Relationships among sexual knowledge, sexual attitudes, and safe sex behaviour among adolescents: A structural equation model

School-based relationship and sexuality education intervention engaging adolescent boys for the reductions of teenage pregnancy: the JACK cluster RCT

Background

The need to engage boys in gender-transformative relationships and sexuality education (RSE) to reduce adolescent pregnancy is endorsed by the World Health Organization and the United Nations Educational, Scientific and Cultural Organization.

Objectives

To evaluate the effects of If I Were Jack on the avoidance of unprotected sex and other sexual health outcomes.

Design

A cluster randomised trial, incorporating health economics and process evaluations.

Setting

Sixty-six schools across the four nations of the UK.

Participants

Students aged 13-14 years.

Intervention

A school-based, teacher-delivered, gender-transformative RSE intervention (If I Were Jack) versus standard RSE.

Main outcome measures

Self-reported avoidance of unprotected sex (sexual abstinence or reliable contraceptive use at last sex) after 12-14 months. Secondary outcomes included knowledge, attitudes, skills, intentions and sexual behaviours.

Results

The analysis population comprised 6556 students: 86.6% of students in the intervention group avoided unprotected sex, compared with 86.4% in the control group {adjusted odds ratio 0.85 [95% confidence interval (CI) 0.58 to 1.26], p = 0.42}. An exploratory post hoc analysis showed no difference for sexual abstinence [78.30% intervention group vs. 78.25% control group; adjusted odds ratio 0.85 (95% CI 0.58 to 1.24), p = 0.39], but more intervention group students than control group students used reliable contraception at last sex [39.62% vs. 26.36%; adjusted odds ratio 0.52 (95% CI 0.29 to 0.920), p = 0.025]. Students in schools allocated to receive the intervention had significantly higher scores on knowledge [adjusted mean difference 0.18 (95% CI 0.024 to 0.34), p = 0.02], gender-equitable attitudes and intentions to avoid unintended pregnancy [adjusted mean difference 0.61 (95% CI 0.16 to 1.07), p = 0.01] than students in schools allocated to receive the control. There were positive but non-significant differences in sexual self-efficacy and communication skills. The total mean incremental cost of the intervention compared with standard RSE was £2.83 (95% CI -£2.64 to £8.29) per student. Over a 20-year time horizon, the intervention is likely to be cost-effective owing to its impact on unprotected sex because it would result in 379 (95% CI 231 to 477) fewer unintended pregnancies, 680 (95% CI 189 to 1467) fewer sexually transmitted infections and a gain of 10 (95% CI 5 to 16) quality-adjusted life-years per 100,000 students for a cost saving of £9.89 (95% CI -£15.60 to -£3.83).

Limitations

The trial is underpowered to detect some effects because four schools withdrew and the intraclass correlation coefficient (0.12) was larger than that in sample size calculation (0.01).

Conclusions

We present, to our knowledge, the first evidence from a randomised trial that a school-based, male engagement gender-transformative RSE intervention, although not effective in increasing avoidance of unprotected sex (defined as sexual abstinence or use of reliable contraception at last sex) among all students, did increase the use of reliable contraception at last sex among students who were, or became, sexually active by 12-14 months after the intervention. The trial demonstrated that engaging all adolescents early through RSE is important so that, as they become sexually active, rates of unprotected sex are reduced, and that doing so is likely to be cost-effective.

Future work

Future studies should consider the longer-term effects of gender-transformative RSE as students become sexually active. Gender-transformative RSE could be adapted to address broader sexual health and other settings.

Trial registration

This trial is registered as ISRCTN10751359.

Funding

This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme (PHR 15/181/01) and will be published in full in Public Health Research; Vol. 11, No. 8. See the NIHR Journals Library website for further project information.

Factors affecting the safe sexual behaviors of Korean young adults by gender: a structural equation model

PURPOSE

The aim of this study was to determine the factors that influence safe sexual behaviors of Korean young adults and identify differences by gender.

METHODS

This study aimed to determine which factors affected safe sexual behaviors based on the Theory of Planned Behavior. Data from 437 Korean young adults (in their 20s and 30s) were collected via online survey between January 3 and January 28, 2022. The questionnaire included items on sexual body image, sexual role perception, sexual attitudes, sexual socialization, sexual communication, and safe sexual behaviors. Structural equation modeling was performed.

RESULTS

According to the overall model fit of the hypothetical model, the final model was acceptable and explained 49% of safe sexual behaviors. Sexual attitudes (β=-.70, p<.001) and sexual communication (β=.53, p<.001) directly affected safe sexual behaviors, and sexual role perception (β=.42, p<.001) indirectly affected safe sexual behaviors in a combined model. There were gender differences in the path from sexual attitudes (β=-.94, p<.001) and sexual communication (β=.66, p<.001) to safe sexual behaviors and from sexual body image (β=.27, p<.001) to sexual communication.

