Theoretical frameworks suggest that romantic relationship satisfaction may influence sexual communication self-efficacy, which involves the confidence to discuss personal sexual health goals and plays a key role in HIV prevention among partnered adolescent males who have sex with males (MSM). The current study examined romantic relationship satisfaction as a correlate of sexual communication self-efficacy in a sample of partnered adolescent MSM. Participants (n = 50) completed self-report measures including romantic relationship satisfaction and sexual communication self-efficacy. Domains of sexual communication self-efficacy included: sexual history, contraception, condom negotiation, negative sexual messages, and positive sexual messages. Multivariable linear regression models were conducted to examine study aims. Relationship satisfaction was positively associated with self-efficacy in communicating about sexual history, contraception, and negative and positive sexual messages, with effect sizes ranging from moderate to large. These findings shed light on pathways often assumed in HIV intervention programs, emphasizing how romantic relationships are associated with adolescents' confidence in discussing sexual health with partners. Interventions aiming to improve sexual communication may be more effective if they include content on enhancing romantic relationship satisfaction.

Although studies suggest that young adults with spina bifida (YASB) often avoid important daily activities (ADL) due to urinary (UI) and fecal (FI) incontinence, no research has prospectively examined how often ADL avoidance occurs, or the context in which it occurs. In this paper, we used ecological momentary assessment (EMA) over 30 days to describe: 1) the frequency of avoidance; 2) the activities YASB most commonly avoid; and 3) preliminary association of daily avoidance with affect, incontinence anxiety and health-related quality of life (HRQoL). As part of a larger 30-day prospective study designed to understand the incontinence in adults with SB (N = 89), participants completed an end-of-day EMA tracking daily ADL avoidance on days when they were worried about possible UI or FI and on days when they had actual UI or FI. Additional day-level measures were: affect and incontinence anxiety. HRQoL was reported in beginning- and end-of-study surveys. We drew a subsample of YASB participants (18-27 years; N = 23 of total 88 participants). ADL avoidance was most frequent with actual FI (20.5%) and least frequent with worry about FI (3.5%, p = 0.02) (UI worry: 8.3; actual UI: 8.9%, p = 0.546). The most common ADL avoided were eating, drinking and spending time with family/friends. Negative mood and incontinence anxiety were significantly higher on days with all types of avoidance. Higher baseline HRQoL was associated with fewer in-study ADLs avoided, which were in turn associated with higher end-of-study HRQoL. Our data suggest that YASB avoid key activities of daily living (e.g., eating, drinking, seeing family/friends) both when they worry about possible incontinence that may but does not occur, and when they experience actual incontinence. Tailored interventions addressing actual incontinence and worry about possible incontinence incorporating daily mood or incontinence anxiety may minimize ADL avoidance and its impact on long-term HRQoL.

Objective: Urinary and bowel incontinence are common in young adults with spina bifida and may affect emotional functioning and health-related quality of life. Prospective data describing day-level incontinence experiences in this population are limited. This study used ecological momentary assessment to characterize daily variability in urinary and bowel incontinence and to examine associations with mood, incontinence-related anxiety, and health-related quality of life. Methods: In a 30-day ecological momentary assessment study of adults with spina bifida and recent incontinence, young adults with spina bifida (n = 23; ages 18–26) completed 643 end-of-day assessments. Daily measures included urinary and bowel incontinence frequency, amount, dry intervals, management independence, activity avoidance, positive and negative mood, and incontinence-related anxiety. Health-related quality of life was assessed at study completion. Analyses were exploratory and used nonparametric methods appropriate for ordinal and intensive repeated measures data. Results: Urinary incontinence was reported on 54.1% of study days and bowel incontinence on 20.8%. For urinary incontinence, greater frequency, shorter dry intervals, larger amounts, and activity avoidance were associated with lower positive mood, higher negative mood, and greater urinary incontinence-related anxiety. For bowel incontinence, greater symptom severity, management dependence, and activity avoidance were associated with poorer mood and higher bowel incontinence-related anxiety. Multiple day-level incontinence characteristics and daily emotional responses were associated with lower end-of-month health-related quality of life. Conclusion: In young adults with spina bifida, day-level incontinence burden is associated with same-day emotional functioning and longer-term health-related quality of life. These findings highlight the relevance of day-level symptom variability for rehabilitation assessment and individualized continence management.

