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Abrams R, Nordmyr J, Forsman AK. Promoting sexual health in schools: a systematic review of the European evidence. Front Public Health 2023; 11:1193422. [PMID: 37469692 PMCID: PMC10352496 DOI: 10.3389/fpubh.2023.1193422] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 06/19/2023] [Indexed: 07/21/2023] Open
Abstract
Introduction Sexual ill-health is an urgent public health issue with subsequent social and economic costs. There is, therefore, a need for more effective sexual health promotion interventions in an early stage of life. Previous research has focused on preventive sexual health interventions applying a risk perspective, and the limited and scattered evidence concerning school-based sexual health promotion interventions employing a health-resource perspective has not been compiled and synthesized. Hence, this study aimed to systematically review the current evidence on the effects of sexual health promotion interventions conducted in schools in Europe. Method A systematic review based on the JBI and PRISMA standards was performed, encompassing searches in seven databases to identify sexual health promotion interventions conducted in European schools between 2012 and 2022. Data coding was performed according to a predetermined protocol and included information on study characteristics, intervention content, methods, and outcomes relevant to the current review. A narrative synthesis of the included studies was performed, highlighting the collective results. Result Seventeen records were included in the review, reporting on 16 individual studies conducted in 7 European countries. Of the 16 included studies, 13 had a quantitative research design, and three had a qualitative design. All three studies with a qualitative research design described positive effects experienced by the participants. Six of thirteen quantitative studies showed statistically significant positive effects on at least one of the outcomes of interest. The outcomes of interest were grouped into five areas, and most studies focused on the area of attitudes toward sexual health. Conclusion The findings indicate promising evidence of effect for interventions with a health promotion approach, highlighting the importance of strengthening sexual health resources related to respect, communication skills, attitudes, and other positive psycho-social aspects of sexual health. Most sexual health promotion intervention studies have focused on sexual health resource outcomes connected to attitudes and skills, whereas a comprehensive focus on the multi-dimensional sexual health literacy concept is less common and can be recommended to be included in future intervention research.
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Abrams JA, Rutledge J, Opara I. Learning from community-based HIV prevention to inform control and mitigation of the COVID-19 pandemic. Prev Med 2023; 169:107445. [PMID: 36750159 PMCID: PMC9899509 DOI: 10.1016/j.ypmed.2023.107445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 01/31/2023] [Accepted: 02/02/2023] [Indexed: 02/07/2023]
Abstract
The current COVID-19 pandemic and the likelihood of future viral pandemics demonstrate a need for strategic prevention campaigns that integrate biomedical, structural, and behavioral interventions within larger scale comprehensive public health initiatives. In Human Immunodeficiency Virus (HIV) prevention, community-based efforts have resulted in reductions in transmission rates, increases in testing, increases in biomedical prevention uptake, and increased engagement in secondary and tertiary prevention efforts. In this paper, we review three community-based strategies (health communication, accessible screening, and accessible prevention resources) that have demonstrated effectiveness in HIV prevention and offer recommendations for utilizing these strategies in the COVID-19 pandemic. For example, health communication strategies have positively influenced HIV testing behavior, sex communication, and condom use among HIV negative individuals and treatment initiation, treatment adherence, and retention in care among people living with HIV. In addition, studies have shown that improving accessibility of HIV screening and prevention resources in community venues such as schools, pharmacies, mobile-testing sites, churches, hair salons, and bars is useful for increasing the uptake of HIV testing, especially among disproportionately affected populations and those deemed hard to reach. Despite differences in modes of transmission, it is plausible that a synergistic multilevel response with emphasis on community-based efforts could lead to similar outcomes for the current COVID-19 pandemic and future viral pandemics. Community-based prevention strategies offer an opportunity to integrate, and bolster disconnected and siloed initiatives that achieve limited impacts independently.
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Affiliation(s)
- Jasmine A Abrams
- Department of Social and Behavioral Sciences, Yale University School of Public Health, USA.
| | | | - Ijeoma Opara
- Department of Social and Behavioral Sciences, Yale University School of Public Health, USA
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Szucs LE, Demissie Z, Steiner RJ, Brener ND, Lindberg L, Young E, Rasberry CN. Trends in the teaching of sexual and reproductive health topics and skills in required courses in secondary schools, in 38 US states between 2008 and 2018. HEALTH EDUCATION RESEARCH 2023; 38:84-94. [PMID: 36315469 PMCID: PMC11002834 DOI: 10.1093/her/cyac032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 09/01/2022] [Accepted: 10/06/2022] [Indexed: 06/16/2023]
Abstract
Information about state and local education policies regarding sexually transmitted infections, including human immunodeficiency virus, and unintended pregnancy prevention is available, yet less is known about school-level implementation of such policies. We examine trends in the percentage of US secondary schools teaching sexual and reproductive health (SRH) topics in a required course in Grades 6-8 and 9-12, including healthy relationships, sexual abstinence, condoms and condoms with other contraceptive methods. We analyze representative data from 38 states across six cycles of School Health Profiles (2008-18) assessed through self-administered questionnaires completed by lead health teachers. Logistic regression models examined linear trends in the percentages of schools teaching topics for Grades 6-8 and 9-12, separately. Trends were calculated for states having representative data for at least three cycles, including 2018. During 2008-18, it was more common to have increases in teaching how to obtain condoms, correct condom use and use condoms with other contraceptive methods in Grades 6-12 than decreases. More states showed decreases in teaching abstinence in Grades 6-12 than increases. Most states had no change in teaching SRH topics across grades. Findings suggest some improvement in school-based SRH education, yet efforts are needed to improve comprehensive, developmentally appropriate content.
