Parental influences on adolescent sexual behaviors

Parents play a significant role in the sexual development and behaviors of their children. Parental monitoring and supervision are important avenues for keeping adolescents from risky situations and activities while the teen develops responsible decision-making skills. A supportive relationship between the parent and adolescent is important for enhancing communication and supervision. In this article we discuss programs that were designed to improve parenting skills to decrease adolescent sexual risk behaviors.

VivaGel (SPL7013 Gel): a candidate dendrimer--microbicide for the prevention of HIV and HSV infection

Microbicides are compounds that applied vaginally or rectally, protect the user from sexually transmitted infections. Although no commercial product is yet available, many candidates are under development. A leading candidate, VivaGel (SPL7013 Gel) is the product of nanotechnology. The active ingredient is SPL7013, a dendrimer that was designed specifically with HIV and HSV antiviral activity and human safety in mind. SPL7013 has demonstrated efficacy against human immunodeficiency virus and herpes simplex virus in in vitro and animal models. VivaGel appears to be well tolerated in both animals and humans. This review summarizes the studies of VivaGel and its active ingredient, SPL7013.

Understanding sexual behaviors of adolescents within a biopsychosocial framework

In this article, adolescent sexual behavior is discussed within a biopsychosocial framework. Prevalence rates for both coital and noncoital behaviors are presented, and trends in coital behaviors are noted over time. Special attention is paid to the role culture plays in the development of sexual behaviors. The discussion includes prevalence rates and trends of pregnancies/births and sexually transmitted diseases among adolescents and the impact of these outcomes for both adolescents and their offspring.

Predictors of using a microbicide-like product among adolescent girls

PURPOSE

This study examined demographic, sexual history and weekly contextual variables, and perceptions about microbicides as predictors of microbicide-like product use.

METHODS

Adolescent girls (N = 208; 14-21 years) participated in a 6-month study in which they completed three face-to-face interviews and 24-weekly phone call interviews. Participants were given microbicide-like products (vaginal lubricants) and encouraged to use them with condoms when they had intercourse.

RESULTS

Of the girls, 75% had had a sexual opportunity to use the product. Using multi-variable logistic regression, the following variables independently predicted ever using the product: length of sexual experience, number of lifetime vaginal partners, and the Comparison to Condoms subscale on the Perceptions of Microbicides Scale. Using a mixed model repeated measure linear regression, the following variables independently predicted frequency of use: week of the study, age, condom frequency prior to the study, and three subscales on the Perceptions of Microbicide Scale: namely, the Comparison to Condoms subscale, the Negative Effects subscale, and the Pleasure subscale.

CONCLUSION

Most girls used the product, including those who were not protecting themselves with condoms. Girls' initial perceptions regarding the product predicted initial use and frequency of use. Further research should evaluate the best methods for supporting the use of these products by young or sexually less experienced girls.

Vaccinating young adults against human papillomavirus: the importance of understanding health decision-making and behaviour

Vaccination of young teenage females against human papillomavirus (HPV) with a newly licenced quadrivalent vaccine designed to prevent cervical cancer and genital warts has recently been recommended by the Australian government and will be implemented through schools from April 2007. In addition, a fully funded 'catch-up' vaccination program for young women up to age 26 years has been approved for a 2-year period, from July 2007. As general practitioners (GPs) will be the main immunisation providers for this age group, in order to achieve high vaccination coverage and maximal impact on disease, it will be critical for GPs to be opportunistic in recommending this vaccine. An initial study of young Australians' attitudes towards HPV vaccination and hypothetical acceptance of the vaccine was published in this journal. We draw on this study and data published elsewhere to discuss issues of HPV vaccine acceptability, and the likely challenges of a mass vaccination initiative in this age group in Australia. We suggest specific strategies to support GPs, and highlight areas for further research in HPV vaccine acceptability.

Factors Influencing Pediatricians' Intention to Recommend Human Papillomavirus Vaccines

OBJECTIVES

The objectives of this qualitative study were to describe the range of pediatricians' attitudes about human papillomavirus (HPV) vaccines and to explore factors influencing their intention to recommend HPV vaccines, extending the findings of previous quantitative studies.

