Nicole M. Fava

Adolescent Girls’ Assessment and Management of Sexual Risks: Insights From Focus Group Research

We conducted focus groups with girls ages 14 to 17 (N = 43) to study how the dominant discourse of sexual risk shapes young women’s understanding of the sexual domain and their management of these presumably pervasive threats. Through inductive analysis, we developed a coding scheme focused on three themes: (a) types of sexual risk, (b) factors that moderate sexual risk, and (c) strategies for managing sexual risk. Collectively, participants identified many risks but distanced themselves from these by claiming that girls’ susceptibility is largely a function of personal factors and therefore avoidable given the right traits, values, and skills. We consider this reliance on other-blaming and self-exemption, as well as instances in which individual participants diverged from this group discourse, in the context of neoliberalism.

Young Women's Experiences and Perceptions of Cunnilingus during Adolescence

Recent studies indicate that cunnilingus may be as prevalent as fellatio among American adolescents. Despite this approximate equivalence in rates, there is an imbalance in the amount and type of attention paid to fellatio and cunnilingus. Furthermore, there has been little empirical examination of young womens experiences and perceptions of cunnilingus during adolescence. Two studies in response to this gap in knowledge were conducted. In Study 1, regression analyses indicated that a young womans sexual assertiveness was linked to having more lifetime cunnilingus partners, as well as more cunnilingus experiences in the past three months. Study 2 explored young womens perceptions of cunnilingus and their speculations about their male partners’ perceptions thereof. Linear mixed modeling revealed that participants had highly favorable impressions of cunnilingus, which they believed their male partners shared. These findings are considered in terms of positive adolescent sexual development and cultural norms regarding female sexuality.

Patient-Centered Communication and Health Assessment With Youth

Background:Patient-centered communication is fundamental to individualizing healthcare, but there has been limited evaluation of provider communication with youth. Objectives:The aim was to compare communication outcomes after use of an event history calendar (EHC) and Guidelines for Adolescent Preventive Services (GAPS) to structure interactions during a clinic visit. Patient and provider descriptions of EHC and GAPS communication experiences were also obtained. Methods:This is a secondary analysis of data obtained during a randomized controlled trial. A sequential explanatory mixed-methods approach was used. A split-plot design with one between factor (EHC, GAPS) and one within factor (pretest, posttest) was used for the quantitative portion. Qualitative data were collected from open-ended questions, audiotaped visits, and exit interviews. Providers (n = 9) at three clinics were assigned at random and trained to implement either the EHC or GAPS protocol. Male and female youth (n = 186) were randomly assigned to the EHC or GAPS intervention. Before their clinic visit, youth completed assessments of past communication experiences with healthcare providers (pretest); communication during the current visit was assessed immediately after the visit (posttest). Results:Communication outcomes from pretest to posttest improved for youth in both the EHC and GAPS groups. Post hoc subgroup analysis suggested that men and Arab Americans derived more benefit from the EHC intervention in some aspects of communication. Qualitatively, the EHC group identified improved outcomes in validating patient perspective, being viewed in context, reaching a shared understanding of needs and preferences, and being helped to share power in the healthcare interaction. Discussion:EHC and GAPS provided effective frameworks for structuring communication during a clinic visit. Compared with GAPS, the integrated time-linked assessment captured by the EHC enhanced patient-centered communication in select groups.

Trauma-informed sexuality education: recognising the rights and resilience of youth

Experiences of maltreatment during childhood and the emergence of sexuality during adolescence are both critical developmental issues that intersect in meaningful ways, yet the two are often isolated from each other in practice. Despite the prevalence of childhood maltreatment, sexuality education does not accommodate young people with trauma histories. This results in curricula and content that ignore the particular needs and experiences of a proportion of students in sexuality education classrooms. Trauma interventions commit a similar oversight by neglecting the prospects for positive, growth-promoting sexual experiences and relationships among young people who have been abused. The failure to account for young peoples resilience in the sexual domain results in treatment approaches that emphasise sexual risks (e.g. revictimisation) and problem behaviours to the exclusion of guidance in cultivating positive sexualities. Consequently, many forms of sexuality education and maltreatment interventions may be of limited effectiveness and relevance in promoting the future sexual well-being of young people with histories of trauma. To redress this gap, we advocate for trauma-informed sexuality education, an approach that acknowledges past experiences of abuse, the promise of resilience, and young peoples right to positive sexualities.

