Gender differences in sexual risk behaviour among adolescents in Catalonia, Spain

A systematic review of the association between history of sexually transmitted infections and subsequent condom use in adolescents

Sexually transmitted infections (STIs) are common among adolescents. According to the Health Belief Model, cues to action influence preventive behaviors. Cues to action can include health experiences such as being diagnosed with an STI. The impact of a history of STIs on subsequent condom use among adolescents remains largely unexamined, despite high rates of recurrence and their health impacts. This project aimed to systematically review the literature on the association between curable STIs and subsequent condom use among adolescents. The systematic review, reported following PRISMA guidelines, was conducted using the Joanna Briggs Institute method. Eligible studies, in the form of cohort studies, case-control studies, or cross-sectional studies, targeted adolescents aged 10 to 24, with or without a history of curable STIs; the outcome was subsequent condom use. MEDLINE (Ovid), Embase (Elsevier), and Web of Science were searched from January 2012 to December 2022 with the assistance of an information specialist. Two reviewers independently selected articles and extracted data. Risk of bias analysis was performed using ROBINS-E. The review explores results, with tables, based on population characteristics, exposure, and outcome, and addresses the influence of gender, ethnicity, and age. Of 3088 articles identified, seven studies were retained. Almost all the studies focused on African-American, Nigerian, or Rwandan adolescents, and several included only girls. Among girls, a history of STI increased subsequent condom use in combination with other contraceptive methods (n = 4). Among boys and older adolescents of both genders, a history of STI was associated with a decrease in condom use (n = 3). No study distinguished between different STIs. While all the studies (n = 7) presented a high risk of bias, six did not present a threat to conclusion validity. All the studies indicated that a history of STI could influence subsequent protective behaviors, possibly by acting as a cue to action, as posited by the Health Belief Model. This information enhances our understanding of factors leading to the adoption of preventive health measures among adolescents and could apply to other infectious experiences.Registration The protocol is registered in PROSPERO (CRD42023397443).

Past Bullying Victimization Experiences and Current Sexual Risk Taking among Emerging Adults

A growing body of research suggests that a history of bullying victimization is a risk factor for sexual risk taking (e.g., unprotected sex, multiple sexual partners, using drugs or alcohol before or during sex). However, previous studies that have examined the association between bullying victimization and sexual risk taking used only single, or very few, items to measure sexual risk taking. Therefore, the aim of the current study was to use a more comprehensive, psychometrically validated self-report measure to better capture the construct of sexual risk taking as an outcome linked with a history of bullying victimization (N = 650; 336 women, 314 men; M_age = 20.07, SD = 1.70). Negative binomial regression analyses provided support for hypotheses. Emerging adults with a history of bullying victimization were more likely to engage in various sexual risk behaviors such as casual sex, risky sex acts, impulsive sexual behaviors, intent to have risky sexual behaviors, risky anal sex acts, and overall sexual risk taking compared to emerging adults without a history of bullying victimization. These results may have implications for informing interventions to help emerging adults better manage past bullying experiences.

The Associations of Mental Health Disturbances, Self-Esteem, and Partner Violence Victimization with Condom Use in Spanish Adolescents

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.

Gender Differences in Sexual Behaviors and Their Relevance to Mental Health among High School Students with Sexual Experience in South Korea

We explored gender differences in sexual behavior, and their relevance to mental health among high school students in South Korea. This study was based on data from the 14th Korea Youth Risk Behavior Web-Based Survey (2018). The subjects were 2460 high school students who reported sexual experiences. Student′s t-test, ANOVA, and Rao-Scott chi-squared test were performed to identify the significance of the differences. Boys had earlier sexual debuts (Rao-Scott χ² = 53.55, p < 0.001), a lower frequency of using contraceptives (Rao-Scott χ² = 26.57, p < 0.001), and lower rates of sex education in school (Rao-Scott χ² = 11.20, p = 0.004). With respect to mental health factors, there was a difference in suicidality according to sexual risk behaviors, with a stronger association found in boys. In girls, there was an association between pregnancy experiences and suicidal ideation (Rao-Scott χ² = 9.90, p = 0.003), plans (Rao-Scott χ² = 17.25, p < 0.001), and attempts (Rao-Scott χ² = 23.11, p < 0.001). Our findings suggest differences by gender and age group in the association between sexual behavior and mental health. It is necessary to devise a sex education strategy for adolescents considering gender and early versus late adolescent development period.

