Exploring the Influence of Romantic Relationship Communication on Adolescents' Self-Efficacy to Ask for Sexual Consent.

Adolescence represents a crucial period for sexual and romantic relationship development, and acquisition of skills and confidence essential for effective sexual consent communication. However, various barriers may interfere with adolescents' belief in their ability (i.e., their self-efficacy) to negotiate consent in practice. This study aimed to investigate the state of adolescents' self-efficacy to ask for consent and explore the influence of romantic relationship communication (a construct comprised of three characteristics: relationship assertiveness skills, positive conflict resolution, and communication awkwardness). Participants were 411 adolescents who had current or past relationships (61% girls, 77% Latine, 79% heterosexual). Participants generally reported above-average levels of self-efficacy to ask for consent (M = 4.14 out of 7, SD = 1.24), with LGBQ+ adolescents exhibiting statistically significantly higher levels of self-efficacy compared to heterosexual adolescents (M = 4.51 vs. 4.09, t = -2.66, p = .008). Self-efficacy to ask for consent was positively individually related to positive conflict resolution and relationship assertiveness skills, and negatively related to communication awkwardness (all ps < .001). In a path model, romantic relationship communication displayed a statistically significant association with adolescents' self-efficacy to ask for consent, with high positive conflict resolution, low communication awkwardness, and high relationship assertiveness skills being associated with higher self-efficacy to ask for consent. Findings suggest improving adolescents' romantic communication skills may enhance their self-efficacy to ask for consent, and contribute to increased rates of sexual consent communication. Intervention strategies should target multiple levels of influence to promote positive consent cognitions, behaviors, and cultural norms.

PACT: Developing and Evaluating a Digital Sexual Consent Program for Youth.

Understanding affirmative sexual consent is crucial for violence prevention and health promotion, yet few adolescents receive adequate consent education. The current study aimed to evaluate the acceptability and preliminary efficacy of a brief online program designed to teach adolescents information and skills about communicating and interpreting affirmative sexual consent (PACT: Promoting Affirmative Consent among Teens) in a randomized controlled trial with a national sample of 833 U.S. adolescents (ages 14-16; 42% White, 17% Asian, 17% Black, 13% Latinx; 53% girls, 31% boys, 12% non-binary; 45% heterosexual; 29% sexually active). PACT, grounded in health behavior change and persuasion theories, was developed using feedback from youth advisors and usability testers. Participants considered the program generally acceptable. Compared to youth who completed a control program, PACT was efficacious at shifting three measures of affirmative consent cognitions (i.e., knowledge, attitudes, self-efficacy) from baseline to immediate posttest. Youth who completed PACT also demonstrated more accurate affirmative consent knowledge at 3 months post-baseline. PACT's effects on consent cognitions were generally similar among youth with various gender, racial/ethnic, and sexual identities. We discuss next steps for this program, including the possibilities of expanding to include additional concepts and tailoring to address the unique needs of specific youth.

Evaluation of a Brief Online Sexual Health Program for Adolescents: A Randomized Controlled Trial.

Adolescents are at increased risk of acquiring sexually transmitted infections (STIs) and experiencing unintended pregnancy. In particular, adolescents from marginalized communities experience significant sexual health disparities compared to their more advantaged peers. Digital sexual health programs, such as HEART (Health Education and Relationship Training), may be effective in reducing these risks and addressing these disparities. HEART is a web-based intervention focused on the promotion of positive sexual health outcomes, such as sexual decision-making skills, sexual communication skills, sexual health knowledge, and sexual norms and attitudes. The current study evaluates the efficacy of HEART, and examines whether effects were moderated by gender, socioeconomic status (SES), race, English as a second language, and sexual orientation to ensure the program is effective for diverse groups of adolescents. Participants were 457 high school students (Meanage=15.06, 59% girls, 35% White, 78% heterosexual, 54% receive free or reduced-price lunch). Students were randomized to HEART or an attention matched control and assessed at pretest and immediate posttest. HEART was effective in increasing sexual assertiveness, sexual communication intentions, HIV/STI knowledge, condom attitudes, and safer sex self-efficacy compared to the control condition. There were no significant interactions by gender, SES, race, English as a second language, or sexual orientation, suggesting the program worked equally well for all groups of youth. The findings of this study suggest that HEART may be a promising avenue for the promotion of positive sexual health outcomes for diverse groups of youth.

