JPP Student Journal Club Commentary: Adolescent Condom Use and Connectivity in the Social-Planful Brain.

According to the Centers for Disease Control and Prevention (CDC), youth (ages 15–24 years) account for half of all new sexually transmitted infection (STI) cases (CDC, 2013), which could be reduced with safe sex practices. While the teen pregnancy rates have been on a decline for several years (Martin, Hamilton, & Osterman, 2017) and condom use rates in adolescents have increased (though with signs of a recent decrease; Copen, 2017; Reece et al., 2010), there is ongoing need to help increase safe sex practices (e.g., encouraging use of condoms even if a contraceptive pill is used to reduce STI risk). Unfortunately, some interventions have been found to be ineffective or sometimes iatrogenic (Kirby, Laris, & Rolleri, 2007). To better target these behaviors, we need a clearer understanding of the factors that contribute to adolescent decision-making. Caouette, Hudson, Bryan, and Feldstein Ewing (2018) examine this very topic by looking at neuroimaging of sexually active adolescents to see if greater connectivity in the social region of the brain is associated with condom use. They found this to be true in males, but not in females. As they point out in their article, one of the main factors in determining adolescent behaviors is ongoing brain development. For example, many of the executive functioning pathways, which span the entirety of the brain (Alvarez & Emory, 2006; Stuss, 1992), are actively undergoing maturation throughout adolescence (Best, Miller, & Naglieri, 2011). This development also includes advancements in social cognition, which itself relies on a number of advanced cognitive skills (e.g., perspective taking; Blakemore & Choudhury, 2006). Part of the relevant neurological development, as Caouette et al. (2018) point out, is the improved connection between areas of gray matter in the brain (Giorgio et al., 2008), potentially allowing for better intercommunication and thus more advanced cognitive skills that may influence behaviors. However, it should be noted that such studies need to be interpreted with caution for a variety of reasons. First, as Caouette et al. (2018) point out in the discussion section of their article, imaging techniques such as functional magnetic resonance imaging (fMRI) are still maturing as research tools. Findings from imaging studies are currently informative, but nonconclusive because of (1) small sample sizes; (2)indirect measurement methods (i.e., blood flow and oxygen concentrations; Logothetis, 2008); (3) uncertainty about excitatory versus inhibitory activity (Logothetis, 2008); and (4) presumed functions of different brain areas with interpersonal variation related to neuroplasticity (e.g., presumed left-lateralized language when it can be right-lateralized or mixed; Rutten, Ramsey, van Rijen, Alpherts, & van Veelen, 2002). In the context of sexual behaviors specifically, there are also many other factors outside of social planning that seem to contribute to decisions (e.g., perceived ability to engage in a behavior; Fishbein, 2000). Finally, causality of neural pathway development and sexual behaviors is difficult to determine. Discussion of sex-related behaviors also requires consideration of gender roles, cultural norms, and the diversity of potential sexual encounters. For example, adolescent males have reported more regular use of condoms than females (Copen, 2017; Reece et al., 2010), and gender-related power differences may contribute to likelihood of condom use (e.g., East, Jackson, O’Brien, & Peters, 2007). In addition, while many adolescents are aware of female condoms, their