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The Nature of Peer Sexual Health Communication among College Students Enrolled in a Human Sexuality Course

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Title: The Nature of Peer Sexual Health Communication among College Students Enrolled in a Human Sexuality Course
Language: English
Authors: Porter, Andrew, Cooper, Spring, Henry, Myrthle, Gallo, Jennifer, Graefe, Beck
Source: American Journal of Sexuality Education. 2019 14(2):139-151.
Availability: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
Peer Reviewed: Y
Page Count: 13
Publication Date: 2019
Document Type: Journal Articles
Reports - Research
Education Level: Higher Education
Postsecondary Education
Descriptors: Peer Relationship, Sexuality, Sex Education, Values, Student Attitudes, Undergraduate Students, Interpersonal Communication, Safety, Sexually Transmitted Diseases, Health Behavior, Pregnancy, Gender Differences, Sexual Orientation, Introductory Courses, Course Descriptions, Rape
DOI: 10.1080/15546128.2018.1529644
ISSN: 1554-6128
Abstract: Most young people go to their friends for information on sexuality-related topics, thus it is important to understand the context of these communications so that we may gather insight into sexual values and the underlying emotions and styles of communication. We conducted qualitative weekly surveys regarding discussion of sexual health topics among peers with students enrolled in an undergraduate human sexuality course. A four-stage inductive analysis process was utilized to examine a total number of 824 survey submissions from 102 college students who agreed to participate. Seven relevant common themes emerged: safer sex, sexually transmitted infections, pregnancy, feelings about sex, sexual acts, peer support, and peer communication norms. Some perspectives varied between males and females. Life events create opportunities for peers to discuss sexual health with each other. The connection between life events and peer sexual health communication has numerous implications for both research and education.
Abstractor: As Provided
Entry Date: 2019
Accession Number: EJ1214341
Database: ERIC
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  Value: <anid>AN0136149624;[1h2p]01apr.19;2019May02.05:00;v2.2.500</anid> <title id="AN0136149624-1">The nature of peer sexual health communication among college students enrolled in a human sexuality course </title> <p>Most young people go to their friends for information on sexuality-related topics, thus it is important to understand the context of these communications so that we may gather insight into sexual values and the underlying emotions and styles of communication. We conducted qualitative weekly surveys regarding discussion of sexual health topics among peers with students enrolled in an undergraduate human sexuality course. A four-stage inductive analysis process was utilized to examine a total number of 824 survey submissions from 102 college students who agreed to participate. Seven relevant common themes emerged: safer sex, sexually transmitted infections, pregnancy, feelings about sex, sexual acts, peer support, and peer communication norms. Some perspectives varied between males and females. Life events create opportunities for peers to discuss sexual health with each other. The connection between life events and peer sexual health communication has numerous implications for both research and education.</p> <p>Keywords: Sexual health; peer communication; emerging adults; sexuality; sexuality education</p> <p>There is a large body of evidence that supports the implementation of comprehensive sexuality education as part of the solution to decrease the incidence of sexually transmitted infection (STI) transmission and unplanned pregnancy among youth, but there are still questions about how to best communicate comprehensive sex and healthy relationship information to young people as well as how they communicate about reproductive and sexual health among themselves (APHA, [<reflink idref="bib1" id="ref1">1</reflink>]). This study examines the nature of peer communication to better understand the causes and content of sexual health discussions.</p> <p>Making up 21% of the population in the United States, adolescents (ages 10–19) and young adults (ages 20–24) are an important demographic to target in public health interventions (US Census Bureau, [<reflink idref="bib29" id="ref2">29</reflink>]). During these important developmental years, the behavioral patterns established largely determine young people's current health status as well as their risk for developing chronic and acute diseases in adulthood (Healthy People 2020, [<reflink idref="bib15" id="ref3">15</reflink>]). Of importance is learning healthy behaviors and creating healthy habits regarding reproductive and sexual health. The American Public Health Association (APHA) has asserted that all adolescents and young adults need "the knowledge, attitudes, and skills necessary to avoid HIV, other sexually transmitted infections (STIs), and unintended pregnancy so that they can become sexually healthy adults" (APHA, [<reflink idref="bib1" id="ref4">1</reflink>], para. 1).