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Affiliation(s)
- Leigh E. Szucs
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS US8-1, Atlanta, GA 30329-4027, USA
| | - Zewditu Demissie
- Division of Violence Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS S106-10, Atlanta, GA 30333, USA\
- U.S. Public Health Service Commissioned Corps, 1101 Wootton Pkwy, Rockville, MD 20852, USA
| | - Riley J. Steiner
- Division of Reproductive Health, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS S107-2, Atlanta, GA 30333, USA
| | - Nancy D. Brener
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS US8-1, Atlanta, GA 30329-4027, USA
| | - Laura Lindberg
- The Guttmacher Institute, 125 Maiden Lane, New York, NY 10038, USA
| | - Emily Young
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS US8-1, Atlanta, GA 30329-4027, USA
- Oak Ridge Institute for Science and Education, 1299 Bethel Valley Rd, Oak Ridge, TN 37830, USA
| | - Catherine N. Rasberry
- Division of Adolescent and School Health, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS US8-1, Atlanta, GA 30329-4027, USA
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Amoo EO, Adebayo ME, Owoeye MO, Egharevba ME. To Save a Girl-Child, You Must Train a Boy-Child: A Note on Situational Irony. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16313. [PMID: 36498385 PMCID: PMC9740179 DOI: 10.3390/ijerph192316313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/16/2022] [Accepted: 11/29/2022] [Indexed: 06/17/2023]
Abstract
Despite numerous initiatives and resources to save and protect the health and sexual rights of girls and women, the persistently high rate of unwanted pregnancy, abortion, and sexual violence in sub-Saharan Africa (SSA) has remain a topical public health challenge. This study hypothesised that the continuous conspicuous omission of boys/men in the interventions to combat this menace could be a long-life impediment to the realisation of sustainable health for girls and women in the region. The study adopted a systematic review of extant population-based published studies from Scopus, Google Scholars, PubMed, EMBASE, and AJOL. Literature coverage included the post-United Nations' coordinated International Conference on Population and Development (ICPD), Cairo, 1994, which marked the beginning of a massive campaign for women/girls sexual rights. The obtained qualitative data were appraised and synthesised towards spurring policy recommendations for gender balanced initiatives on the sexual and reproductive health rights in SSA. The study highlighted that unwanted pregnancy occurs only when a boy/man has unprotected sex with a girl/woman without considering her choice or rights. It is considered ironic that the dominant factors are boys and men but many enlightenment initiatives/campaigns are concentrated on girls and women. The study developed a schematic save-a-girl-child framework that illustrated the possible dividends inherent in the training of a boy-child to achieve a safer world for the girls/women. It recommends increase in the exposure of boys and men to sexual education and counselling, which can motivate them to be supporters of family planning, supporters of only wanted pregnancy, wanted fatherhood, marital fidelity, intimate partners' harmonious living rather than violence, and wife or partner empowerment.
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Affiliation(s)
- Emmanuel O. Amoo
- Demography and Social Statistics, Covenant University, Ota 112104, Nigeria
| | - Mercy E. Adebayo
- Department of Sociology, Covenant University, Ota 112104, Nigeria
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Prevalence and risk factors for female and male adolescents involved in pregnancy and abortion: a population-based cross-sectional study in Taiwan, 2006–2016. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-022-01772-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Hamid NC, Malek KA, Mat-Nasir N, Mohamad M, Nasir NM. Prevalence of Good Condom Usage and Its Association with Condom Use Self-Efficacy among Youth Attending HIV/STDs Clinics in Primary-Care Settings in Malaysia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191912179. [PMID: 36231478 PMCID: PMC9565083 DOI: 10.3390/ijerph191912179] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 09/08/2022] [Accepted: 09/16/2022] [Indexed: 05/30/2023]
Abstract
The low prevalence of condom usage among youth with Human Immunodeficiency Virus/Sexually Transmitted Diseases (HIV/STDs) is a concern. Condom use self-efficacy has been identified as a significant predictor of condom usage. This cross-sectional study examines the prevalence of good condom usage and its association with condom use self-efficacy among Malaysian urban youth, aged between 18 to 24 years old attending HIV/STDs clinics in primary-care settings, Selangor. Utilising the Harmonised Malay version of Condom Use Self-Efficacy Scale (CUSES M-H) questionnaire, the data from 218 responders were analysed using univariate and multiple logistic regression. The prevalence of good condom usage was 61% (95% CI: 54%, 68%). The average mean score of condom use self-efficacy was 3.07. Condom use self-efficacy was divided into four subscales of mechanics, perceived barriers, assertiveness and intoxicants. The assertiveness subscale had the highest average mean score of 3.42, while the intoxicant subscale score had the lowest average mean score of 2.24. Good condom usage was significantly associated with condom use during first sexual intercourse (aOR = 5.81, 95% CI: 1.97, 17.14), duration diagnosis of HIV/STDs of more than 12 months (aOR = 6.40, 95% CI: 2.30, 17.86) and the high assertiveness subscale score (aOR = 1.19, 95% CI: 1.03, 1.36). A behavioural change campaign that targets high-risk youth in primary care settings could promote condom use self-efficacy particularly assertiveness to increase condom usage among the youth.
