Teen pregnancy, motherhood, and unprotected sexual activity

Teen Pornography: An Emerging Mental Health Challenge

Exposure to pornography is not an uncommon and unusual phenomenon in the digital era, with teens being no exception. Exposure to pornography among teens may happen accidentally, out of curiosity, or intentionally to derive sexual excitement. Many individuals exposed to pornography may later develop pornography addiction. Most parents who are aware that their children view pornography are often worried about such behavior and sometimes seek help from mental health professionals. So, it can be certainly said that exposure to pornography among teens may cause significant distress in them and their parents. As pornography is a major source of sex education for a large number of teens, lots of myth and misguided information are harbored from watching pornography. This article focuses on the mental health aspects of pornography exposure among teens and the possible remedial measures.

Partnership Dynamics and HIV-Related Sexual Behaviors Among Adolescent Mothers in South Africa: A Longitudinal Analysis of HIV Prevention Trials Network 068 Data

PURPOSE

In South Africa, adolescent mothers have a three times higher risk of HIV acquisition than nonadolescent mothers. Yet, limited evidence exists regarding how early childbearing may affect HIV risk. A better understanding of adolescent mothers' partnership dynamics and sexual behaviors is critical to tailoring interventions to prevent new infections.

METHODS

Data are from HIV Prevention Trials Network 068, a longitudinal study of adolescent girls and young women (AGYW) aged 13-20 in South Africa who were followed annually for up to 6 years. Log-binomial regression models were used to assess whether adolescent motherhood was associated with partnership dynamics (intimate partner violence, gender inequitable norms, low relationship power, no HIV prevention communication) and if the association between partnership dynamics and sexual behaviors (unprotected sex and transactional sex) varied by adolescent motherhood. Generalized estimating equations, with an exchangeable correlation structure, were used to account for nonindependence.

RESULTS

Adolescent mothers were more likely than nonadolescent mothers to be in partnerships characterized by intimate partner violence, low relationship power, gender inequitable norms, and no HIV prevention communication. A higher proportion were also more likely to experience these dynamics, as well as engage in transactional sex, after giving birth. Poor partnership dynamics put AGYW at a higher risk for unprotected sex and transactional sex, regardless of adolescent motherhood status.

DISCUSSION

Engaging adolescent mothers in interventions post birth and developing interventions that address power imbalances in AGYW's sexual partnerships have the potential to reduce engagement in HIV-related sexual behaviors and HIV risk in the long term.

Cultural and religious determinants of HIV transmission: A qualitative study with people living with HIV in Belu and Yogyakarta, Indonesia

As a part of a larger qualitative study to understand HIV-risk factors and impacts on people living with HIV (PLHIV) (52 women and 40 men) in Belu and Yogyakarta, Indonesia, this paper reports the influences of cultural practices and religious beliefs on sexual relationships and behaviours of participants as contributors for HIV transmission. This study was conducted from June to December 2020. Data collection was conducted using one-one-one in-depth interviews. Participants were recruited using the snowball sampling technique. Data analysis was guided by a qualitative data analysis framework. The findings showed that cultural practices in Belu related to the use of bride wealth, managing spousal disputes, marriage, and condom use, influenced spousal relationships and sexual behaviours or practices which contributed to HIV transmission. Javanese cultural practices and expectation of an ‘ideal wife’, Islamic religious beliefs about expected husband-wife relationships, forbidden premarital sex, and the participants’ individual interpretation of their religious beliefs about condom use spousal sexual relations, also influenced spousal sexual relations and behaviours, which supported HIV transmission among the participants. The findings indicate the need for HIV education programs that address cultural practices and religious beliefs for community members and population groups to enhance their understanding about HIV, condom use, and how cultural practices and religious beliefs play a role in HIV transmission. The findings also indicate the need for involvement of religious leaders in HIV education programs to bring insights to people and help them interpret their religious beliefs in health promoting ways. Future studies that explore different aspects of culture and religion which may contribute to HIV transmission are recommended.

Dating Violence in Adolescence: Implications for Girls' Sexual Health

Adolescents in the United States are too often involved in relationships characterized by coercion and violence. An emerging body of research suggests that dating violence is linked with other health risks in adolescent relationships, particularly sexual risk behavior. The confluence of risks conferred by dating violence and sexual risk behavior are particularly acute for adolescent girls. Adolescent gynecology providers need to understand the nature of dating violence in adolescence and the ways in which dating violence and sexual risk behavior are mutually influential. This article reviews the literature on the links between dating violence and sexual risk in adolescent girls' relationships. The prevalence, risk factors, and consequences of dating violence in adolescence are discussed, followed by a review of the research linking dating violence and sexual risk, with a focus on common mechanisms underlying these relationship risk behaviors. The review concludes with implications for screening, prevention, intervention, and future directions for research.

Examining dual method contraceptive use among midwestern parenting Latinx teens: Perspectives from adolescent parents, caretakers, and nurses

BACKGROUND

Despite dual method (DM) contraception being effective in reducing repeat-births and sexually transmitted infections (STIs), Latinx adolescent parents who live in non-traditional migration areas remain vulnerable for both outcomes.

OBJECTIVE

This study applied the Unified Theory of Behavior (UTB) and drew upon Bronfenbrenner's social ecological model to explore multiple stakeholders' (adolescent parents, caregivers, and nurses) perceptions of factors that influence DM intentions and use among Latinx adolescent parents.

METHODS

Semi-structured interviews with Latinx adolescent parent-caregiver dyads and nurses were analyzed using thematic analysis.

RESULTS

Study findings revealed that while all participant groups considered medical providers as DM influencers, contradicting views related to caregivers' as DM influencers emerged among adolescent parents and caregivers. Findings suggest that DM is deemed both acceptable and effective; and adolescent parents' reported DM self-efficacy. DM obstacles included negative emotions, environmental constraints, and poor knowledge and skills.

