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Rodrigues DL, Carvalho AC, Prada M, Garrido MV, Balzarini RN, de Visser RO, Lopes D. Condom Use Beliefs Differ According to Regulatory Focus: A Mixed-Methods Study in Portugal and Spain. JOURNAL OF SEX RESEARCH 2024; 61:709-726. [PMID: 36877803 DOI: 10.1080/00224499.2023.2181305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Reports worldwide have been showing increasing rates of sexually transmitted infections (STIs) and condomless sex in recent years. Research has identified several individual and situational variables that can determine the decision to use condoms or forgo their use. We argue that such a decision can also be shaped by motives related to pleasure and safety (i.e., regulatory focus in sexuality). Using open ended questions, we asked 742 Portuguese and Spanish adults to indicate situations and reasons that could inform the decision making process with casual partners and the functions/attributes related to condoms. Using thematic analyses, we coded the drivers of condomless sex and condom use into themes and subthemes, and computed their frequencies. Using quantitative measures, we also asked participants to indicate their condom use expectancies and perceived barriers. Comparing participants according to regulatory focus revealed some differences. Pleasure promotion participants were more likely to consider that condom use decision making is driven by unexpectedness, pleasure, and intimacy pursuit, attached more pleasure reduction functions to condoms, expected more negative outcomes in condom use, and endorsed more sensation and partner barriers in condom use. In contrast, disease prevention participants were more likely to consider that condom use decision making is driven by adequate sexual education, responsibility, and behavioral control, and attached more health protective functions to condoms. These differences can inform the development of tailored intervention and awareness campaigns aimed at helping people to use condoms more consistently with casual partners and to avoid behaviors that put them at risk of STI transmission.
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Affiliation(s)
- David L Rodrigues
- Iscte-Instituto Universitário de Lisboa, CIS-Iscte, Lisboa, Portugal
| | | | - Marília Prada
- Iscte-Instituto Universitário de Lisboa, CIS-Iscte, Lisboa, Portugal
| | | | - Rhonda N Balzarini
- Department of Psychology, Texas State University, San Marcos, TX, USA
- The Kinsey Institute, Indiana University, Bloomington, IN, USA
| | - Richard O de Visser
- Department of Primary Care & Public Health, Brighton and Sussex Medical School, Falmer, UK
| | - Diniz Lopes
- Iscte-Instituto Universitário de Lisboa, CIS-Iscte, Lisboa, Portugal
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Rodrigues DL, de Visser RO, Lopes D, Prada M, Garrido MV, Balzarini RN. Prevent2Protect Project: Regulatory Focus Differences in Sexual Health Knowledge and Practices. ARCHIVES OF SEXUAL BEHAVIOR 2023; 52:1701-1713. [PMID: 36702994 PMCID: PMC9879562 DOI: 10.1007/s10508-023-02536-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 09/05/2022] [Accepted: 01/07/2023] [Indexed: 06/18/2023]
Abstract
The way people perceive risks and make decisions about their health is regulated by two motivational systems-prevention of harm or promotion of pleasure. People more focused on prevention strive to avoid negative outcomes and enact more health-protective behaviors. In contrast, people more focused on promotion strive to attain positive outcomes and take more risks with their health. Building upon recent evidence extending this framework to sexual behaviors and health, we conducted a pre-registered online survey ( OSF ) with Portuguese and Spanish adults (N = 742; Mage = 31.42, SD = 9.16) to examine whether self-reported STI knowledge and sexual health practices differ based on predominant regulatory focus. This study was part of the Prevent2Protect project ( OSF ). Results showed that prevention-focused participants had heard about more STIs and retrieved more of their knowledge from scientific sources but had been tested for fewer STIs in the past. In contrast, promotion-focused participants indicated they had specific knowledge about more STIs, retrieved more of their knowledge from medical and peer sources, and had been tested for more STIs in the past. They also reported more frequent STI testing, using free testing facilities or asking their family practice doctor to get tested, more routine sexual health check-ups, and more use of other contraceptive methods, such as birth control pills. These results remained unchanged after controlling for demographic differences. Overall, our findings showed that different motives in sexuality shape sexual health knowledge and sexual health practices.