Internet Usage and Risky Sexual Behavior among High School Students in a Suburban Area of Indonesia

BACKGROUND: Internet has been of great benefit to human life, however, it has some disadvantages which exist particularly among young people. AIM: Therefore, this study aims to investigate the internet usage and risky sexual behavior among high school students in a suburban area in Indonesia. METHODS: This was a cross-sectional study carried out using stratified random sampling in a high school located in a suburban area in West Java, Indonesia. Furthermore, self-administered Modified Internet Sex Screening Test (ISST) questionnaire was applied to measure the risky sexual behavior among the students. RESULTS: The results showed that based on the overall risky sexual behavior from internet usage, 35 (12.9%), 211 (77.6%), and 26 (9.6%) subjects were at low, medium, and high risk, respectively. Furthermore, the male gender and browsing for sexual content video were discovered to be the significant risk factors associated with risky sexual behavior with an adjusted odds ratio (AOR) of 5.79 (95% CI: 1.15-29.14) and 3.11 (95% CI: 1.03-9.39), respectively. CONCLUSIONS: From the results obtained, it was concluded that the prevalence of risky sexual behavior based on internet usage is high among students. Furthermore, it was discovered that male students need more attention by being involved in healthy sexual education. In addition, the role of policy-maker in filtering the accessible content for students is required.

Patterns of sexting and sexual behaviors in youth: A Latent Class Analysis

INTRODUCTION

A sizable minority of youth are sexting; however there are likely large individual differences in sexting and sexual behaviors, yet to be captured. A Latent Class Analysis was used to identify subgroups of youth characterized by differential engagement in sexting and sexual behaviors.

METHODS

Participants were an ethnically diverse sample of 894 youth (55.8% female; Mage = 17.04, SD = 0.77) from a longitudinal survey study in southeast Texas. Latent classes were identified through participants' responses to the following indicator variables: sending, receiving, and requesting sexts, sexual activity, contraception use, ≥ three partners, and substance use prior to sexual activity. Gender, ethnicity, impulsivity, and living situation were analyzed as predictors, and depressive symptoms as an outcome, of class membership.

RESULTS

The analysis revealed four distinct classes: No sexting-Low sex (42.2%), Sexting-Low sex (4.5%), No sexting-Moderately risky sex (28.3%), and Sexting-Moderately risky sex (24.9%). Gender and ethnicity predicted class membership wherein females and ethnic minority youth were less likely to be in groups displaying higher rates of sexting. Impulsivity and living situation predicted class membership, such that youth reporting higher impulsivity and living in a situation other than with two biological parents were less likely to be in classes displaying low sexting and sexual behaviors. Group membership predicted depressive symptoms.

CONCLUSIONS

Results suggest that not all youth who are sexting are having sex, and not all youth who are having sex are sexting. Evidence of individual differences in youth sexual behaviors should inform educational initiatives aimed at teaching youth about sexual and online health.

Individual and contextual factors associated with sexual initiation among adolescents

Adolescent sexual practices have been widely investigated as experiences that pose potential risks for health. The present study, therefore, aimed to investigate individual and contextual factors associated with sexual initiation, sexual activity before the age of 15 years, and inconsistent condom use. A total of 253 adolescents aged 11 to 18 years, from public schools in the capital and metropolitan region of Rio Grande do Sul, were interviewed. They answered a questionnaire covering sociodemographic data and sexual behaviors and completed the Perception of Family Support Inventory. The data were analyzed through descriptive and inferential statistics and it was verified that both individual (higher level of education, school repetition, and use of licit and illicit substances) and contextual factors (perception of less affective-consistent support and greater autonomy from the family) were related to sexual initiation among adolescents. The associations found for the groups with sexual initiation before and after 15 years of age were similar, indicating that age did not increase the exposure to risks. Inconsistent condom use was related to the use of tobacco and other drugs. Taken together, the results indicated the co-occurrence of risk behaviors, such as sexual risks and substance abuse, as well as highlighting some family characteristics as protective factors.