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Affiliation(s)
- Norbainun Che Hamid
- Department of Primary Care Medicine, Faculty of Medicine, Sungai Buloh Campus, Universiti Teknologi MARA (UiTM), Sungai Buloh 47000, Malaysia
| | - Khasnur Abd Malek
- Department of Primary Care Medicine, Faculty of Medicine, Sungai Buloh Campus, Universiti Teknologi MARA (UiTM), Sungai Buloh 47000, Malaysia
| | - Nafiza Mat-Nasir
- Department of Primary Care Medicine, Faculty of Medicine, Sungai Buloh Campus, Universiti Teknologi MARA (UiTM), Sungai Buloh 47000, Malaysia
| | - Mariam Mohamad
- Department of Public Health Medicine, Faculty of Medicine, Sungai Buloh Campus, Universiti Teknologi MARA (UiTM), Sungai Buloh 47000, Malaysia
| | - Nik Munirah Nasir
- Department of Primary Care Medicine, Faculty of Medicine, Sungai Buloh Campus, Universiti Teknologi MARA (UiTM), Sungai Buloh 47000, Malaysia
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Debele GR, Tsegaye D, Gemechu T, Siraj SZ. Influences of parental monitoring and school connectedness on age at first sexual debut among unmarried female youth in Bedele town, Ethiopia: A survival analysis of timing using accelerated failure time model. PLoS One 2022; 17:e0271906. [PMID: 35881614 PMCID: PMC9321400 DOI: 10.1371/journal.pone.0271906] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 07/08/2022] [Indexed: 12/04/2022] Open
Abstract
Background The age of first sexual debut among youth continues to attract interest as it marks the start of their exposure to a variety of sexual and reproductive health problems. Parental monitoring (PM) and school connectedness (SC) has been found to have an effect on this problem. Despite this fact, there is a dearth of literature on implications of PM and SC on age at first sexual debut in Ethiopia. Therefore, this paper examined the influences of PM and SC age at first sexual debut among female youth. Methods A retrospective follow-up study was conducted on 470 randomly selected female youth in Bedele town, Oromia regional state, southwest Ethiopia from February 1 to March 30, 2021. The age at first sexual debut was asked in full years for respondents who ever engaged in sexual debut at a time of data collection. Data were entered using Epi-Data version 4.6 and analyzed using Stata version 14. All variables at P-values less than 0.2 in bivariable analysis were exported to multivariable analysis. Multivariable Accelerated Failure Time (AFT) regression analyses using Weibull distribution were used to examine the association of age at first sexual debut with PM and SC at 5% level of significance. Results Overall, 132(28.1%) youths were begun sexual activities of which 79.54% was an early (vaginal penetrative sex before 18 years old). The incidence rate was 15.58/1000 PY with 95% CI of [13.14, 18.47]. The result shows that, female youth start first sexual debut as early as 10 year and mean age was 16.89±2.82. Only 27.97% of those who began sexual debut used contraception during first sex. Multivariable Weibull AFT regression analyses adjusted for different variables showed that high PM (Adjusted Time Ratio (ATR) 1.13: 95%CI; [1.04, 1.21]) and good SC (ATR: 1.14: 95% CI; [1.06, 1.22] significantly delays the age at first sexual debut. Conclusions Overall, four out of every five premarital sexual activities were early sexual debuts. High PM and high SC significantly decrease early sexual debut by delaying the age of sexual initiation. Therefore, family and school involvement focused on PM and SC of the youth is recommended as an important mechanism for preventing youths’ risky sexual behaviour, including early sexual debut.
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Affiliation(s)
- Gebiso Roba Debele
- Department of Public Health, College of Health Sciences, Mettu University, Mettu, Ethiopia
- * E-mail:
| | - Dereje Tsegaye
- Department of Public Health, College of Health Sciences, Mettu University, Mettu, Ethiopia
| | | | - Sabit Zenu Siraj
- Department of Public Health, College of Health Sciences, Mettu University, Mettu, Ethiopia
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George G, Beckett S, Reddy T, Govender K, Cawood C, Khanyile D, Kharsany AB. Role of Schooling and Comprehensive Sexuality Education in Reducing HIV and Pregnancy Among Adolescents in South Africa. J Acquir Immune Defic Syndr 2022; 90:270-275. [PMID: 35302969 PMCID: PMC9177157 DOI: 10.1097/qai.0000000000002951] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 02/11/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Comprehensive sexuality education (CSE) seeks to reduce risky sexual behaviour and subsequent incidence of unintended pregnancy and HIV among schoolgoing adolescents. This study estimates the association between exposure to CSE and key biomedical and behavioural indicators among adolescent girls in South Africa. SETTING Four DREAMS implementation districts in Gauteng and KwaZulu-Natal provinces in South Africa. METHODS Data from a household-based representative sample of adolescent girls (between the ages 12-18 years) (n = 9673) was collected. Independent variables included school attendance and exposure to CSE, with outcome variables measuring prevalence of HIV, pregnancy, and sexual risky behaviour, including condom use, incidence of age-disparate relationships, and transactional sex. RESULTS Adolescent girls in school and who had attended CSE classes in the previous 12 months were associated with reduced adjusted odds of being HIV-positive [full sample: adjusted odds ratios (AOR): 0.76, 95% confidence interval [CI]: 0.61 to 0.95, P < 0.05; sexually active sample: AOR: 0.62, 95% CI: 0.40 to 0.96, P < 0.05]. Those in school who attended CSE in the previous 12 months were also more likely to get tested for HIV (AOR: 1.48, 95% CI: 1.32 to 1.65, P < 0.001). CONCLUSIONS The results indicate that school attendance and exposure to CSE is associated with a reduction in risky sexual behaviour. Exposure to CSE is also associated with increased access to HIV testing for adolescent girls both in and out of school. Keeping adolescent girls in school produces the greatest positive sexual behavioural effect; this, coupled with the delivery of quality CSE, is a key strategy for reducing HIV risk.
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Affiliation(s)
- Gavin George
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Sean Beckett
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Tarylee Reddy
- Biostatistics Research Unit, South African Medical Research Council (SAMRC), Durban, South Africa
| | - Kaymarlin Govender
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - Cherie Cawood
- Epicentre AIDS Risk Management (Pty) Limited, Durban, South Africa; and
| | - David Khanyile
- Epicentre AIDS Risk Management (Pty) Limited, Durban, South Africa; and
| | - Ayesha B.M. Kharsany
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), University of KwaZulu-Natal, Durban, South Africa
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Kamke K, Stewart JL, Widman L. Multilevel Barriers to Sexual Health Behavior Among Vulnerable Adolescent Girls in the USA. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 19:822-833. [PMID: 36212514 PMCID: PMC9542138 DOI: 10.1007/s13178-021-00594-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/23/2021] [Indexed: 06/03/2023]
Abstract
Introduction Most sexual health interventions focus on individual-level predictors of sexual behavior. Given the considerable influence of environmental factors on adolescent girls' sexual health, current interventions may be insufficient to promote safer sex. In this study, we aimed to understand adolescent girls' anticipated barriers to engaging in safer sex behavior after completing a brief, web-based sexual health intervention called HEART. Methods This study used qualitative interviews with 50 adolescent girls who were recruited from community-based organizations that serve vulnerable youth. All participants were 12 to 19 years old (mean age=15.62, SD=1.83), and identified with a marginalized racial/ethnic group (58% Black; 18% Latinx; 24% Asian, biracial, or multiracial). Further, 24% identified as LGBTQ+, and 58% were sexually active. Results Guided by the social ecological model, we delineate six unique barriers to safer sex discussed by adolescents: partner manipulation, slut shaming, unclear sexual values, present time orientation, embarrassment, and access to sexual and reproductive health services. Discussion We conclude with recommendations for addressing these barriers to optimize adolescent girls' sexual health.
