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Mustanski B, Donenberg G, Emerson E. I can use a condom, i just don't: the importance of motivation to prevent HIV in adolescent seeking psychiatric care. AIDS Behav 2006; 10:753-62. [PMID: 16639541 DOI: 10.1007/s10461-006-9098-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Youth continue to show high HIV infection rates, and adolescents with mental health problems are especially at risk. We used longitudinal data to test a cognitive-behavioral model of risky sexual behavior among 175, ethnically diverse urban adolescents seeking mental health services. Path analyses of the cross-sectional data revealed that Motivation was a strong predictor of Behavioral Skills and Sexual Risk Taking. The model explained 42% of the variance in Sexual Risk Taking with age included-29% without age. In the longitudinal path analyses, Motivation had a significant negative effect on levels of Sexual Risk Taking 6 months later, controlling for Information, Behavioral Skills, age, and baseline levels of Sexual Risk Taking. These longitudinal effects explained 60% of the variance in Sexual Risk Taking. These results underscore the need to address motivational factors in HIV prevention programs designed for adolescents with mental health problems.
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Affiliation(s)
- Brian Mustanski
- Institute for Juvenile Research, University of Illinois at Chicago, 60608, USA.
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Asbel LE, Newbern EC, Salmon M, Spain CV, Goldberg M. School-Based Screening for Chlamydia Trachomatis and Neisseria Gonorrhoeae Among Philadelphia Public High School Students. Sex Transm Dis 2006; 33:614-20. [PMID: 16614587 DOI: 10.1097/01.olq.0000216010.43296.42] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT The prevalence of sexually transmitted diseases among adolescents is high. Innovative screening and treatment programs need evaluation. OBJECTIVES The objectives of this study were to identify, treat, and describe the prevalence of Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) infections among Philadelphia public high school students. DESIGN We analyzed cross-sectional data from the first year of an annual program offering education, screening, and treatment for CT and GC. For the school year analyzed, screening took place between January 2003 and June 2003. RESULTS In the first year, 19,394 students aged 12-20 years were voluntarily tested; 1,052 students were identified with GC, CT, or both; 1,051 received treatment. Prevalence of CT among females (95% confidence interval [CI] = 8.1) was 3.3 times higher than among males (95% CI = 2.5%). Attending disciplinary schools and residing in high reported morbidity areas were also related to higher prevalence of CT and GC. CONCLUSIONS A high prevalence of CT infections was identified among Philadelphia public high school students. This program demonstrated the effectiveness of a school-based screening program to identify and treat these infections.
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Affiliation(s)
- Lenore E Asbel
- Philadelphia Department of Public Health, Drexel University College of Medicine, Pennsylvania, USA.
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53
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DiClemente RJ, Salazar LF, Crosby RA, Rosenthal SL. Prevention and control of sexually transmitted infections among adolescents: the importance of a socio-ecological perspective--a commentary. Public Health 2006; 119:825-36. [PMID: 15913678 DOI: 10.1016/j.puhe.2004.10.015] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2004] [Revised: 09/01/2004] [Accepted: 10/22/2004] [Indexed: 11/26/2022]
Abstract
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.
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Affiliation(s)
- R J DiClemente
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Room 554, 1518 Clifton Road 30322 Atlanta, GA, USA.
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Boyer CB, Sebro NS, Wibbelsman C, Shafer MA. Acquisition of sexually transmitted infections in adolescents attending an urban, general HMO teen clinic. J Adolesc Health 2006; 39:287-90. [PMID: 16857543 DOI: 10.1016/j.jadohealth.2005.12.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2005] [Revised: 11/30/2005] [Accepted: 12/07/2005] [Indexed: 11/30/2022]
Abstract
To determine association between acquisition of sexually transmitted infections (STIs) over a nine-month period among sexually experienced adolescents attending an urban, general HMO teen clinic and African American race, use of marijuana more than once or twice a week, and having had relationships with a sexual partner who is more than four years older.
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Affiliation(s)
- Cherrie B Boyer
- Department of Pediatrics, Division of Adolescent Medicine, University of California, San Francisco, San Francisco, California 94143-0503, USA.
