Utilization of Sexual and Reproductive Health Services in Ethiopia--does it affect sexual activity among high school students?

OBJECTIVE

Universal access to Sexual and Reproductive Health (SRH) services for adolescents was added as a target to the revised Millennium Development Goals framework in 2005. However, the utilization of SRH services among adolescents and their sexual activity is not well explored in Ethiopia, with the result that there is no well-designed and sustainable school based intervention for high school students. We aimed to investigate the utilization of sexual and reproductive health services and sexual activity and, to provide evidence based information and recommendations for possible interventions.

STUDY DESIGN

A cross-sectional survey was conducted among 1031 female and male high school students aged 14-19 years in Mekelle town, Tigray Region, North Ethiopia. A total of 1031 students participated. Self-administered questionnaire was used.

MAIN OUTCOME MEASURES

Utilization of sexual and reproductive health services and sexual activity were investigated using a self-administered questionnaire.

RESULTS

One out of five students had used the SRH services in the past year. The primary reason for visiting the SRH services was to receive information. The mean age for the first sexual intercourse was 15.7 and one-quarter of the students had multiple sexual partners. Unwanted pregnancies and abortions were reported by female students.

CONCLUSION

SRH services are known and used by students. However, sexual activity at an early age among high school students and unwanted pregnancies and abortions among female students still call for attention. Therefore, providing accurate SRH information on safe sex and enhancing family-student discussion could be a good approach to reach SRH of adolescents.

Parental monitoring affects the relationship between depressed mood and alcohol-related problems in adolescents

BACKGROUND

Parental monitoring has been identified as a protective factor for adolescent drinking, whereas depressed mood, peer substance use, and peer tolerance of substance use have been identified as risk factors. The purpose of this study was to test the association between depressed mood and alcohol-related problems in adolescents, and to test whether parental monitoring and peer substance use/tolerance of use moderate the strength of this relationship.

METHODS

Participants included 227 adolescents (Mage = 15.36; 51.5% female) recruited from a hospital emergency department and surrounding community who completed self-report assessments.

RESULTS

Hierarchical linear regression analysis demonstrated that depressed mood was associated with more alcohol-related problems. A significant interaction between depressed mood and parental monitoring indicated a moderating effect, with high levels of depressed mood being associated with alcohol-related problems when parental monitoring was low; at low levels of depressed mood, parental monitoring was not related to alcohol-related problems.

CONCLUSIONS

This study highlights the protective role that parental monitoring may play in the association between depressed mood and alcohol-related problems and suggests that parenting practices, in addition to individual counseling, should be addressed in treatment of depressed adolescents who drink.

Mother-adolescent monitoring dynamics and the legitimacy of parental authority

This multi-informant longitudinal study aimed to understand whether the family dynamics that underlie adolescent voluntary disclosure regarding their leisure time behavior differs when adolescents strongly or weakly endorse the legitimacy of parental authority. Longitudinal linkages between parental monitoring behaviors and adolescents' secrecy and disclosure were tested among youths with strong and weak legitimacy beliefs. The sample included 197 adolescents (51% female, M age 12 years) and their mothers. Mothers reported on several of their own monitoring efforts (i.e., solicitation, active involvement, observing and listening, and obtaining information from spouses, siblings, and others). Adolescents reported their disclosure, secrecy, and legitimacy beliefs. Only among youths reporting strong legitimacy beliefs, more mother engagement and supervision (indexed by mother-reported active involvement and observing and listening) predicted more adolescent disclosure and less secrecy over time, and more mother solicitation predicted less secrecy.

Externalizing behavior and substance use related problems at 15 years in prenatally cocaine exposed adolescents

The effect of prenatal cocaine exposure (PCE) on externalizing behavior and substance use related problems at 15 years of age was examined. Participants consisted of 358 adolescents (183 PCE, 175 non-cocaine exposed (NCE)), primarily African-American and of low socioeconomic status, prospectively enrolled in a longitudinal study from birth. Regression analyses indicated that the amount of PCE was associated with higher externalizing behavioral problems (β = .15, p = .02). Adolescents with PCE were also 2.8 times (95% CI = 1.38-5.56) more likely to have substance use related problems than their NCE counterparts. No differences between PCE adolescents in non-kinship adoptive/foster care (n = 44) and PCE adolescents in maternal/relative care (n = 139) were found in externalizing behavior or in the likelihood of substance use related problems. Findings demonstrate teratologic effects of PCE persisting into adolescence. PCE is a reliable marker for the potential development of problem behaviors in adolescence, including substance use related problems.

Child diurnal cortisol rhythms, parenting quality, and externalizing behaviors in preadolescence

This study examined a neurobiologically informed model of the emergence of child externalizing behaviors in an ethnically diverse community sample of 232 9-12 year old children. Replicating extensive prior research, our analyses revealed that parents' inconsistent discipline and poor quality monitoring were predictive of child externalizing behavior. In addition, poor parental monitoring, but not inconsistent discipline, was associated with children having a significantly flatter morning-to-evening cortisol slope, which was in turn, related to higher levels of externalizing behaviors. An indirect effect of parental monitoring on externalizing behaviors, through child diurnal cortisol rhythms, was also supported. These findings highlight the role of the hypothalamic-pituitary-adrenal (HPA) axis and its hormonal end product, cortisol, in the relationship between the caregiving environment and the development of externalizing behaviors.