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Affiliation(s)
- Kristyn Kamke
- Department of Psychology, North Carolina State University, Raleigh, NC, USA
| | - J. L. Stewart
- Department of Psychology, North Carolina State University, Raleigh, NC, USA
| | - Laura Widman
- Department of Psychology, North Carolina State University, Raleigh, NC, USA
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Pilar M, Elwy AR, Lushniak L, Huang G, McLoughlin GM, Hooley C, Nadesan-Reddy N, Sandler B, Moshabela M, Alonge O, Geng E, Proctor E. A Perspective on Implementation Outcomes and Strategies to Promote the Uptake of COVID-19 Vaccines. FRONTIERS IN HEALTH SERVICES 2022; 2:897227. [PMID: 36925818 PMCID: PMC10012688 DOI: 10.3389/frhs.2022.897227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022]
Abstract
Recent articles have highlighted the importance of incorporating implementation science concepts into pandemic-related research. However, limited research has been documented to date regarding implementation outcomes that may be unique to COVID-19 vaccinations and how to utilize implementation strategies to address vaccine program-related implementation challenges. To address these gaps, we formed a global COVID-19 implementation workgroup of implementation scientists who met weekly for over a year to review the available literature and learn about ongoing research during the pandemic. We developed a hierarchy to prioritize the applicability of "lessons learned" from the vaccination-related implementation literature. We identified applications of existing implementation outcomes as well as identified additional implementation outcomes. We also mapped implementation strategies to those outcomes. Our efforts provide rationale for the utility of using implementation outcomes in pandemic-related research. Furthermore, we identified three additional implementation outcomes: availability, health equity, and scale-up. Results include a list of COVID-19 relevant implementation strategies mapped to the implementation outcomes.
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Affiliation(s)
- Meagan Pilar
- Department of Infectious Diseases, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - A. Rani Elwy
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School, Brown University, Providence, RI, United States
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, United States
| | - Larissa Lushniak
- Department of Infectious Diseases, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Grace Huang
- Department of Infectious Diseases, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Gabriella M. McLoughlin
- College of Public Health, Temple University, Philadelphia, PA, United States
- Implementation Science Center for Cancer Control and Prevention Research Center, Brown School, Washington University in St. Louis, St. Louis, MO, United States
| | - Cole Hooley
- School of Social Work, Brigham Young University, Provo, UT, United States
| | - Nisha Nadesan-Reddy
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Brittney Sandler
- Bernard Becker Medical Library, Washington University in St. Louis School of Medicine, St. Louis, MO, United States
| | - Mosa Moshabela
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Olakunle Alonge
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Elvin Geng
- Department of Infectious Diseases, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO, United States
| | - Enola Proctor
- Shanti K. Khinduka Distinguished Professor Emerita, Brown School, Washington University in St. Louis, St. Louis, MO, United States
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Vaivada T, Lassi ZS, Irfan O, Salam RA, Das JK, Oh C, Carducci B, Jain RP, Als D, Sharma N, Keats EC, Patton GC, Kruk ME, Black RE, Bhutta ZA. What can work and how? An overview of evidence-based interventions and delivery strategies to support health and human development from before conception to 20 years. Lancet 2022; 399:1810-1829. [PMID: 35489360 DOI: 10.1016/s0140-6736(21)02725-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 09/14/2021] [Accepted: 11/23/2021] [Indexed: 12/14/2022]
Abstract
Progress has been made globally in improving the coverage of key maternal, newborn, and early childhood interventions in low-income and middle-income countries, which has contributed to a decrease in child mortality and morbidity. However, inequities remain, and many children and adolescents are still not covered by life-saving and nurturing care interventions, despite their relatively low costs and high cost-effectiveness. This Series paper builds on a large body of work from the past two decades on evidence-based interventions and packages of care for survival, strategies for delivery, and platforms to reach the most vulnerable. We review the current evidence base on the effectiveness of a variety of essential and emerging interventions that can be delivered from before conception until age 20 years to help children and adolescents not only survive into adulthood, but also to grow and develop optimally, support their wellbeing, and help them reach their full developmental potential. Although scaling up evidence-based interventions in children younger than 5 years might have the greatest effect on reducing child mortality rates, we highlight interventions and evidence gaps for school-age children (5-9 years) and the transition from childhood to adolescence (10-19 years), including interventions to support mental health and positive development, and address unintentional injuries, neglected tropical diseases, and non-communicable diseases.
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Affiliation(s)
- Tyler Vaivada
- Center for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Zohra S Lassi
- Robinson Research Institute and Adelaide Medical School, the University of Adelaide, SA, Australia; Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Omar Irfan
- Center for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Rehana A Salam
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Jai K Das
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Christina Oh
- Center for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Bianca Carducci
- Center for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada; Department of Nutritional Sciences, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Reena P Jain
- Center for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Daina Als
- Center for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Naeha Sharma
- Center for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - Emily C Keats
- Center for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada
| | - George C Patton
- Centre for Adolescent Health, Murdoch Children's Research Institute, Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Robert E Black
- Institute for International Programs, Johns Hopkins Bloomberg School of Public Health, Baltimore, Johns Hopkins University, MD, USA
| | - Zulfiqar A Bhutta
- Center for Global Child Health, The Hospital for Sick Children, Toronto, ON, Canada; Centre of Excellence in Women and Child Health and Institute for Global Health and Development, The Aga Khan University, Karachi, Pakistan.