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55
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Wiefferink CH, Peters L, Hoekstra F, Dam GT, Buijs GJ, Paulussen TGWM. Clustering of Health-Related Behaviors and Their Determinants: Possible Consequences for School Health Interventions. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2006; 7:127-49. [PMID: 16596470 DOI: 10.1007/s11121-005-0021-2] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2005] [Accepted: 10/14/2005] [Indexed: 11/30/2022]
Abstract
Characterizing school health promotion is its category-by-category approach, in which each separate health-related behavior is addressed independently. Such an approach creates a risk that extra-curricular activities become overloaded, and that teaching staff are distracted by continuous innovations. Within the health promotion sector there are thus increasing calls for an integrative approach to health-related behaviors. However, a meaningful integrative approach to different lifestyles will be possible only if there is some clustering of individual health-related behaviors and if health-related behaviors have a minimum number of determinants in common. This systematic review aims to identify to what extent the four health-related behaviors smoking, alcohol abuse, safe sex and healthy nutrition cluster; and how their determinants are associated. Potentially modifiable determinants that offer clues for an integrative approach of school health-promotion programs are identified. Besides, the direction in which health educators should look for a more efficient instructional design is indicated.
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56
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O'Sullivan LF, Brooks-Gunn J. The timing of changes in girls' sexual cognitions and behaviors in early adolescence: a prospective, cohort study. J Adolesc Health 2005; 37:211-9. [PMID: 16109340 DOI: 10.1016/j.jadohealth.2004.08.019] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2004] [Accepted: 08/18/2004] [Indexed: 10/25/2022]
Abstract
PURPOSE This small, prospective cohort study of 162 12- to 15-year-old girls examines timing of changes in sexual cognitions and behaviors (breast fondling, genital contact, and sexual intercourse) over a 1-year period. METHODS Girls from community sites in New York City provided information about sexual experiences and related cognitions (arousability, sexual agency, abstinence attitudes, perceived parental and peer approval, and sexual self-esteem) in 2 interviews 1 year apart. RESULTS Percentages who reported breast fondling, genital contact, and sexual intercourse (18%, 24%, and 6%) increased significantly over the year (42%, 44%, and 19%) and with age. For each behavior, analyses compared girls who did not report the behavior at either Time 1 or 2, those who reported by Time 2 but not 1, or those who reported at both time points. Girls with no breast fondling experience at either time point had stronger abstinence values, and lower arousability, agency, peer approval, and sexual self-esteem scores compared to girls who initiated breast fondling over the year (transitioners). Transitioners were markedly similar in sexual cognitions to girls with this experience before Time 1, suggesting that changes in sexual cognitions precede actual experience. A similar pattern was found between groups for genital contact. Few differences between groups by comparison were noted for sexual intercourse, which occurs later in the trajectory. CONCLUSIONS Sexual experiences that occur before intercourse (e.g., breast fondling) are central to research on sexual development and related to greater changes in girls' sexual cognitions than is intercourse. Changes in cognitions precede, rather than follow, new sexual experiences.
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Affiliation(s)
- Lucia F O'Sullivan
- College of Physicians and Surgeons, Columbia University, New York, New York, USA.
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57
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Beadnell B, Morrison DM, Wilsdon A, Wells EA, Murowchick E, Hoppe M, Gillmore MR, Nahom D. Condom use, frequency of sex, and number of partners: multidimensional characterization of adolescent sexual risk-taking. JOURNAL OF SEX RESEARCH 2005; 42:192-202. [PMID: 19817033 DOI: 10.1080/00224490509552274] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Sexual health research often relies on single risk indicators. However multi-variable composites may better capture the underlying construct of risk-taking. Latent Profile Analysis identified subgroups based on condom use consistency, partner numbers, and sex frequency among 605 adolescents. Three profiles were identified for each of grades 8 to 10 (Condom Users, Few Partners, and Risk-Takers) and 4 in grades 11 and 12 (Condom Users, One Partner Two Partners, and Risk-Takers). Inconsistent condom use groups reported more non-condom (and often less effective) birth control use and STD and pregnancy histories. Females had greater representation in the Few Partners, One Partners, and Two Partners groups, which also contained increasing proportions of participants in each subsequent year. Males had greater representation in the Risk-Takers group. A profile approach to measurement has methodological advantages, can add to substantive knowledge, and can inform content, timing, and targets of sexual health interventions.