The impact of youth, family, peer and neighborhood risk factors on developmental trajectories of risk involvement from early through middle adolescence

Few studies have analyzed the development course beginning in pre-/early adolescence of overall engagement in health-risk behaviors and associated social risk factors that place individuals in different health-risk trajectories through mid-adolescence. The current longitudinal study identified 1276 adolescents in grade six and followed them for three years to investigate their developmental trajectories of risk behaviors and to examine the association of personal and social risk factors with each trajectory. Group-based trajectory modeling was applied to identify distinctive trajectory patterns of risk behaviors. Multivariate multinomial logistic regression analyses were performed to examine the effects of the personal and social risk factors on adolescents' trajectories. Three gender-specific behavioral trajectories were identified for males (55.3% low-risk, 37.6% moderate-risk, increasing, and 7.1% high-risk, increasing) and females (41.4% no-risk, 53.4% low-risk, increasing and 5.2% moderate to high-risk, increasing). Sensation-seeking, family, peer, and neighborhood factors at baseline predicted following the moderate-risk, increasing trajectory and the high-risk, increasing trajectory in males; these risk factors predicted following the moderate to high-risk, increasing trajectory in females. The presence of all three social risk factors (high-risk neighborhood, high-risk peers and low parental monitoring) had a dramatic impact on increased probability of being in a high-risk trajectory group. These findings highlight the developmental significance of early personal and social risk factors on subsequent risk behaviors in early to middle adolescence. Future adolescent health behavior promotion interventions might consider offering additional prevention resources to pre- and early adolescent youth who are exposed to multiple contextual risk factors (even in the absence of risk behaviors) or youth who are early-starters of delinquency and substance use behaviors in early adolescence.

Parental monitoring and alcohol use among Mexican students

Parental monitoring has been described as a protective factor and useful strategy to prevent substance misuse among youths. The aim of this study was to examine whether perceived parental monitoring influences frequency of alcohol use, age of drinking onset and risky drinking among entering public high school and university students in Mexico City. The study is a cross-sectional survey of entering first year students in the high school and university school system of a large public university in Mexico City conducted during registration at the beginning of the school year. In 2008, of 34,840 students accepted to the affiliated high schools, 28,996 students (51.8% female) completed the alcohol survey and of 37,683 students accepted into university 30,084 students (51.5% female) completed the alcohol survey. The findings suggest that compared to students with higher perceived parental monitoring those reporting lower perceived parental monitoring were more likely to report risky behavior. They were more likely to be ever drinkers, frequent drinkers, have earlier age of onset and high AUDIT scores. Overall, higher parental monitoring was strongly associated with being female and lower parental monitoring with being male. Our findings suggest that more research on parental monitoring as a protective strategy against alcohol misuse is needed. Research focusing on cultural factors including gender and age-related norms and familismo would increase knowledge of the association of parental monitoring and alcohol use among Mexican youths, Mexican American youths and potentially youths from other Hispanic backgrounds.

Adolescents' access to their own prescription medications in the home

PURPOSE

The objective of this descriptive study was to determine adolescents' access to their own medications at home, specifically prescription pain, stimulant, antianxiety, and sedative medications.

METHODS

Semistructured interviews were conducted with a cohort of 501 adolescents from two southeastern Michigan school districts. Participants were asked what medications had been prescribed to them during the previous 6 months; if they had received prescription medications, they were asked in-depth questions about them, including how medications were stored and supervised at home.

RESULTS

The sample was comprised of adolescents in the 8th and 9th grades, and 50.9% were male. Participants were primarily white (72.9%, n = 365) or African-American (21.6%, n = 108). Slightly less than half of the adolescents (45.9%, n = 230) reported having been prescribed medications in the previous 6 months. Of this group, 14.3% (n = 33) had been prescribed pain medications, 9.6% (n = 22) stimulants, 1.7% (n = 4) antianxiety medications, and .9% (n = 2) sedatives. In total, 57 adolescents were prescribed medications in the pain, stimulant, antianxiety, or sedative categories (including controlled medications), and the majority (73.7%, n = 42) reported that they had unsupervised access to medications with abuse potential.

CONCLUSIONS

The majority of adolescents who were prescribed medications in the pain, stimulant, antianxiety, or sedative categories during the previous 6 months had unsupervised access to them at home. It is critical that clinicians educate parents and patients about the importance of proper storage and disposal of medications, particularly those with abuse potential.

Stress Among African American Emerging Adults: The Role of Family and Cultural Factors

The aim of this study was to examine the effects of family and cultural variables on stress among African American emerging adults. Data from this study was collected as part of a larger study that examined cultural, family, and contextual factors and smoking among African American youth in 5th, 8th, and 12th grades. Data were collected from high school seniors at the end of their 12th grade year and 6 months post high school. Multiple regression analyses were conducted to determine whether racial identity, family cohesion, and parental monitoring influence students' perceived frequency of stress. Higher levels of racial identity were associated with more perceived stress. There were no significant main effects for either parental monitoring or family cohesion on stress. There were significant interactions between racial identity and parental monitoring and between parental monitoring and family cohesion. Study implications are discussed regarding the importance of stress reduction programs for African American emerging adults and for parents of these adults.

Victimization and Relational Aggression in Adolescent Romantic Relationships: The Influence of Parental and Peer Behaviors, and Individual Adjustment

Consistent with the view that adolescent relationships are established in the context of important characteristics of their social networks, we examined the effects of adolescents' experiences of parenting (psychological control and positive monitoring) and of peer aggression and victimization, on their self reports of dating victimization and aggression. We also examined the effects of individual differences in emotional and behavioral problems. We used questionnaire data from a population-based sample of youth 12-18 years old who were in dating relationships (n = 149). Parental monitoring emerged as a protective factor in reducing both dating victimization and relational aggression. Our findings also point to a significant transfer of aggression in peer relationships to relational aggression in dating relationships.