METHODS

A diverse sample of pediatricians participated in semistructured individual interviews to assess attitudes and intentions regarding HPV immunization. Framework analysis was used for qualitative analysis.

RESULTS

The mean age of the 31 participants was 47 years, 17 (55%) were female, 9 (29%) were black, and 4 (13%) were Latino. The efficacy, safety, and potential health impact of vaccination were the primary factors driving participants' decisions about recommending HPV vaccines. Perceived benefits of HPV vaccination included prevention of HPV-related disease and the opportunity to educate adolescents. Perceived barriers included anticipated parental beliefs (eg, parental denial that their child would be at risk) and provider beliefs (eg, reluctance to discuss sexuality with preadolescents). Participants reported high intention to recommend HPV vaccines overall, but intention varied according to patient age, patient gender, and HPV vaccine type. The primary reasons underlying this variation included perceptions about the health impact of vaccination and relevance of HPV vaccines to the provider's patients. The main factors driving intention to recommend HPV vaccines included knowledge, personal and professional characteristics, office procedures, vaccine cost and reimbursement, parental factors, and specific attitudes about HPV vaccination.

CONCLUSIONS

These findings provide a framework for understanding pediatricians' decisions to recommend HPV vaccines and may be used to guide the design of interventions to maximize vaccine recommendations.

Effective strategies for HPV vaccine delivery: the views of pediatricians

PURPOSE

Pediatricians will play a critical role in human papillomavirus (HPV) vaccine delivery. The objectives of this research were to examine pediatricians' views about key issues related to HPV vaccine delivery and identify their strategies for effective vaccine delivery.

METHODS

A diverse sample of practicing pediatricians was recruited from a three-state region using a purposeful sampling strategy. Participants completed in-depth, semi-structured interviews. Qualitative data were analyzed using framework analysis.

RESULTS

The mean age of the 31 participants was 47 years (range 30-78 years), and 17 (55%) were female. In all, 18 were white, nine (29%) black, and four (13%) Latino. Participants noted that cultural issues, including a family's religious and ethnic background, were important considerations when recommending an HPV vaccine. Almost all participants believed that vaccination should be universal rather than targeted, but opinions regarding legislative mandates for vaccination varied. Those in favor of mandates cited their potential to maximize the public health impact of immunization, while those opposed noted that HPV is not transmitted casually and were concerned about limited data on the long-term safety and efficacy of HPV vaccines. Pediatricians noted that specific strategies for effective vaccine delivery would be needed for an STI vaccine targeted toward adolescents, especially considering the poor public understanding of HPV. These included provision of HPV vaccines in alternative settings, guidance for pediatricians as to how to address parental concerns, and specific educational initiatives.

CONCLUSIONS

The views of pediatricians, who have extensive experience administering vaccines to children and adolescents, will be valuable as HPV vaccine delivery strategies are designed.

Measurement of microbicide acceptability among U.S. adolescent girls

BACKGROUND AND OBJECTIVE

Topical microbicides will only be effective if they are acceptable to potential users. The purpose of this study is to develop a scale to evaluate characteristics and aspects of topical microbicides that are important to adolescent girls.

STUDY DESIGN

Girls (n = 207) completed a questionnaire on perceptions of microbicide-like products.

RESULTS

A principal components factor analysis with a varimax rotation produced a 6-factor solution. The mean factor scores suggested that girls saw the products positively. Age was positively correlated with "comparison to condoms" and "comfort while using" factor scores and inversely correlated with "negative impact on interpersonal relationships" factor score. Sexually transmitted infection (STI) history was related to higher scores on the "health benefits" and "pleasure" factors. Age, race/ethnicity, and STI history were not related to the other factor scores.

CONCLUSION

The current scale shows promise in assessment of microbicide acceptability, and in general, girls expressed positive views about microbicides.

Attitudes of mothers in Da Nang, Vietnam toward a human papillomavirus vaccine

PURPOSE

To describe attitudes and acceptability toward a human papillomavirus (HPV) vaccine among mothers in Da Nang, Vietnam and examine factors that may influence HPV vaccine uptake.