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Affiliation(s)
- Blair Beadnell
- University of Washington School of Social Work, Seattle, WA 98105, USA.
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Lesser J, Verdugo RL, Koniak-Griffin D, Tello J, Kappos B, Cumberland WG. Respecting and protecting our relationships: a community research HIV prevention program for teen fathers and mothers. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2005; 17:347-60. [PMID: 16178704 DOI: 10.1521/aeap.2005.17.4.347] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
This article describes a two-phase community and academic collaboration funded by the California Collaborative Research Initiative to develop and test the feasibility of an innovative HIV prevention program relevant to the needs of the population of inner-city Latino teen parenting couples and realistic for implementation in community settings. The article describes (a) the identification of special issues that needed to be addressed before formation of a productive academic-community-based organization research partnership, including integrating a dominant theoretical model used in health education with principles of practice derived from clinical experience; (b) the first phase of the project that helped to inform the development of the HIV prevention program for couples; (c) examples from the intervention pilot study (Phase 2) that illustrate both the intervention strategies and the young participants' responses to the curriculum; and (d) the feasibility of program implementation and evaluation in a community setting.
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Affiliation(s)
- Janna Lesser
- Department of Family Nursing Care, University of Texas Health Science Center, San Antonio, TX 76229, USA.
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59
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Donenberg GR, Schwartz RM, Emerson E, Wilson HW, Bryant FB, Coleman G. Applying a cognitive-behavioral model of HIV risk to youths in psychiatric care. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2005; 17:200-16. [PMID: 16006207 PMCID: PMC1237132 DOI: 10.1521/aeap.17.4.200.66532] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
This study examined the utility of cognitive and behavioral constructs (AIDS information, motivation, and behavioral skills) in explaining sexual risk taking among 172 12-20-year-old ethnically diverse urban youths in outpatient psychiatric care. Structural equation modeling revealed only moderate support for the model, explaining low to moderate levels of variance in global sexual risk taking. The amount of explained variance improved when age was included as a predictor in the model. Findings shed light on the contribution of AIDS information, motivation, and behavioral skills to risky sexual behavior among teens receiving outpatient psychiatric care. Results suggest that cognitive and behavioral factors alone may not explain sexual risk taking among teens whose cognitive and emotional deficits (e.g., impaired judgment, poor reality testing, affect dysregulation) interfere with HIV preventive behavior. The most powerful explanatory model will likely include a combination of cognitive, behavioral, developmental, social (e.g., family), and personal (e.g., psychopathology) risk mechanisms.
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Affiliation(s)
- Geri R Donenberg
- Institute for Juvenile Research at the University of Illinois at Chicago, 60608, USA.
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60
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Martin A, Ruchkin V, Caminis A, Vermeiren R, Henrich CC, Schwab-Stone M. Early to bed: a study of adaptation among sexually active urban adolescent girls younger than age sixteen. J Am Acad Child Adolesc Psychiatry 2005; 44:358-67. [PMID: 15782083 DOI: 10.1097/01.chi.0000153226.26850.fd] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine the association between sexual activity among urban adolescent girls and four global measures of psychosocial adaptation (academic motivation, school achievement, depressive symptoms, and expectations about the future). METHOD Data derived from the Social and Health Assessment, a self-report survey administered in 1998 to students in the public school system in New Haven, CT (149 classes at 17 middle and high schools). RESULTS Of 1,413 respondents (57% black, 28% Hispanic; mean age 13.4 +/- 1.7 years), 414 (29%) acknowledged prior sexual intercourse; the proportions of sexually active girls in 6th, 8th, and 10th grades were 14%, 30%, and 50%, respectively. In multivariate analyses of covariance, sexual activity was significantly associated with all four measures of psychosocial adaptation (p < .001). Other correlates of at least one measure of maladaptation included socioeconomic status, sensation seeking, and lower school grade (p < .001 for each), peer pressure (p < .01), and black ethnicity, and the interaction of sexual activity by lower school grade (p < .05 for each). CONCLUSIONS Compared with their sexually naive peers, sexually active adolescent girls had lower scores on global measures of psychosocial adaptation. These findings have clinical, policy, and research relevance to a vulnerable population at high risk of teenage pregnancy and sexually transmitted diseases.