Young women's adolescent experiences of oral sex: Relation of age of initiation to sexual motivation, sexual coercion, and psychological functioning

Research examining oral sex during adolescence tends to investigate only potential negative consequences without considering its place in sexual development or distinctions between cunnilingus and fellatio. Using retrospective reports from 418 undergraduate women, we examined the relations among young womens ages of initiation of both cunnilingus and fellatio and sexual motives, experiences of sexual coercion, and indicators of psychological functioning. Age at cunnilingus initiation was unrelated to sexual coercion or psychological functioning; however it was related to engaging in sex for personal stimulation and gratification (personal drive motive) and to feel agentic, assertive, and skillful (power motive). Age at fellatio initiation was related to feelings of inferiority compared to others and a devaluing of the self (interpersonal sensitivity). Findings challenge the unilateral assumption that all adolescent sexual activity is negative and indicate the need for future research distinguishing between cunnilingus and fellatio.

Sex differences in the development of mild cognitive impairment and probable Alzheimer’s disease as predicted by hippocampal volume or white matter hyperintensities

ABSTRACT This study examined biological sex differences in the development of mild cognitive impairment (MCI) and probable Alzheimer’s disease (AD) development as predicted by changes in the hippocampus or white matter hyperintensities. A secondary data analysis of the National Alzheimer’s Coordinating Center Uniform Data Set was conducted. We selected samples of participants with normal cognition at baseline who progressed to MCI (n = 483) and those who progressed to probable AD (n = 211) to determine if hippocampal volume or white matter hyperintensities (WMH) at baseline predicted progression to probable AD or MCI and whether the rate of progression differed between men and women. The survival analyses indicated that changes in hippocampal volumes affected the progression to probable AD (HR = 0.535, 95% CI [0.300–0.953]) only among women. White men had an increased rate of progression to AD (HR = 4.396, CI [1.012–19.08]; HR = 4.665, 95% CI [1.072–20.29]) compared to men in other race and ethnic groups. Among women, increases in hippocampal volume ratio led to decreased rates of progressing to MCI (HR = 0.386, 95% CI [0.166–0.901]). Increased WMH among men led to faster progression to MCI (HR = 1.048. 95% CI [1.011–1.086]). Women and men who were older at baseline were more likely to progress to MCI. In addition, results from longitudinal analyses showed that women with a higher CDR global score, older age at baseline, or more disinhibition symptoms experienced higher odds of MCI development. Changes in hippocampal volumes affect the progression to or odds of probable AD (and MCI) more so among women than men, while changes in WMH affected the progression to MCI only among men.

Positive and negative posttraumatic change following childhood sexual abuse are associated with youths' adjustment

Meanings made of childhood sexual abuse (CSA) experiences are important to psychosocial adjustment. The current study examined adolescents’ and young adults’ perceptions of posttraumatic change (PTC) in the self, relationships, sexuality, and worldviews attributed to prior CSA experiences. We sought to document the prevalence of positive and negative PTC and examine their unique and joint associations with psychosocial adjustment. Participants included 160 youth with confirmed cases of CSA (73% female; 8–14 years at abuse discovery) who were part of a longitudinal study of the long-term effects of CSA. Six years after discovery, youth were interviewed about their abuse experiences. Interviews were coded for the valence and strength of PTC. The majority of youth reported PTC, and negative changes were more frequent and stronger than positive changes. Controlling for age, gender, abuse severity, and negative PTC, positive PTC was associated with lower abuse stigmatization for all youth. Controlling for age, gender, abuse severity, and positive PTC, negative PTC was associated with greater abuse stigmatization, post-traumatic stress disorder, sexual problems, and dating aggression for all youth. Relations of positive PTC with depression and support from friends and romantic partner were moderated by negative PTC, such that positive PTC was associated with better adjustment for youth with low versus high levels of negative PTC. Results highlight the importance of both negative and positive PTC for understanding meanings made of CSA experiences and their implications for psychosocial adjustment and intervention.