</p> <p>Adolescents and young adults are most at risk for STDs, HIV, intimate partner violence, sexual assault, and rape than any other age group. From 2014 to 2015 the rates of chlamydia, gonorrhea and syphilis increased significantly, with most reported cases of sexually transmitted diseases (STDs) occurring among 15–24 year-olds (CDC, [<reflink idref="bib9" id="ref5">9</reflink>]). Young people, especially young, gay or bisexual men of color, are most at risk for HIV (CDC, [<reflink idref="bib10" id="ref6">10</reflink>]). The overall incidence of HIV has decreased from 2005 to 2014, but that change has not been even across all groups. During this time, diagnoses rose by 24% among Hispanic/Latino gay and bisexual men; and 87% among young African American gay and bisexual men (HIV in the United States, 2016). Young women are most at risk for rape and sexual assault—more than three-quarters of female victims of rape were first raped before their 25th birthday (Black et al., [<reflink idref="bib5" id="ref7">5</reflink>]).</p> <p>Myths and misconceptions about sexuality and sexual health are common, specifically around: pregnancy, contraceptive effectiveness, side effects, symptoms of STIs, risk factors, and transmission of STIs (Buzi, Smith, & Barrera, [<reflink idref="bib8" id="ref8">8</reflink>]; Gillam, Warden, Goldstein, & Tapia, [<reflink idref="bib12" id="ref9">12</reflink>]; Guzzo & Hayford, [<reflink idref="bib14" id="ref10">14</reflink>]; Kaiser Family Foundation, [<reflink idref="bib18" id="ref11">18</reflink>]; Yee & Simon, [<reflink idref="bib34" id="ref12">34</reflink>]). These myths serve as threats to the reliability of information dispersed among youth.</p> <p>Despite the efforts of parents and educators, youth are most likely to go to their peers for sexual information regardless of their age, gender, or ethnicity (Bleakley, Hennessy, Fishbein, & Jordan, [<reflink idref="bib6" id="ref13">6</reflink>]; Martin & Mak, [<reflink idref="bib23" id="ref14">23</reflink>]). One of the reasons why young adults rely so heavily on peer knowledge/communication is that they tend to overrate their peers' sexual knowledge (Brandhorst, Ferguson, Sebby, & Weeks, [<reflink idref="bib7" id="ref15">7</reflink>]).</p> <p>Additionally, the source of sexual health information appears to have a strong influence on the sexual behavior of adolescents. For example, a study of 14–16 year olds found that sexual activity and the use of condoms was strongly influenced by their perceptions of their peers' sexual activity and condom use (Whitaker & Miller, [<reflink idref="bib33" id="ref16">33</reflink>]). A meta-analysis by van de Bongardt, Reitz, Sandfort, and Deković ([<reflink idref="bib30" id="ref17">30</reflink>]) found that perceived sexual activity of peers and positive peer attitudes toward sexual activity were correlated with increased sexual activity in adolescents. In addition, they found that adolescents who perceived their peers to engage in risky sexual behaviors were more likely to engage in risky sexual behaviors themselves.</p> <p>Early discussions with parents about sex seem to delay initiation of sexual activity when compared to adolescents who only discuss sexual information with their friends (Bleakley et al., [<reflink idref="bib6" id="ref18">6</reflink>]). However, young people report getting information about sex from their friends more frequently than from their mothers or fathers (Bleakley et al., [<reflink idref="bib6" id="ref19">6</reflink>]). Young people also find sexual health information on the Internet and share it through their social networks (Jones & Biddlecom, [<reflink idref="bib17" id="ref20">17</reflink>]; Selkie, Benson, & Moreno, [<reflink idref="bib27" id="ref21">27</reflink>]). When seeking sexual health information online, young people are more inclined to use anonymous web sites, where their identities can remain anonymous (Buzi, Smith, & Barrera, [<reflink idref="bib8" id="ref22">8</reflink>]; Wartella, Rideout, Montague, Beaudoin-Ryan, & Lauricella, [<reflink idref="bib32" id="ref23">32</reflink>]).</p> <p>Due to the influence of peer sexual communication on sexual health behavior, it is important to understand the content of peer communications (Trinh & Ward, [<reflink idref="bib28" id="ref24">28</reflink>]). Understanding young people's sexual values, underlying emotions, and styles of communication will provide insight into topics that need to be addressed through education. This study explores how students describe their experiences with peer sexual communication, which may provide opportunities to tailor sexual health education to address their specific needs.