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Affiliation(s)
- Andrés Martin
- Child Study Center, Yale University School of Medicine, Yale-New Haven Hospital, New Haven, CT 06520, USA.
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61
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Newbern EC, Miller WC, Schoenbach VJ, Kaufman JS. Family socioeconomic status and self-reported sexually transmitted diseases among black and white american adolescents. Sex Transm Dis 2004; 31:533-41. [PMID: 15480114 DOI: 10.1097/01.olq.0000137898.17919.35] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The objective of this study was to assess associations between socioeconomic status (SES) and adolescent sexually transmitted diseases (STDs) stratified by race and gender. STUDY In cross-sectional analyses of the National Longitudinal Study of Adolescent Health Wave One (1995), unadjusted and adjusted associations between 4 family SES indicators and STD reports for black and white 7th through 12th graders were examined. RESULTS Lower maternal education and nonprofessional maternal occupations were associated with higher STD reports in all groups except white females. Generally, STD reports were higher for adolescents not living in 2-parent homes, and lower income was only associated for black males. CONCLUSION Overall, SES is only a weak to moderate marker for adolescent STD risks. The relationship of SES and STDs varies by the SES measure used and differs across race-gender groups. Other individual factors such as risk behaviors or community factors such as income inequality could play a more critical role for adolescent STDs than family SES.
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Affiliation(s)
- Elizabeth Claire Newbern
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7435, USA
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Upchurch DM, Kusunoki Y. Associations between forced sex, sexual and protective practices, and sexually transmitted diseases among a national sample of adolescent girls. Womens Health Issues 2004; 14:75-84. [PMID: 15193635 DOI: 10.1016/j.whi.2004.03.006] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2003] [Revised: 01/13/2004] [Accepted: 03/09/2004] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The main objective of this study is to better understand the associations between forced sex history and history of sexually transmitted disease (STD) infection. Three research questions are investigated. Is history of forced sex associated with risk-taking behaviors? Are these risk-taking behaviors associated with history of STD? Is history of forced sex independently associated with history of STD? METHODS Information on the sexual and STD histories is obtained from 3,579 sexually active adolescent girls using data from the National Longitudinal Study of Adolescent Health. Weighted logistic and OLS regressions are employed, using techniques that account for the complex sampling design. RESULTS Girls with a history of forced sex are significantly more likely to have a greater number of sexual partners, be younger at first sex, and be more likely to use alcohol or drugs at last sex; there is no difference in condom use at last sex. These factors, in turn, are significantly associated with a positive STD history. Condom use at last sex is negatively associated with ever having had an STD. When all five sexual and protective practices are investigated simultaneously, history of forced sex remains significantly associated with STD history (odds ratio [OR] = 1.39, p =.014); number of sexual partners and early onset of sex remain significant. Condom use and substance use at last sex reduce to marginal significance. CONCLUSIONS These results suggest that a history of forced sex is independently associated with a history of STD among sexually active adolescent girls. Programmatic strategies aimed at reducing STDs through encouraging responsible sexual behavior would potentially benefit from also including a component that addresses sexual victimization.
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Affiliation(s)
- Dawn M Upchurch
- UCLA School of Public Health, Los Angeles, California 90095, USA.