CONCLUSION

Sexual attitudes and sexual communication were predictors of safe sexual behaviors, which differed by gender. Strategies that consider sexual attitudes, sexual communication, sexual role perception, and differences between men and women should be developed to improve the safe sexual behaviors of young adults.

Examining HIV and STIs Related Knowledge Among Male Adolescents in Saudi Arabia

Background:

Sexually Transmitted Infection (STI) is a major global cause of acute illness, long-term disability and death, with serious medical and psychological consequences. Knowledge and awareness about the transmission of sexual disease play an important role in the prevention of the disease. Very little is known about HIV and STI in adolescents and associated factors in Saudi Arabia.

Objective:

The aim of this study was to examine the association between self-rated STI knowledge and HIV and STI knowledge test scores, as well as to investigate the association between adolescents’ HIV and STI knowledge and their demographic background and sexually related behaviors.

Methods:

A multi-stage cross-sectional study was conducted using a self-administered questionnaire, recruiting 453 male adolescents (15 and 20 years) from private and public male high schools in Riyadh, the capital city of Saudi Arabia.

Results:

More than half (53.4%) of the adolescents reported their STI knowledge as excellent or good (42%). However, based on the total score scale of HIV and STI knowledge, 64.3% had a poor level of knowledge. The sexual information sources commonly cited were friends (70%) and internet (40.0%); and the least cited sources were fathers (16%) and mothers (15%). The logistic regression analysis revealed that adolescents’ father and mother education (>12 years) were positively associated with adolescent’s HIV and STI knowledge level (OR= 1.6, 95% CI: 1.1-2.4, p= 0.040) and (OR= 1.8, 95% CI: 1.2-2.8, p= 0.010). No significant association was found between adolescents’ HIV and STI knowledge and their sexual behaviors and attitudes.

Conclusion:

Findings suggest that a high proportion of male adolescents have poor HIV and STI related knowledge. Poor knowledge and reliance on potentially unreliable informational sources coupled with an over-estimate perception of STI expertise suggests that improvements in STI and HIV education should be addressed. Additional research is needed to help identify factors (beyond knowledge) associated with sexual behavior and attitudes that may increase the risk for STIs and HIV among adolescents.

A cross-sectional survey of relationships between sexual knowledge, sexual attitudes, and reproductive health behaviour among female university students

BACKGROUND

Reproductive health includes responsible, satisfying, and safe sex as well as reproductive well-being. This study aimed to examine relationships between sexual knowledge, sexual attitudes, and reproductive health behaviour among female college students.

DESIGN

Cross-sectional survey.

METHODS

Female undergraduate students (N = 407) from 4 universities completed a series of self-report questionnaires consisted of sexual knowledge, sexual attitudes, and reproductive health behaviour.

RESULTS

Reproductive health behaviour was significantly influenced by sexual knowledge (β = .67) and sexual attitudes (β = .20). Structural equation modelling indicated that sexual knowledge directly and indirectly affected reproductive health behaviour with sexual attitudes acting as a mediator.

CONCLUSIONS

The findings indicate that it is necessary to consider sexual attitudes as well as sexual knowledge in promoting young women's reproductive health behaviour. The results may guide the development of sexual education programmes for young women. Impact Statement: Sexual attitude is an important factor influencing relationship between sexual knowledge and reproductive health behaviour among young female.

A Comparison of HIV Knowledge, Attitudes, and Sources of STI Information Between Female and Male College Students in Taiwan

Taiwan withdrew from the United Nations in 1971, which led to missed opportunities for participating in global HIV/AIDS programs and made Taiwan more vulnerable to HIV. Employing a questionnaire of 996 college students in Taiwan, the authors assessed and compared female and male HIV/AIDS-related knowledge, attitudes, and sources of HIV/sexually transmitted infections (STI) information. Students reported moderate knowledge and attitudes. Females had more positive attitudes toward people with HIV/AIDS than males. Most participants reported learning about HIV and STIs from traditional media, school teachers, and the Internet. We suggest evidence-based educational interventions for students should include targeted electronic and cultural awareness strategies.

Parents' perceptions of timing of initiation of sexuality discussion with adolescents in Anambra State, South Eastern Nigeria

STUDY OBJECTIVE

This study was aimed at determining the perception of the timing and practice of sexuality discussion among parents in South Eastern Nigeria.

DESIGN

A cross-sectional, descriptive, community-based study.

SETTING

The study was carried out in 3 randomly selected Local Government Areas in Anambra State, South Eastern Nigeria.

PARTICIPANTS

The study participants were parents with adolescent children resident in the study areas for at least 2 years.