CONCLUSIONS

Study results suggest that constructs from the UTB framework are useful in identifying individual and social factors that can potentially influence DM intentions and use among Latinx adolescent parents.

IMPLICATIONS FOR PUBLIC HEALTH NURSING

This study's findings have potential implications for public health nurses interested in designing community-based interventions to reduce repeat-births and STIs among Latinx adolescent parents.

"My partner was not fond of using condoms and I was not on contraception": understanding adolescent mothers' perspectives of sexual risk behaviour in KwaZulu-Natal, South Africa

Background

Adolescent pregnancy has been a persistent area of interest and concern in the field of public health. The debate about adolescents’ sexual risk behaviour has also gained prominence due to findings that have demonstrated that adolescent girls between 15 and 19 years of age give birth to 16 million infants and account for 62% of new HIV infections in the Caribbean and African regions. Health compromising behaviours often develop in adolescence, yet the sexual and reproductive health of adolescent mothers is often marginalised in the healthcare field. The aim of this study was to explore adolescent mothers’ understanding of sexual risk behaviour.

Methods

The study employed a descriptive qualitative design. To collect the data, four focus group discussions were conducted with adolescent mothers aged 16–19 years. The eighteen adolescent mothers were recruited using purposive sampling technique from a hospital in the Ugu district in KwaZulu-Natal, South Africa. Data were analysed using thematic analysis.

Results

The study revealed that decisions to engage in risky sexual behaviour is influenced by peer pressure, drugs and alcohol, sexual experimentation, myths about contraception, the media, poor parental supervision and power gender dynamics, poverty leading to transactional sex, the vulnerability of young girls, and the fear of partner rejection.

Conclusion

The findings of this study will contribute to a better understanding of adolescent mothers’ perspectives of sexual risk behaviour. In the subject matter of sexual and reproductive health, adolescents’ autonomy with respect to cultural and social recommendations should not be sidelined. Due to their vulnerability, adolescent women are exposed to transactional sex, and it is particularly due to poverty that adolescent women are driven into sexual relations with older men as a means of survival. Moreover, interventions to curb postpartum sexual risk behaviour are important to protect adolescent women and mothers against HIV/AIDS. The sexual and reproductive education of adolescent women should focus on resilience, negotiating skills, and protective decision making. Collaborative efforts to curb sexual risk taking by young women should be encouraged and should involve relevant agents from the educational, social and clinical fields.

Applying the Theory of Reasoned Action to Understanding Teen Pregnancy with American Indian Communities

Objectives American Indian girls have higher teen pregnancy rates than the national rate. Intervention studies that utilize the Theory of Reasoned Action have found that changing attitudes and subjective norms often leads to subsequent change in a variety of health behaviors in young adults. The current study goal is to better understand sexual decision-making among American Indian youth using the Theory of Reasoned Action model and to introduce ways to utilize attitudes and subjective norms to modify risky behaviors. Methods The project collected qualitative data at a reservation site and an urban site through 16 focus groups with American Indian young people aged 16-24. Results Attitudes towards, perceived impact of, and perception of how others felt about teen pregnancy vary between American Indian parents and non-parents. Particularly, young American Indian parents felt more negatively about teen pregnancy. Participants also perceived a larger impact on female than male teen parents. Conclusions There are differences between American Indian parents and non-parents regarding attitudes towards, the perceived impact of, and how they perceived others felt about teen pregnancy. Teen pregnancy prevention programs for American Indian youth should include youth parents in curriculum creation and curriculum that addresses normative beliefs about teen pregnancy and provides education on the ramifications of teen pregnancy to change attitudes.

Communication Between Asian American Adolescents and Health Care Providers About Sexual Activity, Sexually Transmitted Infections, and Pregnancy Prevention

Asian American adolescents have been reported to have the lowest amount of communication with health care providers regarding sexual health topics (sexual activity, contraception, sexually transmitted infections, and pregnancy prevention). This study identified Asian American adolescents’ attitudes/beliefs regarding how health care providers can be most helpful in communicating about sexual health topics. Twenty participants revealed the following information: (a) confidentiality concerns resulted in lying to health care providers about sexual histories or refusing hormonal contraception, (b) a general lack of knowledge regarding sexual health topics, and (c) a hesitancy to discuss sexual histories with Asian American health care providers. Asian American adolescents expressed a need for privacy from parents regarding their sexual behaviors, and want health care providers to initiate conversations and provide information about sexual health topics.

Indirect and direct perceived behavioral control and the role of intention in the context of birth control behavior

Unintended pregnancies can have negative consequences for both mother and child. The focus of this study was to utilize perceived behavioral control measures (PBC; part of the theory of planned behavior) to identify relevant behavioral determinants of birth control use. This study also tested associations between direct and indirect PBC measures and intention of birth control use and between intention and birth control use. The methods included a randomly selected sample of patients at a health care system in the Upper Midwest who were sent a self-administered survey, with 190 non-pregnant women returning completed surveys. Participants indicated a high level of control over using birth control, and a significant positive correlation was observed between direct and indirect PBC measures. Participants also reported high intentions to use birth control, and a significant positive correlation was observed between intention and PBC. Additionally, both PBC measures and intention were independently and significantly associated with behavior, and PBC remained significantly associated with behavior when intention was added into the model. In conclusion, compared to the previous literature, this study is unique in that it examines indirect PBC measures and also the important role that PBC plays with actual birth control behavior.