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63
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Ungan M, Yaman H. AIDS knowledge and educational needs of technical university students in Turkey. PATIENT EDUCATION AND COUNSELING 2003; 51:163-167. [PMID: 14572946 DOI: 10.1016/s0738-3991(02)00190-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
AIDS is a main health problem of the recent century and is now considered a very important cause for mortality and morbidity among young people. The aim of this research is to determine the Turkish university students knowledge, sexual risk behavior, attitude towards AIDS and educational needs concerning AIDS. A cross-sectional exploratory design is utilized in this study. One thousand four hundred and twenty-seven university new registrants from the Middle East Technical University participated and answered a 32-item self-administered questionnaire. The questionnaire addressed sociodemographics, sexual risk behavior, self-assessed knowledge on HIV transmission and AIDS, attitudes towards AIDS infection and AIDS patient, source of information and need for AIDS course. The response rate was 84%. Two hundred and seventy-one (19%) participants had sexual intercourse. Eighty-one (30%) participants reported condom use during the last encounter. Seven hundred and twenty-four (51%) stated they knew "very much" about AIDS. Students of faculty of engineering (n=384, 69%), economic and administrative sciences (n=115, 55%), and architecture (n=42, 52%) declared they knew "very much" on AIDS and had a higher frequency as the students from the faculty of arts and sciences (n=119, 43%) and education (n=64, 40%). Television was reported as the major source of information about AIDS (n=871, 61%). Students in faculty of education had lower scores than others (P=0.01). Almost all students stated that there should be a course on AIDS in their curriculum. Educational and medical institutions are the minor information sources for students at universities. Therefore, schools have to integrate new courses on AIDS and sexual health in their curricula, physicians caring for these students have to take more time for health education.
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Affiliation(s)
- Mehmet Ungan
- Medical Center, Middle East Technical University, Ankara, Turkey
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64
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Gökengin D, Yamazhan T, Ozkaya D, Aytuğ S, Ertem E, Arda B, Serter D. Sexual knowledge, attitudes, and risk behaviors of students in Turkey. THE JOURNAL OF SCHOOL HEALTH 2003; 73:258-263. [PMID: 14513628 DOI: 10.1111/j.1746-1561.2003.tb06575.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
This survey produced baseline information about student knowledge of sexually transmitted diseases (STDs), their sexual attitudes, and their behavior to help establish control and education programs. The study was conducted at Ege University, Izmir, Turkey, during the 1999-2000 academic year. A total of 2,217 first- and fourth-year students determined by stratified sampling constituted the study group. All students who volunteered to participate completed a questionnaire assessing sociodemographic and knowledge factors, sexual attitudes, behavior, and history of STDs. The rate of students having had sexual experience was 36.6%. Males were more sexually active than females. Most students (71.4%) began sexual activity at ages 15-19 without any difference by gender. Males reported significantly more sexual partners than females. Similarly, the rate of male students never using condoms was significantly higher than females. Condom was the most frequent contraception method, followed by oral contraceptives and withdrawal. Mean score on the knowledge questions was 16.29 (highest score 30). The most widely known STD was HIV infection and AIDS. Students' knowledge of transmission routes, signs and symptoms, and risk groups of STDs was insufficient. Main sources of knowledge were visual and print media, and friends. Most students (84.7%) viewed prevention from STDs as a person's own responsibility. Young people in Turkey are sexually active and tend to engage in high-risk behavior. However, their knowledge on sexual health and sexually transmitted diseases is insufficient. Study results suggest a need for implementation of STD control programs and provision of school sexuality education for adolescents and young adults.
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Affiliation(s)
- Deniz Gökengin
- Dept. of Clinical Microbiology and Infectious Diseases, Ege University, Faculty of Medicine, 35100 Bornova, Izmir, Turkey.
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Otto-Salaj LL, Gore-Felton C, McGarvey E, Canterbury RJ. Psychiatric functioning and substance use: factors associated with HIV risk among incarcerated adolescents. Child Psychiatry Hum Dev 2002; 33:91-106. [PMID: 12462349 DOI: 10.1023/a:1020714423998] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
This study examined several types of psychiatric functioning (neuropsychiatric, emotional, and cognitive functioning) and substance use in relation to HIV risk behavior among 894 incarcerated girls and boys. Youth remanded to juvenile correctional facilities in a southern US state completed a structured interview regarding abuse history, emotional and behavioral difficulties, and demographics. Adolescents who experienced sullen affect were significantly more likely to engage in behaviors that put them at risk for HIV infection. Moreover, higher levels of alcohol use predicted HIV risk behavior. HIV prevention efforts need to address emotional distress as well as substance use among delinquent adolescents to reduce HIV risk behavior. Implications for treatment and future research are discussed.