Portuguese Version of the HIV-Related Attitudes Scale (HIV-AS) for Adolescents

Abstract. The HIV-related Attitudes Scale (HIV-AS) is a brief, valid, and reliable instrument, widely used in Spain. Because of the high risk of HIV in adolescents in Portugal and the scarcity of multidimensional measures to assess attitudes toward HIV-related aspects, reliable and valid instruments are essential for understanding sexual risk behaviors in this population. The aim of this study was to adapt and validate the Spanish version of the HIV-AS into Portuguese. Factor structure, internal consistency, temporal stability, and measurement equivalence with the Spanish version were examined. Analyses were conducted based on a sample of 1,618 adolescents aged 15–18 years (Portugal N = 624, and Spain N = 994). This study confirmed the four-factor structure of HIV-AS, including attitudes toward obstacles to safe sex, HIV testing, condom use, and people living with HIV/AIDS. Reliability was excellent (α = .82) and temporal stability was moderate ( r = .51). Results provided good initial support for the invariance at a strict level for Portuguese and Spanish samples. The Portuguese version of the HIV-AS is a valid and reliable tool for assessing relevant dimensions of attitudes toward HIV-related aspects in adolescents. Future research is needed to consolidate these findings and to generalize them to other populations and countries.

Sexual behavior across the transition to adulthood and sexually transmitted infections: Findings from the national survey of human papillomavirus prevalence (POP-Brazil)

The sexual behaviors of 15- to 24-year-olds increase the risk of this population to acquire sexually transmitted infections (STIs). The present study aimed to describe the sexual behavior in the transition to adulthood Brazilian population and its association with STI history.We analyzed cross-sectional data collected from 8562 sexually active women and men who participated in the National Survey of Human Papillomavirus Prevalence (POP-Brazil). This large-scale survey enrolled participants from 26 Brazilian capitals and the Federal District. Professionals from primary care facilities were trained to collect data utilizing a standardized questionnaire with questions on sociodemographic, sexual behavior, and drug use. We constructed a Poisson model with robust variance for both crude and adjusted analysis to investigate the associations between the variables. To adjust the distribution of the sample to the study population, we weighted the measures by the population size in each city and by gender.There were differences in several aspects from sexual behavior between genders. The majority of men reported an early sexual initiation, more sexual partners, and a different practice in sexual positions when compared with women. Women reported use of contraception more frequently than men (P < .001). The use of alcohol and drugs and the use of drugs before sexual intercourse impact in STIs equally between the genders. Exclusive for women, the presence of any STI was associated with the practice of vaginal sex and other types of intercourse (adjusted prevalence ratio [APR] 1.43, 95% CI 1.08-1.88). For men, the number of sexual partners in the last year (APR 1.02, 95% CI 1.01-1.04), not having vaginal sex (APR 3.25, 95% CI 1.78-5.92) and sexual experience with someone of the same sex (APR 4.05, 95% CI, 2.88-5.70) were associated with a higher presence of STIs.This is the first report regarding sexual behavior in a nationally representative population sample in Brazil. This study provides more valid estimates of sexual behavior and associated STIs, identifying important differences in sexual behavior and identifying predictors for referred STIs among females and males.

Is higher risk sex common among male or female youths?

There are several studies that showed the high prevalence of high-risk sexual behaviors among youths, but little is known how significant the proportion of higher risk sex is when the male and female youths are compared. A meta-analysis was done using 26 countries' Demographic and Health Survey data from and outside Africa to make comparisons of higher risk sex among the most vulnerable group of male and female youths. Random effects analytic model was applied and the pooled odds ratios were determined using Mantel-Haenszel statistical method. In this meta-analysis, 19,148 male and 65,094 female youths who reported to have sexual intercourse in a 12-month period were included. The overall OR demonstrated that higher risk sex was ten times more prevalent in male youths than in female youths. The practice of higher risk sex by male youths aged 15-19 years was more than 27-fold higher than that of their female counterparts. Similarly, male youths in urban areas, belonged to a family with middle to highest wealth index, and educated to secondary and above were more than ninefold, eightfold and sixfold at risk of practicing higher risk sex than their female counterparts, respectively. In conclusion, this meta-analysis demonstrated that the practice of risky sexual intercourse by male youths was incomparably higher than female youths. Future risky sex protective interventions should be tailored to secondary and above educated male youths in urban areas.