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Affiliation(s)
- David L Rodrigues
- Iscte-Instituto Universitário de Lisboa, CIS-Iscte, Av. das Forças Armadas, 1649-026, Lisbon, Portugal.
| | | | - Diniz Lopes
- Iscte-Instituto Universitário de Lisboa, CIS-Iscte, Av. das Forças Armadas, 1649-026, Lisbon, Portugal
| | - Marília Prada
- Iscte-Instituto Universitário de Lisboa, CIS-Iscte, Av. das Forças Armadas, 1649-026, Lisbon, Portugal
| | - Margarida V Garrido
- Iscte-Instituto Universitário de Lisboa, CIS-Iscte, Av. das Forças Armadas, 1649-026, Lisbon, Portugal
| | - Rhonda N Balzarini
- Department of Psychology, Texas State University, San Marcos, TX, USA
- The Kinsey Institute, Indiana University, Bloomington, IN, USA
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The Associations of Mental Health Disturbances, Self-Esteem, and Partner Violence Victimization with Condom Use in Spanish Adolescents. J Clin Med 2022; 11:jcm11092467. [PMID: 35566593 PMCID: PMC9104900 DOI: 10.3390/jcm11092467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/16/2022] Open
Abstract
Risky sexual behaviors, such as not using a condom for preventing sexually transmittable diseases and unwanted pregnancies, are associated with emotional and psychological problems in adolescence, including higher levels of depression, anxiety, stress, and low self-esteem. Adolescents with a history of violence victimization are also at increased risk of engaging in sexual risk behaviors. In this study, we examined the associations between mental health disturbances and partner violence victimization and the non-use of condoms among young people in Spain. We also examined self-esteem as a mediator of mental health problems and unprotected sexual relationships. A cross-sectional study was conducted on a sample of 831 adolescents randomly selected from 25 high schools in Spain. From the initial sample, 285 students (144 men and 141 women) from high schools in Alicante (Spain) who reported having experienced sexual activity with at least one partner were approached. The results showed that one in three adolescents between 14 and 19 years old did not use condoms during sexual intercourse. The factors associated with the non-use of condoms in the estimated models of Poisson robust variance were having a history of physical, psychological, or sexual violence; having been expelled from school because of behavioral problems; and having higher levels of depression, anxiety, and stress and lower levels of self-esteem. Self-esteem was independently associated with the non-use of condoms. Having lower levels of self-esteem increased the risk of not using a condom during participants’ last sexual intercourse. These findings suggest the importance of developing public health strategies for mental health promotion to increase condom use among adolescents.
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Vives N, Garcia de Olalla P, González V, Barrabeig I, Clotet L, Danés M, Borrell N, Casabona J. Recent trends in sexually transmitted infections among adolescents, Catalonia, Spain, 2012-2017. Int J STD AIDS 2020; 31:1047-1054. [PMID: 32753002 DOI: 10.1177/0956462420940911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Monitoring sexually transmitted infections (STIs) in adolescents is essential to inform STI prevention strategies at primary and secondary levels in this key population. We aim to describe recent trends in STIs among adolescents and to analyse their socio-demographic and behavioural characteristics in Catalonia, Spain between 2012 and 2017. Data on Chlamydia trachomatis (CT) infection, gonorrhoea and syphilis cases aged from 13 to 19 years reported to the Catalan Mandatory Notifiable System from 2012 to 2017 were analysed. Diagnosis rates were calculated and a descriptive analysis was performed. Between 2012 and 2017, CT infection, gonorrhoea and syphilis cases reported among adolescents aged 13-19 years accounted for more than one-eleventh of all reported cases in Catalonia. The rate of the three nationally-notifiable STIs increased dramatically among adolescents. CT infection rates rose from 13 to 144.1 per 100,000 adolescents between 2012 and 2017, an increase of 1007%; gonorrhoea cases increased by 246% (from 13.4 to 45.4/100,000) and syphilis cases increased by 247% (from 1.7 to 5.9/100,000). Gonorrhoea and syphilis cases affected mainly males while CT infection cases were mostly in females (84%). Adolescents are being increasingly affected by CT infection, gonorrhoea and syphilis. A broader array of intervention strategies aimed at adolescents should be reinforced through strong prevention campaigns, improved sexual health information, as well as encouragement of regular offers of STI screening by healthcare providers.