METHODS

Women who were the primary caregiver of a girl 10-18 years old ("mothers") were eligible to participate. Mothers were recruited face-to-face from Da Nang General Hospital. Participants completed a survey addressing general vaccine attitudes, attitudes toward an HPV vaccine, beliefs about sexuality, recommendations from others, and likelihood of having their daughter vaccinated against HPV. A total of 194 surveys were returned; 181 (93%) contained analyzable data.

RESULTS

Eleven percent of mothers were aware of an HPV vaccine. Ninety-four percent believed that the HPV vaccine will be effective and 90% disagreed that their daughter would have sex early if she was vaccinated. Beliefs regarding premarital sex, such as "girls who have sex before marriage are not respected" and "it would be hard to find a husband" were held by 76% and 62% of mothers, respectively. Despite this, over 90% were in favor of their daughter receiving the HPV vaccine. Ninety-five percent indicated that a recommendation from their doctor would be very important in their decision-making, and 78% indicated that the media would be very important.

CONCLUSIONS

Initial responses to the HPV vaccine for girls in Vietnam appear favorable. Beliefs regarding negative social consequences for girls who engage in premarital sex are prevalent but unassociated with HPV vaccine acceptability. Accurate and consistent recommendations from doctors and media sources will be important for vaccination efforts.

Perceptions of sexual assertiveness among adolescent girls: initiation, refusal, and use of protective behaviors

STUDY OBJECTIVE

We describe adolescent girls' perceptions of sexual assertiveness and examine the relationship of these perceptions with developmental and interpersonal variables.

DESIGN

Cross-sectional analysis.

SETTING

Participants were recruited from a school-based health clinic and local colleges, and through snowballing to participate in a 6-month study examining microbicide acceptability.

PARTICIPANTS

106 sexually experienced girls (ages 14 through 21 years).

METHODS

Girls described their demographics, sexual history, and romantic relationships and completed the Sexual Assertiveness Scale for Women (SAS-W), which assesses perceptions of sexual assertiveness: Initiation of Sex, Refusal of Unwanted Sex, and Pregnancy-STD Prevention.

RESULTS

Girls perceived themselves as asserting themselves between 50% and 75% of the time with their current or most recent partner. The Initiation subscale was not related to the other two subscales. In final models, girls with a prior pregnancy perceived themselves as initiating sex more than girls without a prior pregnancy. Having a greater number of lifetime partners was related to perceptions of less refusal, whereas greater number of partners, being sexually experienced longer, and engaging in more unprotected sex were related to perceptions of less implementation of preventive methods. None of the relationship variables were related to scores on any subscale.

CONCLUSIONS

Most of these girls perceived themselves as sexually assertive. Given that sexual experience, not relationship factors, were related to perceptions of sexual assertiveness, the design of counseling messages should incorporate sexual experience. These messages should find effective ways to help girls both to communicate their sexual desires and to enhance their ability to protect themselves.

Adolescents' descriptions of the physical characteristics of microbicide surrogates and experiences of use

PURPOSE

Our purpose was to describe adolescent girls' perceptions of microbicide surrogates and experiences of use, including impact on sexual pleasure.

METHODS

Sexually experienced girls, 14-21 years, were recruited for a study examining microbicide acceptability. The girls were given vaginal moisturizers (gel or suppository) to use as if they were microbicides. Girls (n = 175) discussed their perceptions and experiences of use of these products in response to semistructured interviews. Girls were asked at weekly phone interviews about the impact of product use on their and their partners' sexual pleasure. These answers were averaged, and girls were categorized into those for whom the product predominantely made sex feel worse, better less than half the time, or better half the time or more. The relationship of demographics and sexual history to the impact on pleasure was evaluated.

RESULTS

Overall, participants were positive about their experience with the products. More girls preferred the gel. Specific concerns about the suppository included the wait period, texture, and messiness of self-insertion. Many liked the lubricating quality of both of the surrogates. Girls discussed messiness, leakage, clumping, and the difficulties in communicating with partners. Over half reported an increase in pleasure most of the time for themselves and their partners. None of the demographic and sexual history predictors were significantly related to impact on pleasure.

