which were similar to each other. The average age of first sexual activity was similar for all the respondents and the first visit to a gynecologist occurred significantly later among the state school students. Conclusions: The more frequent pregnancies and abortions by the state school students can be a consequence of the lower demand for or insufficient access to gynecologic services, depriving these students of the necessary care to promote sexual and reproductive health. This demonstrates the need for public policies that promote and facilitate access to routine preventive gynecologic care by low-income adolescent girls. [Copyright &y& Elsevier]

The purpose of this study was to determine and describe the prevalence of risky behaviours among the learners in a rural secondary school in the Eastern Cape Province. A cross-sectional sample of 150 learners in grades 10-12 with mean age of 18.8±1.73 years was undertaken. Data were collected using a self-administered questionnaire which was designed to collect demographic information and risky behaviour practices. The study found that overwhelming proportion (86%) of the participants were sexually active; and of these, 3.23% reported having their sexual debut at age 10. The results also reveal that 46.1% reported contracting sexually transmitted infections (STIs) which was far higher than the 2002 national average prevalence of 7.4%. In addition, only about 1 in 4 (24%) participants discussed sexual issues with their parents/guardians. Reproductive health promotion programmes should be intensified in schools especially among rural learners with strong parents and community involvement. [ABSTRACT FROM AUTHOR]

Background: Fostering adolescents' communication on sexuality issues with their parents and other significant adults is often assumed to be an important component of intervention programmes aimed at promoting healthy adolescent sexual practices. However, there are few studies describing the relationship between such communication and sexual practices, particularly in sub-Saharan Africa. This study examined the relationships between adolescents' communication with significant adults and their condom use in three sites in this region. Methods: Data stem from a multi-site randomized controlled trial of a school-based HIV prevention intervention implemented in Cape Town and Mankweng, South Africa and Dar es Salaam, Tanzania. Only data from comparison schools were used. The design is therefore a prospective panel study with three waves of data collections. Data were collected in 2004 from 6,251 participants in 40 schools. Associations between adolescents' communication with adults about sexuality issues and their use of condoms were analysed cross-sectionally using analysis of variance, as well as prospectively using multiple ordinal logistic regression analysis. Results: Cross-sectional analyses showed that consistent condom users had significantly higher mean scores on communication (across topics and communication partners) than both occasional users and never-users, who had the lowest scores. After controlling for condom use at the first data collection occasion in each model as well as for possible confounders, communication scores significantly predicted consistent condom use prospectively in all three ordinal logistic regression models (Model R2 = .23 to .31). Conclusion: The findings are consistent with the assertion that communication on sexuality issues between adolescents and significant adults results in safer sexual practices, as reflected by condom use, among in-school adolescents. The associations between communication variables and condom use might have been stronger if we had measured additional aspects of communication such as whether or not it was initiated by the adolescents themselves, the quality of advice provided by adults, and if it took place in a context of positive adult-adolescent interaction. Studies with experimental designs are needed in order to provide stronger evidence of causality. [ABSTRACT FROM AUTHOR]

How might we understand young men’s sexual embodiment at school? This article is concerned with the body as a site for the intersection of masculinities and sexualities at school. In a bid to contribute to existing narrative analyses of young men’s sexualities in educational contexts, this research employs visual methods in order to “picture” these intersections. Findings are drawn from an exploratory study in two secondary schools, where photo diaries and photo elicitation were undertaken with twenty-two students aged sixteen to eighteen years. It is argued that, the idea of boys as “sexy bodies,” that is, bodies that are experienced and viewed as sexual, is missing. This omission occurs in two ways; as a focus for school-based research and as an understanding of young men’s schooled experience. Through an analysis of enfleshed bodies captured by photo methods, the ways in which male sexuality is corporeally manifested as active, desiring, heteronormative and “sexy” are explored. [ABSTRACT FROM PUBLISHER]

Recently, a phenomenon known as sexting, defined here as the transfer of sexually explicit photos via cell phone, has received substantial attention in the U.S. national media. To determine the current and potential future impact of sexting, more information about the behavior and the attitudes and beliefs surrounding it must be gathered, particularly as it relates to sexting by minors. The present study was designed to provide preliminary information about this phenomenon. Participants were 606 high school students (representing 98 % of the available student body) recruited from a single private high school in the southwestern U.S. Nearly 20 % of all participants reported they had ever sent a sexually explicit image of themselves via cell phone while almost twice as many reported that they had ever received a sexually explicit picture via cell phone and, of these, over 25 % indicated that they had forwarded such a picture to others. Of those reporting having sent a sexually explicit cell phone picture, over a third did so despite believing that there could be serious legal and other consequences attached to the behavior. Given the potential legal and psychological risks associated with sexting, it is important for adolescents, parents, school administrators, and even legislators and law enforcement to understand this behavior. [ABSTRACT FROM AUTHOR]