INTRODUCTION:Common chronic health conditions associated with spina bifida (SB) may impact sexual health among adults in this population, including genital self-image (GSI), but no studies explore this topic. AIM:The primary aim of this study was to provide a preliminary psychometric assessment of the four-item Female Genital Self-Image Scale (FGSIS-4) and the five-item Male Genital Self-Image Scale (MGSIS-5) for use among adults with SB. A secondary aim was to describe the association of GSI with key demographic, health, and sexual experience characteristics. METHODS:An international online survey collecting background and clinical data was administered to adults with SB over 12 months. We assessed internal consistency, construct validity, and convergent validity for GSI. Bivariate regression was used to explore the individual associations of each variable with the FGSIS-4 and MGSIS-5. OUTCOMES:GSI was measured using the 4-item Female Genital Self-Image Scale (FGSIS-4) and the 5-item Male Genital Self-Image Scale (MGSIS-5); sexual function measures (sexual desire and overall satisfaction) from the Female Sexual Function Index and the International Index of Erectile Function; and health-related quality of life with Quality of Life Assessment in Spina Bifida for Adults. RESULTS:Participants (N = 217 women and N = 146 men) were primarily heterosexual and had a median partial-to-full college education. Half of all the participants were in a relationship and living independently. A third of both men and women were community ambulators, and a quarter of both reported full genital sensation. About half of the sample (women: 47.1%; men: 46.2%) reported clean intermittent catheterization (CIC). Both scales demonstrated good internal reliability (FGSIS-4: 0.845; MGSIS-5: 0.877) and a single-factor construct structure. Higher FGSIS-4 and MGSIS-5 scores correlated positively with sexual desire overall sexual satisfaction, health-related quality of life, and urinary continence but did not vary with using CIC. CLINICAL IMPLICATIONS:Because GSI negatively impacts sexual health and sexual function, clinicians treating patients with SB should consider discussing GSI as part of routine care. STRENGTHS AND LIMITATIONS:Although this research measured women's and men's GSI behavior in a large international sample of adults with SB, it is limited by its cross-sectional and retrospective design, as well as by its non-clinical convenience sample. CONCLUSION:The FGSIS-4 and MGSIS-5 show preliminary desirable psychometric properties for the measurement of GSI in the SB population.

Background:Urinary (UI) and fecal (FI) incontinence are prevalent secondary chronic conditions among young adults with spina bifida (YASB). UI and FI decrease daily functioning for YASB, but no research has prospectively examined characteristics of UI and FI among YASB. We used ecological momentary assessment (EMA) over 30 days to describe the prevalence, episode-specific characteristics and negativity associated with UI and FI among a cohort of YASB. Method:Data were collected as part of a larger 30-day EMA study prospectively examining the daily prevalence and context of UI and FI in adults with SB. We drew an analytic sample of young adults (YASB) participants aged 18-27 years (N=23 [26.1% of all study-participants [N=88];). Participants completed an end-of-day EMA tracking the frequency, dry intervals, volume, activity avoidance, management, positive and negative mood, current UI (UIA) or FI (FIA) anxiety, past UIA and FIA and past number of UI or FI events. Results:YASB contributed a 643 daily EMAs. Nearly 60% (370/643) of all daily entries was associated with a general report of incontinence (UI: 54.1% [348/643]; FI: 20.8% [134/643]). Prevalence, characteristics and negativity associated with UI and FI varied significantly from day-to-day. Higher UI frequency, shorter dry intervals, greater UI volume, needing management help, avoiding activities because of UI, higher past median UIA, higher negative mood and fewer past UI events were associated with higher daily UIA. Shorter FI dry intervals, higher past median FIA, higher negative mood and fewer past FI events were associated with higher daily FIA. Discussion:Day-to-day experiences of UI and FI vary among adults with SB across multiple dimensions. Negativity about incontinence when it occurs varies not only based on individual- and episode-specific characteristics, but also on incontinence in the preceding days. Operationalizing these insights into potential clinical interventions warrants further investigation. Discussion and Implications:Young people with SB (YASB) experience day-to-day differences in the characteristics of urinary (UI) and fecal (FI) incontinence (e.g. frequency, self-management) events and the way they felt (e.g. affect) about UI and FI. The unique relationship of these factors to UI and FI anxiety suggest novel potential points of intervention.

