Keeping children on top of the states' policy agendas

There is no longer any doubt that national consciousness of the truth that the future always depends on today's children has reached new levels of legislative action. This article cites Alaska's progress, and what has been and has not been achieved, and movements in other states, as a call to vigorous action.     

Sexual self-concept and sexual self-efficacy in adolescents: a possible clue to promoting sexual health?

This study examined the associations between sexual self-concept (sexual esteem and sexual anxiety) and sexual self-efficacy (situational and resistive) in a sample of 388 high school students (59% Caucasian, 28% African American). Males reported lower sexual esteem and lower sexual self-efficacy than females. Males and African Americans reported higher levels of sexual anxiety and lower levels of resistive self-efficacy than females and Caucasians. In regression models, higher sexual self-esteem uniquely predicted higher sexual self-efficacy scores, even after controlling for demographic variables, knowledge of sexual risk, and previous coital experience. In post hoc analyses, sexual self-esteem mediated the relation between knowledge of sexual risk and both types of sexual self-efficacy. Results suggest the need for interventions to promote male sexual self-efficacy and sexual esteem and the need for longitudinal research that explicates models of sexual health in adolescence.     

Coital debut: the role of religiosity and sex attitudes in the Add Health Survey

Recent reviews suggest that religiosity is associated with the delay of adolescent coital debut (Rostosky, Wilcox, Wright, Randall, in press; Wilcox, Rostosky, Randall, Wright, 2001). Few studies, however, have examined this association using longitudinal data to test theoretically driven models. We analyzed data from 3,691 adolescents (ages 15-21), testing the hypothesis that adolescent religiosity and sex attitudes (at Wave 1) predict later coital debut (at Wave 2) and that these predictive relationships vary by gender. Findings indicated that beyond demographic factors and number of romantic partners, religiosity reduced the likelihood of coital debut for both males and females. After accounting for the effects of religiosity, anticipation of negative emotions after coital debut (sex attitude factor 1) further reduced its likelihood for females and males. Finally, adolescent girls - but not boys - who anticipated positive emotions following sexual intercourse (sex attitude factor 2) were more likely to debut. While virginity pledge status was associated with coital debut for boys and girls, more conservative beliefs about sex appeared to mediate its effect. Finally, a significant interaction between race and religiosity indicated that African American adolescent males who had either signed a virginity pledge or were more religious were significantly more likely to debut than both White non-Hispanic males and African American males who were less religious and/or who had not signed a pledge. The implications of these results for adolescent pregnancy prevention programming are discussed.     

Coital debut: The role of religiosity and sex attitudes in the add health survey

Recent reviews suggest that religiosity is associated with the delay of adolescent coital debut (Rostosky, Wilcox, Wright, & Randall, in press; Wilcox, Rostosky, Randall, & Wright, 2001). Few studies, however, have examined this association using longitudinal data to test theoretically driven models. We analyzed data from 3,691 adolescents (ages 15–21), testing the hypothesis that adolescent religiosity and sex attitudes (at Wave 1) predict later coital debut (at Wave 2) and that these predictive relationships vary by gender. Findings indicated that beyond demographic factors and number of romantic partners, religiosity reduced the likelihood of coital debut for both males and females. After accounting for the effects of religiosity, anticipation of negative emotions after coital debut (sex attitude factor 1) further reduced its likelihood for females and males. Finally, adolescent girls—but not boys—who anticipated positive emotions following sexual intercourse (sex attitude factor 2) were more likely to debut. While virginity pledge status was associated with coital debut for boys and girls, more conservative beliefs about sex appeared to mediate its effect. Finally, a significant interaction between race and religiosity indicated that African American adolescent males who had either signed a virginity pledge or were more religious were significantly more likely to debut than both White non‐Hispanic males and African American males who were less religious and/orwho had not signed a pledge. The implications of these results for adolescent pregnancy prevention programming are discussed.     

Ethical challenges in conducting research on dying patients and those at high risk of dying

Clinical research to improve care across the broad spectrum of health care has led to better quantity and quality of life for many patients. However, imposing arbitrary restrictions that might result in the exclusion from clinical research of patients who are at the end of life, or patients with a high risk of dying, is undesirable. Such exclusions may violate the principle of justice, by denying these patients a valid opportunity to make an important socio-medical contribution, and could make it difficult or impossible to advance clinical knowledge about the care of these patients. This article reviews issues relevant to the conduct of research on dying patients and those who are at high risk of dying, and outlines special considerations for ensuring that such research is ethical. In particular, precautions should be taken to ensure that informed consent is obtained from patients who are capable (or their substitute decision maker if the patient is not capable), free from coercion, and not harboring false expectations about the likelihood of benefiting from the study intervention. The unique circumstances surrounding the timing of this research (at the end of life or potentially there) may warrant that some patients be considered vulnerable, requiring special protective measures. Adhering to these principles will help ensure that dying patients or patients at high risk of dying can still participate in research that has the potential to advance knowledge and improve future care.