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Junck LD, George G. Giving condoms to school children: educators' views on making condoms available in South African schools. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2022; 21:58-64. [PMID: 35361058 DOI: 10.2989/16085906.2022.2040550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/01/2022] [Accepted: 02/01/2022] [Indexed: 06/14/2023]
Abstract
One of the policy goals of the South African Department of Basic Education's National Policy on HIV, STIs and TB of 2017 is to reduce the incidence of HIV and pregnancy among learners. This is expected to be achieved by improving access to prevention services, including the provision of condoms in schools. This study uses street- level bureaucracy theory to explain how educators can play a more productive role in ensuring that policy goals are achieved. Educators provide their views on their role as condom promotion agents, their perception of demand and utilisation among learners, as well as their insights on suitable distribution mechanisms in the school setting. Trepidation exists among educators about their roles in the promotion and education of condoms. Educator statements suggest that they see the value in their policy-ascribed role to deliver sexual health messages and are also open to performing a role in the distribution of condoms at schools. However, our findings reveal that their role as policy communicators or "street-level bureaucrats" is complicated by inadequate policy guidance. We therefore conclude that to achieve optimal outcomes in terms of safer sexual practices among learners, condom messaging and distribution mechanisms in school settings require evidence-informed implementation strategies.
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Affiliation(s)
- Leah D Junck
- Institute for Humanities in Africa (HUMA), University of Cape Town, Cape Town, South Africa
| | - Gavin George
- Health Economics & HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
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George G, Maughan-Brown B, Thirumurthy H. Behavioural science to improve effectiveness of HIV programmes, South Africa. Bull World Health Organ 2021; 99:840-842. [PMID: 34737478 PMCID: PMC8542262 DOI: 10.2471/blt.21.285626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 11/27/2022] Open
Affiliation(s)
- Gavin George
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Westville Campus, Durban 4041, South Africa
| | - Brendan Maughan-Brown
- Southern Africa Labour and Development Research Unit (SALDRU), University of Cape Town, Cape Town, South Africa
| | - Harsha Thirumurthy
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, United States of America
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Dombola GM, Manda WC, Chipeta E. Factors influencing contraceptive decision making and use among young adolescents in urban Lilongwe, Malawi: a qualitative study. Reprod Health 2021; 18:209. [PMID: 34663362 PMCID: PMC8524908 DOI: 10.1186/s12978-021-01259-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/06/2021] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND The prevalence of teenage pregnancies in Malawi is 29%. About 25% of those are married while 30% are unmarried adolescents (15-19 years old) who use contraceptives. Data on contraceptive use has focused on older adolescents (15-19 years old) leaving out the young adolescents (10-14 years old). This study assessed factors that influence contraceptive decision-making and use among young adolescents aged 10-14 years. METHODS This was a qualitative study that used the Theory of Reasoned Action (TRA) model to understand the processes that influence contraceptive decision-making among young adolescents (10-14 years old) in urban Lilongwe. The study was conducted in six youth health-friendly service centers and 12 youth clubs. Two focus group discussions and 26 in-depth interviews were conducted among sexually active in and out of school young adolescents and key informants. The results are organized into themes identified during the analysis. RESULTS Results showed that contraceptive decision-making is influenced by social factors (individual, interpersonal, society) and adolescents' perceptions regarding hormonal contraceptives. There is also a disconnect between Education and Adolescent Sexual and Reproductive Health policies. CONCLUSION The findings suggest that interventions that scale up contraceptive use need male and female involvement in decision making. Addressing myths around contraceptives, and harmonization of Education and Sexual and Reproductive Health policies in the country would motivate adolescents to use contraceptives.
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Affiliation(s)
- Gift Mtawali Dombola
- Department of Health Systems and Policy, College of Medicine, Private Bag 360, Blantyre, Malawi
| | | | - Effie Chipeta
- The Centre for Reproductive Health, College of Medicine, Private Bag 360, Blantyre, Malawi
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Adekola AP, Mavhandu-Mudzusi AH. Addressing Learner-Centred Barriers to Sexuality Education in Rural Areas of South Africa: Learners' Perspectives on Promoting Sexual Health Outcomes. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2021; 20:1-17. [PMID: 34608403 PMCID: PMC8480970 DOI: 10.1007/s13178-021-00651-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/23/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION The school-based sexuality education programmes in South Africa aim to improve the sexual and reproductive health of school-going adolescents. However, the high rate of unplanned pregnancy and sexually transmitted infections among learners in some schools in rural areas of King Cetshwayo district suggests that the programmes in these schools might not be effective due to certain learner-centred factors. METHOD This qualitative study explored lived experiences of 84 learners from nine public schools in 2020 through focus group interviews. Data was analysed using Interpretative Phenomenological Analysis. RESULTS Learner-centred barriers to effective school-based sexuality education identified in this study were attitudes, age disparity, psychological status, peer pressure, socio-economic status, the exploratory attitude of learners, media, lack of role models, previous experiences, socio-economic status, and lack of parental love. These factors could reduce good sexual health. Learner-targeted interventions such as campaigns, using guest professionals, condom distribution, videos, on-site family planning, formal demonstrations, and on-site counselling could address these barriers. CONCLUSIONS Addressing these barriers and implementing the proposed interventions will enhance school-based sexuality education and consequently improve adolescents' sexual health. POLICY IMPLICATIONS The findings could guide programming, implementation, and delivery of school-based sexuality education leading to improved adolescents' sexual and reproductive health.