Objective: To investigate on relationship among family environment, pornography and sexual behavior of adolescents. Pornography may start from early youth along with starting of sexual behavior. Therefore it is important that the role of family factors in pornography be studied. Materials and methods: The sample includes 362 students who were chosen by Proportional Cluster method from the first grade of High School (14 and 15 years old). The research instruments were Schaefer's Family Environment Scales (FES), a researcher made Sexual Behaviors Scale (SBS), and Pornography Scale (PS). Results: The results indicate that there is a positive significant relationship between sexual Behaviors Scale (SBS) and pornography and there is a positive significant relationship between levels of coldness in family relationship and adolescents' Freedom. Also the result of stepwise regression shows, in the first step, level of sexual behavior is the strongest variable that predicts .42 of variance of adolescent's pornography. In the second step, Coldness in family relationship determines .05 of variances of pornography of adolescents. Gender differentiates shows that boys' pornography is more than for girls. Conclusion: Therefore coldness in family relationship is related with pornography and sexual behavior of adolescents. [ABSTRACT FROM AUTHOR]

It is known that sexual maturation is dependent on genetic and environmental factors and socio-economic status. The purpose of this study was to describe secondary sexual characteristics of stunted and non-stunted black South African boys from a low socio-economic status living in a township in the North West Province. A total of 129 boys aged 12 to 16 years participated in the study. Height and weight were measured according to the standard protocol suggested by the International Society of Kinanthropometry, and secondary sexual maturation on voice changes, pubic hair and genital stage development were assessed by Tanner stage questionnaire. The results show an increasing height and weight with age among the boys. Furthermore, the results show that the non-stunted boys reached pubertal development earlier than the stunted boys, which starts first with sign of voice breaking at age 13.04(SD2.90) years followed by pubic hair and genital development. In conclusion, the boys were at a less developed pubertal stage compared to boys of a similar age in other studies and stunted boys tended to be at an even earlier development stage than non-stunted boys of a similar age. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the relation between self-esteem and sexual risk taking behavior (non-condom use, early sexual experience, early pregnancy, diverse sexual partners, AIDS and other STDs) on adolescents living in Aracaju. The sample was composed of 159 adolescents, including boys and girls, high school students from two large public schools. Participants were 57.9% female, aged between 14-23 (M= 17.19; SD=1.47). The instrument was adapted from "Juventude Brasileira" study, and it was composed of multiple choices, Likert itens and Rosenberg's self-esteem scale. Results showed that 55.8% have already had sexual experience and 83.3% use condom regularly. Bivariate analyses suggests that the higher their self-esteem, the lower is the chance of early sexual experience and less sexual behavior using drugs (χ²=7.137; p=0.028). Data suggests sexual behavior changes and a positive self-esteem effect upon early debut. [ABSTRACT FROM AUTHOR]

Background: Understanding the full range of sexual behaviors of young people is crucial in developing appropriate interventions to prevent and control sexually transmitted infections including HIV. However, such information is meager in developing countries. The objective of this study was to describe oral and anal sex practices and identify associated factors among high school youth. Methods: A cross-sectional study was conducted among high school youth in Addis Ababa, Ethiopia. A multistage sampling procedure was followed to select a representative sample of school youth. The total sample size for this study was 3840. Data were collected using a self-administered questionnaire. Data analysis was guided by the ecological framework. Results: The overall proportion of people who reported ever having oral sex was 5.4% (190) and that of anal sex was 4.3% (154). Of these 51.6% (98) had oral sex and 57.1% (87) had anal sex in the past 12 months. Multiple partnerships were reported by 61.2% of the respondents who had oral sex and 51.1% of students practicing anal sex. Consistent condom use was reported by 12.2% of those practicing oral sex and 26.1% of anal sex. Reasons for oral and anal sex included prevention of pregnancy, preserving virginity, and reduction of HIV and STIs transmission. Oral sex practice was strongly and significantly associated with perception of best friends engagement in oral sex (AOR = 5.7; 95% CI 3.6-11.2) and having illiterate mothers (AOR = 11.5; 95%CI 6.4-18.5). Similarly, anal sex practice was strongly and significantly associated with favorable attitude towards anal sex (AOR = 6.2; 95%CI 3.8-12.4), and perceived best friends engagement in anal sex (AOR = 9.7; 95%CI 5.4-17.7). Conclusion: Considerable proportion of adolescents had engaged in oral and anal sex practices. Multiple sexual partnerships were common while consistent condom use was low. Sexual health education and behavior change communication strategies need to cover a full range of sexual practices. [ABSTRACT FROM AUTHOR]