Reproductive Health CHOICES for Young Adults with Sickle Cell Disease or Trait: Randomized Controlled Trial Outcomes over Two Years

Interventions to assist reproductive health decision-making in populations affected by sickle cell disease (SCD) or trait (SCT) lack proven efficacy over time. Our aim was to compare effects of CHOICES, a Web-based multimedia education program on implementing informed reproductive plans, and usual care education (e-Book) on reproductive knowledge, intention, and behavior over 24 months. We randomized 234 participants with SCD (n = 138) or SCT (n = 96) (age 18-35 years, 35 % male, 94 % African American) to CHOICES and e-Book groups. Participants completed a sickle cell-specific reproductive measure before and four times after the intervention (6, 12, 18 and 24 months). Compared to the e-Book group the CHOICES group had significantly more improvement in knowledge over time (p = .004) but not intention (p = .18) or behavior (p = .69). At baseline, 114 (48.7 %) participants reported having partners who would not put the couple at risk for their children inheriting SCD. Of the 116 (49.6 %) at-risk participants, a higher poroportion of those who were in the CHOICES group chose partners that reduced their risk by the last visit than the e-Book group (p = .04). Study findings provide important insights for designing a national trial of the CHOICES intervention focusing on subjects whose partner status puts them at risk for having a child with SCD.

Co-Parenting Relationship Experiences of Black Adolescent Mothers in Active Romantic Partnerships With the Fathers of Their Children

We conducted an interpretive description of co-parenting relationship experiences of romantically involved Black adolescent mothers and fathers with shared biological children. The study was conducted in Brooklyn, New York, using data from individual in-depth interviews with adolescent mothers and fathers (n = 10). Four themes were identified: (a) putting our heads together; (b) balancing childhood and parenthood; (c) less money, more problems; and (d) if we use condoms, it is for contraception. The co-parenting couples managed very complex relationships, but their mutual interest in the welfare of their children was a relational asset. Co-parents had sparse financial resources but used a moral economy strategy to provide mutual support. Future research is needed that focuses on identifying other co-parent relationship assets and integrating and evaluating their utility for enhancing interventions for adolescent families.

Prevalence and Frequency of Heterosexual Anal Intercourse Among Young People: A Systematic Review and Meta-analysis

We aim to assess if heterosexual anal intercourse (AI) is commonly practiced and how frequently it is practiced by young people. We searched PubMed for articles published 1975 to July 2014 reporting data on the proportion of young people (mean age <25) practicing heterosexual AI (AI prevalence) and on number of AI acts (AI frequency). Stratified random-effects meta-analysis and meta-regression were used to produce summary estimates and assess the influence of participant and study characteristics on AI prevalence. Eighty-three and thirteen of the 136 included articles reported data on lifetime AI prevalence and monthly AI frequency, respectively. Estimates were heterogenous. Overall summary estimates of lifetime AI prevalence were 22 % (95 % confidence interval 20-24) among sexually active young people, with no statistically significant differences by gender, continent or age. Prevalence increased significantly with confidentiality of interview method and, among males and in Europe, by survey year. Prevalence did not significantly differ by recall period. An estimated 3-24 % of all reported sex acts were AI. Reported heterosexual AI is common but variable among young people worldwide. To fully understand its impact on STI spread, more and better quality data on frequency of unprotected AI, and trends over time are required.

Unpacking the "Black Box" of Race-Ethnic Variation in Fertility

Race-ethnic differences in a range of childbearing behaviors are long-standing and well-documented, and these differences are attenuated, but not eliminated, when accounting for socioeconomic disparities. The residual differences are often attributed to vague and untested variation across race-ethnic groups in knowledge, attitudes, psychological attributes, normative beliefs, and social context. We use the longitudinal Toledo Adolescent Relationship Study (TARS), which contains a rich set of such factors measured in early adolescence, to assess whether they contribute to race-ethnic differences in having a birth among men and women ages 17-24 (n=1,042). Specifically, we test whether individual attitudes, religiosity, and academic behaviors; knowledge and behaviors regarding sex and dating; peer normative context; and parental communication about sex account for variation in the risk of an early birth. We find that socioeconomic factors attenuate but do not reduce differences between Black, Hispanic, and White respondents. Including adolescent academic performance and early entry into sex reduces the Black-White difference in the odds of early fertility to nonsignificance; however, beyond socioeconomic status, none of the broad range of factors further attenuate Hispanic-White differences, which remain large and statistically significant.

Pubertal timing and sexual risk behaviors among rural African American male youth: testing a model based on life history theory

Life History Theory (LHT), a branch of evolutionary biology, describes how organisms maximize their reproductive success in response to environmental conditions. This theory suggests that challenging environmental conditions will lead to early pubertal maturation, which in turn predicts heightened risky sexual behavior. Although largely confirmed among female adolescents, results with male youth are inconsistent. We tested a set of predictions based on LHT with a sample of 375 African American male youth assessed three times from age 11 to age 16. Harsh, unpredictable community environments and harsh, inconsistent, or unregulated parenting at age 11 were hypothesized to predict pubertal maturation at age 13; pubertal maturation was hypothesized to forecast risky sexual behavior, including early onset of intercourse, substance use during sexual activity, and lifetime numbers of sexual partners. Results were consistent with our hypotheses. Among African American male youth, community environments were a modest but significant predictor of pubertal timing. Among those youth with high negative emotionality, both parenting and community factors predicted pubertal timing. Pubertal timing at age 13 forecast risky sexual behavior at age 16. Results of analyses conducted to determine whether environmental effects on sexual risk behavior were mediated by pubertal timing were not significant. This suggests that, although evolutionary mechanisms may affect pubertal development via contextual influences for sensitive youth, the factors that predict sexual risk behavior depend less on pubertal maturation than LHT suggests.

The influence of religion on sexual HIV risk

This systematic review examines the relationship between religion and sexual HIV risk behavior. It focuses primarily on how studies have conceptualized and defined religion, methodologies, and sexual risk outcomes. We also describe regions where studies were conducted and mechanisms by which religion may be associated with sexual risk. We included 137 studies in this review, classifying them as measuring: (1) only religious affiliation (n = 57), (2) only religiosity (n = 48), and (3) both religious affiliation and religiosity (n = 32). A number of studies identified lower levels of sexual HIV risk among Muslims, although many of these examined HIV prevalence rather than specific behavioral risk outcomes. Most studies identified increased religiosity to be associated with lower levels of sexual HIV risk. This finding persists but is weaker when the outcome considered is condom use. The paper reviews ways in which religion may contribute to increase and reduction in sexual HIV risk, gaps in research, and implications for future research on religion and HIV.