CONCLUSIONS

Anticipatory guidance should help girls initiate and sustain use. Future research should examine the best way to accomplish counseling about microbicide use with adolescent girls.

Predictors of sexual satisfaction in an adolescent and college population

STUDY OBJECTIVE

To assess the degree to which adolescents/young adults are satisfied in their current sexual relationships and to evaluate intrapersonal and interpersonal predictors of sexual satisfaction among that population.

DESIGN

Cross-sectional analysis.

SETTING

Participants were recruited from an adolescent medicine clinic and a college in Cincinnati, Ohio.

PARTICIPANTS

A total of 313 sexually experienced adolescent/young adults ranging in age from 14 to 24 participated. Fifty percent were white and 60% female.

METHODS

Participants completed a questionnaire about their demographics, romantic relationships, mental health, sexual history/behavior, and sexual satisfaction. Univariate logistic regression models were conducted to determine the relationship between each predictor and satisfaction with their current sexual relationship. To identify the most important predictors of sexual satisfaction, a final multiple logistic regression model was created using backward elimination.

RESULTS

Approximately 85% of adolescents/young adults in the present study reported feeling satisfied in their current sexual relationships. Those who were in an overall positive relationship, who were less sensitive emotionally within interpersonal relationships, and who had more frequent sex, fewer lifetime sexual partners, and more condom-protected sex were more likely to be satisfied with the current sexual relationship.

CONCLUSIONS

Sexuality develops within the context of both intrapersonal and interpersonal factors. Thus, researchers should incorporate a multi-factorial approach when designing studies on adolescent sexuality.

Personal meaning of human papillomavirus and pap test results in adolescent and young adult women

OBJECTIVE

As new cervical cancer screening recommendations are adopted, more adolescents may learn they are infected with human papillomavirus (HPV). The objective of this study was to explore personal meaning of HPV and Pap test results in adolescent and young adult women.

DESIGN

The authors recruited sexually active 14- to 21-year-old adolescent girls from an urban teen health center. Participants underwent HPV and Pap testing at baseline and returned 2 weeks later to receive test results and to be interviewed about their responses to test results. The authors analyzed interview transcripts using qualitative methods and developed a conceptual framework to explain participants' responses.

MAIN OUTCOME MEASURES

Of the 100 participants, 51% were HPV positive and 23% had an abnormal Pap test. Personal meaning was comprised of four core dimensions: labeling of results, perceived risk of HPV-related disease, personal accountability, and anticipated shame or stigma. The association between test result and personal meaning was mediated through cognitive understanding of test results, which in turn was influenced by education about HPV and prior health experiences.

CONCLUSION

Clinicians who communicate HPV and Pap test results to adolescent girls should provide accurate information in a nonjudgmental manner, take into account adolescents' personal experiences with sexually transmitted infections and cancer, and explore personal meaning of results such as anticipated risk and stigma. In this way, clinicians may be able to minimize adverse psychosocial outcomes while promoting positive reproductive health behaviors.

Adolescent girls' communication with "mothers" about topical microbicides

STUDY OBJECTIVE

Topical microbicides, a female-initiated method to protect against sexually transmitted infections (STI) and pregnancy, will only be effective if found acceptable. Mothers may have an influence on acceptability and use among adolescent girls. The current study examined the communication between girls and mothers to understand the potential predictors and nature of conversations regarding surrogate microbicide products.

DESIGN

Sexually experienced girls, 14 to 21 years, were recruited for a 6-month study examining microbicide acceptability. During face-to-face interviews, qualitative data were collected regarding communication between girls and mothers. Two independent raters coded the responses, which were organized into themes. Themes were interpreted according to the conceptual understanding of mother-daughter communication.

RESULTS

Fifty percent of the 171 girls with codable responses had a conversation with their mother. Higher levels of indirect parental monitoring were related to being more likely to have a conversation. Concrete events related to the study (i.e. receiving phone call from the researcher, having an appointment, or seeing the product) or inquiries by mothers appeared to promote conversation. Barriers to conversation included the private nature of the information and relationship issues between the mother and daughter. Conversations often addressed issues related to girls' participation in the study, although some conversations included global issues related to sexuality.