Trends in Inequalities in the Use of Condom by Urban Teenagers in Spain

Social and economic inequalities in condom use by adolescents have been reported previously. Also, condom use has declined during the last decade. The aim of the study was to describe trends in the use of condoms in our setting, and how these trends may differ between socioeconomic groups in boys, and separately in girls, aged 17-19 years attending school in Barcelona between 2004 and 2012. We analyzed data from three annual surveys on risk factors in secondary students, which included a representative sample of the city's population; individuals who had previously had sexual intercourse (n = 1570) were included in the study. We calculated adjusted prevalence ratios (aPR) and their confidence intervals (95% CI) using robust Poisson regression models. The prevalence of condom use among boys was 87.0% in 2004 and 76.2% in 2012, and 76.7 and 64.7% among girls, respectively. This decrease was greater in adolescents with a low socioeconomic level, both in boys (aPR = 0.80) and girls (aPR = 0.84). The observed increase of socioeconomic inequalities in condom use in adolescents highlights a possible deterioration in good sexual practices and policies during the studied period.

[Effects of a contraceptive counselling intervention in adolescents from deprived neighbourhoods with a high proportion of immigrants]

OBJECTIVE

To evaluate the effectiveness of a contraceptive counselling intervention among adolescents by sex and origin.

METHODS

A pre-post study with a 3-month follow-up was conducted in adolescents from three disadvantaged neighbourhoods. Participants received a counselling session at a community centre. Contraception use at last intercourse and knowledge, beliefs and self-efficacy before and after the intervention were compared with χ(2) and McNemar tests, stratified by sex and origin (autochthonous or immigrant).

RESULTS

A total of 138 (76%) participants completed the follow-up. Fifty-five percent of the participants were girls, 85% were aged 16-19 years and 71% were immigrants. Knowledge and several self-efficacies increased after the intervention. Condom use increased by 5.4% and the proportion not using any method declined by 7.7%.

CONCLUSIONS

Contraceptive counselling in the community setting increased the use of contraception and improved psychosocial determinants, especially in immigrant adolescents.

Influence of risk-taking health behaviours of adolescents on cervical cancer prevention: a Hungarian survey

An anonymous questionnaire survey was conducted among the Hungarian adolescents to establish their use of tobacco, alcohol and drugs in relation to sexual behaviours, knowledge of human papillomavirus (HPV) and cervical cancer, and beliefs and attitudes towards screening and vaccination. Results indicated that adolescent risk-taking health behaviours correlate with risky sexual behaviours. As risk-taking behaviours do not correlate with a better awareness of the risk associated with HPV infection, it is of crucial importance that HPV/cervical cancer preventing educational programmes shall be sensitive to this 'vulnerable' population and draw the attention of these adolescents to their increased risk of sexually transmitted diseases and undesired pregnancies. Well-designed behavioural change interventions may be effective when in addition to providing adolescents (both men and women) with clear information about the implications of an HPV infection, they also aim to improve safer sex behaviours: consistent condom usage, limiting the number of sex partners, as well as encouraging regular participation in gynaecological screenings and uptake of the HPV vaccine. As this study population demonstrated positive attitudes towards the primary and secondary prevention of cervical cancer, the free HPV vaccination for the 12-13-year-old girls in Autumn 2014 will hopefully increase the currently low uptake of the vaccine in Hungary.

Riesgo sexual en adolescentes según la edad de debut sexual

En España los jóvenes debutan sexualmente antes que en otros países; sin embargo, poco se sabe de la relación entre la edad de debut sexual y el comportamiento sexual en esta población. Se analizan las prácticas sexuales y el uso del preservativo según la edad de debut sexual en adolescentes españoles sexualmente experimentados (N = 351); la edad media fue 15.9 años (DT = .75, rango: 14-18). Se establecieron tres grupos a partir de la edad de debut sexual informada: debut sexual temprano (anterior a los 15 años), promedio (15 años) y tardío (posterior a los 15 años). El grupo con debut sexual temprano practicó en mayor medida masturbación mutua, coito vaginal y sexo oral, con un número de parejas sexuales superior al resto. El uso del preservativo en la primera relación sexual, el porcentaje de uso y el uso consistente del preservativo fue inferior en el grupo debut sexual temprano respecto a los otros dos. El debut sexual anterior a los 15 años se asoció con mayor riesgo de contraer infecciones sexuales por déficit en el uso del preservativo y mayor exposición sexual. Los hallazgos de este estudio sugieren que la edad de debut sexual tiene implicaciones en la salud sexual de los jóvenes.