Course of depression and anxiety symptoms during the transition to parenthood for female adolescents with histories of victimization

The aim of the current study was to increase understanding of how victimization history impacts the longitudinal course of depression and anxiety in a sample of 55 adolescents emerging into parenthood. Adolescents were interviewed about their victimization experiences during their second trimester of pregnancy, and interviews were subsequently classified according the Maltreatment Classification Scale (Barnett, Manly, & Cicchetti, 1993). Adolescents reported on their symptoms of depression and anxiety prenatally and 6 and 12 months postpartum. Growth curve modeling revealed that, on average, there was a steady linear decline in depression and anxiety symptoms across the transition to parenthood, with a rate of change of 25% and 20%, respectively, from the prenatal assessment to 12 months postpartum. Sexual abuse history attenuated the likelihood of a decrease in depressive symptoms over time. Neglect history was associated with higher prenatal levels of anxiety, as well as a steeper decline in anxiety symptoms over time. Future research is needed to determine the role of poly-victimization in predicting the onset and change of depression and anxiety symptoms. Findings from the current study have the potential to aid in the design of preventative and intervention efforts to reduce risks of mental health difficulties in adolescent parents.

Reproductive health choices for young adults with sickle cell disease or trait: randomized controlled trial immediate posttest effects

BACKGROUND

People with sickle cell disease (SCD) or sickle cell trait (SCT) may not have information about genetic inheritance needed for making informed reproductive health decisions. CHOICES is a Web-based, multimedia educational intervention that provides information about reproductive options and consequences to help those with SCD or SCT identify and implement an informed parenting plan. Efficacy of CHOICES compared with usual care must be evaluated.

OBJECTIVE

The purpose was to compare immediate posttest effects of CHOICES versus an attention-control usual care intervention (e-Book) on SCD-/SCT-related reproductive health knowledge, intention, and behavior.

METHODS

In a randomized controlled study, we recruited subjects with SCD/SCT from clinics, community settings, and online networks with data collected at sites convenient to the 234 subjects with SCD (n = 136) or SCT (n = 98). Their ages ranged from 18 to 35 years; 65% were women, and 94% were African American. Subjects completed a measure of sickle cell reproductive knowledge, intention, and behavior before and immediately after the intervention.

RESULTS

Compared with the e-Book group, the CHOICES group had significantly higher average knowledge scores and probability of reporting a parenting plan to avoid SCD or SCD and SCT when pretest scores were controlled. Effects on intention and planned behavior were not significant. The CHOICES group showed significant change in their intention and planned behavior, whereas the e-Book group did not show significant change in their intention, but their planned behavior differed significantly.

DISCUSSION

Initial efficacy findings are encouraging but warrant planned booster sessions and outcome follow-ups to determine sustained intervention efficacy on reproductive health knowledge, intention, and actual behavior of persons with SCD/SCT.

Black adolescent mothers' perspectives on sex and parenting in nonmarital relationships with the biological fathers of their children

OBJECTIVE

To understand single Black adolescent mothers' perspectives on the sexual and parenting-related aspects of their relationships with the biological fathers of their children.

METHODS

The study was a qualitative description of perspectives from a convenience sample of Black single (nonmarried) adolescent mothers. Data were generated through focus groups and interviews. Participants were recruited using self-referral and health provider referrals.

SETTING

The study was conducted in a county public health department sexually transmitted diseases clinic in Rochester, New York.

PARTICIPANTS

Single mothers (N = 31) ages 15 to 19 participated in the study. The mean age of participants was 17.5 years (SD = 1.4).

FINDINGS

Four themes were identified that reflected the major characteristics of the relationships between the mothers and the biological fathers of their children: (a) You will always care about your "baby daddy" because of your child, (b) Negative behavior is tolerated to keep the family together, (c) The "baby daddy" can get sex as long as we are not on bad terms, and (d) He will always be part of our lives.

CONCLUSION

Black adolescent mothers have complex relationships with the biological fathers of their children that may include ongoing sexual activity. The intersection of coparenting and sexual health needs among adolescent mothers highlights the importance of integrating sexually transmitted infections prevention with perinatal health programs. It is important to consider this unique coparenting relationship when providing risk-reduction counseling to young mothers.

Testing the theory of reasoned action in explaining sexual behavior among African American young teen girls

This study tested the Theory of Reasoned Action to examine the prediction of early sexual behavior among African American young teen girls. Baseline data from a longitudinal randomized clinical trial were used. Between 2001 and 2005, 198 middle-school girls aged 11 to 14 years were recruited. As girls aged, they held more permissive attitudes toward engaging in early sexual behavior and had a higher intention to engage in early sexual behavior. Intention was a significant predictor to explain sexual behavior among the girls. There is a need to develop strategies that promote intention related to delay and prevention of early sexual behavior.

Adolescent mothers' sexual, contraceptive, and emotional relationship content with the fathers of their children following a first diagnosis of sexually transmitted infection

PURPOSE

A sexually transmitted infection (STI) diagnosis may profoundly change the meaning of adolescent women's relationships, particularly when the relationship involves a shared child. This study explored the sexual, contraceptive, and emotional characteristics of sexual partners with whom adolescent women had and did not have children in the 3 months after the first STI diagnosis.

METHODS

Adolescent women (n = 387; age: 14-17 years at enrollment) were tested quarterly for STI and completed partner-specific items on emotional and sexual relationship content. We used nonparametric statistics (SPSS/18.0) to compare these characteristics between partners with whom these adolescent women did (n = 20) or did not (n = 118) share a child.

RESULTS

Rates of condom use at last sex, overall condom use, and condom insistence were lower with sexual partners involving shared children as compared with childless sexual partners. Relationship status, commitment to partner, and using no method of contraception were more common in parous sexual relationships as compared with nulliparous sexual relationships after an STI.