</p> <hd id="AN0136149624-2">Methods</hd> <p>This data was collected to help improve an introductory human sexuality course, which includes gender development, sexual orientation, reproduction, unintended pregnancy, sexually transmitted infections, sexual response, sexual assault, and safer-sex strategies. We conducted a qualitative weekly survey with undergraduate students enrolled in the course to explore how college students describe their experiences with peer sexual health communication and to determine whether course information was being distributed throughout the peer networks of course participants and thereby providing a benefit to a larger peer network. Later, when we wanted to analyze the results of the data for publication, the Institutional Review Board (IRB) approved the data set as exempt from IRB review because the data was completely anonymized by the course management system.</p> <p>During the Spring 2009 semester, all students enrolled in an introduction to human sexuality course were invited to complete a short anonymous weekly survey through ANGEL, an online course management system used to facilitate course assignments, communication, content, and grading. Students were awarded.5 points of extra credit for completing each survey and an additional 3 points for completing all the surveys. After demographic variables (age, sex, orientation, race) were retrieved, students were asked three open-ended survey questions. The first question was "Please describe the specific sexual health topics discussed with your peers last week," the second was "Please briefly describe the purpose of your discussions with your peers about these sexual health topics," and the third question was "Anything else?" The responses to the three open ended questions were grouped together to create a complete picture of the experience for each student. Students in the human sexuality course had 11 opportunities to fill out the survey during weeks 5 through 15 of the semester. ANGEL kept a tally of the number of times each student completed the survey, but kept no record of which students were associated with which responses.</p> <hd id="AN0136149624-3">Participants</hd> <p>A total number of 110 students were enrolled in the course at a mid-Atlantic public university. Of those enrolled, 102 students (57 women and 45 men) ranging in age from 18 to 25 years (<emph>M</emph> = 21.2 years, <emph>SD</emph> = 1.2 years) voluntarily completed the weekly survey at least once. While there were seven students who only completed one or two surveys, most students submitted 10 or 11 of the surveys. There were 824 submissions and the response rate was 74.3% for female students and 72.3% for male students.</p> <p>Most participants identified as White (<emph>n</emph> = 87), with the remainder identifying as Black or African American (<emph>n</emph> = 5), Asian or Pacific Islander (<emph>n</emph> = 5), Hispanic or Latino (<emph>n</emph> = 3), or with multiple racial identities (<emph>n</emph> = 2). The small percentage of non-White students limited our ability to detect any differences based on racial demographics.</p> <hd id="AN0136149624-4">Data analysis</hd> <p>We conducted a content analysis to examine how students described their experience with peer sexual health communication (Hsieh & Shannon, [<reflink idref="bib16" id="ref25">16</reflink>]). Data were extracted through ANGEL and imputed into SPSS and Excel. Data were analyzed using a four-stage inductive technique (Glaser & Strauss, [<reflink idref="bib13" id="ref26">13</reflink>]), which facilitated the identification of key categories and patterns in participants' responses over the 11-week period. An Excel spreadsheet was created, with a tab for each survey and each row representing one survey submission. Each response was read, and then coded with a few words or short phrases that summarized the topics, purpose, and emphasized elements. These codes included sexual health topics (e.g., "HPV vaccination," "using condom"), triggering conditions (e.g., "doctor's appointment," "boyfriend visit"), emotional states (e.g., "upset," "curious"), and other words or phrases that emerged.</p> <p>After clarifying codes, all submissions were reorganized by their common codes. Because each submission could have multiple codes, submissions were duplicated and placed in as many groups as needed. Each code was then reviewed to ensure that the submissions had enough in common to be grouped together. The codes were then placed together in a common category. Demographic information associated with each label were examined, and notes were made regarding differences by group. In some cases, this resulted in new labels and categories such as the labels "misogynistic language," "humor," and "storytelling," which were part of a new "peer communications norms" category. Categories were also compared to isolate relationships present between them.