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Affiliation(s)
- N Vives
- Centre for Epidemiological Studies on STI/HIV/AIDS in Catalonia (CEEISCAT), Health Departament, Generalitat of Catalonia, Badalona, Spain.,Cancer Screening Unit, Catalan Institute of Oncology, Hospitalet de Llobregat, Spain.,CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain
| | - P Garcia de Olalla
- CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain.,Epidemiological Service of Public Health Agency of Barcelona, Barcelona, Spain
| | - V González
- Centre for Epidemiological Studies on STI/HIV/AIDS in Catalonia (CEEISCAT), Health Departament, Generalitat of Catalonia, Badalona, Spain.,CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain.,Institute for Health Science Research Germans Trias i Pujol (IGTP), Badalona, Spain.,Microbiology Service, Hospital Universitari Germans Trias i Pujol, Badalona, Spain
| | - I Barrabeig
- CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain.,Epidemiological Surveillance and Response to Public Health Emergencies Service in Barcelona South, Agency of Public Health of Catalonia, Generalitat of Catalonia, Hospitalet del Llobregat, Spain
| | - L Clotet
- Epidemiological Surveillance and Response to Public Health Emergencies Service in Vallès Occidental and Vallès Oriental, Agency of Public Health of Catalonia, Generalitat of Catalonia, Sant Cugat del Vallès, Spain
| | - M Danés
- Epidemiological Surveillance and Response to Public Health Emergencies Service in Girona, Agency of Public Health of Catalonia, Generalitat of Catalonia, Girona, Spain
| | - N Borrell
- Epidemiological Surveillance and Response to Public Health Emergencies Service in Tarragona Camp, Agency of Public Health of Catalonia, Generalitat of Catalonia, Tarragona, Spain
| | - J Casabona
- Centre for Epidemiological Studies on STI/HIV/AIDS in Catalonia (CEEISCAT), Health Departament, Generalitat of Catalonia, Badalona, Spain.,CIBER Epidemiologia y Salud Pública (CIBERESP), Madrid, Spain.,Institute for Health Science Research Germans Trias i Pujol (IGTP), Badalona, Spain.,Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
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León-Gómez BB, Gotsens M, Marí-Dell'Olmo M, Domínguez-Berjón MF, Luque-Fernandez MÁ, Martin U, Rodríguez-Sanz M, Pérez G. Bayesian smoothed small-areas analysis of urban inequalities in fertility across 1999-2013. FERTILITY RESEARCH AND PRACTICE 2020; 5:17. [PMID: 31890237 PMCID: PMC6925428 DOI: 10.1186/s40738-019-0066-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 11/08/2019] [Indexed: 11/23/2022]
Abstract
Background Since the 2008 economic crisis in Spain, overall fertility has continued to decrease, while urban inequalities have increased. There is a general lack of studies of fertility patterns in small-areas of Spanish cities. We explored the effects of the economic crisis on fertility during three time periods in urban settings in Spain. Methods We studied the distribution of fertility rates among women (15–49 years) from Spain and low-middle income countries (LIC) who were living in 13 Spanish cities. We mapped fertility and the MEDEA socioeconomic deprivation index in small-areas, and analyzed age-related trends in fertility rates. We performed an ecological regression analysis of fertility and the deprivation index in two pre-crisis periods (1999–2003 and 2004–2008) and one crisis period (2009–2013). Fertility rates were calculated and smoothed using the hierarchical Bayesian model (BYM). Results Higher fertility was generally associated with socioeconomic deprivation, with adjustment for the mothers’ age and nationality. While Spanish citizens tended to delay childbearing throughout the three study periods, fertility increased among Spanish adolescents from deprived urban areas during the economic crisis. There was a general decline in fertility among immigrants after the crisis, especially in southern cities. Overall, fertility appeared to be stable, with higher fertility in more deprived areas. Conclusion Increased unemployment and changes to government family policies may have contributed to delayed childbearing in Spain. For immigrants, more restrictive immigration policies may have played a crucial role in decreasing fertility rates. Reforming such policies will be key for better reproductive rights and improved fertility rates across all population cohorts in Spain.