PURPOSE:While adolescent exposure to school gun violence (SGV) incidents in the United States (U.S.) has risen sharply over the past decade, limited research has examined adolescent worries about SGV. We examined the frequency and correlates of SGV worry in a U.S. nationally representative sample of adolescents. METHODS:Data were from adolescent participants (14-17 years; N = 1,017) in the 2022 National Survey of Sexual Health and Behavior, a nationally representative study of sexual health experiences of people in the U.S. SGV worry was a single five-point item (not at all worried - extremely worried). We used both weighted descriptive statistics to examine SGV frequency and random intercept mixed effects ordinal regression to examine demographic and background impact on SGV worry. RESULTS:Nearly 75% of adolescents reported some degree of SGV worry; of these, one in five was very or extremely worried. SGV worry was significantly higher for adolescents in younger grades and among racial/ethnic minority youth, as well as for cisgender female and gender minority teens. Adolescents in higher income homes were less worried about SGV. Both teens living in metropolitan locations and teens who reported higher anxiety in the past 2 weeks noted higher SGV worry. DISCUSSION:The U.S. adolescents have a significant level of worry about SGV. Because there are detrimental long-term impacts of prolonged worry, targeted interventions are important for reaching those who are at greatest worry risk, including lower income, race/ethnic minority, and gender minority teens.

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

Background No studies have evaluated the day-to-day variations in urinary incontinence (UI) and fecal incontinence (FI) among adults with spina bifida (SB). We aimed to 1) describe variations in UI/FI over 30 days, 2) assess factors associated with anxiety about incontinence, and 3) correlate anxiety about incontinence and health-related quality of life (HRQOL) among adults with SB (exploratory). Methods Adults with SB participated in a larger 30-day smartphone-based ecological momentary assessment (EMA) study of well-being and incontinence. We analyzed baseline demographics, temporal variables (baseline UI/FI, incontinence, and anxiety on days prior), and incontinence episode-specific variables (number of daily episodes, incontinence interval, quantity). Urinary and fecal incontinence- related anxiety (UIA/FIA) was measured on a 5-point Likert scale ("How anxious were you because of urine/stool leaks today?"), HRQOL with QUALAS-A (scores range 0-100, 0 = lowest HRQOL). Mixed- effects, random intercept ordinal and linear regression was used. Results Eighty-nine adults participated at a median age of 33 years old (71 % female, 53 % shunted, 49 % community ambulators). Participants contributed 2578 total diary days: 61 % were associated with any incontinence (41 % UI only, 6 % FI only, 13 % both). Eighty-two (92 %) adults reported UI on a median of 16 days, but experiences varied: 6 % had a single episode, while 33 % had UI on 28-30 days (Summary Figure). Seventy adults (79 %) reported FI on a median of 5 days, less frequently than UI (p < 0.001), but experiences varied: 11 % had a single FI episode, while 31 % had FI on 10 or more days. Fewer participants reported any UIA than FIA (50 % vs. 72 %, respectively, p < 0.001). On multivariate regression, (1) higher UIA was reported by individuals with higher baseline UIA, higher UIA on days prior, multiple daily episodes and higher UI quantity (p < 0.02), while (2) higher FIA was reported by those with lower baseline HRQOL, fewer FI episodes on days prior, higher FIA on days prior, and higher UI quantity (p < 0.02). FIA was correlated with lower end-of-study HRQOL (p = 0.03). Discussion Instances of incontinence are not uniform experiences. Their effects vary with factors beyond the actual episode. This suggests novel potential points of intervention to improving long-term HRQOL among people with incontinence. Conclusion Day-to-day experiences of UI and FI vary among adults with SB across multiple dimensions. Anxiety about incontinence when it occurs varies not only based on individual- and episode-specific characteristics, but also on incontinence in the preceding days. Operationalizing these insights into potential clinical interventions warrants further investigation.