How We Get Free: Graduate Training as an Opportunity for Equitable Participation and Liberation.

In this conceptual article, we assert that psychology should be transformed to adopt the explicit goal of working toward the liberation of people oppressed by society rather than striving for mere equality. To achieve such a transformation, it is necessary to reenvision graduate training in psychology. Graduate training in psychology is an important vehicle by which psychologists can become prepared to use research and practice to eradicate inequities in society. Therefore, we propose six pillars for liberation-focused graduate training in psychology: critical unlearning/unknowing, cooperative modes of production, prioritizing indigenous knowledge, embedded interdependence, systems-level action, and prioritizing members of oppressed groups. Although this conceptualization may engender resistance, we argue that there are many potential pathways by which graduate training may use liberation psychology to work equitably with oppressed groups to seek justice.

Internal Consent, Affirmative External Consent, and Sexual Satisfaction Among Young Adults.

Sexual satisfaction is an important part of sexual health. Recently, efforts have been underway to better understand what factors contribute to positive sexual experiences among young adults. One factor may be sexual consent. This study aimed to explore individual and interactive effects of two distinct, but related dimensions of sexual consent - internal consent and affirmative external consent - on young adults' feelings of sexual satisfaction following their most recent sexual intercourse experience. Participants were 294 young adults (ages 18-25, Mage = 23.7; 59% women) recruited from Amazon's MTurk. Results showed that each dimension of consent had a significant, unique relationship with satisfaction, and that the two dimensions of consent alone accounted for half of the variance in satisfaction. Additional analyses showed that there are specific components of both internal and affirmative external consent (e.g., safety/comfort; arousal; consent/want; communicator/initiator cues) that may be most influential in driving this relationship. As both consent dimensions greatly contribute to positive sexual experiences, researchers attempting to promote sexual wellbeing may be wise to attend to both internal and external consent.

Examining the efficacy of STD testing public health messages tailored to youth's regulatory focus.

Only 25% of sexually active youth have ever been tested for sexually transmitted diseases (STDs). One potential strategy to increase testing is to target youth with health messages tailored to their regulatory focus. People have a dominant regulatory focus and tend to be either more concerned with the risks of unhealthy choices (prevention-focused) or the benefits of healthy choices (promotion-focused). Theoretically, when someone is targeted with a message that matches their regulatory focus, the message will be more effective. Among 380 sexually active youth, we examined whether matching STD testing messages to youth's regulatory focus strengthens the efficacy of the message for improving STD testing stigma, self-efficacy, and intentions. We evaluated participants' regulatory focus and then assigned them to watch either a prevention-focused or promotion-focused video encouraging STD testing. Among prevention-focused youth, those who watched the prevention-focused video had more stigmatizing attitudes toward STD testing than those who watched the promotion-focused video. Post hoc analyses confirmed the robustness of these findings for our stigma outcome and revealed a similar pattern for self-efficacy: youth who were more prevention-focused and received the prevention-focused video had lower STD testing self-efficacy. Our results for testing intentions were not significant. Interventionists should consider making STD testing messages for youth promotion-focused. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Is Regulatory Focus Related to Condom Use, STI/HIV Testing, and Sexual Satisfaction?

Regulatory focus theory contends that when making decisions people are either more inclined to focus on avoiding negative consequences (more prevention-focused) or achieving pleasurable outcomes (more promotion-focused). Some research suggests that regulatory focus is related to health behaviors, although this has not been thoroughly investigated in the sexual health domain. The purpose of this study was to examine the relationship between regulatory focus (prevention, promotion) and sexual health. In an online survey of 409 youth from the U.S. (ages = 18-25; Mage = 23.5; 57.2% women; 74.1% White, 13.4% Asian, 10.5% Black, 9.8% Hispanic), we examined the relationship between regulatory focus and three sexual health outcomes: condom use, STI/HIV testing, and sexual satisfaction. Of youth in our sample, 31.8% had a dominant prevention-focus, while 54.8% had a dominant promotion-focus. Compared to youth who were more promotion-focused, more prevention-focused youth used condoms more frequently but reported less sexual satisfaction. No differences were found in rates of STI/HIV testing. This study lays the groundwork to investigate the dynamic role that regulatory focus may play in contributing to youths' sexual health. More experimental and longitudinal studies are needed to confirm the causal nature of the association between regulatory focus and sexual health.

