Free Standard AU & NZ Shipping For All Book Orders Over $80!
Register      Login
Sexual Health Sexual Health Society
Publishing on sexual health from the widest perspective
RESEARCH ARTICLE

Social self-efficacy and sexual communication among adolescents in the United States: a cross-sectional study

Julia Brasileiro https://orcid.org/0000-0001-6936-6965 A B , Laura Widman A , Reina Evans A and Hannah Javidi A
+ Author Affiliations
- Author Affiliations

A North Carolina State University, Department of Psychology, Campus Box 7650, Raleigh, NC, USA.

B Corresponding author. Email: jcbrasil@ncsu.edu

Sexual Health 18(2) 172-179 https://doi.org/10.1071/SH20221
Submitted: 13 December 2020  Accepted: 05 February 2021   Published: 30 April 2021

Abstract

Background: Sexual communication between partners is associated with safer sex behaviours, including condom use among adolescents. Several studies have found a relationship between negative psychological constructs (e.g. depression, anxiety) and poor sexual communication; however, scant research exists regarding positive psychological constructs and their potential to promote effective sexual communication among adolescents. This study examined the association between a positive construct, social self-efficacy – a person’s belief in their ability to successfully manage social relationships – and three components of sexual communication: sexual assertiveness, self-efficacy for communication, and frequency of sexual communication with dating partners. Methods: Data were collected in a cross-sectional survey from 222 high school girls in a rural school district in the south-eastern United States (Mage = 15.2; 38% White, 29% Latina, 24% Black; 50% were in a dating relationship in the past 3 months). Variables were measured with Likert-type scales. Bivariate correlation and regression analyses were conducted. Results: Social self-efficacy was significantly positively associated with sexual assertiveness and sexual communication self-efficacy for all girls, and there was a positive trend in the relationship between social self-efficacy and communication frequency among the subsample of girls who had a dating partner. The significant relationship with sexual assertiveness (β = 0.22, s.e. = 0.07, P = 0.001) and sexual communication self-efficacy (β = 0.17, s.e. = 0.04, P = 0.013) remained when controlling for sexual activity status. Conclusions: Strengthening social self-efficacy may enhance girls’ sexual communication and assertiveness skills. Future studies are needed to confirm the causal and temporal nature of these associations.

Keywords: adolescent sexual health, sexual communication, social self-efficacy, sexual assertiveness, safer sex, sexual behaviours, teenagers, positive/negative psychological constructs.


References

[1]  Centers for Disease Control and Prevention. Sexual risk behaviors can lead to HIV, STDS, & teen pregnancy. 2020. Available online at: https://www.cdc.gov/healthyyouth/sexualbehaviors/index.htm [cited 28 May 2020].

[2]  Djamba YK, Davidson TC, Aga MG. Sexual health of young people in the U.S. South: challenges and opportunities. Center for Demographic Research; 2012. Available online at: https://www.gcapp.org/sites/default/files/images/CDR_SexualHealth_6.pdf [cited 9 December 2020].

[3]  Centers for Disease Control and Prevention. STDs in adolescents and young adults. 2019. Available online at: https://www.cdc.gov/std/stats18/adolescents.htm [cited 9 December 2020].

[4]  Witwer E, Jones RK, Lindberg LD. Sexual behavior and contraceptive and condom use among U.S. high school students, 2013-2017. 2018. Available online at: https://www.guttmacher.org/report/sexual-behavior-contraceptive-condom-use-us-high-school-students-2013-2017 [cited 7 December 2020].

[5]  National Institute of Allergy and Infectious Diseases. Sexually transmitted diseases. 2015. Available online at: https://www.niaid.nih.gov/diseases-conditions/sexually-transmitted-diseases [cited 25 November 2019].