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Affiliation(s)
- Ayobami Precious Adekola
- Department of Health Studies, College of Human Sciences, University of South Africa, Pretoria, South Africa
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The Effectiveness of Free Face Mask Distribution on Use of Face Masks. A Cluster Randomised Trial in Stovner District of Oslo, Norway. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18178971. [PMID: 34501561 PMCID: PMC8430712 DOI: 10.3390/ijerph18178971] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/20/2021] [Accepted: 08/24/2021] [Indexed: 12/29/2022]
Abstract
Face masks are recommended as a means of reducing the spread of COVID-19, but there are practically no studies of interventions to increase face mask use. Over three weeks, nine grocery stores in the Stovner District of Oslo were randomly selected each day to have distribution of free face masks outside their entrance. Free face mask distribution increased the proportion of customers wearing a mask by 6.0 percentage points (adjusted, 95% CI 3.5–8.5). Mean mask usage was 91.7% in the control group and 97.1% in the treatment group (pooled SD 5.3%). Practically all those who wore masks had both nose and mouth covered. We conclude that free distribution of face masks increased their use. Similar trials can be conducted within a short period of time.
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Maina BW, Juma K, Igonya EK, Osindo J, Wao H, Kabiru CW. Effectiveness of school-based interventions in delaying sexual debut among adolescents in sub-Saharan Africa: a protocol for a systematic review and meta-analysis. BMJ Open 2021; 11:e044398. [PMID: 34020975 PMCID: PMC8144038 DOI: 10.1136/bmjopen-2020-044398] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 03/12/2021] [Accepted: 04/23/2021] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Early sexual debut is associated with poor sexual and reproductive health outcomes across the life course. A majority of interventions aimed at delaying sexual debut among adolescents in sub-Saharan Africa (SSA) have been implemented in schools with mixed findings on the effectiveness of such interventions. This systematic review will summarise and synthesise existing evidence on the effectiveness of school-based interventions in delaying sexual debut among adolescents aged 10-19 years. METHODS AND ANALYSIS We will conduct a comprehensive database search of peer-reviewed studies published in PubMed, Scopus, Science Direct, Web of Science, HINARI and EBSCO (PsycINFO, Global Health, CINAHL) and in Cochrane library, National Institute of Health and Turning Research into Practice databases for ongoing studies yet to be published. All studies conducted in SSA between January 2009 and December 2020, regardless of the study design, will be included. Two authors will independently screen all retrieved records and relevant data on sexual debut extracted.Data will be pooled using the random effects model. Dichotomous outcomes will be reported as risk ratios and continuous data as mean difference at 95% CI. Heterogeneity will be assessed using the I² statistic. Findings will be presented in tables and charts, while providing a description of all included studies, themes and concepts drawn from literature. ETHICS AND DISSEMINATION Ethical approval is not required. The findings will be disseminated through peer-reviewed publications, presentations at relevant conferences and other convening focusing on adolescent sexual and reproductive health.
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Affiliation(s)
- Beatrice W Maina
- Population Dynamics and Reproductive Health, African Population and Health Research Center, Nairobi, Kenya
- School of Public Health, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - Kenneth Juma
- Population Dynamics and Reproductive Health, African Population and Health Research Center, Nairobi, Kenya
| | - Emmy Kageha Igonya
- Population Dynamics and Reproductive Health, African Population and Health Research Center, Nairobi, Kenya
| | - Jane Osindo
- Research Capacity Strengthening, African Population and Health Research Center, Nairobi, Kenya
| | - Hesborn Wao
- Research Capacity Strengthening, African Population and Health Research Center, Nairobi, Kenya
| | - Caroline W Kabiru
- Research Capacity Strengthening, African Population and Health Research Center, Nairobi, Kenya
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Duby Z, Jonas K, McClinton Appollis T, Maruping K, Dietrich J, Mathews C. "Condoms Are Boring": Navigating Relationship Dynamics, Gendered Power, and Motivations for Condomless Sex Amongst Adolescents and Young People in South Africa. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2021; 33:40-57. [PMID: 38596471 PMCID: PMC10807805 DOI: 10.1080/19317611.2020.1851334] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 11/03/2020] [Accepted: 11/06/2020] [Indexed: 04/11/2024]
Abstract
Condoms remain an important method for preventing HIV prevention and unintentional pregnancies, however their use in South Africa is sub-optimal. We analyzed survey data on reported condom use among 3009 sexually active adolescent girls and young women (AGYW) aged 15-24 years, and qualitative data from interviews and focus group discussions with 237 AGYW and 38 male peers. Our findings describe the current condom use landscape among adolescents and young people in South Africa, illustrating relationship dynamics, gendered power and notions of masculinity which influence condom negotiation and use in young heterosexual South Africans' sexual encounters.
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Affiliation(s)
- Zoe Duby
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Division of Social and Behavioural Sciences in the School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Kim Jonas
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Division of Child and Adolescent Psychiatry, Adolescent Health Research Unit (AHRU), University of Cape Town, Cape Town, South Africa
| | - Tracy McClinton Appollis
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Division of Child and Adolescent Psychiatry, Adolescent Health Research Unit (AHRU), University of Cape Town, Cape Town, South Africa
| | - Kealeboga Maruping
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Janan Dietrich
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Catherine Mathews
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- Division of Child and Adolescent Psychiatry, Adolescent Health Research Unit (AHRU), University of Cape Town, Cape Town, South Africa
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Ramos-Ortiz J, Strube OL, Kinman N, Meier S, DeMaria AL. Condom-vending machines in Italy: a qualitative exploration of gender differences to improve promotion and use. EUR J CONTRACEP REPR 2020; 25:456-464. [PMID: 32886016 DOI: 10.1080/13625187.2020.1810226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The purposes of this study were to explore gender differences in condom purchasing from condom-vending machines (CVMs) and identify ways to improve CVM promotion. METHODS Semi-structured interviews with 42 men and women aged 18-50 years (mean ± standard deviation, 29.1 ± 7.9) and living in or near Florence, Italy, were conducted between May and June 2019. Techniques from expanded grounded theory-guided data analysis allowed for a constant comparative approach to contextualise data and identify emergent themes. RESULTS Three themes emerged: (1) attitudes and barriers towards CVMs; (2) gender-specific purchasing influences and behaviours; and (3) CVM improvement and promotion. Women and men described varied concerns surrounding CVM purchasing, illuminating reasons for hesitancy. Focussing on CVM quality and improving product offerings were suggested by participants to increase use. CONCLUSION Findings offer practical recommendations to guide CVM messaging to increase access to and use of condoms and other personal care items. Men were cited as primary CVM users, expressing practical concerns surrounding CVMs, while, for women, CVM visibility was as much an advantage as a drawback. Reflecting consumer needs via diversified product offerings should be considered a priority for increased CVM use. Working to promote CVMs requires clear messaging that attends to gender norm limitations, details product safety and establishes CVMs as a reliable condom purchase outlet.