CONCLUSIONS

After an STI, adolescent women have different sexual risk behaviors with the fathers of their children, even after a signal event such as a recent STI diagnosis. Tailored counseling may specifically address the challenges of STI prevention with partners who have the unique status of being the "father of the baby."

Effects of group prenatal care on psychosocial risk in pregnancy: results from a randomised controlled trial

Few interventions have succeeded in reducing psychosocial risk among pregnant women. The objective of this study was to determine whether an integrated group prenatal care intervention already shown to improve perinatal and sexual risk outcomes can also improve psychosocial outcomes compared to standard individual care. This randomised controlled trial included pregnant women ages 14-25 from two public hospitals (N = 1047) who were randomly assigned to standard individual care, group prenatal care or integrated group prenatal care intervention (CenteringPregnancy Plus, CP+). Timing and content of visits followed obstetrical guidelines, from 18-week gestation through birth. Each 2-h group prenatal care session included physical assessment, education/skills building and support via facilitated discussion. Using intention-to-treat models, there were no significant differences in psychosocial function; yet, women in the top tertile of psychosocial stress at study entry did benefit from integrated group care. High-stress women randomly assigned to CP+ reported significantly increased self-esteem, decreased stress and social conflict in the third trimester of pregnancy; social conflict and depression were significantly lower 1-year postpartum (all p-values < 0.02). CP+ improved psychosocial outcomes for high-stress women. This 'bundled' intervention has promise for improving psychosocial outcomes, especially for young pregnant women who are traditionally more vulnerable and underserved.

Coparenting and sexual partner concurrency among white, black, and Hispanic men in the United States

BACKGROUND

Concurrent sexual partnerships (partnerships that overlap in time) increase the spread of infection through a network. Different patterns of concurrent partnerships may be associated with varying sexually transmitted infection (STI) risk depending on the partnership type (primary vs. nonprimary) and the likelihood of condom use with each concurrent partner. We sought to evaluate coparenting concurrency, overlapping partnerships in which at least 1 concurrent partner is a coparent with the respondent, which may promote the spread of STIs.

METHODS

We examined sexual partnership dates and fertility history of 4928 male respondents in the 2002 National Survey of Family Growth. We calculated coparenting concurrency prevalence and examined correlates using Poisson regression.

RESULTS

Among men with ≤ 1 pair of concurrent partnerships, 18% involved a coparent. 33% of black men involved in coparenting concurrency were <25 years, compared to 23% of Hispanics and 6% of whites. Young black men (age, 15-24 years) were more likely to engage in coparenting concurrency than white men, adjusting for sociodemographic characteristics, sexual and other high-risk behaviors, and relationship quality. Compared to white men aged 15 to 24 years, black and Hispanic men were 4.60 (95% confidence interval: 1.10, 19.25) and 3.45 (95% confidence interval: 0.64, 18.43) times as likely to engage in coparenting concurrency.

CONCLUSION

Almost 1 in 5 men engaging in concurrent sexual partnerships in the past year was a coparent with at least one of the concurrent partners. Understanding the context in which different types of concurrency occur will provide a foundation on which to develop interventions to prevent STIs.

Building Positive Life Skills the Smart Girls Way: Evaluation of a School-Based Sexual Responsibility Program for Adolescent Girls

In response to the public health epidemic of teenage pregnancy, the present study investigated a new, gender-specific, school-based approach to adolescent pregnancy prevention for middle school girls called Smart Girls Life Skills Training© (Smart Girls). Participants included 854 students (633, experimental group; 221, control group) across three time points to assess change in social sexuality expectations, personal/self sexuality expectations, perceived susceptibility, and parent—adolescent communication. Girls who received the Smart Girls curriculum increased their personal/self sexuality expectations and improved some aspects of their parent—adolescent communication compared to control group participants. The evaluation provides initial evidence that Smart Girls is at least partially effective at changing personal/self sexuality expectations and parent—adolescent communication for middle school girls. Implications, recommendations, and next steps for school-based teen pregnancy prevention programs are offered.

Latent growth trajectories of substance use among pregnant and parenting adolescents

We examine changes among adolescent girls in substance use during pregnancy and the postpartum period. Three separate latent growth curve analyses assessed the impact of psychosocial, behavioral, and sociodemographic factors on resumption of or change in use of cigarettes, alcohol, and marijuana. The Vulnerable Populations Model for Research and Clinical Practice (Flaskerud & Winslow, 1998) provided the theoretical foundation for this study. This is a secondary analysis of data from a sample of 305 ethnic minority females (245 Latina, 60 African American), aged 13-18 years, who were pregnant at baseline and were participating in an HIV prevention study conducted in inner-city alternative schools in Los Angeles County. Data collected at 4 time points captured changes in substance use from pregnancy through the postpartum period. Baseline predictors included ethnicity/race, partner substance use, childhood abuse history, religiosity, acculturation, depressive symptoms, length of gestation at baseline, and previous substance use. Common predictors of greater resumption and/or greater level of use included greater history of use before pregnancy, partner substance use, childhood abuse, and a longer time since childbirth. African Americans were more likely to be smoking at baseline when they were still pregnant and to use marijuana postpartum; Latinas were more likely to use alcohol over the course of pregnancy and postpartum. Other variables exerted an influence on specific substances. For instance, religiosity impacted cigarette and alcohol use. Findings may assist prenatal care providers to identify and counsel pregnant adolescents at risk for perinatal substance use and to prevent resumption or initiation of substance use after childbirth.

Evaluation of an HIV/STD sexual risk-reduction intervention for pregnant African American adolescents attending a prenatal clinic in an urban public hospital: preliminary evidence of efficacy

STUDY OBJECTIVE

To evaluate an intervention to reduce HIV/STD-associated behaviors and enhance psychosocial mediators for pregnant African-American adolescents.

DESIGN

A randomized controlled trial. Participants completed baseline and follow-up assessments.

SETTING

An urban public hospital in the Southeastern U.S.