[6]  Gause NK, Brown JL, Welge J, Northern N. Meta-analyses of HIV prevention interventions targeting improved partner communication: effects on partner communication and condom use frequency outcomes. J Behav Med 2018; 41 423–40.
Meta-analyses of HIV prevention interventions targeting improved partner communication: effects on partner communication and condom use frequency outcomes.Crossref | GoogleScholarGoogle Scholar | 29468532PubMed |

[7]  Lalas J, Garbers S, Gold MA, Allegrante JP, Bell DL. Young men’s communication with partners and contraception use: a systematic review. J Adolesc Health 2020; 67 342–53.
Young men’s communication with partners and contraception use: a systematic review.Crossref | GoogleScholarGoogle Scholar | 32624356PubMed |

[8]  Widman L, Choukas-Bradley S, Helms SW, Golin CE, Prinstein MJ. Sexual communication between early adolescents and their dating partners, parents, and best friends. J Sex Res 2014; 51 731–41.
Sexual communication between early adolescents and their dating partners, parents, and best friends.Crossref | GoogleScholarGoogle Scholar | 24354655PubMed |

[9]  Widman L, Welsh DP, McNulty JK, Little KC. Sexual communication and contraceptive use in adolescent dating couples. J Adolesc Health 2006; 39 893–9.
Sexual communication and contraceptive use in adolescent dating couples.Crossref | GoogleScholarGoogle Scholar | 17116521PubMed |

[10]  Byers ES. Beyond the birds and the bees and was it good for you?: Thirty years of research on sexual communication. Can Psychol 2011; 52 20–8.
Beyond the birds and the bees and was it good for you?: Thirty years of research on sexual communication.Crossref | GoogleScholarGoogle Scholar |

[11]  Mastro S, Zimmer-Gembeck MJ. Let’s talk openly about sex: sexual communication, self-esteem and efficacy as correlates of sexual well-being. Eur J Dev Psychol 2015; 12 579–98.
Let’s talk openly about sex: sexual communication, self-esteem and efficacy as correlates of sexual well-being.Crossref | GoogleScholarGoogle Scholar |

[12]  Frederick DA, Lever J, Gillespie BJ, Garcia JR. What keeps passion alive? Sexual satisfaction is associated with sexual communication, mood setting, sexual variety, oral sex, orgasm, and sex frequency in a national U.S. study. J Sex Res 2017; 54 186–201.
What keeps passion alive? Sexual satisfaction is associated with sexual communication, mood setting, sexual variety, oral sex, orgasm, and sex frequency in a national U.S. study.Crossref | GoogleScholarGoogle Scholar | 26900897PubMed |

[13]  Mark KP, Jozkowski KN. The mediating role of sexual and nonsexual communication between relationship and sexual satisfaction in a sample of college-age heterosexual couples. J Sex Marital Ther 2013; 39 410–27.
The mediating role of sexual and nonsexual communication between relationship and sexual satisfaction in a sample of college-age heterosexual couples.Crossref | GoogleScholarGoogle Scholar | 23530670PubMed |

[14]  Schmid A, Leonard NR, Ritchie AS, Gwadz MV. Assertive communication in condom negotiation: insights from late adolescent couples’ subjective ratings of self and partner. J Adolesc Health 2015; 57 94–9.
Assertive communication in condom negotiation: insights from late adolescent couples’ subjective ratings of self and partner.Crossref | GoogleScholarGoogle Scholar | 25937470PubMed |

[15]  Coakley TM, Randolph S, Shears J, Beamon ER, Collins P, Sides T. Parent–youth communication to reduce at-risk sexual behavior: a systematic literature review. J Hum Behav Soc Environ 2017; 27 609–24.
Parent–youth communication to reduce at-risk sexual behavior: a systematic literature review.Crossref | GoogleScholarGoogle Scholar | 31485155PubMed |

[16]  Marston C, King E. Factors that shape young people’s sexual behaviour: a systematic review. Lancet 2006; 368 1581–6.
Factors that shape young people’s sexual behaviour: a systematic review.Crossref | GoogleScholarGoogle Scholar | 17084758PubMed |

[17]  Noar SM, Carlyle K, Cole C. Why communication is crucial: meta-analysis of the relationship between safer sexual communication and condom use. J Health Commun 2006; 11 365–90.
Why communication is crucial: meta-analysis of the relationship between safer sexual communication and condom use.Crossref | GoogleScholarGoogle Scholar | 16720536PubMed |

[18]  Rogers AA. Parent–adolescent sexual communication and adolescents’ sexual behaviors: a conceptual model and systematic review. Adolesc Res Rev 2017; 2 293–313.
Parent–adolescent sexual communication and adolescents’ sexual behaviors: a conceptual model and systematic review.Crossref | GoogleScholarGoogle Scholar |