</p> <p>Three of the authors and an external advisor on qualitative methods reviewed the entire data set. They discussed student responses, codes, categories, use of slang, differences in interpretation, and selection of examples that illustrate qualitative themes. This process was used to combine each unique perspective on the data and limit misunderstandings and personal biases. It was not possible to go back to individual students to ask for clarification on their remarks since, by design, survey responses did not include students' names.</p> <p>The final combination of categories, codes, examples, and the concept map show how students describe the experience of peer sexual health communication. Participant names have been replaced with pseudonyms.</p> <hd id="AN0136149624-5">Results</hd> <p>Seven topic themes emerged: safer sex, sexually transmitted infections, pregnancy, feelings about sex, sexual acts, peer support, and peer communication norms. All quotes provided to illustrate these themes use pseudonyms. The data collected includes the students' demographic information, but not their names.</p> <p>Results indicated that peer sexual health discussions are often tied to life events, either of the participant or someone close to them. Throughout the semester, students described cases where they had peer sexual health discussions that were triggered either by their own experiences or the experiences of their peers. For example, regarding STIs, students talked to their peers who had put themselves at risk for contracting an STI and needed to get tested, peers who had contracted an STI recently or in the past, or peers who were undergoing or had completed treatment for an STI. For example, April (White, female, 22, heterosexual) talked to her friend about her friend going to the doctor to get treatment for her STI. They went on to discuss how they regretted the STI and "how they would do it differently if the situation ever came up again." Jacob (White, male, 21, heterosexual) said that while he and his friends have fears of getting an STI, "when we have sex with a girl for the first time, we never ask or care to know if they have one."</p> <p>Several students talked to peers about pregnancy, largely because they knew people who were concerned about being pregnant or who were pregnant. Moreover, students' discussions about their feelings about sex were often related to their own positive and negative experiences. When students talked to peers about sexual activities, they often discussed sexual acts/techniques that they had performed or were considering performing as well as contraceptive choices that they had used or were considering using. David (Asian, male, 22, heterosexual) reported two discussions with his peers about avoiding pregnancy. In one, they were discussing whether a woman could get pregnant during menstruation and if it was necessary to use a condom. Kevin (White, male, 20, gay) found out that a friend of a friend is pregnant, "She's keeping it. But her boyfriend of a year wants nothing to do with her. She's dropping out of school."</p> <p>Throughout the semester, there were only a few submissions (<emph>n</emph> = 8) for which the initiator of the discussion was something in the media. The peer discussions that did happen based on the media included a news report about abortion legislation, a story about a woman giving birth to octuplets, and an episode of the <emph>Sex and the City</emph> television show. For example, two students, Paul (White/Asian/American Indian, male, 21, gay) and Lauren (Asian, female, 21, heterosexual), talked to their friends about Nadya Suleman, who was nicknamed "Octomom" after she gave birth to octuplets. This raised questions about multiple births and the economic impact of having many children.</p> <p>Menstruation was also a common topic of interest. Female students who discussed menstruation with their peers often mentioned it in a positive light: for example, getting one's period was a definitive sign of not being pregnant. Conversely, a late period was a cause for concern due to a fear of being pregnant. Stephanie (White, female, 19, heterosexual) addressed this perception directly, "We were talking about Depo the BC shot because you don't get any periods. Also, my friend told me she likes to get her period because then she knows she's not pregnant."