PARTICIPANTS

Pregnant African-American adolescents (N=170), 14-20 years of age, attending a prenatal clinic.

INTERVENTION

Intervention participants received two 4-hr group sessions enhancing self-concept and self-worth, HIV/STD prevention skills, and safer sex practices. Participants in the comparison condition received a 2-hr session on healthy nutrition.

MAIN OUTCOME MEASURES

Consistent condom use.

RESULTS

Intervention participants reported greater condom use at last intercourse (adjusted odds ratio=3.9, P=0.05) and consistent condom use (AOR=7.9, P=0.05), higher sexual communication frequency, enhanced ethnic pride, higher self-efficacy to refuse risky sex, and were less likely to fear abandonment as a result of negotiating safer sex.

CONCLUSIONS

Interventions for pregnant African-American adolescents can enhance condom use and psychosocial mediators.

The relationship of perception of invincibility, demographics, and risk behaviors in adolescents of military parents

INTRODUCTION

The purpose of this research was to determine relationships among perceived invincibility, demographic variables, and risk behaviors in adolescents of active duty and retired military personnel.

METHOD

An instrument titled the Adolescent Invincibility Tool (AIT) was constructed and administered to a group of 125 adolescents of military parents. Correlation statistics were analyzed to determine variable relationships.

RESULTS

The AIT demonstrated reliability (Cronbach's alpha .88) in measuring invincibility in this sample. Participant characteristics and demographics were examined and revealed age, sex, ethnicity, and relocation frequency differences in relationship to the teen's level of perceived invincibility. Family relocation frequency and parent ranking/rating were significant variables for a military population. A significant positive relationship was identified between aggressive, delinquent behavior and invincibility; a negative correlation was demonstrated between worry and invincibility.

DISCUSSION

This study provided an opportunity to learn about unique influences related to being the teen of an active duty or retired military parent(s). Study findings indicate significant differences between military teens and national surveys in regard to risk taking and mental health indicators. Risk behaviors were found to occur at a lower frequency than the nationwide average, while depression occurred more frequently in this sample of military adolescents. Variations among teens of military parents in invincibility and worry scores provide direction for further study.

Young parents' relationship characteristics, shared sexual behaviors, perception of partner risks, and dyadic influences

Rising rates of heterosexually transmitted HIV among youth and young adults, particularly from ethnic minorities, create an urgent need to understand risk factors and perceptions of risk within the context of couple relationships. This study examined reports of young mothers and fathers (predominantly Latino) about background characteristics, relationship quality and length, HIV-related risk factors, and perceptions of partners' behaviors and personal history. Higher concordance was found for relationship characteristics and partners' personal history (e.g., incarceration) than on shared sexual behaviors. Most males and females stated that they were monogamous; however, those whose partners reported concurrency were unaware of this. Many were unaware of their partners' HIV testing status. Relationship quality was higher when females accurately perceived their partners' self-reported HIV-related risk behaviors. Length of the relationship did not influence concordance. Findings support the need for HIV prevention programs to promote open discussion about condom use and HIV testing within sexual partnerships.

Multilevel predictors of inconsistent condom use among adolescent mothers

OBJECTIVES

We used Bronfenbrenner's ecological systems theory to identify factors that predicted never or sometimes using condoms in a multiethnic cohort of adolescent mothers.

METHODS

We interviewed adolescent mothers within 48 hours of delivery and surveyed them 6 and 12 months after delivery (n = 636). We used multinomial logistic regression to identify individual-, dyad-, family-, and peer and community-level factors associated with never or sometimes using versus always using condoms during intercourse at 12 months postpartum.

RESULTS

Pregnancy status, partner refusal to use condoms, intimate partner violence, and race/ethnicity predicted both never and sometimes using condoms. Condom use 6 months earlier and church attendance also predicted never using condoms, whereas maternal monitoring was an additional predictor for sometimes using condoms.

CONCLUSIONS

Overlapping yet distinct risk profiles predicted never or sometimes using versus always using condoms. Factors from multiple levels of influence affected the condom use behaviors of adolescent mothers indicating that multilevel interventions are needed to promote safer sexual practices among these young women.

Development of a Web-based program to improve communication about sex

Adolescent sexual risk behavior is a serious and prevalent problem among American youth. Mothers may play a key role in discussing sex and sexual risk behavior with their adolescent children. However, mothers may lack the knowledge and skills to successfully communicate. The purpose of this study was to develop a Web site to teach mothers how to communicate with their children about sex and to demonstrate the efficacy of this Web-based program. This pilot study included 35 rural, low-income mothers of middle-school adolescents. Mothers were randomly assigned to either the Web-based experimental group or written information-only control group. Mothers in the experimental group received computers and Internet access to the Web-based program, peer support, and expert advice from a pediatric nurse practitioner. Major findings of the study were that the Web-based intervention was equally effective at improving mothers' knowledge, communication skills, and self-efficacy as the written material control and that low-income rural women who have had little to no prior experience with computers can effectively learn Web-based health-related information. Future implications for nursing are discussed.

HIV prevention for Latino adolescent mothers and their partners

This study evaluates the outcomes of a theory-based, couple-focused HIV prevention program for Latino adolescent mothers and their male partners. The sample includes 49 couples (98 individuals) who receive either the intervention or only an HIV information session (comparison). The six-session, culturally appropriate intervention was developed through a community-academic partnership. Findings at the 6-month evaluation show that the probability of unprotected sex is significantly reduced and intentions to use condoms increase over time for participants in the experimental group, compared with the comparison group (p < .001), although AIDS knowledge improves for participants in both groups. Females in both groups have higher intentions of using condoms (p < .01) and lower probability of unsafe sex (p < .05) at baseline and over time, compared with their male partners. The intervention is well accepted by the inner-city adolescents and is realistic for implementation in a community setting.