[19]  Widman L, Choukas-Bradley S, Noar SM, Nesi J, Garrett K. Parent–adolescent sexual communication and adolescent safer sex behavior: a meta-analysis. JAMA Pediatr 2016; 170 52–61.
Parent–adolescent sexual communication and adolescent safer sex behavior: a meta-analysis.Crossref | GoogleScholarGoogle Scholar | 26524189PubMed |

[20]  DiClemente RJ, Wingood GM, Crosby R, Cobb BK, Harrington K, Davies SL. Parent–adolescent communication and sexual risk behaviors among African American adolescent females. J Pediatr 2001; 139 407–12.
Parent–adolescent communication and sexual risk behaviors among African American adolescent females.Crossref | GoogleScholarGoogle Scholar | 11562621PubMed |

[21]  Hadley W, Brown LK, Lescano CM, Kell H, Spalding K, DiClemente R, et al Parent–adolescent sexual communication: associations of condom use with condom discussions. AIDS Behav 2009; 13 997–1004.
Parent–adolescent sexual communication: associations of condom use with condom discussions.Crossref | GoogleScholarGoogle Scholar | 18841462PubMed |

[22]  Schonfeld Hicks M, McRee A-L, Eisenberg ME. Teens talking with their partners about sex: the role of parent communication. Am J Sex Educ 2013; 8 1–17.
Teens talking with their partners about sex: the role of parent communication.Crossref | GoogleScholarGoogle Scholar |

[23]  Milhausen RR, McDermott Sales J, Wingood GM, DiClemente RJ, Salazar LF, Crosby RA. Validation of a partner sexual communication scale for use in HIV/AIDS prevention interventions. J HIV AIDS Prev Child Youth 2007; 8 11–33.
Validation of a partner sexual communication scale for use in HIV/AIDS prevention interventions.Crossref | GoogleScholarGoogle Scholar |

[24]  Wilson HW, Donenberg G. Quality of parent communication about sex and its relationship to risky sexual behavior among youth in psychiatric care: a pilot study. J Child Psychol Psychiatry 2004; 45 387–95.
Quality of parent communication about sex and its relationship to risky sexual behavior among youth in psychiatric care: a pilot study.Crossref | GoogleScholarGoogle Scholar | 14982251PubMed |

[25]  Edgar T, Noar SM, Freimuth VS. Communication perspectives on HIV/AIDS for the 21st Century. Routledge; 2009.

[26]  Fortenberry JD. Trust, sexual trust, and sexual health: an interrogative review. J Sex Res 2019; 56 425–39.
Trust, sexual trust, and sexual health: an interrogative review.Crossref | GoogleScholarGoogle Scholar | 30289286PubMed |

[27]  Lehmiller JJ, VanderDrift LE, Kelly JR. Sexual communication, satisfaction, and condom use behavior in friends with benefits and romantic partners. J Sex Res 2014; 51 74–85.
Sexual communication, satisfaction, and condom use behavior in friends with benefits and romantic partners.Crossref | GoogleScholarGoogle Scholar | 23181805PubMed |

[28]  Brawner BM, Gomes MM, Jemmott LS, Deatrick JA, Coleman CL. Clinical depression and HIV risk-related sexual behaviors among African-American adolescent females: unmasking the numbers. AIDS Care 2012; 24 618–25.
Clinical depression and HIV risk-related sexual behaviors among African-American adolescent females: unmasking the numbers.Crossref | GoogleScholarGoogle Scholar | 22292603PubMed |

[29]  Jackson JM, Seth P, DiClemente RJ, Lin A. Association of depressive symptoms and substance use with risky sexual behavior and sexually transmitted infections among African American female adolescents seeking sexual health care. Am J Public Health 2015; 105 2137–42.
Association of depressive symptoms and substance use with risky sexual behavior and sexually transmitted infections among African American female adolescents seeking sexual health care.Crossref | GoogleScholarGoogle Scholar | 25905854PubMed |

[30]  Khan MR, Kaufman JS, Pence BW, Gaynes BN, Adimora AA, Weir SS, et al Depression, sexually transmitted infection, and sexual risk behavior among young adults in the United States. Arch Pediatr Adolesc Med 2009; 163 644–52.
Depression, sexually transmitted infection, and sexual risk behavior among young adults in the United States.Crossref | GoogleScholarGoogle Scholar | 19581548PubMed |

