230. Adolescent Male Perspectives On Sex And Reproductive Health

Abstract

In recent decades, sexual health education and prevention have focused disproportionately on female adolescents due to both their higher burden from risky sexual behavior and their bundled sexual and reproductive healthcare. Young men have been relatively ignored by these efforts, and their utilization of sexual and reproductive health services in general remains low due to barriers including shame, fear, stigma, denial, lack of social support, and not knowing where to go for care. Further, young men are exposed to pervasive toxic masculinity in American culture that may reward them for making risky sexual choices. The goal of this project is to better understand male adolescent sexual decision making In order to identify areas where we might intervene in the future. Expert Model Development - We used a mental models approach from decision science to create an expert model of male adolescent sexual decision making with the input of ten leading experts in male sexual and reproductive health from multiple disciplines, such as medicine, psychology, sociology, public health, and intervention development, implementation, and evaluation. We organized input conceptually, identified and analyzed key concepts, and determined agreement among experts. We synthesized these results into a conceptual model describing young men’s sexual decision. Interviews - We used this expert model of male sexual decision making to guide in-depth, semi-structured interviews with racially diverse male adolescents ages 12-17 on topics related to their emerging sexual identities and decisions, including puberty, relationships, and knowledge of sexual consequences and risk. Expert Model Development - Expert opinion extended existing findings from the literature, providing context and experience related to the idea of toxic masculinity. A point of divergence was how widely endorsed experts believed these norms to be, with some arguing that adolescents feel constrained by the norms but secretly desire the love and intimacy normatively associated with females, indicative of pluralistic ignorance. There was broad consensus among experts about the power of this norm, with disagreement only about degree of internalization. Interviews - Participants spoke candidly, describing lying about virginity to impress a partner, the crude sexual joking and social posturing among young men, and their experiences with pornography. Many expressed frustration with limited sex education, the use of “scare tactics” such as graphic presentation of STIs, the lack of candid discussion by teachers, and the neglect of healthy communication and relationships. There was discussion of norms and peer influence. For example, participants described a “hunter/prey mentality” around sex, identifying each girl as a conquest, and explicitly or implicitly endorsing an objectified view of female partners. Peers were important for communicating norms and conveying reputation. Sexually experienced peers hold considerable social capital. Few described mutual, collaborative decision making around sex beyond cursory statements about consent. Adolescent males confirm our experts’ conceptualization of the power of toxic masculinity norms on their goals and behavior. Future research can explore then for phenomenon further to identify opportunities for intervention.