Barker, D., Houck, C .D., Bala, K., Donenberg, G., & Brown, L. K. (2019). Emotional context as an influence on sexual decision-making among adolescents with mental health symptoms.

This study sought to identify patterns of emotions reported by adolescents proximal to sexual decisions, such as whether to have sex or utilize a condom. Data were from two clinical trials of sexual risk prevention programs for adolescents with mental health concerns. Both trials asked participants about distinct emotions prior to their last vaginal or anal sexual event, some of which were condom protected, and their last perceived sexual opportunity in which they decided not to have sex, for a total of 1343 reported events. The study identified six distinct emotional profiles prior to these events:

  • No Emotion profile, in which adolescents denied experiencing any of the emotions on the survey prior to an event (n=369 participants)
  • Low Emotion profile, in which adolescents described “a little” of all the emotions (n=270 participants)
  • Mid-Emotion profile, in which adolescents endorsed the midpoint of the scale for all the emotions (n=62 participants)
  • Positive Emotion profile, in which adolescents reported mostly positive emotions (e.g., happy, excited, proud) (n=390 participants)
  • Anxious/Negative Emotion profile, in which adolescents reported feeling scared and nervous, with little positive emotion and moderate levels of negative emotions (n=95 participants)
  • Anxious/Positive Emotion profile, in which adolescents reported feeling scared in combination with positive emotions (n=139 participants)

Positive emotions in the moments before a sexual decision were associated with deciding to have sex (VAS) across age and gender. Higher ratings of curiosity was associated with fewer sexual events. In addition, the absence of positive emotions, whether described as an undefined emotional experience (profiles none, low, mid) or the presence of negative emotions (profiles anxious/negative, anxious/positive), was more likely to be associated with an unused sexual opportunity compared to a sexual experience for both males and females and for younger and older youth. Among younger adolescents, feeling lonely was associated with vaginal or anal sex events. Emotions were not useful in predicting condom use in this study. Results suggest that adolescents perceive different emotional experiences prior to having vaginal or anal sex compared to deciding not to have sex when the opportunity was available.

Kendall, A. D., Young, C. B., Emerson, E. M., Freels, S., & Donenberg, G. R. (2019). Do improvements in externalizing symptoms protect against sexually transmitted infections? Results from a mother-daughter STI prevention program for African-American girls.

This study examined whether the evidence-based program IMARA, which is a group-based mother-daughter intervention designed to address the interrelated issues of mental health and sexual risk taking among African-American adolescent girls. This study specifically looked at whether the improvement of girls’ mental health would contribute to the protective effect of this program in preventing future sexually transmitted infection (STI). Participants received either the IMARA program or a control program that focused on health promotion (e.g., nutrition, exercise, violence prevention). The IMARA program was designed to address several factors that can lead to STI risk, including mental health problems. For example, mothers and daughters engaged in a “feelings thermometer” exercise where they learned to identify the effects of their own “hot” (i.e., very strong) emotions on their decision-making and risk behaviors. Daughters then developed personalized plans to bring “hot” emotions into the “cool” (i.e., less intense) zone. Results showed that participants who entered the program with high externalizing symptoms (e.g., aggression, poor impulse control) and who received the IMARA program, showed significantly reduced symptoms at their 6-month follow up and these participant results were still present at the one-year follow up. However, in this study the results did not show any impact of the IMARA program on internalizing behaviors (e.g., anxiety, depression). Among girls with a high baseline of externalizing symptoms who provided STI data, the risk of contracting a new STI by 12 months was on average 42% lower for those who participated in IMARA than the control group. This study provides valuable preliminary evidence for linking the potential of improving externalizing symptoms as a way to promote STI prevention.

Lantos, H., Moreau, C., & Hughes, M. E. (2019). Associations between experiences of community violence and sexual risk-taking in Baltimore: An analysis of the WAVE Study.

This study examined the relationship between perceived community violence — including fear of and witnessing violence — and sexual activity (including condom use) among teenagers in Baltimore, Maryland. The data from these analyses came from the Well-Being of Adolescents in Vulnerable Environments (WAVE) Study, which sought to understand the health and determinants of health among urban adolescents ages 15 to 19 living in low-income neighborhoods. While experiencing community-level violence in Baltimore is common for adolescents, the types of exposures to community violence are diverse and go beyond just direct victimization (i.e., directly experiencing an act of violence) to include fear of violence and witnessing violence. In this study, it was found that girls who reported a fear of violence and having witnessed violence were significantly more likely to engage in sexual intercourse over the last year, and those who were victimized were more likely to have used condoms. Boys who reported a fear of violence were less likely to have engaged in sexual activity whereas boys who witnessed violence were more likely to have engaged in sexual intercourse and where also less likely to have used condoms. Fear of violence seems to have a role distinct from witnessing violence or experiencing direct victimization. The results suggest that exposures to different forms of violence are related to unprotected intercourse and may put adolescents at risk for negative sexual health outcomes.

Song, W., & Qian, X. (2019). Adverse childhood experiences and teen sexual behaviors: The role of self-regulation and school-related factors.

This study examined whether individual and cumulative ACEs (adverse childhood experiences) increased the risk of unhealthy sexual behaviors and adolescent pregnancy. Participants included 9th and 11th grade students who completed the 2016 Minnesota Student Survey. The six ACEs studies were: psychological abuse, physical abuse, sexual abuse, parent or other household member substance abuse, witnessing intimate partner violence, and incarcerated parent or household member. In the sample, 65 percent of the students reported experiencing zero ACEs, 19 percent reported experiencing one ACE, 9 percent reported experiencing two ACEs, and 7 percent reported experiencing three or more ACEs. The study found that, for each category of adverse childhood experience, adolescents who had experienced that ACE were more likely than those who did not experience that ACE to initiate sex, have multiple sex partners, unprotected sex, and be involved in a pregnancy. Experiencing sexual abuse was most strongly associated with reporting sexual risk behaviors or pregnancy. Different youth assets, including self-regulation skills, connectedness to school, not skipping school, and academic performance, were linked to participants being less likely to initiate sexual activity and less likely to report sexual risk-taking. They served as important mechanisms in reducing the negative effects of ACEs on sexual initiation and adolescent pregnancy. These study results suggest that programs that focus on strengthening adolescent’s self-regulation, encouraging school connectedness, improving school engagement and performance may lessen the strong impact of ACEs on adolescent sexual risk behaviors and pregnancy.