'Searching for a "generalized social agent" to predict Namibians' intentions to prevent sexual transmission of HIV

Debate surrounds the definition, measurement and utility of subjective norms (theory of reasoned action, Fishbein & Ajzen, 1975; Ajzen & Fishbein, 1980). Scholars propose alternative concepts including descriptive norms and injunctive norms (Cialdini et al., 1990), enabling factors and social embeddedness (e.g. Barrera, 1986), and betweenness to others in a network (Wasserman & Faust, 1994) to explain social influences on willingness to perform a behaviour. This study explores the relative utility and comparability of different social concepts in understanding Namibians' intentions (n=1200) to abstain from sex or to be faithful to one sexual partner. Neither subjective norms nor the five other concepts consistently predict either intentions, although they account for 21% of variance in intentions to abstain and 24% of intentions to have one sexual partner in one region. Conflicting relationships between injunctive and subjective norms exist; stigma surrounding HIV prevention provides some explanation. Campaigns designed to alter norms may benefit from altering stigma simultaneously.

Gender-specific HIV prevention with urban early-adolescent girls: outcomes of the Keepin' It Safe Program

This study evaluates the efficacy of Keepin' It Safe, a theory-based, gender-specific, CD-ROM-mediated HIV prevention program for urban, early adolescent girls. Intervention effects were examined in a randomized, pretest-posttest wait-list control-group design. Changes in HIV/AIDS knowledge, protective attitudes, and skills for reducing HIV risk-related sexual behaviors were tested using linear regression models that were controlled for baseline values of each outcome. Recruited through youth services agencies located in the greater New York City area, study participants comprised 204 adolescent girls aged 11-14 years. Girls exposed to Keepin' It Safe, relative to wait-list control girls, increased their HIV/AIDS knowledge, perceived efficacy and enjoyment of abstinence, perceived efficacy and enjoyment of condoms, and sexual assertiveness, suggesting that a theory-based, gender-specific, CD-ROM-mediated HIV prevention program can enhance knowledge, protective attitudes, and skills for reducing HIV risk-related sexual behaviors among urban early-adolescent girls.

Physical and sexual abuse and unstable housing among adolescents with HIV

Stable housing is a necessary component of treatment of adolescents with HIV. This study examines the housing status at two points in time of a sample of 224 adolescents with HIV seen at an adolescent medicine clinic in New York City. It addresses whether unstable housing is associated with several forms of abuse, and what factors predict continued instability. 38.6% (n = 86) had a prior history of unstable housing, reduced to 12.9% at the time of program entry. Multivariate logistic regression models predicting current and prior unstable housing revealed two variables related to both outcomes: physical abuse and referral from youth/social services entities. Continued unstable housing was associated with all abuse variables and adolescent history of arrest. When adolescents in abusive situations come to the attention of programs for youth, they have a positive impact on transitioning most adolescents to safer households, potentially improving adolescents' accessing of health care services.

Sexual practices of church youths in the era of HIV/AIDS: Playing the ostrich

The church could be a powerful force for social and behavioural change, particularly in the current efforts to combat the HIV/AIDS pandemic. Anecdotal evidence suggests that church youths are sexually active but few studies have documented the sexual practices of these youths. We looked at the sexual practices of 341 youths in two churches in southern Nigeria. Sixty-five percent were sexually experienced; age at first sexual intercourse for males was seven years and eight years for females. By 19 years of age, 42% of the females and 44% of the males had become sexually active. In the 12 months preceding the study, 19% of the sexually experienced youths abstained from sex, 30% had one sexual partner and 28% had more than one sexual partner; 60% had used condoms 24% of whom used them always. These results suggest that sexual practices of committed church youths might be similar to those of youths in the wider society. More might be achieved by a more pro-active engagement of the church in young people's sexual and reproductive health matters.

Relationship, power, and other influences on self-protective sexual behaviors of African American female adolescents

This study examined risky sexual behaviors, gender, and power issues affecting risk taking, and factors most likely to promote self-protection among female African American adolescents. A cross-sectional design was used for data collection. The sample included 130 adolescents ranging from 14 to 20 years of age, who completed questionnaires. Multiple regression analysis resulted in two models that accounted for 23% and 37% of the variance. Behavioral intention, partner age, pregnancy status, current substance use, and length of sexual relationship were statistically significant predictor variables. Behavioral intentions, in particular, were found to be a strong predictor of condom use among African American youth.

Using social cognitive theory to explain consumers' behavioral intentions in response to direct-to-consumer prescription drug advertising

BACKGROUND

Previous research describing consumers' communication behaviors in response to direct-to-consumer advertising (DTCA) suggests a social cognitive rationale to explain DTCA-related communication behavior.

OBJECTIVE

Guided by social cognitive theory, the objective of this study was to explore outcome expectancy and self-efficacy beliefs as predictors of individuals' intentions to communicate with their physicians about an advertised drug.

METHODS

One hundred and seven female college students completed a questionnaire, read an advertisement for an oral contraceptive drug, and completed a second questionnaire. The questionnaires assessed participants' self-efficacy and outcome expectancy beliefs, intended communication behavior, and demographic information.

RESULTS

Pearson product-moment correlation analyses showed that outcome expectancy (r=0.75, P<.01) and self-efficacy (r=0.21, P<.05) beliefs were associated positively with intentions to communicate with physicians in response to DTCA. However, ordinary least squares regression analyses revealed that only outcome expectancy beliefs predicted intended communication behavior (B=1.56, P<.01). Results also showed that participants had a relatively greater likelihood of requesting information about, than requesting a prescription for, the advertised drug [t(106)=14.75, P<.01].

CONCLUSIONS

The results identify cognitive factors that guide consumers' plans for interacting with physicians in response to DTCA. Health care providers can use these results to guide communication with patients regarding DTCA and meet patients' drug-related informational expectations.

Knowledge about condoms among low-income pregnant Latina adolescents in relation to explicit maternal discussion of contraceptives

PURPOSE

To examine pregnant adolescents' conceptual knowledge about condom use and its relation to maternal implicit and explicit communication about contraceptives.