Rough sex behaviors have become prevalent among young adults in the U.S. and internationally. However, little is known about these behaviors at the population level. Using nationally representative survey data of 9029 U.S. adults, we aimed to provide population estimates and demographic correlates of 10 such behaviors: consensual and nonconsensual hair pulling, biting, face slapping, genital slapping, light spanking, hard spanking, choking, punching, name-calling, and smothering. We found that 47.8% of women, 60.8% of men, and 67.3% of transgender and gender nonbinary participants (TGNB+) had ever done one or more of the behaviors to a partner. Also, 53.8% of women, 45.7% of men, and 69.5% of transgender and gender nonbinary participants reported that a partner had ever performed at least one type of the assessed behaviors on them, with consent. Experiencing one or more of the behaviors done to them without consent was reported by 19.6% of women, 15.9% of men, and 33.5% of TGNB+ participants. As a general pattern, the behaviors we assessed tended to be more prevalent among younger cohorts as compared with older cohorts and to be reported by more sexual orientation minorities than those identifying as heterosexual. Sexuality educators and clinicians need to be aware of these emerging sexual behaviors. Also, public health agencies should address the increased prevalence of sexual choking, which is usually done as a form of neck compression or strangulation and poses unique risks to health.

Vaginal squirting is a phenomenon in which women expel fluid during the sexual response process, but it remains poorly understood in the extant literature. The study purpose was to use nationally representative data to investigate adult women's experiences with vaginal squirting. We assessed the prevalence of women who have ever squirted in their lifetime, the level of pleasure and concurrency of orgasm women reported during squirting, the ways in which women discovered squirting, and the challenges and/or concerns women experience with squirting. Forty percent of U.S. adult women (M = 47.6 years, SD = 16.8; Md = 24 years) had ever squirted in their lifetime (Md frequency = three to five times). Two thirds of women reported unintentional discovery of squirting, and most (75%) used specific techniques to promote build up and release of squirting versus squirting spontaneously. About 60% of participants reported squirting to be very or somewhat pleasurable, but only 20% "always" experienced squirting and orgasm together. Women reported different challenges with squirting, such as the time required to reach squirting or the experience being too emotionally intense. Our findings contribute to the growth of much needed, detailed literature on the ways in which women discover and enjoy squirting as part of their sexual lives. Knowledge of these techniques can enable women to better identify their own preferences, communicate about them with their partners, and advocate for their sexual pleasure.

Research suggests that adolescents and adolescents and young adults with spina bifida (AYASB) find chronic SB-associated health conditions like urinary (UI) or fecal (FI) incontinence to generally bothersome. However, no studies evaluate specifically how different features of incontinence - such as frequency, volume or activity interference – may impact AYASB daily well-being. Because UI and FI are lifelong conditions, these data could support well-being focused interventions across the lifespan.

We used nationally representative data to describe the impact of worrying about school gun violence (SGV) on the mental health of adolescents and young adults (AYA). Prior research links mental health outcomes to family closeness (FC) and social media activity (SMA). We explore these factors as potential modifiers to understand SGV's impact on AYAs. Data were collected from the 2022 National Survey of Sexual Health and Behavior (NSSHB). The NHSSB is an online probability survey nationally representative of the U.S. population studying individuals' behaviors from ages 14 to 75+. The analytic sample includes 1,653 respondents, 17.0% of the total sample [N=9674]) and focuses on adolescents 14-17 (N=1,011) and young adults (YAs) 18-26 (N=642). Design weights account for population traits and nonresponse. Demographic variables: age (14-17/ 18-26 [ref]), gender (male/ female [ref]), sexual orientation (heterosexual/sexual minority (SM) [ref: LGBTQ+]), and race/ethnicity (majority, minority[ref]). Outcome measures were SGV worry (single, 5-point item, not at all worried - very worried); SMA (multiple platforms, 6-point item, not at all - multiple times per day; FC (affective index; closeness to parents/guardians, siblings, and other members, not very close - very close); Combined mental health variable from three questions: symptom frequency (4-point item, never - yes<30 days), overall mental health assessment (5-point item, excellent - poor), and life happiness (3-point item, very happy - not too happy). In Stata (18.0; all p<.05), we employed weighted generalized structural equation modeling (GSEM) to examine 1) the direct association of demographics on SGV worry, 2) the direct association of SGV worry and mental health, and 3) the potential modifying effects of FC and SMA associated with the demographics, SGV worry, and mental health. Approximately 74% of AYAs expressed concerns about SGV. Findings show minorities (B: 0.729, p<0.000) and females (B: 0.573, p<0.000) exhibit higher concerns regarding SGV. Increased SGV worry was significantly associated with elevated anxiety symptoms (B: 0.240, p<0.000). FC became a significant factor, with proximity to family indicating reduced anxiety (B: -0.299, p<0.000) and depression (B: -0.333, p<0.000). FC mitigates SGV worry (B: 0.092, p<0.034). However, SMs (B: -0.585, p<0.000) and YAs (B: -0.415, p<0.000) reported lower levels of FC. Increased SMA was linked to elevated anxiety (B: 0.040, p<0.000) and depression (B: 0.033, p<0.001). Females (B: 1.525, p<0.001) and YAs (B: 2.14, p<0.000) demonstrate higher SMA. Lastly, SMA also increases SGV worry (B: 0.021, p<0.018). Young adults and sexual minorities have increased worries about school gun violence, contributing to increased anxiety. Family closeness is a buffer, lowering anxiety and depression levels, while social media activity amplifies them. Targeted interventions should prioritize reducing heightened school gun violence concerns among young adults and sexual minorities, as these worries contribute to elevated mental strain.