</p> <p>Most students in the class reported only having sexual health discussions with people of their own sex. Females mostly discussed sexual health with other females and males almost exclusively talked about sexual health with other males. Interestingly, gay male students, which made up 11% of the sample, were more likely to have sexual health discussions with both male and female peers. For example, over the course of the semester Richard (White, male, 23, gay) reported talking to male peers about negative sexual experiences, erectile dysfunction, rapid ejaculation, STIs, and male anatomy. Richard also talked with female peers about safer sex and STIs. He added, "It was a straight-girl to gay-guy conversation about men, sex with men, all about sex with men, ugh."</p> <hd id="AN0136149624-6">Discussion</hd> <p>Students talk to their peers about things that are relevant to their lives. Women may have more relevant life event triggers in class: periods and pregnancy concerns, gynecologist visits, and making choices about birth control. In fact, the need to take a birth control pill at the same time every day may be a constant low-level trigger for thinking about sexual health. As mentioned earlier, this can partially explain why studies, including this one, show that women discuss sexual health more frequently with their peers than men (Lefkowitz, Boone, & Shearer, [<reflink idref="bib20" id="ref27">20</reflink>]; Lefkowitz & Espinosa-Hernandez, [<reflink idref="bib21" id="ref28">21</reflink>]). Likewise, using condoms and safer sex are relevant to gay men due to the emphasis on condoms and safer sex to prevent the spread of HIV, which is more prevalent in gay men (Milano, [<reflink idref="bib24" id="ref29">24</reflink>]).</p> <p>News stories, television shows, movies, Internet videos, and other forms of media were expected to lead to peer sexual health discussions (Jones & Biddlecom, [<reflink idref="bib17" id="ref30">17</reflink>]; Selkie et al., [<reflink idref="bib27" id="ref31">27</reflink>]). There were some cases where students described having discussions due to media content, but this was not common. A possible explanation for the weak relationship between media and peer sexual health communication is that news and entertainment media are not as personally relevant as stronger triggers such as life events. Serious life events, such as hearing that a friend is worried about being pregnant are immediate and emotionally charged issues. As demonstrated from survey responses, students react to these serious life events by providing advice and support. However, news and entertainment media are less immediate and less emotional. A television show where a fictional character is concerned about being pregnant may be a part of an interesting story, but there is no expectation or possibility of providing advice and support. In short, a friend's problem is personally relevant, whereas the plight of a television character is not.</p> <p>Safer sex was a very common theme in peer sexual health discussions based on survey submissions from both male and female students. However, safer sex discussions were usually connected to life events. For example, in one of the early survey responses, Ryan (White, male, 21, heterosexual) said, "most all heterosexual guys rarely talk about [sexual health]." However, after he found out that his friend's girlfriend was pregnant, he and his friends began talking about "how they are not ready to be fathers and how to make it more of a point to always have condoms."</p> <p>There were differences between the way that female and male students discussed safer sex. While female students discussed the full range of methods to prevent pregnancy and/or STIs, male students focused almost exclusively on condoms. This finding makes sense if one considers how options to prevent STIs and pregnancy are different for women and men. Women have several options for preventing pregnancy, while males depend largely on condoms. For the male students in the survey, safer sex was often equated with condoms. Men have the option of talking to female partners about their STI status and contraceptive choices, but these conversations are not common during casual sexual encounters with a new partner. In addition, men may struggle with the fact that there is no guarantee that their partner is free of STIs or has been using their contraceptive method correctly. Therefore, from a man's perspective, depending solely on information from an unfamiliar partner is not completely safe. This may explain why there seemed to be an inherent lack of trust and even the use of misogynistic language when male students discussed safer sex.