Peer Norms Research Articles

Longitudinal Associations Between Sexual Communication With Friends and Sexual Behaviors Through Perceived Sexual Peer Norms

ABSTRACT The role of peers in adolescents’ sexual behaviors is not yet fully understood. We investigated the association between sexual communication with friends (at T1) and subsequent changes in adolescents’ experience with sexual behaviors (between T1–T3), and examined whether this association was explained by adolescents’ perceptions of three sexual peer norms (at T2): (1) peers’ sexual behaviors (descriptive norms), (2) peers’ approval of sexual behaviors (injunctive norms), and (3) peer pressure to have sex. The data source was Project STARS, a longitudinal study on adolescent sexual development in the Netherlands, collected via online self-report questionnaires from 1,116 adolescents (11.5–17.9 years). Adolescents who communicated more frequently with their friends about sexuality-related topics at T1 reported significantly larger increases in their experience with different sexual behaviors between T1–T3. More sexual communication with friends also predicted adolescents subsequently perceiving more 1) peer sexual behaviors, 2) peer approval of sex, and 3) peer pressure to have sex. These stronger perceptions, in turn, predicted larger increases in their sexual behaviors between T1–T3. After adjusting for the three norms simultaneously, the main association between sexual communication with friends and sexual behavior change weakened but remained significant. Inspection of specific indirect effects showed this link was explained by injunctive norms only. No gender differences were found.

A Qualitative Exploration of Electronic Image Sharing Among Young People: Navigating the Issues of Conformity, Trust, Intention, and Reputation.

This research sought to explore the main factors affecting young people's image-sharing behaviors, particularly in the context of peer relationships and norms. Ten focus groups were held with young people aged 13 to 14 years (Grade 9) with a total of 68 participants (39 females and 29 males) across 15 Australian schools contributing to the discussions. Focus groups were divided into either all-girls (n = 4), all-boys (n = 4), or mixed gender (n = 2) participants to observe gender-specific issues. Thematic analysis of the data revealed the considerable complexities that young people encounter daily when sharing images in the online environment, including how they navigate issues of conformity, trust, intention, and reputation. Gender-specific differences in young people's perceptions of risky image sharing were also observed. These findings have important implications for the design of school-based interventions to prevent and reduce harm from image-sharing behaviors, including the appointment and training of cyber ambassadors in schools to help positively influence peer-level norms about image sharing.

You-Me-Us: Results of a Cluster Randomized Trial of a Healthy Relationships Approach to Sexual Risk Reduction.

By middle adolescence, most young people have been involved in at least one romantic relationship, a context in which many sexual interactions occur. Indeed, researchers have suggested the importance of attending to relationships in programs focused on sexual risk, yet few evidence-based programs have a strong relationships focus. Our study examined the impact of a healthy relationship program called You-Me-Us that included a classroom curriculum and a school-wide peer norms approach. We evaluated the intervention using a small grouprandomized trial that included nine participating urban middle schools (defined as schools that include grades 6-8) in three urban school districts. We invited all 7th grade students within the study schools to enroll. Students completed three surveys during 7th and 8th grades (baseline plus two follow up surveys at 6 and 18months following baseline). A total of 911 youth with positive consent and assent were enrolled in the study. Follow up survey response rates among those taking the baseline were 92% at 6months and 80% at 18months. Multilevel regression models were used to adjust for the correlation among students within the same school, and the correlation of repeated measurements taken on the same student over time. The intervention reduced vaginal sexual initiation by about half at the 6-month follow-up, and this approached significance. Further, youth in the intervention condition were less likely to believe it is okay for people their age to have vaginal sex without using condoms if the girl is on birth control. None of the remaining variables differed significantly by intervention condition. This study provides insights on using a healthy relationship approach for younger urban adolescents. This approach produced a programmatically significant reduction in sexual initiation that did not reach standard levels of statistical significance, and warrants further exploration.