Social self-efficacy and sexual communication among adolescents in the United States: a cross-sectional study.

Background Sexual communication between partners is associated with safer sex behaviours, including condom use among adolescents. Several studies have found a relationship between negative psychological constructs (e.g. depression, anxiety) and poor sexual communication; however, scant research exists regarding positive psychological constructs and their potential to promote effective sexual communication among adolescents. This study examined the association between a positive construct, social self-efficacy - a person's belief in their ability to successfully manage social relationships - and three components of sexual communication: sexual assertiveness, self-efficacy for communication, and frequency of sexual communication with dating partners. METHODS: Data were collected in a cross-sectional survey from 222 high school girls in a rural school district in the south-eastern United States (Mage = 15.2; 38% White, 29% Latina, 24% Black; 50% were in a dating relationship in the past 3 months). Variables were measured with Likert-type scales. Bivariate correlation and regression analyses were conducted. RESULTS: Social self-efficacy was significantly positively associated with sexual assertiveness and sexual communication self-efficacy for all girls, and there was a positive trend in the relationship between social self-efficacy and communication frequency among the subsample of girls who had a dating partner. The significant relationship with sexual assertiveness (ß = 0.22, s.e. = 0.07, P = 0.001) and sexual communication self-efficacy (ß = 0.17, s.e. = 0.04, P = 0.013) remained when controlling for sexual activity status. CONCLUSIONS: Strengthening social self-efficacy may enhance girls' sexual communication and assertiveness skills. Future studies are needed to confirm the causal and temporal nature of these associations.

Redeveloping a Digital Sexual Health Intervention for Adolescents to Allow for Broader Dissemination: Implications for HIV and STD Prevention.

HIV/STDs and unintended pregnancy persist among adolescents in the United States; thus, effective sexual health interventions that can be broadly disseminated are necessary. Digital health interventions are highly promising because they allow for customization and widespread reach. The current project involved redeveloping and expanding HEART (Health Education and Relationship Training)-a brief, digital sexual health intervention efficacious at improving safer sex knowledge, self-efficacy, and behavior-onto an open-source platform to allow for greater interactivity and accessibility while reducing long-term program costs. The authors describe the process of adapting, reprogramming, and evaluating the new program, which may serve as a guide for investigators seeking to adapt behavioral interventions onto digital platforms. The final product is an open-source intervention that can be easily adapted for new populations. Among 233 adolescents (Mage = 15.06; 64% girls), HEART was highly acceptable and generally feasible to administer, with no differences in acceptability by gender or sexual identity.

Preliminary Evaluation of a Prescription Opioid Misuse Prevention Program Among Rural Middle School Students.

Adolescent opioid misuse, addiction, and overdose have emerged as national health crises. Nearly 17% of high school students have misused prescription opioids. The purpose of this study was to evaluate the reach and acceptability of a widely-used prescription opioid misuse prevention program, This Is (Not) About Drugs© (TINAD), and its preliminary efficacy at improving opioid misuse knowledge, opioid misuse attitudes, self-efficacy to avoid opioid misuse, and intentions to misuse opioids. Participants were 576 7th grade students (Mage = 11.8; 51% boys; 39% Hispanic, 31% White, 20% Black) from a rural county in the southeastern U.S. All participants received the TINAD program and completed pretest and immediate posttest assessments. The program was school-based and implemented in collaboration with school teachers and administrators. Over 91% of all eligible students in the school district participated in the TINAD program. Most participants found the program acceptable-over 83% of students liked the program. Approximately 9% of participants reported prior misuse of prescription opioids. After participating in TINAD, students self-reported higher knowledge and self-efficacy as well as safer attitudes. However, there was no change in intentions to misuse opioids in the future. Effects of the program were consistent across gender, socioeconomic status, race/ethnicity, and previous opioid misuse. TINAD is acceptable and shows promise for improving opioid-related cognitions. However, more rigorous experimental and longitudinal research is needed to understand whether TINAD reduces opioid misuse over time. Given the limited research on adolescent opioid misuse prevention, this study lays the ground work for future randomized control trials.