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Affiliation(s)
- Jaziel Ramos-Ortiz
- Division of Consumer Science, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
| | - Olivia L Strube
- School of Health Sciences, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
| | - Nicole Kinman
- School of Health Sciences, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
| | - Stephanie Meier
- Division of Consumer Science, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
| | - Andrea L DeMaria
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
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Abstract
Rates of sexual activity, pregnancies, and births among adolescents have continued to decline during the past decade to historic lows. Despite these positive trends, many adolescents remain at risk for unintended pregnancy and sexually transmitted infections (STIs). This technical report discusses the new data and trends in adolescent sexual behavior and barrier protection use. Since 2017, STI rates have increased and use of barrier methods, specifically external condom use, has declined among adolescents and young adults. Interventions that increase availability of or accessibility to barrier methods are most efficacious when combined with additional individual, small-group, or community-level activities that include messages about safer sex. Continued research informs public health interventions for adolescents that increase the consistent and correct use of barrier methods and promote dual protection of barrier methods for STI prevention together with other effective methods of contraception.
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Affiliation(s)
- Laura K Grubb
- Departments of Pediatrics and Public Health and Community Medicine, Floating Hospital for Children at Tufts Medical Center, Boston, Massachusetts
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Andrzejewski J, Pampati S, Johns MM, Sheremenko G, Lesesne C, Rasberry CN. Sexual Behaviors, Referral to Sexual Health Services, and Use of Sexual Health Services Among Transgender High School Students. THE JOURNAL OF SCHOOL HEALTH 2020; 90:349-357. [PMID: 32128830 PMCID: PMC8006206 DOI: 10.1111/josh.12880] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 03/13/2019] [Accepted: 06/23/2019] [Indexed: 05/06/2023]
Abstract
BACKGROUND Transgender adolescents are at increased risk for negative sexual health outcomes compared to their cisgender peers. METHODS Using data from 10,231 students from 7 high schools in a large, urban school district, our analysis compared sexual behaviors, referral to sexual health services by school staff, and use of sexual health services between transgender and cisgender students. We used propensity score matching to create a comparable sample of transgender and cisgender students and logistic regression models to examine how gender identity was associated with aforementioned outcomes. RESULTS Transgender students were more likely to have ever had sex, less likely to have used a condom at last sex, and more likely to have been referred for human immunodeficiency virus (HIV) testing, sexually transmitted disease (STD) testing, and other sexual health services than cisgender students. Transgender students were no more likely than cisgender students to have tested for HIV or STDs. CONCLUSIONS These findings underscore the need for understanding the risk perceptions held by transgender students and for prevention efforts that are inclusive for all gender identities. Research is needed to understand if school-based sexual health interventions such as staff referrals for sexual health services are effective for transgender students.
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Affiliation(s)
- Jack Andrzejewski
- ORISE Fellow, Oak Ridge Associated Universities, 1600 Clifton Road MS E-75, Atlanta, GA30329
| | - Sanjana Pampati
- ORISE Fellow, Oak Ridge Associated Universities, 1600 Clifton Road MS E-75, Atlanta, GA 30329
| | - Michelle M. Johns
- Health Scientist, US Centers for Disease Control and Prevention, Division of Adolescent and School Health, 1600 Clifton Road, MS E-75, Atlanta, GA 30329
| | - Ganna Sheremenko
- Lead Research Scientist, ICF, 2635 Century Center Parkway, Suite 1000, Atlanta GA 30345
| | - Catherine Lesesne
- Vice President, Research Science, ICF, 2635 Century Center Parkway, Suite 1000, Atlanta GA 30345
| | - Catherine N. Rasberry
- Health Scientist, US Centers for Disease Control and Prevention, Division of Adolescent and School Health, 1600 Clifton Road, MS E-75, Atlanta, GA 30329
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Logie CH, Lys CL, Mackay K, MacNeill N, Pauchulo A, Yasseen AS. Syndemic Factors Associated with Safer Sex Efficacy Among Northern and Indigenous Adolescents in Arctic Canada. Int J Behav Med 2019; 26:449-453. [PMID: 31218560 DOI: 10.1007/s12529-019-09797-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Syndemic approaches explore the synergistic relationships between social and health inequities. Such approaches are particularly salient for the Northwest Territories, Canada, that experiences national social (food insecurity, intimate partner violence [IPV]) and health (sexually transmitted infections [STI]) disparities. Safer sex efficacy (SSE) includes knowledge, intention, and relationship dynamics that facilitate safer sex negotiation. We examined factors associated with SSE among NWT adolescents. METHODS We conducted a cross-sectional survey with a venue-based sample of adolescents aged 13-17 in 17 NWT communities from 2016 to 2017. Summary statistics and statistical comparisons were conducted, followed by crude and adjusted multivariable regression models to assess factors associated with SSE. RESULTS Among participants (n = 610; mean age 14.2 years [SD 1.5]; 49.5% cisgender women, 48.9% cisgender men, 1.6% transgender persons; 73.3% Indigenous), one-quarter (n = 144; 23.6%) reported food insecurity and nearly one-fifth (n = 111; 18.2%) IPV. In adjusted analyses, among young women, food insecurity (β - 1.89[CI - 2.98, - 0.80], p = 0.001) and IPV (β - 1.31[CI - 2.53, - 0.09], p = 0.036) were associated with lower SSE, and currently dating was associated with increased SSE (β 1.17[CI 0.15, 2.19], p = 0.024). Among young men, food insecurity (β - 2.27[CI - 3.39, - 1.15], p = 0.014) was associated with reduced SSE. Among sexually active participants (n = 115), increased SSE was associated with consistent condom use among young women (β 1.40[0.19, 2.61], p = 0.024) and men (β 2.14[0.14, 4.14], p = 0.036). CONCLUSIONS Food insecurity and IPV were associated with lower SSE-a protective factor associated with consistent condom use-underscoring the need to address poverty and violence to advance adolescent sexual health in the NWT.