Adolescent Tobacco Use and Misperceptions of Social Norms Across Schools in the United States

This study assesses tobacco use norm misperceptions by distinguishing between perceived and actual peer norms for both tobacco use attitudes and behavior, and examines the association between perceived norms and personal use among U.S. students in Grades 6-12. Anonymous self-report surveys were conducted with 28,070 students across 64 schools in 11 U.S. states between 1999 and 2017. Although 77% of students said tobacco use is never good, 64% of students thought that most students in their grade believed that use is acceptable. Similarly, although 79% of students reported never using tobacco, 85% of students perceived that most students in their grade typically use tobacco, with 66% thinking that peers use monthly or more often. Substantial norm misperception existed regardless of student and school factors, increasing by grade. Perceiving that most peers thought tobacco use is acceptable was highly predictive of personal attitude, and perceiving tobacco use as the norm among same-grade peers strongly predicted personal tobacco use, even after we adjusted for actual peer use prevalence and other factors. Males' perception of the male peer norm was a stronger predictor of personal use than was their perception of the female peer norm. Females' perceptions of sex-specific norms were associated with personal use, each at about the same magnitude. Norm misperceptions are pervasive across a diversity of students and schools, whereas perceptions of peer norms about tobacco use are highly associated with personal attitude and use. Results suggest that population-wide interventions correcting these misperceptions may help reduce tobacco use broadly among youth.

A primary care-led intervention to reduce cardiovascular disease risk in people with severe mental illness (PRIMROSE): a secondary qualitative analysis

BackgroundDespite various initiatives, the mortality rate in people with severe mental illness increased between 2004 and 2014. Poor health behaviours contribute, including poor diets, physical inactivity, smoking, and excessive alcohol consumption. Evidence is scarce regarding how primary care interventions can influence health behaviour change in people with severe mental illness. We aimed to explore how health behaviours were supported and changed in people with severe mental illness via an intervention (PRIMROSE) informed by the behaviour change wheel. MethodsPRIMROSE was delivered over 6 months in primary care across England. We did a secondary qualitative analysis of semi-structured interviews with staff and patients describing their experiences of PRIMROSE. The sample were selected from a random 20% of primary care practices in England. Topic guides were based on the capability, opportunity, motivation, and behaviour (COM-B) model of behaviour and the Theoretical Domains Framework. We identified how behaviour change techniques were applied by mapping the coded data to the behaviour change technique taxonomy (version 1). We explored barriers, facilitators, and processes of supporting or making health behaviour changes using thematic analysis. Themes were further informed by COM-B. FindingsBetween April 27 and Dec 19, 2016, 15 patients and 15 health-care professionals participated from a broad range of backgrounds across England, but with limited ethnic diversity. We identified 20 behaviour change techniques being used. Six factors affected supporting and changing health behaviours: motivation, motivated patients were more proactive to action advice, which was affected by witnessing physical health benefits; health knowledge or perceptions, developing knowledge on how to change health behaviour facilitated motivation but negative health perceptions could be difficult to change; difficulties with patient capability, mental and physical health status affected motivation; staff proficiency, previous experience with mental health and motivational interviewing skills aided supporting patients; social influences, patients felt pressure to achieve goals to avoid staff disappointment—creating healthy social (peer) norms facilitated motivation whereas unhealthy norms prevented changes; and environmental level influences, access to time and resources were perceived as critical. Making use of existing opportunities for behaviour change, such as open spaces for walking, facilitated positive changes. InterpretationThe value of the application of behaviour change techniques and primary health-care professionals in supporting health behaviour change in this population was variable. For some, such techniques helped to increase motivation, capability, and opportunity to change health behaviours. In others, complex challenges that people with severe mental illness experienced prevented behaviour change. Our findings suggest that with training and appropriate resources, primary care health-care professionals can facilitate health behaviour change in some cases, but policy makers and commissioners should consider enabling more interdisciplinary involvement. FundingUK National Institute for Health Research School for Primary Care Research.

A study of risky sexual behavior, beliefs about sexual behavior, and sexual self-efficacy in adolescent inpatients with and without borderline personality disorder.