Patient-Centered Participatory Research in Three Health Clinics Benefits, Challenges, and Lessons Learned

Research informed by individuals’ lived experiences is a critical component of participatory research and nursing interventions for health promotion. Yet, few examples of participatory research in primary care settings with adolescents and young adults exist, especially with respect to their sexual health and health-risk behaviors. Therefore, we implemented a validated patient-centered clinical assessment tool to improve the quality of communication between youth patients and providers, sexual risk assessment, and youths’ health-risk perception to promote sexual health and reduce health-risk behaviors among adolescents and young adults in three community health clinic settings, consistent with national recommendations as best practices in adolescent health care. We describe guiding principles, benefits, challenges, and lessons learned from our experience. Improving clinical translation of participatory research requires consideration of the needs and desires of key stakeholders (e.g., providers, patients, and researchers) while retaining flexibility to successfully navigate imperfect, real-world conditions.

A resilience framework: Sexual health trajectories of youth with maltreatment histories

ABSTRACT There is a wealth of knowledge regarding negative sexual outcomes experienced by youth with childhood maltreatment (CM) histories, yet a dearth of research examines healthy sexual development among these youth. This gap exists despite evidence of resilience highlighting alternative and healthy physical, social, and psychological futures for youth who were abused. This study tested whether trajectories of resilience identified in studies of psychological functioning were applicable to sexual health. Using data from the first four waves of the National Longitudinal Study of Adolescent to Adult Health, latent class growth analysis was conducted among individuals with histories of CM (N = 1,437). On average, participants were 15, 16, 21, and 28 years old, respectively, by waves of data collection. About half of the sample was female (55%), the majority were White (66%), and a sizeable portion had experienced multiple forms of CM prior to Wave I (38%). Controlling for CM severity, three distinct sexual health trajectory classes were identified: resilient, survival, and improving, which were differentiated by age and biological sex. Older participants’ sexual health was more likely to diminish over time, girls were more likely to show gains in sexual health over time, and significant differences in levels of sexual behaviors between the classes were only present during adolescence. Findings support the need for increased attention on the potential for sexual health despite experiences of CM, and highlight the applicability of resilience theory to youth sexuality.

What are we missing? Risk behaviors among Arab-American adolescents and emerging adults

BACKGROUND AND PURPOSE Research on Arab-Americans as a distinct ethnic group is limited, especially when considering the health of Arab-American youth. This study describes health risk (substance use, violence); health promotive behaviors (hope, spirituality); and sexual activity (oral, vaginal, anal sex) of Arab-American adolescents and emerging adults (aged 15-23) within their life context, as well as the association between these behaviors. METHODS A secondary analysis of data on a subset of Arab-American participants obtained from a randomized-control trial was utilized to conduct mixed methods analyses. Qualitative analyses completed on the open-ended questions used the constant comparative method for a subsample (n = 24) of participants. Descriptive quantitative analyses of survey data utilized bivariate analyses and stepwise logistic regression to explore the relation between risk behaviors and sexual activity among the full sample (n = 57). CONCLUSIONS Qualitative analyses revealed two groups of participants: (a) multiple risk behaviors and negative life-events, and (b) minimal risk behaviors and positive life-events. Quantitative analyses indicated older youth, smokers, and those with higher hope pathways were more likely to report vaginal sex. IMPLICATIONS FOR PRACTICE The unique cultural and social contexts of Arab-American youth provide a framework for recommendations for the prevention of risk behaviors.