</p> <p>An interesting finding from this study was in relation to how female students and their peers discussed menstruation. Popular media and society at large portrays menstruation as an unpleasant, awkward, and embarrassing phenomenon (Lese, [<reflink idref="bib22" id="ref32">22</reflink>]). However, the female students in this study never discussed menstruation in a negative light. To the contrary, when menstruation was mentioned at all, it was described as a welcome indicator of nonpregnancy. In addition, some female students or their peers began to fear that they were pregnant if their period was late. In this sense, menstruation (or lack of it) acts as a life event that can trigger peer sexual health discussions and action.</p> <p>An interesting demographic pattern in this study was reports of confidante relationships between gay men and heterosexual women. This finding is supported by Russell et al. ([<reflink idref="bib26" id="ref33">26</reflink>]) who note that gay men who were paired with straight women reported trusting their companion's mating advice much more than gay men who were paired with other gay men or lesbians. Russell and his colleagues concluded that this finding is due to perceptions that gay men and straight women can give each other reliable, but unbiased relationship advice because of the lack of sexual pressure and competition between these groups. It also helps that gay men and straight women are interested in male mates, but not interested in each other and unlikely to be competing for the same men. This proposed confidante relationship between women and gay men would explain why nonheterosexual students were found to discuss pregnancy and pregnancy-prevention at rates that were not significantly different from heterosexual students.</p> <hd id="AN0136149624-7">Discussion</hd> <p>Findings reveal numerous insights into the context of peer sexual health communication. Life events, such as recent sexual encounters, preparations for a spring break trip, and an upcoming visit to a gynecologist, create opportunities for peers to discuss sexual health with each other. Moreover, there was not a strong connection between media events and peer sexual health discussions among emerging adults, which suggests that such events may not be personally relevant. Overall, feelings and perspectives about contraceptives varied between males and females. The connection between life events and peer sexual health communication has numerous implications for both research and education.</p> <hd id="AN0136149624-8">Implications for human sexuality courses</hd> <p>In the open-ended questions, students reported that they had discussions with their peers that were triggered by course materials. Specifically, these were course materials that were novel or surprising, made them reflect on their own choices, or made them feel curious about their opinions of their peers. This interaction between novel course information and discussing that information with peers is supported by the short-term increase in peer discussions related to new information on STIs and pregnancy-prevention methods. Students described sharing novel course information and activities with peers such as information about STI rates, proper condom use, writing a letter to their parents about being HIV-positive, watching a video about circumcision, and completing a survey about regretted sex. Human sexuality courses can be designed to have booster/mini-assignments where students survey their peers every two weeks and then discuss those findings in their small group discussion sessions. This would create a structure that supports peer sexual health discussions at a regular interval.</p> <p>Human sexuality courses should be designed to prepare students to handle a variety of positive and negative situations. For example, one activity could have students respond to a very positive situation where an older cousin is pregnant and asking for advice about birthing options. Another activity could have students respond to a friend in crisis who blacked out at a party and is dealing with emotional issues in addition to concerns over pregnancy and STIs. By preparing students for a variety of situations with positive and negative tones, the sexual health course will prepare students for a wider range of situations that they may encounter.</p> <hd id="AN0136149624-9">Broader recommendations</hd> <p>A number of sex education programs, using peer education models or more traditional models, have been developed and shown to effectively reduce sexual risk behavior (Kirby, [<reflink idref="bib19" id="ref34">19</reflink>]). At the same time, it is important to note that participation in the most effective sex education program is sometimes not enough to promote and sustain healthy adolescent sexual and reproductive health outcomes—sex education approaches alone have "short-lived and moderate effects on adolescent sexual risk behavior" (Gavin, Catalano, & Markham, [<reflink idref="bib11" id="ref35">11</reflink>], p. S1; see also Mullen, Ramirez, & Strouse, [<reflink idref="bib25" id="ref36">25</reflink>]). In addition to evidence-based sex education, adolescents might further benefit from access to clinical services and efforts that build and support other protective factors operating in their family, peers, school, and community (Bearinger, Sieving & Ferguson, [<reflink idref="bib2" id="ref37">2</reflink>]; Gavin et al., [<reflink idref="bib11" id="ref38">11</reflink>]).