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Affiliation(s)
- Laura L Otto-Salaj
- Center for AIDS Intervention Research (CAIR), Department of Psychiatry and Behavioral Medicine, Medical College of Wisconsin, Milwaukee, WI 53202, USA.
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66
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Diclemente RJ, Wingood GM, Sionean C, Crosby R, Harrington K, Davies S, Hook EW, Oh MK. Association of adolescents' history of sexually transmitted disease (STD) and their current high-risk behavior and STD status: a case for intensifying clinic-based prevention efforts. Sex Transm Dis 2002; 29:503-9. [PMID: 12218840 DOI: 10.1097/00007435-200209000-00002] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Adolescents are at high risk of sexually transmitted disease (STD)/HIV infection, and one vulnerable subgroup is African American females. The association between adolescents' previous experience of STD and recent sexual risk behaviors has been ill-defined. GOAL The goal was to examine the associations between adolescents' self-reported history of STD diagnosis and current sexual risk behaviors, prevention knowledge and attitudes, and STD infection status. STUDY DESIGN This was a cross-sectional survey. Recruitment sites were in low-income neighborhoods of Birmingham, Alabama, characterized by high rates of unemployment, substance abuse, violence, and STDs. Participants were sexually active adolescent females (N = 522) 14 to 18 years of age. Information on STD history and current sexual behaviors (within the 30 days before assessment) was collected in face-to-face interviews. Less sensitive topics, such as STD prevention knowledge, attitudes about condom use, and perceived barriers to condom use, were addressed via self-administered survey. DNA amplification of vaginal swab specimens provided by the adolescents was performed to determine current STD status. Outcomes associated with past STD diagnosis were determined by means of logistic regression to calculate adjusted odds ratios (AORs) in the presence of observed covariates. RESULTS Twenty-six percent of adolescents reported ever having an STD diagnosed. Although past STD diagnosis was associated with increased STD prevention knowledge, it was not associated with increased motivation to use condoms. Compared with adolescents who had never had an STD, adolescents with a history of diagnosed STD were more likely to report not using a condom at most recent intercourse (AOR = 2.54; 95% CI = 1.64-3.93; = 0.0001), recent unprotected vaginal intercourse (AOR = 1.79; 95% CI = 1.15-2.79; = 0.010), inconsistent condom use (AOR = 2.27; 95% CI = 1.46-3.51; < .0001), sexual intercourse while drinking alcohol (AOR = 2.09; 95% CI = 1.33-3.28; = 0.001), and unprotected intercourse with multiple partners (AOR = 3.29; 95% CI = 1.09-9.89; = 0.034). Past STD diagnosis was associated with increased risk for current biologically confirmed gonorrhea and trichomoniasis (AOR = 2.48; 95% CI = 1.09-5.23; = 0.030; and AOR = 2.05; 95% CI = 1.18-3.59; = 0.011, respectively). Past STD diagnosis was not significantly associated with increased risk of current biologically confirmed chlamydia (AOR = 0.78; 95% CI = 0.45-1.37; = 0.38). CONCLUSION Among this sample of female adolescents, past STD diagnosis was an indicator of current high-risk sexual activity and increased risk for two common STDs: gonorrhea and trichomoniasis. Although adolescents may gain factual knowledge from the experience of having an STD diagnosed, they are not applying that knowledge to their current sexual behaviors. Thus, these adolescents remain at risk for subsequent STD infection. Therefore, the findings suggest that there is a need to intensify clinic-based prevention efforts directed toward adolescents with a history of STDs, as a strategy for reducing STD-associated risk behaviors and, consequently, the likelihood of new STD infections.
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Affiliation(s)
- Ralph J Diclemente
- Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Emory University, Atlanta, Georgia 30322, USA.