[31]  Seth P, Raiji PT, DiClemente RJ, Wingood GM, Rose E. Psychological distress as a correlate of a biologically confirmed STI, risky sexual practices, self-efficacy and communication with male sex partners in African-American female adolescents. Psychol Health Med 2009; 14 291–300.
Psychological distress as a correlate of a biologically confirmed STI, risky sexual practices, self-efficacy and communication with male sex partners in African-American female adolescents.Crossref | GoogleScholarGoogle Scholar | 19444707PubMed |

[32]  Shrier LA, Harris SK, Beardslee WR. Temporal associations between depressive symptoms and self-reported sexually transmitted disease among adolescents. Arch Pediatr Adolesc Med 2002; 156 599–606.
Temporal associations between depressive symptoms and self-reported sexually transmitted disease among adolescents.Crossref | GoogleScholarGoogle Scholar | 12038894PubMed |

[33]  Boehm JK, Trudel-Fitzgerald C, Kivimaki M, Kubzansky LD. The prospective association between positive psychological well-being and diabetes. Health Psychol 2015; 34 1013–21.
The prospective association between positive psychological well-being and diabetes.Crossref | GoogleScholarGoogle Scholar | 25603420PubMed |

[34]  Hernandez R, Kershaw KN, Siddique J, Boehm JK, Kubzansky LD, Diez-Roux A, et al Optimism and cardiovascular health: Multi-Ethnic Study of Atherosclerosis (MESA). Health Behav Policy Rev 2015; 2 62–73.
Optimism and cardiovascular health: Multi-Ethnic Study of Atherosclerosis (MESA).Crossref | GoogleScholarGoogle Scholar | 26213688PubMed |

[35]  Park N, Peterson C, Szvarca D, Vander Molen RJ, Kim ES, Collon K. Positive psychology and physical health: research and applications. Am J Lifestyle Med 2016; 10 200–6.
Positive psychology and physical health: research and applications.Crossref | GoogleScholarGoogle Scholar | 30202275PubMed |

[36]  Snyder CR, Lopez SJ. Handbook of positive psychology. Oxford University Press; 2001.

[37]  Maddux JE, Gosselin JT. Self-efficacy. In: Leary MR, Tangney JP, editors. Handbook of self and identity, 2nd edn. New York: The Guilford Press; 2012. pp. 198–224.

[38]  Tsang SKM, Hui EKP, Law BCM. Self-efficacy as a positive youth development construct: a conceptual review. Sci World J 2012; 2012 452327

[39]  Zimmerman MA. Resiliency theory: a strengths-based approach to research and practice for adolescent health. Health Educ Behav 2013; 40 381–3.
Resiliency theory: a strengths-based approach to research and practice for adolescent health.Crossref | GoogleScholarGoogle Scholar | 23863911PubMed |

[40]  Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process 1991; 50 179–211.
The theory of planned behavior.Crossref | GoogleScholarGoogle Scholar |

[41]  Jones CL, Jensen JD, Scherr CL, Brown NR, Christy K, Weaver J. The health belief model as an explanatory framework in communication research: exploring parallel, serial, and moderated mediation. Health Commun 2015; 30 566–76.
The health belief model as an explanatory framework in communication research: exploring parallel, serial, and moderated mediation.Crossref | GoogleScholarGoogle Scholar | 25010519PubMed |

[42]  National Cancer Institute. Theory at a glance: a guide for health promotion practice. 2005. Available online at: https://cancercontrol.cancer.gov/brp/research/theories_project/theory.pdf

[43]  Muris P. A brief questionnaire for measuring self-efficacy in youths. J Psychopathol Behav Assess 2001; 23 145–9.
A brief questionnaire for measuring self-efficacy in youths.Crossref | GoogleScholarGoogle Scholar |

[44]  Smith HM, Betz NE. Development and validation of a scale of perceived social self-efficacy. J Career Assess 2000; 8 283–301.
Development and validation of a scale of perceived social self-efficacy.Crossref | GoogleScholarGoogle Scholar |

[45]  Zullig KJ, Teoli DA, Valois RF. Evaluating a brief measure of social self-efficacy among U.S. adolescents. Psychol Rep 2011; 109 907–20.
Evaluating a brief measure of social self-efficacy among U.S. adolescents.Crossref | GoogleScholarGoogle Scholar | 22420120PubMed |

[46]  Erozkan A. The effect of communication skills and interpersonal problem solving skills on social self-efficacy. Educ Sci Theory Pract 2013; 13 739–45.