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Affiliation(s)
- Brenda Biaani León-Gómez
- 1Sistemes d'Informació Sanitària, Agència de Salut Pública de Barcelona, Barcelona, Spain.,2Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Mercè Gotsens
- 1Sistemes d'Informació Sanitària, Agència de Salut Pública de Barcelona, Barcelona, Spain.,3Institut de Recerca Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,4Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Marc Marí-Dell'Olmo
- 5Qualitat i Intervenció Ambiental, Agència de Salut Pública de Barcelona, Barcelona, Spain
| | | | - Miguel Ángel Luque-Fernandez
- 7Faculty of Epidemiology and Population Health, Department of Non-Communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - Unai Martin
- 8Departamento de Sociología 2, Universidad del País Vasco UPV/EHU, Leoia, Bizkaia Spain
| | - Maica Rodríguez-Sanz
- 9Recerca, Docència i Comunicació, Agència de Salut Pública de Barcelona, Barcelona, Spain
| | - Gloria Pérez
- 1Sistemes d'Informació Sanitària, Agència de Salut Pública de Barcelona, Barcelona, Spain.,2Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain.,3Institut de Recerca Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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Ssebunya RN, Matovu JKB, Makumbi FE, Kisitu GP, Maganda A, Kekitiinwa A. Factors associated with prior engagement in high-risk sexual behaviours among adolescents (10-19 years) in a pastoralist post-conflict community, Karamoja sub-region, North eastern Uganda. BMC Public Health 2019; 19:1027. [PMID: 31366339 PMCID: PMC6670181 DOI: 10.1186/s12889-019-7352-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescent sexual risky behaviours continue to be significant drivers of the HIV epidemic globally. The objective of this study was to determine factors associated with prior engagement in high-risk sexual behaviours among adolescents (10-19 years) in Karamoja sub-region, a pastoralist and post-conflict community in North-eastern Uganda. METHODS Between August and September 2016, we conducted a cross-sectional study among 1439 adolescents receiving primary healthcare services at nine public health facilities located in five of the seven districts that make up Karamoja sub-region. High-risk sexual behaviour was defined as engaging in sex with two or more (2+) sexual partners in the 6 months preceding the survey or exchanging sex for money or gifts with no or inconsistent use of condoms over the same period of time. Factors associated with prior engagement in high-risk sexual behaviours were analysed using a modified Poison regression model with log-link and Poisson-family via a generalized linear model. RESULTS Eighty-two percent (81.8%, n = 1177) of the respondents had ever tested for HIV while 62 % (61.5%, n = 885) had ever had sex. Of those that had ever had sex, 11.4% (n = 101) reported prior engagement in high-risk sexual behaviours. Prior engagement in high-risk sexual behaviours was lower among men than women (adjusted prevalence ratio (adj. PR) = 0.46; 95% Confidence Interval (95% CI): 0.33, 0.62) and those whose sex debut was above 14 years (adj.PR = 0.63; 95% CI: 0.57, 0.69). However, prior engagement in high-risk sexual behaviours was significantly higher in adolescents who were not aware of their recent sexual partner's HIV status (adj.PR = 2.43; 95% CI: 1.68, 3.52) and those who used illicit drugs (adj.PR = 2.76; 95% CI: 1.88, 4.05). CONCLUSION Prior engagement in high-risk sexual behaviours was significantly associated with having sex with partners of unknown HIV sero-status and use of illicit drugs. These findings suggest a need for targeted interventions to improve mutual HIV status disclosure between sexual partners while minimizing their use of illicit drugs/substances.
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Affiliation(s)
- Rogers N Ssebunya
- Directorate of Research, Monitoring and Evaluation, Baylor College of Medicine Children's Foundation, P.O. Box 72052, Kampala, Uganda.
| | - Joseph K B Matovu
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.,Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Fredrick E Makumbi
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Grace P Kisitu
- Directorate of Research, Monitoring and Evaluation, Baylor College of Medicine Children's Foundation, P.O. Box 72052, Kampala, Uganda
| | - Albert Maganda
- Directorate of Research, Monitoring and Evaluation, Baylor College of Medicine Children's Foundation, P.O. Box 72052, Kampala, Uganda
| | - Adeodata Kekitiinwa
- Directorate of Research, Monitoring and Evaluation, Baylor College of Medicine Children's Foundation, P.O. Box 72052, Kampala, Uganda
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