Risky sexual behavior (RSB) during adolescence increases risk for sexually transmitted diseases and teenage pregnancy. Youth with psychiatric diagnoses are more likely to engage in RSB, and borderline personality disorder (BPD) in adolescence may be particularly relevant to RSB. It is not yet clear whether adolescents with BPD engage in higher levels of RSB than adolescents with other psychiatric diagnoses. The present study examined RSB and correlates of RSB among adolescent inpatient females with and without BPD. One hundred twenty-three female adolescent inpatients (Mage = 15.15, 71.5% Caucasian, 40.6% BPD) completed an interview to assess BPD diagnosis and measures of BPD traits, RSB, attitudes and perceived norms related to RSB, and sexual self-efficacy. Results indicated no differences in RSB based on BPD diagnosis. However, the BPD group evidenced significantly lower self-efficacy to refuse sex, and riskier attitudes and perceived peer norms about sexual behavior than inpatient controls. When examined dimensionally using borderline traits and controlling for level of psychopathology, borderline traits were significantly related to lower self-efficacy to refuse sex. Results suggest that adolescent girls with BPD do not engage in higher levels of RSB than inpatient psychiatric controls; however, riskier attitudes and norms related to RSB, and particularly lower self-efficacy to refuse sex, may influence adolescent girls with BPD or BPD traits to engage in higher levels of RSB later in life and therefore present important preventative treatment targets. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Compatible or conflicting? Peer norms and minority and majority adolescents' acculturation patterns

Minority and majority acculturation orientations (i.e., their preferences for minorities) show consistent intergroup asymmetries: Minority adolescents see heritage and mainstream culture orientations as compatible (i.e., positively correlated), whereas majority adolescents see them as conflicting (i.e., negatively correlated). It remains unclear (a) how minority and majority adolescents' compatible versus conflicting acculturation patterns evolve over time; and (b) how peer acculturation norms in school affect evolving individual acculturation patterns. Multi-level autoregressive cross-lagged panel models with Turkish-/Moroccan-minority (N = 1147, Mage = 15.60) and Belgian-majority (N = 1716; Mage = 15.08) adolescents in the same schools (N = 69) revealed that mainstream and heritage culture orientations were partially compatible over time for minorities, yet conflicting for majority adolescents. Moreover, peer acculturation norms predicted individual acculturation orientations longitudinally, in line with existing asymmetric acculturation patterns across minority and majority adolescents.

Mediation Analysis of Peer Norms, Self-Efficacy, and Condom Use Among Chinese Men Who Have Sex with Men: A Parallel Process Latent Growth Curve Model.

The objective of this study was to examine direct and indirect relationships among peer norms, self-efficacy, and condom use among Chinese men who have sex with men (MSM). A longitudinal study determined the effectiveness of a condom use video promotion among Chinese MSM in 2015. In this analysis, 804 Chinese MSM were recruited at baseline and then followed at 3weeks and 3months after the intervention. Parallel process latent growth curve modeling (LGM) with multiple indicators and bootstrapping was conducted using Mplus 7.4. The LGM model fit indexes were good with RMSEA = 0.046, 90% CI (0.044, 0.048), CFI = 0.956, TLI = 0.955. Our results showed that the initial measure of peer norms affected the initial measure of condom use indirectly through the initial measure of self-efficacy (αβ = 0.414, 95% CI 0.260-0.759). The rate of change in peer norms over time also significantly affected the rate of change in condom use through the rate of change in self-efficacy (αβ = 0.101, 95% CI 0.014-0.262). Self-efficacy mediated the association between peer norms and condom use, indicating a strong potential of causal relationship between peer norms and self-efficacy among Chinese MSM.

Sleep quality is associated with psychosocial functioning and health-related quality of life in pediatric transplant recipients.

This study examined patient-reported sleep quality in a single-center cross-sectional sample of adolescents with solid organ transplants and evaluated associations between sleep quality, psychosocial functioning (ie, depression/anxiety symptoms), and HRQOL. Health disparities associated with minority race/ethnicity and socioeconomic variables were also examined. Sixty-nine adolescents (M=16.51years; SD=1.63) who received a solid organ transplant (kidney: n=25; liver: n=24; heart: n=20) completed self-report measures of sleep quality, psychosocial functioning, and HRQOL. Adolescent transplant recipients endorsed significantly lower levels of sleep quality (ie, falling asleep) compared with previously published norms of healthy peers (t=-3.60; P≤.001). Higher sleep quality was significantly associated with fewer anxiety and depressive symptoms (r=-.31 to -.40), and higher physical and psychosocial HRQOL (r=.33-.43). Adolescents from minority backgrounds had significantly worse sleep quality compared with non-Hispanic Whites. Adolescent transplant recipients, particularly those from minority backgrounds, may be at increased risk for experiencing poor sleep quality. Suboptimal sleep is a risk factor for higher levels of anxiety and depressive symptoms, as well as lower levels of physical and psychosocial HRQOL. Sleep is an important modifiable factor that, if improved, may contribute to lower anxiety/depressive symptoms and better HRQOL in adolescent transplant recipients.