[47]  Connolly J. Social self-efficacy in adolescence: relations with self-concept, social adjustment, and mental health. Can J Behav Sci 1989; 21 258–69.
Social self-efficacy in adolescence: relations with self-concept, social adjustment, and mental health.Crossref | GoogleScholarGoogle Scholar |

[48]  Hermann KS, Betz NE. Path models of the relationships of instrumentality and expressiveness, social self-efficacy, and self-esteem to depressive symptoms in college students. J Soc Clin Psychol 2006; 25 1086–106.
Path models of the relationships of instrumentality and expressiveness, social self-efficacy, and self-esteem to depressive symptoms in college students.Crossref | GoogleScholarGoogle Scholar |

[49]  Lee JY. Predictors of female college students’ relationship satisfaction: attachment and sexual assertiveness. Psychol Stud (Mysore) 2017; 62 70–4.
Predictors of female college students’ relationship satisfaction: attachment and sexual assertiveness.Crossref | GoogleScholarGoogle Scholar |

[50]  Ménard AD, Offman A. The interrelationships between sexual self-esteem, sexual assertiveness and sexual satisfaction. Can J Hum Sex 2009; 18 35–45.

[51]  Tschann JM, Flores E, de Groat CL, Deardorff J, Wibbelsman CJ. Condom negotiation strategies and actual condom use among Latino youth. J Adolesc Health 2010; 47 254–62.
Condom negotiation strategies and actual condom use among Latino youth.Crossref | GoogleScholarGoogle Scholar | 20708564PubMed |

[52]  Leddy A, Chakravarty D, Dladla S, de Bruyn G, Darbes L. Sexual communication self-efficacy, hegemonic masculine norms and condom use among heterosexual couples in South Africa. AIDS Care 2016; 28 228–33.
Sexual communication self-efficacy, hegemonic masculine norms and condom use among heterosexual couples in South Africa.Crossref | GoogleScholarGoogle Scholar | 26344386PubMed |

[53]  Pearson J. Personal Control, self-efficacy in sexual negotiation, and contraceptive risk among adolescents: the role of gender. Sex Roles 2006; 54 615–25.
Personal Control, self-efficacy in sexual negotiation, and contraceptive risk among adolescents: the role of gender.Crossref | GoogleScholarGoogle Scholar |

[54]  Suvivuo P, Tossavainen K, Kontula O. Negotiation in teenage girls’ sexually motivated situations. Electron J Hum Sex 2011; 14. Available online at: http://www.ejhs.org/volume14/Negotiation.htm [cited 16 July 2020].

[55]  Rew L, Whittaker TA, Taylor‐Seehafer MA, Smith LR. Sexual health risks and protective resources in gay, lesbian, bisexual, and heterosexual homeless youth. J Spec Pediatr Nurs 2005; 10 11–9.
Sexual health risks and protective resources in gay, lesbian, bisexual, and heterosexual homeless youth.Crossref | GoogleScholarGoogle Scholar | 15673425PubMed |

[56]  Rickert VI, Neal WP, Wiemann CM, Berenson AB. Prevalence and predictors of low sexual assertiveness. J Pediatr Adolesc Gynecol 2000; 13 88–9.
Prevalence and predictors of low sexual assertiveness.Crossref | GoogleScholarGoogle Scholar | 10869973PubMed |

[57]  Widman L, Golin CE, Kamke K, Burnette JL, Prinstein MJ. Sexual assertiveness skills and sexual decision-making in adolescent girls: randomized controlled trial of an online program. Am J Public Health 2017; 108 96–102.
Sexual assertiveness skills and sexual decision-making in adolescent girls: randomized controlled trial of an online program.Crossref | GoogleScholarGoogle Scholar | 29161072PubMed |

[58]  Dolezal C, Marhefka SL, Santamaria EK, Leu C-S, Brackis-Cott E, Mellins CA. A comparison of audio computer-assisted self-interviews to face-to-face interviews of sexual behavior among perinatally HIV-exposed youth. Arch Sex Behav 2012; 41 401–10.
A comparison of audio computer-assisted self-interviews to face-to-face interviews of sexual behavior among perinatally HIV-exposed youth.Crossref | GoogleScholarGoogle Scholar | 21604065PubMed |

[59]  Turner CF, Ku L, Rogers SM, Lindberg LD, Pleck JH, Sonenstein FL. Adolescent sexual behavior, drug use, and violence: increased reporting with computer survey technology. Science 1998; 280 867–73.
Adolescent sexual behavior, drug use, and violence: increased reporting with computer survey technology.Crossref | GoogleScholarGoogle Scholar | 9572724PubMed |

[60]  Snell W. The multidimensional sexual self-concept questionnaire. In: Milhausen R, Sakaluk J, Fisher T, Davis C, Yarber W, editors. Handbook of sexuality-related measures, 4th edn. Routledge; 2019. pp. 545–51.