</p> <p>One such effort that builds and supports protective factors is the positive youth development (PYD) theory (Birkhead et al., [<reflink idref="bib4" id="ref39">4</reflink>]; Bernet & Resnick, [<reflink idref="bib3" id="ref40">3</reflink>]; Gavin et al., [<reflink idref="bib11" id="ref41">11</reflink>]). PYD is a field of study that combines research and programmatic efforts to strengthen adolescents' ability to respond to developmental challenges in effective ways (Gavin et al., [<reflink idref="bib11" id="ref42">11</reflink>]). PYD may provide the motivation needed for adolescents to successfully apply the skills and knowledge learned in sex education programs (Gavin et al., [<reflink idref="bib11" id="ref43">11</reflink>]). PYD interventions can be defined as "the intentional process of providing all youth with the support, relationships, experiences, resources, and opportunities needed to become successful and competent adults" (Bernet & Resnick, [<reflink idref="bib3" id="ref44">3</reflink>], p. S10; see also Wagner, [<reflink idref="bib31" id="ref45">31</reflink>]). Peer leadership programs fit into the PYD philosophy, as they aim to treat youth as valuable resources who can help solve the problems youth face, rather than treating youth as the problems that need solving. There is growing empirical evidence that well-designed youth development interventions can lead to positive outcomes (Bernet & Resnick, [<reflink idref="bib3" id="ref46">3</reflink>]).</p> <hd id="AN0136149624-10">Study limitations</hd> <p>Participants in this study were enrolled in an undergraduate class that discussed sexual health topics, and were primarily white heterosexual students. The sample for this study was not random, but rather a convenience sample based on course enrollment, which may have introduced bias and homogeneity. Additionally, participants' answers may have been affected by social desirability, which may have resulted in either under reporting, over reporting, or biased reporting of their communications.</p> <hd id="AN0136149624-11">Recommendations for future research</hd> <p>Future research should focus on what characteristics are more common among peers who are more likely to share sexual health information, as these persons may be beneficial in the dissemination of more reliable sexual health information within peer networks. There is a need for longitudinal quantitative and qualitative research that follows students and examines how peer communication changes over time to better craft interventions and course materials to suit their changing needs. Moreover, further quantitative studies need to be conducted to evaluate the effects of human sexuality courses on peer sexual health communication.</p> <ref id="AN0136149624-12"> <title> References </title> <blist> <bibl id="bib1" idref="ref1" type="bt">1</bibl> <bibtext> American Public Health Association (2016). Sexuality Education as Part of a Comprehensive Health Education Program in K to 12 Schools. Retrieved from https://<ulink href="http://www.apha.org/policies-and">www.apha.org/policies-and</ulink> - advocacy/public-health- policy-statements/policy-database/2015/01/23/09/37/sexuality- education-as- part-of- a-comprehensive-health- education-program- in-k- to-12- schools.</bibtext> </blist> <blist> <bibl id="bib2" idref="ref37" type="bt">2</bibl> <bibtext> Bearinger, H., Sieving, R., & Ferguson, J. (2007). Global perspectives on the sexual and reproductive health of adolescents: Patterns, prevention, and potential. Lancet, 369, 1220 – 1231. 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  Group: Ti
  Data: The Nature of Peer Sexual Health Communication among College Students Enrolled in a Human Sexuality Course
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  Data: <searchLink fieldCode="AR" term="%22Porter%2C+Andrew%22">Porter, Andrew</searchLink><br /><searchLink fieldCode="AR" term="%22Cooper%2C+Spring%22">Cooper, Spring</searchLink><br /><searchLink fieldCode="AR" term="%22Henry%2C+Myrthle%22">Henry, Myrthle</searchLink><br /><searchLink fieldCode="AR" term="%22Gallo%2C+Jennifer%22">Gallo, Jennifer</searchLink><br /><searchLink fieldCode="AR" term="%22Graefe%2C+Beck%22">Graefe, Beck</searchLink>
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  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22American+Journal+of+Sexuality+Education%22"><i>American Journal of Sexuality Education</i></searchLink>. 2019 14(2):139-151.