Are Impulsive Adolescents Differentially Vulnerable to Normative or Situational Peer Influences? A Partial Replication Study

Ample research in criminology investigates the role of deviant peers in the development of adolescent offending. Different theoretical explanations account for distinct peer influences. The socialization perspective argues that deviant peers influence behavior through the provision of norms and values, whereas the situational perspective argues that deviant peers provide situational opportunities for deviant behavior. This study partially retests the propositions put forward by Thomas and McGloin’s study of dual systems, differential peer effects, and adolescent offending. We address the question to what extent trait impulsivity affects social and situational peer processes controlling for parental supervision, family bond, school bond, and deviant norms. Analysis of the cross-national International Self-Report Delinquency Study (ISRD3) data suggests that adolescents at the edges of trait impulsivity are differentially vulnerable to the effects of deviant peer processes. However, the findings need to be nuanced. We discuss the contribution of the current study to a better understanding of the interplay between individual characteristics and exposure to deviant peers.

Who is most influential? Adolescents’ intergroup attitudes and peer influence within a social network

Research has shown that adolescents’ intergroup attitudes are subject to friends’ influence, but it remains unknown if certain friends are more influential than others. Popular adolescents may be especially influential of their friends’ intergroup attitudes because they can set peer norms. We examined several indicators of popularity in social networks as possible determinants of social influence: sociometric popularity, prestige popularity, being a clique leader, and frequency of contact with friends. Longitudinal analysis of adolescents’ friendship networks (12–13 years, N = 837) allowed estimating influence of friends on adolescents’ intergroup attitudes, while controlling for the tendency of adolescents to befriend peers with similar intergroup attitudes. Results showed that adolescents’ intergroup attitudes changed in the direction of friends’ intergroup attitudes. Only peers who are popular in terms of having many friends (sociometric popular) were especially influential of their friends’ intergroup attitudes. These findings may inform future interventions aiming to reduce prejudice.

Study Protocol: 6th National Survey of Australian Secondary Students and Adolescent Sexual Health, 2018.

Introduction: Since 1992 the Australian Government has funded a periodic national survey of HIV and Sexually Transmissible Infection (STI) knowledge and sexual risk behavior among secondary school students. Adolescents continue to be a priority population in public health efforts to reduce rates of STIs in Australia. The purpose of the survey is to inform progress on national strategic sexual health priorities. The results are used by federal and state/territory government agencies, youth-serving community organizations and health educators to improve knowledge, promote healthy sexual behaviors and target educational efforts aimed at communicating public health messages to young people.Materials and Equipment: The 6th survey entitled the “National Survey of Secondary Students and Adolescent Sexual Health” was conducted online in 2018 among 14–18 year olds living in Australia. The anonymous self-complete survey contained up to 286 items assessing three primary domains of knowledge, behaviors and education experiences. Factual knowledge measures covered HIV transmission and STI knowledge around transmission and prevention covering gonorrhea, Chlamydia, syphilis, hepatitis, herpes, and HPV. Behavioral measures examined perceived susceptibility, peer norms, protective behaviors, age of onset for various behaviors, reasons for not being sexually active yet, and/or sexual histories with additional detail on most recent sexual event. The 6th survey was completed by 8,400 Australian adolescents a represents a broad cross-section by age, gender, year in school, type of school (e.g., government, Catholic), and state/territory which closely matched census data on these strata. The one-of-a-kind survey instrument, grounded in public health theories, may prove valuable for public health researchers.Expected Impact of the Study on Public Health: Findings from the 6th National Survey of Secondary Students and Adolescent Sexual Health will contribute important insights into current knowledge, behaviors and educational experiences of young people. Results, similar to previous iterations of the survey, will inform public health practitioners, policymakers, educators, and advocates for the sexual health and well-being of young Australians. Results may assist sexual health services to align with broader public health goals articulated in the national HIV and STI strategies aimed to reduce the burden of disease and improve the quality of sexual lives of young Australians.