METHODS

Forty-five pregnant Latina adolescents (aged 14 to 18 years) were interviewed regarding their knowledge about how condoms prevent pregnancy. In addition, the adolescents were videotaped having a conversation with their mothers (23 English-speaking, 22 Spanish-speaking) about dating and sexuality, which was coded for maternal explicit and implicit messages about contraception.

RESULTS

A more detailed, accurate understanding of how condoms work, and the ability to explicitly describe that knowledge, was associated with adolescents reporting higher levels of confidence about using condoms, and increased comfort talking to partners about condoms. Mothers' explicit mention of contraception was related to their adolescents having detailed, accurate information about condoms. Among Spanish-speaking dyads only, maternal explicit messages were associated with adolescents using more explicit terminology in describing their knowledge.

CONCLUSIONS

Study results have implications for intervention with a high-risk population of Latina mothers and adolescents. The study also highlights the importance of examining specific aspects of knowledge, namely conceptual, biological knowledge.

Predictors of inconsistent contraceptive use among adolescent girls: findings from a prospective study

PURPOSE

To assess the independent effects of various behavioral and psychosocial antecedents on contraceptive use among a sample of low-income African-American adolescent females.

METHODS

Stepwise logistic regression was used to calculate odds ratios for baseline predictors of inconsistent contraceptive use six months later. Study participants include 375 nonpregnant African-American girls aged 14-18 years who reported sexual activity in the previous six months. Data were collected using a self-administered survey, individual interview and urine pregnancy test.

RESULTS

Adolescents who were inconsistent contraceptive users at follow-up were more likely to have reported a desire for pregnancy, previous inconsistent contraceptive use, less frequent communication with their partners about prevention issues, and an increased number of lifetime sexual partners at the baseline assessment. Of equal importance was the finding that a previous pregnancy or sexually transmitted infection did not influence future contraceptive behaviors.

CONCLUSIONS

Clinicians can play an important role in counseling adolescents about sexual health and dispelling misperceptions that hinder consistent contraceptive use. Findings from this research could have significant implications for the development of effective sexually transmitted infection (STI) and pregnancy prevention programs for adolescents and can help in guiding clinicians toward relevant treatment practices.

Health-risk behaviors in a sample of first-time pregnant adolescents

OBJECTIVE

The purpose of this study was to assess the frequency of prenatal health-risk behaviors (substance use, sexual risk taking, and prenatal class attendance) among a nonrandom sample of first-time pregnant adolescents.

DESIGN

The design is descriptive.

SAMPLE

145 ethnically diverse first-time pregnant adolescents aged 15-18 years.

MEASUREMENT

Health behavior questions modified from the Center for Disease Control's Youth Risk Behavior Surveillance System.

RESULTS

The health-risk behavior most modified during pregnancy was alcohol use (64/145 drank but quit and 1/145 did not quit). Of the 52/145 who used street drugs, nine continued despite pregnancy. Of the 75/145 who smoked early in pregnancy, 39 continued. The majority did not use a condom at last sexual intercourse. Approximately half attended a prenatal class and half attended a teen parenting class.

CONCLUSION

Health-risk behaviors captured by birth certificate data are thought to be underreported for all age groups, and the prevalence of health-risk behaviors in this sample of pregnant teens was often greater than the most recent national trend data available. The magnitude of the effects of health-risk behaviors on pregnancy outcomes necessitates improved data gathering to enhance planning and evaluation of research and interventions at community, system, and individual/family levels.

Condom use among high-risk adolescents: testing the influence of alcohol use on the relationship of cognitive correlates of behavior

The goal of this study was the exploration of distal effects of alcohol use on condom use. Criminally involved adolescents completed an initial measure of attitudes, beliefs, and prior behavior. Of the 300 who completed the initial measurement, 267 (89%) completed a behavioral assessment 6 months later. Analyses validated a theoretical model of condom use intentions and indicated that intentions and attitudes measured at baseline were significant predictors of condom use behavior 6 months later. Neither alcohol use nor alcohol problems moderated relationships among model variables or the influence of intentions and attitudes on behavior. The findings do not support a distal role for alcohol use in altering the cognitive correlates of condom use intentions and behavior among high-risk adolescents.

Tailoring STI & HIV Prevention Programs for Teens

Successful HIV/sexually transmitted infection (STI) prevention programs are not "one size fits all." To effectively meet the HIV/STI prevention needs of all adolescents, programs should be developmentally and gender specific, should integrate an understanding of racial/ethnic culture, and should be open to variations in sexual expression. Nurse researchers have demonstrated the importance of these differences in programs, and this article offers concrete suggestions for ways to apply this knowledge in community programs.

Systematic review of sexual risk among pregnant and mothering teens in the USA: pregnancy as an opportunity for integrated prevention of STD and repeat pregnancy

Behaviors that lead to teen pregnancy also place young women at risk for STDs and repeat pregnancy. Compared to the broad literature on adolescent sexual risk behavior, our understanding of sexual risk in pregnant/mothering teens lags far behind. Primary objectives of this systematic review (1981-2003) of pregnant/mothering teens were to: (1) document rates of STD, repeat pregnancy, condom use, and contraception; (2) identify correlates of these biological and behavioral outcomes; (3) review sexual risk reduction interventions; and (4) discuss directions for future research and implications for clinical care. Fifty-one studies met inclusion criteria. Rates of STD and repeat pregnancy were high, with the majority of teens engaging in unprotected sex during and after pregnancy. An Ecological Model of Sexual Risk, based on Bronfenbrenner's (1989) Ecological Systems Theory, was proposed to organize findings on correlates of sexual risk. Improvements in research, including integration of outcomes and risk factors, stronger methodologies, and standardized assessments, are essential. Results suggest that teen pregnancy is a marker for future sexual risk behavior and adverse outcomes, and that pregnant/mothering teens need hybrid interventions promoting dual use of condoms and hormonal contraception. Pregnancy may provide a critical "window of opportunity" for sexual risk reduction.