CONCLUSIONS

Girls may talk to their mothers about new products for STI prevention, and such conversations may provide opportunities to promote use.

Prevalence of herpes simplex virus types 1 and 2 among children and adolescents attending a sexual abuse clinic

BACKGROUND

Children and adolescents with a history of sexual abuse are at risk for acquiring herpes simplex virus (HSV) type 2. We evaluated the prevalence of HSV-1 and HSV-2 and the usefulness for this population of 2 commercially available tests.

METHODS

Sera from 150 children seen in a sexual abuse clinic were analyzed for type-specific HSV antibodies using Focus HerpeSelect HSV-2 ELISA (Focus), Biokit HSV-2 Rapid Test (Biokit), and by Western blot (WB).

RESULTS

The patient sample was 81% female, had a mean age of 11.6 years (range, 1 to 18 years), and was 46% Caucasian, 28% Hispanic, 25% African American, and 2% other. According to WB, 77 (51%) of the children were HSV-1 seropositive. For HSV-2, there was 1 "true positive" (positive by all 3 tests) and 1 patient whose serum had atypical HSV-2 bands by WB but was positive by Focus. There were 6 sera that were positive by Focus and negative by WB. Index values of these 6 Focus tests were not predictive of WB status. For the 105 samples for which Biokit data were available, all samples were concordant with WB.

CONCLUSIONS

The findings of this study suggest that routine screening for HSV-2 in sexually abused children does not have a high yield. The Focus test has an unacceptably high rate of false-positive results in children; however, Biokit may be an acceptable substitute for WB in evaluating children for HSV-2 antibodies.

Vaccination: an opportunity to enhance early adolescent preventative services

New vaccines are being developed that will be recommended for adolescents Adolescence is a time period when adolescent-parent dynamics change and when adolescents may be confronted with increasing opportunities to engage in risk-taking behaviors such as sexual behavior and substance use. Despite clear recommendations regarding preventative counseling, many adolescents do not receive adequate preventive care. In this manuscript, we provide suggestions as to how a new vaccination schedule can be used to enhance preventative services to both adolescents and their parents.

Prevention and control of sexually transmitted infections among adolescents: the importance of a socio-ecological perspective--a commentary

The sexually transmitted infection (STI) epidemic among adolescents in the USA is inextricably tied to individual, psychosocial and cultural phenomena. Reconceptualizing the epidemic within an expanded socio-ecological framework may provide an opportunity to better confront its challenges. In this article, we use a socio-ecological framework to identify determinants of adolescents' sexual risk and protective behaviours as well as antecedents of their STI acquisition. The goal is to provide a synthesis of several discrete categories of research. Subsequently, we propose an integrated strategy that addresses the STI epidemic among adolescents by promoting a socio-ecological perspective in both basic research and intervention design. This approach may expand the knowledge base and facilitate the development of a broader array of intervention strategies, such as community-level interventions, policy initiatives, institutionally based programmes, and macro-level societal changes. Although there are inherent challenges associated with such an approach, the end result may have reciprocal and reinforcing effects designed to enhance the adoption and maintenance of STI-preventive practices among adolescents, and further reduce the rate of STIs.

Perceptions of parents seeking an experimental herpes simplex vaccine for their adolescent and preadolescent daughters

Perceptions of parents willing to enroll their daughters in genital herpes vaccine trials were examined by questionnaire. Respondents were knowledgeable about genital herpes and endorsed personal and societal protection as important reasons to vaccinate. A belief among some that the vaccine might promote sexual activity did not prevent them from seeking protection for their daughters.

When adolescent girls say, "I don't know"

STUDY OBJECTIVE

To understand adolescent girls' use of "I don't know" within the context of discussing information related to sexual attitudes and behaviors.

DESIGN

Qualitative analysis of seven focus groups with adolescent girls.

SETTING

Urban primary care clinic.

PARTICIPANTS

Adolescent girls (n = 23) with a mean age of 16.4 years (range 14 to 18 years). Fifty-two percent were African-American, 26% were Caucasian, 17% were Hispanic/Latino, and 5% were Asian.