The role of socialization agents in adolescents’ responses to app-based mobile advertising

This study examines how parents, peers, and media use affect adolescents’ attitudinal and behavioral responses to app-based mobile advertising. A survey conducted with 603 smartphone users aged between 12 and 19 in Singapore suggests that parental factors, particularly control-based restrictive parental mediation, are more influential on younger adolescents than older ones. Findings also demonstrate that adolescents’ susceptibility to normative peer influence makes them less critical about app-based mobile advertising, regardless of their age. Regarding the role of media use, adolescents’ responses to app-based mobile advertising are more a function of perceived smartphone competency than the amount of time spent on smartphones.

Peer Substance Use Norms and Nonmedical Use of Prescription Drugs among a National Sample of African American Adolescents

The purpose of this study was to examine the relationship between peer substance use norms and lifetime and past year nonmedical use of prescription drugs (NMUPD) among African American adolescents. A secondary analysis of the 2013 National Survey on Drug Use and Health was conducted (N = 2,420). We performed multivariable logistic regression analyses to examine the associations between peer norms and lifetime and past year NMUPD. For lifetime NMUPD, results revealed that participants who reported that most/all of their peers used substances were significantly more likely to report lifetime use. Similar results were found for past year NMUPD. Recommendations are included.

A national experiment reveals where a growth mindset improves achievement

A global priority for the behavioural sciences is to develop cost-effective, scalable interventions that could improve the academic outcomes of adolescents at a population level, but no such interventions have so far been evaluated in a population-generalizable sample. Here we show that a short (less than one hour), online growth mindset intervention—which teaches that intellectual abilities can be developed—improved grades among lower-achieving students and increased overall enrolment to advanced mathematics courses in a nationally representative sample of students in secondary education in the United States. Notably, the study identified school contexts that sustained the effects of the growth mindset intervention: the intervention changed grades when peer norms aligned with the messages of the intervention. Confidence in the conclusions of this study comes from independent data collection and processing, pre-registration of analyses, and corroboration of results by a blinded Bayesian analysis.

Family Incarceration and Bullying Among Urban African American Adolescents: The Mediating Roles of Exposure to Delinquent Peer Norms, Trauma, and Externalizing Behaviors

The present study examined whether having had an incarcerated adult family member was associated with youth bullying perpetration. The study also examined whether exposure to delinquent peers’ norms, trauma, and externalizing behaviors mediated the link between adult family member’s incarceration and bullying perpetration. The study sample consisted of 638 African American adolescents, aged 13 to 21, in Chicago’s Southside. Major findings indicated that 46.8% of the study participants reported bullying perpetration (i.e., at least 1 to 2 times in the past 30 days). Moreover, an adult family member’s incarceration history was found to be positively associated with having peers who endorsed delinquent norms, trauma, and externalizing behaviors, which were linked to youth’s bullying perpetration. Programs addressing youth bullying need to consider the family dynamics.

Correcting for norm misperception of anti-bullying attitudes

Research has documented the presence of norm misperception in the context of school bullying, as children and adolescents typically underestimate the degree to which their peers disapprove of bullying behavior. Despite commonly held attitudes in opposition to bullies and in support of helping victims, widespread misperception of the norm makes students vulnerable to acting in a manner that reinforces bullying, as they aim to align themselves with perceived peer beliefs. This study investigated whether personalized normative feedback, a social norms intervention that juxtaposes individuals’ own perceptions of peer norms against their peers’ true normative values, could operate as a mechanism by which to reduce norm misperception of peer attitudes toward bullying. Whereas this type of intervention has shown promising effects in a variety of contexts, no study to date has examined its utility in the specific context of bullying. Baseline participants included 188 seventh grade students, 175 of whom were randomized into four study groups for follow-up data collection. Individuals in the experimental condition received personalized normative feedback on attitudes toward bullying. Control conditions were the following: general normative feedback on anti-bullying attitudes, the absence of normative feedback, and personalized normative feedback on a construct separate from bullying (i.e., antidrug use attitudes). Findings indicated that personalized normative feedback on bullying attitudes led to significant change in perceived peer attitudes in the direction of the group norm, with an effect size in the small-to-medium range. No intervention effects emerged on personal attitude change. Implications highlight strategies for improving the strength of similar interventions in future research as well as the positive clinical outcomes that could result from reduced norm misperception and increased engagement in prosocial bystander behavior.