Over 5,000 adolescents enrolled in required rural high school health courses reported their perceptions of mastery and extrinsic goal structures in their health classrooms. Data were collected from all students at three time points (prior to HIV and pregnancy instruction, 3 months after instruction, and 1 year after instruction). Results indicated that classroom goal structures were related to both proximal and distal knowledge, attitudes, intentions, and efficacy beliefs. Results in particular indicate that the perception of a mastery goal structure in health education classrooms fosters knowledge, improved attitudes, enhanced efficacy beliefs, and lower intentions to have sexual intercourse. [ABSTRACT FROM AUTHOR]

In this qualitative study, we examine whether male high school coaches could effectively serve as advocates or educators for male-focused programs to prevent sexual aggression. We conduct open-ended key informant individual and focus group interviews with high school coaches and administrators. The five themes the authors identified suggest that coaches (a) believe they have influences over athletes, (b) lack education about sexual aggression, (c) endorse rape myths, (d) minimize the problem of sexual aggression, and (e) are resistant to being engaged in sexual aggression prevention. Our results reveal that coaches may need in-depth training on sexual aggression even if they do not want to engage in prevention efforts because they may be transmitting values and beliefs that support and condone sexual aggression of their athletes. [ABSTRACT FROM PUBLISHER]

The present study tested associations between common developmental contexts (relationship involvement, independent living, college attendance, work) and risky sexual behavior (casual sex, inconsistent condom use, high-risk sex) across the 2 years following high school. Data were drawn from the Raising Healthy Children project, and included 801 participants aged 18-21 years. Longitudinal analyses, which controlled for early sexual debut, high school substance use, and high school grades, showed that living with a parent was protective against all three sexual risk behavior outcomes (ORs about 0.70). Being in a romantic relationship was associated with a lower probability of casual sex, but a higher probability of inconsistent condom use. Attending college was associated with a lower probability of high-risk sex (OR = 0.67). Working was not related to the sexual risk behaviors examined. Levels of sexual risk behavior showed little change across the 2 years following high school. Findings from this study suggest that developmental context may affect young adults' engagement in risky sexual behavior. Programs aimed at promoting sexual health and reducing risk behaviors for STIs among young adults should consider targeting those in romantic relationships, those not living with parents, and those not attending college. Further, to develop effective prevention programs for these targeted youth, it is critical that we understand the mechanisms leading to risky sex in these groups. [ABSTRACT FROM AUTHOR]

Based on semistructured interviews with a racially and ethnically diverse sample of 58 U.S. high school students, this study examines teens’ exposure to contraceptive information from a range of sources and the extent to which they trust this information. Teens report exposure to contraceptive information from many individuals and places, most commonly school, family, and friends. Few teens rely on the Internet for contraceptive information, and most are wary of this source. The authors identify two themes that characterized teens’ discussions: wariness about hormonal methods, and the compatibility of contraception and abstinence messages. The findings suggest ways that schools, a common and trusted source of sexual health information for teens, could better improve students’ access to accurate contraceptive information. [ABSTRACT FROM AUTHOR]

A qualitative evaluation explored the experiences and perceived benefits of students who participated in an abstinence-plus sex education program at enrollment and conclusion. The sample included 1130 inner-city high school students, 73.7% of whom were Hispanic. Thematic analysis was used to identify main themes in responses made by students to 3 open-ended questions. The most common preparticipation request was for information about sexually transmitted infections. At program conclusion, the most common response theme involved the quality of course delivery. Students indicated that they appreciated the facilitators who allowed open conversations. The implications of these findings to sex education programs are discussed. [ABSTRACT FROM AUTHOR]

The aim of this study was to examine characteristics of precoital sexual behaviors and types of sexual contact in adolescent. A representative sample of 4,456 Spanish high school students participated. These participants were selected by means of a stratified random sampling procedure. They completed a questionnaire about their sexual behaviour. It is a cross-sectional survey study. Differences according to age and gender in characteristics of sexual behaviour before the onset of sexual intercourse were found. Compared to females, males started non penetrative sexual experiences earlier, had a higher number of sexual partners and a higher percentage of males reported having had casual sexual partner. This study not only adds to knowledge about sexual behaviour before the initiation of sexual intercourse among adolescents, it also highlights the importance of developing sexual prevention strategies for young adolescents. [ABSTRACT FROM AUTHOR]