[61]  Brown LK, Hadley W, Donenberg GR, DiClemente RJ, Lescano C, Lang D, et al Project STYLE: a multisite RCT for HIV prevention among youths in mental health treatment. Psychiatr Serv 2014; 65 338–44.
Project STYLE: a multisite RCT for HIV prevention among youths in mental health treatment.Crossref | GoogleScholarGoogle Scholar | 24382603PubMed |

[62]  Widman L, Stewart J. Adolescent sexual communication scale. In: Milhausen R, Sakaluk J, Fisher T, Davis C, Yarber W, editors. Handbook of sexuality-related measures, 4th edn. New York: Routledge; 2019. pp. 251–3.

[63]  Collins WA, Welsh DP, Furman W. Adolescent romantic relationships. Annu Rev Psychol 2009; 60 631–52.
Adolescent romantic relationships.Crossref | GoogleScholarGoogle Scholar | 19035830PubMed |

[64]  James G, Witten D, Hastie T, Tibshirani R. An introduction to statistical learning with applications in R, 1st edn. New York: Springer; 2013.

[65]  Crosby RA, DiClemente RJ, Wingood GM, Salazar LF, Harrington K, Davies SL, et al Identification of strategies for promoting condom use: a prospective analysis of high-risk African American female teens. Prev Sci 2003; 4 263–70.
Identification of strategies for promoting condom use: a prospective analysis of high-risk African American female teens.Crossref | GoogleScholarGoogle Scholar | 14598998PubMed |

[66]  Tolman DL, McClelland SI. Normative sexuality development in adolescence: a decade in review, 2000–2009. J Res Adolesc 2011; 21 242–55.
Normative sexuality development in adolescence: a decade in review, 2000–2009.Crossref | GoogleScholarGoogle Scholar |

[67]  Bell J. Why embarrassment inhibits the acquisition and use of condoms: a qualitative approach to understanding risky sexual behaviour. J Adolesc 2009; 32 379–91.
Why embarrassment inhibits the acquisition and use of condoms: a qualitative approach to understanding risky sexual behaviour.Crossref | GoogleScholarGoogle Scholar | 18691747PubMed |

[68]  van Teijlingen E, Reid J, Shucksmith J, Harris F, Philip K, Imamura M, et al Embarrassment as a key emotion in young people talking about sexual health. Sociol Res Online 2007; 12 1–16.
Embarrassment as a key emotion in young people talking about sexual health.Crossref | GoogleScholarGoogle Scholar |

[69]  Gavin LE, Catalano RF, David-Ferdon C, Gloppen KM, Markham CM. A review of positive youth development programs that promote adolescent sexual and reproductive health. J Adolesc Health 2010; 46 S75–91.
A review of positive youth development programs that promote adolescent sexual and reproductive health.Crossref | GoogleScholarGoogle Scholar | 20172462PubMed |

[70]  Amaro H, Raj A. On the margin: power and women’s HIV risk reduction strategies. Sex Roles 2000; 42 723–49.
On the margin: power and women’s HIV risk reduction strategies.Crossref | GoogleScholarGoogle Scholar |

[71]  Martino SC, Elliott MN, Corona R, Kanouse DE, Schuster MA. Beyond the “big talk”: the roles of breadth and repetition in parent–adolescent communication about sexual topics. Pediatrics 2008; 121 e612–8.
Beyond the “big talk”: the roles of breadth and repetition in parent–adolescent communication about sexual topics.Crossref | GoogleScholarGoogle Scholar | 18310180PubMed |

[72]  Fortenberry JD. The evolving sexual health paradigm: transforming definitions into sexual health practices. AIDS 2013; 27 S127–33.
The evolving sexual health paradigm: transforming definitions into sexual health practices.Crossref | GoogleScholarGoogle Scholar | 24088679PubMed |