RESULTS

Most parents opined that sexuality discussion should be initiated after puberty. Only 20% of them discussed reproductive health issues often with their adolescents, while another 20% never discussed such issues with their adolescent children. Topics most commonly discussed bordered on the adverse consequences of sex rather than measures for preventing them. About half of parents were willing to discuss contraception with their adolescent child. Predictors of parent-child communication were age, gender, and educational status.

CONCLUSION

Common reasons for low parental involvement in sexuality discussions were due to their lack of capacity and the perception that discussing such issues before puberty is ill timed. Therefore, measures should be taken to improve the capacity of parents to engage in such conversations to provide sexuality information to their teens.

Factors associated with attitude toward premarital sexual activities among school-going adolescents in Kelantan, Malaysia

The objective of this cross-sectional study was to determine the factors associated with the attitudes toward premarital sexual activities among school-going adolescents in Kelantan, Malaysia. It was conducted among 1032 secondary school students using a self-administered validated questionnaire. Multiple logistic regression revealed that the risk factors for having permissive attitudes toward practice of premarital sexual activities were male students (odds ratio [OR] = 1.83; 95% confidence interval [CI] = 1.34-2.48), being less religious (OR = 2.02; 95% CI = 1.49-2.73), and younger age group of students (13 to 14 years old; OR = 1.42; 95% CI = 1.05-1.92). Having good knowledge on sexual and reproductive health was a protective factor against permissive sexual attitude (OR = 0.27; 95% CI = 0.20-0.36). In conclusion, male and young adolescents were at risk of having permissive attitudes toward sexual behaviors, but good knowledge on sexual and reproductive health and being more religious may protect them from it.

Relationship between oral health-related knowledge, attitudes and behavior among 15-16-year-old adolescents: a structural equation modeling approach

OBJECTIVE

The aim of this study was to confirm the previously observed attitudinal factor structure related to behavioral change and the knowledge-attitude-behavior model on dental health and hygiene among adolescents.

MATERIALS AND METHODS

The study population consisted of all 8(th) and 9(th) graders (15-16 years) who started the 2004-2005 school year in Rauma, Finland (n = 827). Data on knowledge, attitudes, toothbrushing and using fluoride toothpaste were gathered by questionnaires. Hypothesized structure included four attitudinal factors related to dental health and hygiene: 'importance of toothbrushing when participating in social situations' (F1), 'importance of toothbrushing for health-related reasons and better appearance' (F2), 'being concerned about developing caries lesions' (F3) and 'importance of toothbrushing for feeling accepted' (F4). Structural equation modeling (SEM) was used to test the hypothesized model: pathways lead from knowledge to behavior both directly and via attitudes. The hypothesized model was also modified by removing non-significant pathways and studying the inter-relationships between attitudes.

RESULTS

A confirmatory factor analysis revealed that factor F4 had to be removed. In the final model, knowledge influenced behavior directly and via two attitude factors, F1 and F2, which were inter-related. 'Concern about developing caries lesions' was a background factor influencing only knowledge. The final factor structure and SEM model were acceptable-to-good fit. Knowledge had a smaller effect on behavior than on attitudes.

CONCLUSIONS

Our results support theories about the causal knowledge-attitudes-behavior chain, also for adolescents' oral health-related behaviors.

Sex education during the school-aged years influences sexual attitudes and sexual health in college: a comparative study from Korea

Sex education is provided routinely to school-aged children in many countries without enough evidence that it will benefit them when they become adults. The purpose of this study was to examine the long-term influence of the sex education that was provided during the school-aged years on the attitudes, behaviors, and sexual health among male and female college students in Korea. For this descriptive, comparative study, the data were obtained from 3609 male and 2180 female college students by using the proportional quota sampling method. Overall, the female students had more opportunities for sex education. Receiving this education during the school-aged years lowered the sexual double standard score but was not related to sexual activity among the male and female students. Receiving sex education at different time points during the school-aged years had differential influences on the sexual attitudes and indicators of sexual health between the male and the female students. The results of this study suggest extending the role of school nurses to include redesigning the content of sex education programs, based on the sex and age of the students, and using midwives to provide sex education in community settings.

Nursing's silence on lesbian, gay, bisexual, and transgender issues: the need for emancipatory efforts

The purpose of this study was to selectively review the nursing literature for publications related to lesbian, gay, bisexual, and transgender health, using (1) a key word search of CINAHL, the database of nursing and allied health publications; (2) from the top-10 nursing journals by 5-year impact factor from 2005 to 2009, counting articles about lesbian, gay, bisexual, and transgender issues; and (3) content analysis of the articles found in those journals. Only 0.16% of articles focused on lesbian, gay, bisexual, and transgender health (8 of nearly 5000 articles) and were biased toward authors outside of the United States. We discuss the impact of this silence.