Sexual Health Programs for Latinx Adolescents: A Meta-analysis.

CONTEXT: Latinx adolescents are at risk for negative sexual health outcomes, and many interventions have been developed to reduce this risk. OBJECTIVE: In this meta-analysis, we synthesized the literature on sexual health interventions for Latinx adolescents and examined intervention effects on 3 behavioral outcomes (abstinence, condom use, number of sex partners) and 3 psychological outcomes (safer sex knowledge, intentions, self-efficacy). Moderators of intervention success were explored. DATA SOURCES: A systematic search of studies published through January 2019 was conducted by using PubMed, PsycINFO, and Cumulative Index to Nursing and Allied Health Literature databases. STUDY SELECTION: All studies included a US-based sample of Latinx adolescents, evaluated sexual health intervention by using an experimental or quasiexperimental design, included a behavioral outcome, and were in English. DATA EXTRACTION: Standardized mean difference (d) and 95% confidence intervals (CIs) were meta-analyzed by using random-effects models. RESULTS: Effect sizes from 12 studies, sampling 4673 adolescents, were synthesized. Sexual health interventions improved abstinence (d = 0.15, 95% CI: 0.02 to 0.28), condom use (d = 0.44, 95% CI: 0.18 to 0.70), number of sex partners (d = -0.19, 95% CI: -0.37 to -0.001), and sexual health knowledge (d = 0.40, 95% CI: 0.10 to 0.70), compared with control conditions. Effects were consistent across a number of demographic and clinical characteristics, although culturally tailored interventions produced greater change in condom use than nontailored interventions. LIMITATIONS: There was variation across studies in measures of sexual behavior, and some elements of individual study quality were unclear. CONCLUSIONS: Sexual health interventions have a small but significant impact on improving safer sexual behavior among Latinx adolescents. Health educators should consider the importance of cultural tailoring to program success.

Association of Sexual Health Interventions With Sexual Health Outcomes in Black Adolescents: A Systematic Review and Meta-analysis.

Importance: Black adolescents are at increased risk of contracting HIV and other sexually transmitted infections (STIs) and experiencing unplanned pregnancy. Although sexual health interventions aimed at decreasing these risks exist, evidence of the association between sexual health interventions and the sexual behavior of black adolescents has not been synthesized to our knowledge. Objective: To examine the associations between sexual health interventions and behavioral, biological, and psychological outcomes. Data Sources: For this systematic review and meta-analysis, a systematic search was conducted of studies published through January 31, 2019, using the PubMed, PsycINFO, and CINAHL databases and relevant review articles. The following key words were used: youth, adolesc* or teen*; sexual health or safe* sex or sexually transmitted disease or sexually transmitted infection or STD or STI or HIV or AIDS or pregnancy or reproductive health or condom* or contracept* or unprotected sex or abstinence; intervention or program or education or prevention or promotion or trial; latino* or latina* or latinx* or minorit* or ethnic* or hispanic or african american* or black* or race or racial or biracial. Study Selection: Studies were included if they included a US-based sample of black adolescents, evaluated a sexual health intervention using experimental or quasi-experimental designs, included a behavioral outcome, and were published in English. Data Extraction and Synthesis: Standardized mean differences and 95% CIs were extracted and meta-analyzed using random-effects models. Main Outcomes and Measures: Behavioral outcomes were abstinence, condom use, and number of sex partners. Biological outcomes were pregnancy and STI contraction. Psychological outcomes were sexual health intentions, knowledge, and self-efficacy. Results: Across 29 studies including 11 918 black adolescents (weighted mean age, 12.43 years), there was a significant weighted mean association of sexual health interventions with improvements in abstinence (Cohen d = 0.14; 95% CI, 0.05-0.24) and condom use (Cohen d = 0.25; 95% CI, 0.11-0.39). No significant mean association of these interventions with number of sex partners, pregnancy, or STI contraction was found. Sexual health interventions were significantly associated with improvements in psychological outcomes: sexual health intentions (Cohen d = 0.17; 95% CI, 0.05-0.30), knowledge (Cohen d = 0.46; 95% CI, 0.30-0.63), and self-efficacy (Cohen d = 0.19; 95% CI, 0.09-0.28). Intervention effect sizes were consistent across factors, such as participant sex and age and intervention dose. Conclusions and Relevance: The findings suggest that sexual health interventions are associated with improvements in sexual well-being among black adolescents. There appears to be a need for wide-scale dissemination of these programs to address racial disparities in sexual health across the US.