Sexual behavior among high school students in Brazil: alcohol consumption and legal and illegal drug use associated with unprotected sex

OBJECTIVE

Alcohol and other drug use appears to reduce decision-making ability and increase the risk of unsafe sex, leading to possible unplanned pregnancies, sexually transmitted diseases/human immunodeficiency virus/HIV transmission, and multiple sexual partners. This study aimed to test the hypothesis that risky sexual behaviors among adolescents are associated with legal and illegal drug use.

METHODS

A national cross-sectional survey of 17,371 high-school students was conducted in 2010. Students were selected from 789 public and private schools in each of the 27 Brazilian state capitals by a multistage probabilistic sampling method and answered a self-report questionnaire. Weighted data were analyzed through basic contingency tables and logistic regressions testing for differences in condom use among adolescents who were sexually active during the past month.

RESULTS

Approximately one third of the high school students had engaged in sexual intercourse in the month prior to the survey, and nearly half of these respondents had not used a condom. While overall sexual intercourse was more prevalent among boys, unsafe sexual intercourse was more prevalent among girls. Furthermore, a lower socioeconomic status was directly associated with non-condom use, while binge drinking and illegal drug use were independently associated with unsafe sexual intercourse.

CONCLUSION

Adolescent alcohol and drug use were associated with unsafe sexual practices. School prevention programs must include drug use and sexuality topics simultaneously because both risk-taking behaviors occur simultaneously.

[Cigarette smoking prevalence and associated factors in secondary school children in Catalunya]

Objetivos

Analizar aquellos factores asociados al consumo de tabaco en adolescentes para plantear futuras intervenciones de promoción de la salud desarrolladas por las escuelas y centros de atención primaria.

Diseño

Estudio transversal, muestreo por conglomerados bietápico.

Emplazamiento

Se incluyeron 97 centros escolares de Cataluña, 2005-2006.

Participantes

Se obtuvieron 9.340 cuestionarios completos de estudiantes entre 14-16 años.

Mediciones principales

Encuesta autoadministrada que recogía variables sociodemográficas, académicas, estado de salud, familiares, relaciones sexuales, sustancias adictivas, estados de ánimo y variables de opinión sobre el consumo. Se analizó la asociación de estas variables con la variable dependiente fumador/no fumador y también fueron analizadas como factores que aumentaban la probabilidad de ser fumador mediante modelos multinivel.

Resultados

Se incluyeron 4.653 chicos y 4.687 chicas, con una edad media de 15,2 años. El 71,1% de los estudiantes eran no fumadores, el 75% de los chicos y el 67,3% de las chicas. Aumentaban la probabilidad de ser fumador (OR e IC 95%): ser chica 0,60 (0,53-0,68), cursar 4.^o ESO 1,27 (1,12-1,43), tener un rendimiento escolar bajo 3,38 (2,74-4,17), tener una autopercepción de salud regular/mala 2,81 (2,21-3,58), tener padres fumadores 1,68 (1,45-1,95), consumir alcohol 5,05 (4,35-5,86), tener 3 o más problemas de estado de ánimo 1,22 (1,05-1,41), vivir sin ningún progenitor 1,59 (1,07-2,38), estar de acuerdo en que exista publicidad sobre tabaco 1,64 (1,45-1,85), y opinar que el tabaco ayuda a relajarse 3,57 (3,23-4,17).

Conclusiones

Aunque la mayoría de los estudiantes eran no fumadores, el consumo de tabaco era más prevalente en las chicas. Factores sociodemográficos, socioculturales, del entorno y opinión se asociaban con el consumo de tabaco entre los jóvenes.

Knowledge of HIV/AIDS prevention and factors associated with condom use among adolescents in northeast Brazil

AIM

To assess the knowledge of HIV/AIDS prevention and factors associated with condom use among adolescent.

METHODS

A cross-sectional study was conducted among 410 outpatient adolescents. Association between knowledge on the transmission of HIV/AIDS and variables were analyzed using the chi-square test. Logistic regression model was used to estimate the factors associated to condom use.

RESULTS

The knowledge about HIV/AIDS transmission was high and lower percentages of knowledge were observed regarding the non-transmission of HIV/AIDS. Younger adolescents revealed less knowledge than older adolescents. After multiple logistic regression the following factors were associated with condom use: male gender (p = 0.029), same age between partners (p = 0.002) and having until 1 year elapsed since sexual initiation (p = 0.001).

CONCLUSION

The knowledge regarding HIV/AIDS prevention was satisfactory. However, this does not imply that adolescents put such knowledge to use.