Aim This study, wave 2 of the International Sexual Health and Reproductive Health (I-SHARE) study, aims to explore the prevalence and correlates of online harassment in 10 countries including low- and middle-income countries. Subject and methods Data were collected through the I-SHARE-2 survey from March 2021 to July 2022, in 10 countries ( N = 2860) during the COVID-19 pandemic. Results Overall, 30% of participants reported that they believed online harassment was happening more frequently than before COVID-19; 20% of participants reported having received unsolicited advances, 17% reported having received unsolicited obscene images or videos, and 7% reported that someone had shared a photo or video of them doing something humiliating or embarrassing without permission. This perceived increase in online harassment during the pandemic was potentially due to more online behavior amid lockdowns. A mixed-effects logistic regression revealed that people identifying as gender/sexual minority, people with worse economic situations, and people living in a country with lower gender inequality had higher odds of experiencing online harassment. Conclusion These results align with prior research, emphasizing the vulnerability of minorities to online harassment. Our study findings have implications for the development of interventions to decrease online harassment.

BACKGROUND:Naloxone is critical for reversing opioid-related overdoses. However, there is a dearth of research examining how naloxone possession and carriage are impacted by time-varying individual and social determinants, and if this differed during the height of the COVID-related mitigation measures (e.g., shutdowns). METHODS:We utilized weekly ecological momentary assessments (EMA) to measure factors associated with naloxone possession and carriage among 40 people who use illicit opioids in New York City, for 24 months. Descriptive statistics were used to explore the frequency of weeks with consistent naloxone possession and carriage. Mixed effects binary and multivariable logistic regression was used to test for the impact of time-varying EMA- and baseline-level factors on each outcome. RESULTS:Approximately 70% of weekly EMAs were associated with consistent naloxone possession or carriage. In multivariable models, compared to during the height of the COVID-related shutdowns (March 12, 2020-May 19, 2021), the time before was associated with lower odds of consistent possession (Odds Ratio (OR) = 0.05, 95% Confidence Interval (CI) = 0.01-0.15) and consistent carriage (OR = 0.06, CI = 0.01-0.25). Additionally, being female (OR = 11.15, CI = 2.85-43.42), being White versus being Black or Hispanic/Latinx (OR = 8.05, CI = 1.96-33.06), and lifetime overdose (OR = 1.96, CI = 1.16-19.80) were associated with higher odds of consistent possession. Recent opioid injection (OR = 3.66, CI = 1.34-9.94), being female (OR = 7.91, CI = 3.91-8.23), and being White (OR = 5.77, CI = 1.35-24.55) were associated with higher odds of consistent carriage. Not wanting to be perceived as a drug user was reported in nearly one third (29.0%; 190/656) of EMAs where inconsistent possession was reported. CONCLUSIONS:Our findings paint a relatively positive picture of possession and carriage during COVID-related shutdowns, particularly among white and female participants, and highlight the importance of capturing time-varying factors to understand naloxone-related behavior. To curb growing disparities, outreach to equip Black and Hispanic/Latinx people with naloxone is needed as well as interventions to reduce stigma as a barrier to naloxone engagement.

The loss of a federal legal right to abortion care in the United States has reduced adolescent and young adult (AYA) agency to manage their own reproductive health decisions, particularly in States with more restrictive laws. Emerging digital technology – including AI conversational chatbots – could ensure AYA access to important State-specific information about abortion, such as availability, parental requirements or financial assistance. Existing studies have evaluated chatbot efficacy in providing public health information, but not examined them in the context of abortion access.