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Abstract
BACKGROUND Adolescents learn about sexually transmitted diseases (STDs) from many sources, yet little is known about how well these educational sources are teaching them about STDs. GOAL The goal was to assess basic knowledge about STDs and their prevalence, to determine the correlates of high STD knowledge levels, and to explore whether self-perceptions of STD knowledge correlated with knowledge test scores. STUDY DESIGN A convenience sample of adolescents from waiting areas in an urban children's hospital were asked by peer educators about their STD education, the sources of this education, and their self-perception of their STD knowledge. They then were given a short assessment testing their knowledge of major, incurable, and curable STDs. RESULTS In the 393 surveys collected from adolescents aged 12 to 21 years (mean [+/-SD] age, 16.9 +/- 1.8 years), 97% self-reported having been educated about STDs, and the reported major sources were school (70%), parents (52%), and friends (31%). Only 7 (2%) correctly named all 8 major STDs, 35 (9%) named the 4 curable STDs, and 13 (3%) named the 4 incurable STDs. HIV was the mostly commonly named of the 8 major STDs (91%), followed by gonorrhea (77%) and syphilis (65%). Trichomonas infection (22%), human papillomavirus infection (22%), and hepatitis B (15%) were the least-named STDs. Forty-six percent thought HIV was the most common STD in the Philadelphia area. The participants' mean total STD knowledge score was 3.5 +/- 1.9 (maximum possible score, 8). There were fair correlations between knowledge scores and age (correlation coefficient [r] = 0.31; P < 0.0001), as well as between knowledge score and self-perception of STD knowledge (r = 0.23; P < 0.0001). Adolescents educated by parents, school, other relatives, and friends performed better than those educated by other sources. Those educated by multiple sources outperformed those educated by one source. CONCLUSIONS Adolescents' specific knowledge about non-HIV STDs is only cursory, despite their reports of having received education about STDs. We must attempt to improve and balance our STD education so that adolescents receive and retain detailed age-appropriate STD information that is consistent with their risk for disease.
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Affiliation(s)
- Linar R Clark
- Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, Center for Excellence for Minority Health, Philadelphia, Pennsylvania 19104, USA.
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Harper GW, Doll M, Bangi AK, Contreras R. Female adolescents and older male sex partners: HIV associated risk. J Adolesc Health 2002; 30:146-7. [PMID: 11869917 DOI: 10.1016/s1054-139x(01)00403-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Lavan H, Johnson JG. The association between axis I and II psychiatric symptoms and high-risk sexual behavior during adolescence. J Pers Disord 2002; 16:73-94. [PMID: 11881162 DOI: 10.1521/pedi.16.1.73.22559] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study was conducted to investigate the association between psychiatric disorders and high-risk sexual behavior among adolescent primary care patients. Interviews assessing anxiety, conduct, depressive, eating, substance use, and personality disorders (PDs), as well as histories of sexual behavior were administered to 119 male and 284 female adolescent primary care patients. Results indicated that, after co-occurring psychiatric disorders were controlled statistically, adolescents with elevated PD symptom levels were more likely than adolescents without elevated PD symptom levels to report a high number of sexual partners during the past year and during their lifetime. Adolescents with a history of conduct disorder were more likely than adolescents without such a history to report a high number of lifetime unsafe sexual partners. Elevated antisocial, dependent, and paranoid PD symptom levels were associated with high-risk sexual behavior after co-occurring psychiatric disorders were controlled. Further, certain specific antisocial, borderline, dependent, histrionic, narcissistic, obsessive-compulsive, paranoid, and schizotypal PD symptoms were independently associated with high-risk sexual behavior after co-occurring psychiatric disorders and overall PD symptom levels were controlled. The association between overall PD symptom levels and the number of sexual partners was significantly stronger among the females than among the males in the sample. Increased recognition and treatment of PDs, coupled with increased recognition of high-risk sexual behavior may facilitate the prevention of sexually transmitted diseases and teenage pregnancy among adolescents.
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Affiliation(s)
- Hannah Lavan
- Columbia University, New York State Psychiatric Institute, USA
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