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Affiliation(s)
- Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, Ontario, M5S 1V4, Canada.
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada.
| | - Candice L Lys
- Fostering Open eXpression among Youth (FOXY), Yellowknife, Northwest Territories, Canada
- Aurora Research Institute, Inuvik, Northwest Territories, Canada
| | - Kayley Mackay
- Fostering Open eXpression among Youth (FOXY), Yellowknife, Northwest Territories, Canada
| | - Nancy MacNeill
- Fostering Open eXpression among Youth (FOXY), Yellowknife, Northwest Territories, Canada
| | - Analaura Pauchulo
- Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, Ontario, M5S 1V4, Canada
| | - Abdool S Yasseen
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Andrzejewski J, Liddon N, Leonard S. Condom Availability Programs in Schools: A Review of the Literature. Am J Health Promot 2019; 33:457-467. [PMID: 30068218 PMCID: PMC6540114 DOI: 10.1177/0890117118791118] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This review synthesizes findings from the peer-reviewed evaluation literature on condom availability programs (CAPs) in secondary schools. DATA SOURCE Peer-reviewed evaluation literature indexed in MEDLINE, EMBASE, PsychINFO, ERIC, CINAHL, Sociological Abstracts, SCOPUS, and POPLINE. STUDY INCLUSION AND EXCLUSION CRITERIA Manuscripts had to be, written in English, and report evaluation data from a US school-based CAP. DATA EXTRACTION Articles were coded independently by 2 authors. Discrepancies were resolved through open discussion. DATA SYNTHESIS We grouped findings into outcome evaluation and process evaluation findings. Outcome evaluation findings included sexually transmitted infections (STIs), pregnancy rates, condom use, contraception use, sexual risk, and substance use. Process evaluation findings included awareness of CAPs, attitudes toward CAPs, attitudes toward condoms, and receipt of education and instruction. RESULTS Of the 138 citations reviewed, 12 articles published between 1995 and 2012 met the inclusion criteria, representing 8 programs. Evaluations indicate CAPs yield condom acquisition rates between 23% and 48%, have mixed results related to condom use, and are not associated with increases in sexual and other risk behaviors. One program found CAPs were associated with a decrease in a combined rate of chlamydia and gonorrhea. One program found no association between CAPs and unintended pregnancy. Students' attitudes toward CAPs were favorable and awareness was high. CONCLUSIONS Condom availability programs are accepted by students and can be an appropriate and relevant school-based intervention for teens. Condom availability programs can increase condom use, but more evaluations are needed on CAP impact on rates of HIV, STIs, and unintended pregnancy.
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Affiliation(s)
| | - Nicole Liddon
- 2 Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sandra Leonard
- 2 Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Smith S, Platt JM, Clifford D, Preston M, Satterwhite C, Kelly PJ, Ramaswamy M. A State-Level Examination of School Nurses' Perceptions of Condom Availability Accompanied by Sex Education. J Sch Nurs 2019; 36:386-393. [PMID: 30669935 DOI: 10.1177/1059840518824728] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
School nurses are often sources of health-care support for teens with sexually transmitted infections (STIs) and unintended pregnancies. However, providing prevention (e.g., condoms) and teaching technical skills (e.g., condom use) needed to reduce high-risk sexual behavior may require a change in perceptions and policies. This study used a cross-sectional study design to assess nurses' perceptions of condom availability accompanied by sex education programs among high school nurses (n = 87) in Kansas. Results showed that school nurses in this study supported condom availability, were comfortable providing condoms, and felt condom availability was within the scope of their job but were less likely to provide condoms because of external barriers. Common barriers include administration, parents, cost, community support, and policies. School nurses, by virtue of their access to the majority of Kansas' adolescents, have the potential to provide sex education and tools such as condoms, so young people can prevent STIs and unintended pregnancies.
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Affiliation(s)
- Sharla Smith
- Department of Preventive Medicine and Public Health, 8586University of Kansas, Wichita, KS, USA
| | - Joey M Platt
- Montefiore Medical Center, 2006Albert Einstein College of Medicine, Bronx, NY, USA
| | - Daniel Clifford
- Public Health Performance Division, Sedgwick County Division of Health, Wichita, KS, USA
| | - Michael Preston
- Department of Surgery, College of Medicine, 155638University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Catherine Satterwhite
- Department of Preventive Medicine and Public Health, 12251University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Megha Ramaswamy
- Department of Preventive Medicine and Public Health, 12251University of Kansas Medical Center, Kansas City, KS, USA
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Tibbits M, Ndashe TP, King K, Siahpush M. Promoting Condom Use Through a Youth-Focused Community-Wide Free Condom Distribution Initiative. Am J Public Health 2018; 108:1506-1508. [PMID: 30252514 DOI: 10.2105/ajph.2018.304679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We describe the implementation of a youth-focused condom distribution initiative in Omaha, Nebraska, developed by the Women's Fund of Omaha. During a 2.5-year period, initiative partners distributed nearly 1.4 million free condoms to community members via outreach events and 197 condom distribution boxes. The Women's Fund of Omaha also implemented seven media campaigns encouraging condom use. The number of condoms distributed per month increased from 9840 in September 2015 to 71 220 in February 2018. Condom distribution initiatives can play an important role in increasing condom access.
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Affiliation(s)
- Melissa Tibbits
- All of the authors are with the Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha
| | - Tambu Phiri Ndashe
- All of the authors are with the Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha
| | - Keyonna King
- All of the authors are with the Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha
| | - Mohammad Siahpush
- All of the authors are with the Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha
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