RESULTS

The use of "I don't know" served three functions: (1) place holder, (2) lack of commitment to an opinion; and (3) reduction of commitment to an opinion or belief.

CONCLUSIONS

These results suggest that girls use "I don't know" when asked about their thoughts and opinions related to sexual health, and that its use can have varying implications. Discriminating the intent may help providers respond appropriately. Responses should include providing a safe and nonjudgmental environment in which girls can express their feelings and opinions regarding their sexual health.

The psychosocial impact of serological diagnosis of asymptomatic herpes simplex virus type 2 infection

OBJECTIVES

To evaluate the impact of a positive herpes simplex virus type 2 (HSV-2) serological test on psychosocial functioning among people with no known history of genital herpes.

METHODS

Individuals (age 14-30 years) without a history of genital herpes were recruited from an urban university setting and sexually transmitted diseases (STD), primary care, and adolescent clinics. Participants completed a questionnaire addressing psychological functioning, psychosocial adjustment, and perceived quality of sex and were offered free HSV-2 antibody testing. 33 HSV-2 positive people and 60 HSV-2 negative people demographically matched from the same source of recruitment were re-evaluated at a 3 month follow up visit. HSV-2 positive participants also completed a genital herpes quality of life (GHQOL) measure.

RESULTS

Of the 33 who were HSV-2 seropositive, four did not recall their diagnosis. In comparing those who were HSV-2 positive with those who were negative, repeated measures analysis of variance indicated there were no significant differences over time on any of the measures. None the less, many HSV-2 positive individuals indicated that the diagnosis had a notable impact on their quality of life. Also, among the HSV-2 positive people, lower GHQOL at the 3 month follow up was predicted by higher interpersonal sensitivity (r = -0.44, p<0.05), lower social support (r = 0.40, p<0.05), and quality of sex (r = 0.62, p<0.01) at baseline.

CONCLUSIONS

A diagnosis of asymptomatic HSV-2 infection does not appear to cause significant lasting psychological difficulties. Those for whom the diagnosis had the greatest impact were interpersonally vulnerable before the diagnosis. These results suggest that assessment of interpersonal distress may be important to include as part of pretest and post-test counselling.

Religion/spirituality and adolescent health outcomes: a review

Religion/spirituality is important to adolescents, is usually considered a protective factor against a host of negative health outcomes, and is often included in adolescent health outcomes research. Previous reviews of the relationship among spirituality, religion, and adolescent health have been limited by scope, focusing primarily on distal aspects of religion/spirituality (e.g., attendance at religious services). We reviewed the literature examining proximal domains of religion/spirituality (e.g., spiritual coping) in adolescent health outcomes research. Constructs such as spiritual coping and religious decision-making were the ones most often studied and were generally positively associated with health outcomes. Measurement of proximal domains, associations of proximal domains with health outcomes, methodological issues and recommendations for future research were covered in this review.

Intergenerational transfer of douching information

STUDY OBJECTIVE

To characterize the discussions on douching that female parents/guardians have with daughters.

DESIGN

A questionnaire assessing personal douching history, beliefs on the practice of douching, and what they had discussed or intended to discuss about douching with their daughters was administered to women who were parenting females 11-21 years of age.

PARTICIPANTS

Fifty-seven women who had douched or currently douche completed the questionnaire.

RESULTS

Fifty-six of the women had discussed or planned to discuss the subject with their daughters. The girls with whom they had had a discussion were significantly older (16.2 years) than those with whom they planned to have a discussion (14.1 years). Most (73%) of the women had encouraged or planned to encourage douching, while only 18% had or planned to discourage it. Mothers had or planned to have the conversation in the context of menses (76%), sexual activity (40%), or when their daughter instigated the conversation (44%). Over 40% of the mothers had not or did not intend to discuss any negatives about douching. Only ten of the women stated that a health care provider had spoken to them or their daughter about the subject.

CONCLUSION

Female parents/guardians are an important source of information about douching for their daughters. Health care providers need to educate girls as well as the women who parent them on the health risks associated with douching. Public campaigns aimed at decreasing douching should target this intergenerational transfer of information.