Understanding Adolescents' Attitudes Toward Affirmative Consent.

A clear understanding of sexual consent is important for sexual violence prevention. To date, most research has focused on how college students understand and negotiate consent. Although adolescence is a critical period for the development of sexual attitudes, identity, and intimate relationships, the perspectives of high school-aged youth have been largely absent from the consent literature. The current study investigated adolescents' attitudes toward affirmative consent in a sample of 226 high school students (58% female; 46% White, 24% Black, 25% Hispanic) from the southeastern U.S., as well as associations between affirmative consent attitudes and gender, gender role beliefs, and sexual activity status. Additionally, we tested whether gender role beliefs were a mediator between gender and affirmative consent attitudes. Overall, adolescents reported supportive attitudes toward affirmative consent. On average, girls and adolescents with more egalitarian gender role beliefs had more positive attitudes toward affirmative consent than boys and those with less egalitarian gender role beliefs, though no differences by sexual activity status were found. Gender role beliefs mediated the relationship between gender and attitudes toward affirmative consent. The results suggest that adolescents are generally supportive of affirmative consent practices, although some important group differences emerged.

Assessment of Parent-Based Interventions for Adolescent Sexual Health: A Systematic Review and Meta-analysis.

IMPORTANCE: Parent-based sexual health interventions have received considerable attention as one factor that can increase safer sexual behavior among youth; however, to our knowledge, the evidence linking parent-based interventions to youth sexual behaviors has not been empirically synthesized. OBJECTIVE: To examine the association of parent-based sexual health interventions with 3 primary youth outcomes-delayed sexual activity, condom use, and parent-child sexual communication-as well as several secondary outcomes. We also explored potential moderators of intervention effectiveness. DATA SOURCES: A systematic search was conducted of studies published through March 2018 using MEDLINE, PsycINFO, Communication Source, and CINAHL databases and relevant review articles. STUDY SELECTION: Studies were included if they: (1) sampled adolescents (mean age, ≤18 years), (2) included parents in a key intervention component, (3) evaluated program effects with experimental/quasi-experimental designs, (4) included an adolescent-reported behavioral outcome, (5) consisted of a US-based sample, and (6) were published in English. DATA EXTRACTION AND SYNTHESIS: Standardized mean difference (d) and 95% confidence intervals were computed from studies and meta-analyzed using random-effects models. A secondary analysis evaluated potential moderating variables. MAIN OUTCOMES AND MEASURES: The primary outcomes were delayed sexual activity, condom use, and sexual communication. RESULTS: Independent findings from 31 articles reporting on 12 464 adolescents (mean age = 12.3 years) were synthesized. Across studies, there was a significant association of parent-based interventions with improved condom use (d = 0.32; 95% CI, 0.13-0.51; P = .001) and parent-child sexual communication (d = 0.27; 95% CI, 0.19-0.35; P = .001). No significant differences between parent-based interventions and control programs were found for delaying sexual activity (d = -0.06; 95% CI, -0.14 to 0.02; P = .16). The associations for condom use were heterogeneous. Moderation analyses revealed larger associations for interventions that focused on younger, compared with older, adolescents; targeted black or Hispanic youth compared with mixed race/ethnicity samples; targeted parents and teens equally compared with emphasizing parents only; and included a program dose of 10 hours or more compared with a lower dose. CONCLUSIONS AND RELEVANCE: Parent-based sexual health programs can promote safer sex behavior and cognitions in adolescents, although the findings in this analysis were generally modest. Moderation analyses indicated several areas where future programs could place additional attention to improve potential effectiveness.