Teacher perceptions of sun protection practices in the secondary school setting: Barriers, enablers and recommendations for future

This qualitative study aimed to explore sun protection barriers and enablers in secondary schools in Victoria. Five focus groups were conducted with nominated Health or Physical Education (PE) Coordinators (or other staff representatives) from schools in metropolitan and regional Victoria. Discussions were audio-recorded, transcribed and coded thematically. Participants identified the need for regulatory influences that included minimum standards for sun protection policy, training and shade in the built environment. Participants perceived that sun protection is not always acknowledged to be a duty of care in secondary schools. A crowded health and well-being curriculum, a focus on fostering independence, and challenges overcoming peer norms were perceived to be important contextual influences. At an organisational level, strong leadership and a united approach among staff were identified as critical ingredients for successful policy implementation and organisational change. Several potentially effective strategies were proposed, including increased shade, leveraging from student leaders, normalising sun protection practices and prioritising staff role modelling. A cultural shift is required for many schools to accept and act on sun protection as a duty of care. A comprehensive approach that includes regulatory action, healthy school policies and leading by example may help protect students and staff from harmful UV exposure during school hours. SO WHAT?: Without regulatory support, strong leadership is required to implement and enforce sun protection practices within schools. Health promotion programs could assist schools to trial and evaluate the sun protection strategies that involve student-led solutions, role modelling and increasing shade.

Peer Benchmarking and Norm-Based Scoring to Improve Telephonic Health Coaching Quality

Studies evaluating telephonic coaching to improve population health have focused on outcomes, but measurement of consistency of coaching quality is also needed. The aim of this study was to describe how one multistate health plan developed, scored, and implemented a Coach Case Quality Assessment (CCQA) for quality improvement. The nine-item CCQA is a checklist of elements selected by quality improvement teams for peer benchmarking to improve telephonic coaching. The health plan fielded the CCQA to 470 clinical coaches in 2016. Quality reviewers rated coaches' call quality on each item (1 = learning; 2 = progressing; 3 = succeeding) and planned training around composite scores in relation to team norms. A total of 470 coaches completed CCQAs with a norm-based mean score of 50.0 (standard deviation [SD] ± 10.0); 54.0% of coaches had scores within ±1 SD of the mean ("norm"), with 20.9% of coaches scoring below that range, and 25.1% scoring above it. Ninety-six percent (451/470) of coaches completed a nine-month follow-up. The mean norm-based score improved to 56.2 (SD ± 9.3), with 8.2% performing below, 42.4% at, and 49.4% above the peer norm. Scores represent significant mean and proportional changes over time, reflecting improvement on the part of whole teams. This study demonstrates norm-based scoring as an effective strategy for measuring and improving coaching quality in a telephonic behavioral change program. Health plans can implement case quality review with norm-based scoring and peer benchmarking to aid coaches in continuous quality improvement.

The Interplay between Peer and Authoritative Injunctive Norms of Parents Discussing Pornography with Adolescents

The role and functionality of injunctive norms is an understudied phenomenon within sexual communication processes. Using the theory of normative social behavior (TNSB), the present study examined emergent peer-oriented and authoritative injunctive norms as they relate to the context of parents discussing pornography with adolescent children. Findings from a multicase, qualitative analysis of 33 in-depth interviews from parents of middle schoolers revealed several injunctive norm patterns. Observations included disparities within messages shared by influential peers concerning parent-child pornography communication, insight regarding peer-judgement versus peer-support, tensions between previous closed communication family patterns, and a recognition by participants that open parent-child communication about pornography is needed. Suggestions are offered for educators and practitioners to more fully evaluate the role of injunctive norm messaging in efforts to share positive messages about parent-child pornography communication.