Social context, community norms, and adolescent girls' sexual health and wellbeing

The National Institute of Child Health and Human Development awarded The Johns Hopkins University $149,190 on July 1, 2026, under the Child Health and Human Development Extramural Research program (CFDA 93.865) to conduct research on sexual readiness among adolescent girls and young women in low- and middle-income countries.

The recipient will explore the cross-cultural applicability of a measure of sexual readiness, examine its social determinants, assess its predictive value on sexual and reproductive health outcomes across low- and middle-income countries, and evaluate the adaptation of the measure in humanitarian settings. Aim 1 analyses will examine the construct of readiness at sexual debut in sub-Saharan Africa using Performance Monitoring for Action surveys with national longitudinal data on fertility and contraceptive behaviors among women ages 15–49 in five sub-Saharan African countries, applying latent class analysis to identify readiness profiles and assess their predictive effect on subsequent sexual and reproductive health outcomes. Aim 2 analyses will use multilevel structural equation models to examine associations between social norms, individual attitudes, and sexual readiness, and the moderating role of social norms on the relationship between sexual readiness and sexual and reproductive health outcomes. Aim 3 will adapt this research and model to humanitarian settings using data on marriage and sexual and reproductive health outcomes among adolescent girls and young women from conflict-affected and displaced populations.

The period of performance runs from July 1, 2026, through August 15, 2027. Work is performed in Baltimore, Maryland.

Abstract

Sexual agency among adolescent girls and young women (AGYW), or an individual's ability to make decisions about engaging in sexual activity independently, fully informed, and free from coercion, has become a topic of interest in sexual and reproductive health and rights. However, readiness to initiate sexual activity, itself a reflection of sexual agency, has been less studied. To advance the understanding of sexual readiness, its causes, and associated sexual and reproductive health (SRH) outcomes in low- and middle-income countries (LMICS), this study will explore the cross-cultural applicability of a measure of sexual readiness, examine its social determinants, assess its predictive value on SRH outcomes across LMICS, and evaluate the adaptation of the measure in humanitarian settings. Specifically, aim 1 analyses will examine the construct of readiness at sexual debut sub-saharan africa (SSA), identify profiles of adolescents' readiness at sexual debut, and compare the measures of age at sexual debut and readiness in predicting SRH outcomes. Using performance monitoring for action (PMA) surveys with national longitudinal data about fertility and contraceptive behaviors among women ages 15-49 in five SSA countries, this analysis involves using latent class analysis to identify readiness profiles and assess their predictive effect on subsequent SRH outcomes. Secondly, using multilevel structural equation models, aim 2 analyses will examine the association between social norms, individual attitudes, and sexual readiness as well as the association between sexual readiness and SRH outcomes and the moderating role of social norms. Finally, aim 3 analyses will adapt this research and model to humanitarian settings with data on marriage and SRH outcomes among AGYW from the "early marriage and fertility decision making among conflict-affected and displaced adolescents in bangladesh and yemen" (EMEC) study. Using multilevel multivariate logistic regression, the analysis will evaluate the influence of social norms on adolescents' readiness in marriage in humanitarian settings in south and western asia and examine the effect of readiness in marriage on subsequent SRH outcomes and the moderating role of social norms. To support this dissertation research, the applicant has brought together a group of faculty with extensive subject-matter and methodological expertise related to the research proposal to serve as her mentorship team, led by DR. Caroline moreau. The training plan includes coursework, research, conferences, and other opportunities that will deepen the applicant's conceptual understanding and subject matter expertise in adolescent SRH and social norms, strengthen her advanced methodological skills in statistics, including structural equation modeling, and expand her research experience addressing srhr issues in humanitarian contexts. This research aligns with the nichd 2020 strategic plan to "characterize typical and atypical physical, social, and emotional development in adolescence". This training plan and research project will enable the applicant to build the skillset critical to becoming an independent researcher with expertise in applying a life course framework to issues of adolescent development and SRH.