Associations between romantic views and sexual behavior were examined in a community sample of 200 high school adolescents. This study incorporated interview and self-report measures of romantic views, assessed multiple facets of sexual behavior (frequency, rapidity, onset, and risky behavior), and examined light nongenital, heavy nongenital, and genital sexual behaviors. Avoidant romantic views were related to later onset of genital sexual behavior and less frequent sexual behavior, particularly light and heavy nongenital behaviors. Anxious views were related to more frequent sexual behavior and more risky behavior. Direct effects were found between avoidant views and light and heavy nongenital sexual frequency, and indirect effects were found between avoidant views and genital frequency, onset of heavy nongenital and genital sexual behavior. [ABSTRACT FROM AUTHOR]

Background: Considering the importance of sexual drive among teenagers, parental and societal concerns about teenagers' sexual drives, particularly in religious communities such as Iran is of practical importance; therefore, this present research was designed to study students' sources of sexual knowledge acquisition. Methods: This research was carried out among 2600 high school students in the cities of Tabriz, Urmia, and Ardabil in Northwest Iran. Students were selected through a multi-staged randomized sampling method in Tabriz and by the convenience method in Ardabil and Urmia. The instrument was a self-administered questionnaire, which included 19 different resources. The resources were categorized into seven main groups and the results were statistically analyzed with SPSS version 11.5 software. Results: Based on the mean score of each of the seven main groups of resources, the ranking order of the resources was as follows: 1) immediate friends and peers 2) pictures, magazines, and books 3) audiovisual (CDs, foreign movies, satellite programs, and the Internet) 4) school trainings 5) physicians, clergy, and counseling centers 6) family (parents and siblings) and 7) close family members. The differences between the resources were statistically significant (P value= 0.0001). Conclusion: Results of the present study emphasize that teenagers should be educated in different areas of sexual problems with the help of parents, schools, and official sources and centers in the society as confident sources of obtaining sexual knowledge. There is a need to prepare a codified educational curriculum in different levels in order to offer teenagers' sexual education in the form of books or specific school credits. [ABSTRACT FROM AUTHOR]

BACKGROUND: The importance of school contextual effects on health and well-being among young people is currently recognized. This study examines the contextual effects of school satisfaction as well as the effects of individual-level school satisfaction on health-risk behaviors in Japanese high school students. METHODS: Self-administered questionnaires were distributed to 3248 students in grades 10 through 12 at 29 public high schools throughout Okinawa, Japan. Using multilevel logistic regression models, the effects of individual- and contextual-level school satisfactions on health-risk behaviors were analyzed. The contextual-level school satisfaction was defined as satisfaction at the school level and was measured using aggregated individual scores. Behaviors studied included current smoking, current drinking, and sexual activity. RESULTS: Approximately 15%, 6%, and 5% of the total individual differences in smoking, drinking, and sexual behaviors, respectively, occurred at the school level. Students with lower school satisfaction were more likely to engage in health-risk behaviors compared with those with higher school satisfaction. After adjustment for individual-level school satisfaction and other covariates, the odds of smoking and drinking increased with decreasing contextual-level school satisfaction. However, the association of contextual school satisfaction with sexual activity did not reach statistical significance. CONCLUSIONS: This study showed that individual- and contextual-level school satisfactions affected smoking and drinking behaviors in Japanese high school students. However, no significant association between contextual-level school satisfaction and sexual activity was observed. [ABSTRACT FROM AUTHOR]

The paper is mainly based in two ethnographic studies which describe how high school students live their youth and their sexuality in two different contexts: natives youngsters in rural communities and youngsters in a high school placed in Mexico City. These studies assume that school is, above all, a place of youthful encounter, particularly of encounter with the other gender. The identity of the youngsters and the representations of the worlds of love and sexuality are built in practice, in the encounter with the "other" and its reflection. [ABSTRACT FROM AUTHOR]

This study was aimed at determining the influence of household chumship on premarital sexuality of senior secondary school students in Rivers State. A survey data collected from a sample of 1000 senior secondary school two students were used for the study. The one way analysis of variance (ANOVA) was used in testing the hypothesis at 0.05 level of significance. The results obtained showed a significant influence of household chumship on the particular area of coition, and not in the particular areas of peripheral premarital sexual activities and overall sexuality. The pattern of significant influence of household chumship on coital premarital sexuality is explored using Fisher's least significant difference (LSD) post hoc pair wise multiple comparison analysis. The results showed that students with low level of involvement in household chumship and those with moderate level are both significantly more involved in coital premarital sexuality than students with high level of involvement in household chumship. It was recommended among others that high family closeness in the form of robust sibling relationship be encouraged. [ABSTRACT FROM AUTHOR]