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  Data: Routledge. Available from: Taylor & Francis, Ltd. 530 Walnut Street Suite 850, Philadelphia, PA 19106. Tel: 800-354-1420; Tel: 215-625-8900; Fax: 215-207-0050; Web site: http://www.tandf.co.uk/journals
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  Label: Peer Reviewed
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  Data: Y
– Name: Pages
  Label: Page Count
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  Data: 13
– Name: DatePubCY
  Label: Publication Date
  Group: Date
  Data: 2019
– Name: TypeDocument
  Label: Document Type
  Group: TypDoc
  Data: Journal Articles<br />Reports - Research
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  Label: Education Level
  Group: Audnce
  Data: <searchLink fieldCode="EL" term="%22Higher+Education%22">Higher Education</searchLink><br /><searchLink fieldCode="EL" term="%22Postsecondary+Education%22">Postsecondary Education</searchLink>
– Name: Subject
  Label: Descriptors
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Peer+Relationship%22">Peer Relationship</searchLink><br /><searchLink fieldCode="DE" term="%22Sexuality%22">Sexuality</searchLink><br /><searchLink fieldCode="DE" term="%22Sex+Education%22">Sex Education</searchLink><br /><searchLink fieldCode="DE" term="%22Values%22">Values</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Attitudes%22">Student Attitudes</searchLink><br /><searchLink fieldCode="DE" term="%22Undergraduate+Students%22">Undergraduate Students</searchLink><br /><searchLink fieldCode="DE" term="%22Interpersonal+Communication%22">Interpersonal Communication</searchLink><br /><searchLink fieldCode="DE" term="%22Safety%22">Safety</searchLink><br /><searchLink fieldCode="DE" term="%22Sexually+Transmitted+Diseases%22">Sexually Transmitted Diseases</searchLink><br /><searchLink fieldCode="DE" term="%22Health+Behavior%22">Health Behavior</searchLink><br /><searchLink fieldCode="DE" term="%22Pregnancy%22">Pregnancy</searchLink><br /><searchLink fieldCode="DE" term="%22Gender+Differences%22">Gender Differences</searchLink><br /><searchLink fieldCode="DE" term="%22Sexual+Orientation%22">Sexual Orientation</searchLink><br /><searchLink fieldCode="DE" term="%22Introductory+Courses%22">Introductory Courses</searchLink><br /><searchLink fieldCode="DE" term="%22Course+Descriptions%22">Course Descriptions</searchLink><br /><searchLink fieldCode="DE" term="%22Rape%22">Rape</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1080/15546128.2018.1529644
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  Label: ISSN
  Group: ISSN
  Data: 1554-6128
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Most young people go to their friends for information on sexuality-related topics, thus it is important to understand the context of these communications so that we may gather insight into sexual values and the underlying emotions and styles of communication. We conducted qualitative weekly surveys regarding discussion of sexual health topics among peers with students enrolled in an undergraduate human sexuality course. A four-stage inductive analysis process was utilized to examine a total number of 824 survey submissions from 102 college students who agreed to participate. Seven relevant common themes emerged: safer sex, sexually transmitted infections, pregnancy, feelings about sex, sexual acts, peer support, and peer communication norms. Some perspectives varied between males and females. Life events create opportunities for peers to discuss sexual health with each other. The connection between life events and peer sexual health communication has numerous implications for both research and education.
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  Data: 2019
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  Data: EJ1214341
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        Value: 10.1080/15546128.2018.1529644
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      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 13
        StartPage: 139
    Subjects:
      – SubjectFull: Peer Relationship
        Type: general
      – SubjectFull: Sexuality
        Type: general
      – SubjectFull: Sex Education
        Type: general
      – SubjectFull: Values
        Type: general
      – SubjectFull: Student Attitudes
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      – SubjectFull: Undergraduate Students
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      – SubjectFull: Interpersonal Communication
        Type: general
      – SubjectFull: Safety
        Type: general
      – SubjectFull: Sexually Transmitted Diseases
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      – SubjectFull: Health Behavior
        Type: general
      – SubjectFull: Pregnancy
        Type: general
      – SubjectFull: Gender Differences
        Type: general
      – SubjectFull: Sexual Orientation
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      – SubjectFull: Introductory Courses
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      – SubjectFull: Course Descriptions
        Type: general
      – SubjectFull: Rape
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      – TitleFull: The Nature of Peer Sexual Health Communication among College Students Enrolled in a Human Sexuality Course
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