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Rosen B, Dauria E, Shumway M, Smith JD, Koinis-Mitchell D, Tolou-Shams M. Association of pregnancy attitudes and intentions with sexual activity and psychiatric symptoms in justice-involved youth. CHILDREN AND YOUTH SERVICES REVIEW 2022; 138:106510. [PMID: 38107676 PMCID: PMC10723635 DOI: 10.1016/j.childyouth.2022.106510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Context With over one-third of detained girls experiencing teenage pregnancy, it is critical that the juvenile justice system better addresses the sexual and reproductive health (SRH) needs of youth. Although pregnancy attitudes and intentions (PAI) are associated with pregnancy outcomes among the general adolescent population, this relationship has not been examined among justice-involved youth. Methods Participants were drawn from a longitudinal study characterizing trajectories of behavioral and reproductive health and recidivism among newly justice-involved youth in a Northeast family court. Baseline and four-month follow-up data from 288 justice-involved youth (JIY) were analyzed to characterize PAI; examine associations between pregnancy intentions and unprotected sexual activity (i.e., no hormonal, intrauterine, or barrier protection against pregnancy); and explore the relationship between pregnancy intentions and psychiatric symptoms. Results At baseline, 39% of JIY youth were sexually active, 44% of these youth reported inconsistent condom use and 14% had not used birth control at last sexual intercourse. Nearly half of sexually active youth reported some intent around pregnancy and those with any pregnancy intentions were more likely to report depression, low self-esteem, substance use, and trauma history. Pregnancy intentions at baseline predicted higher rates of unprotected sexual activity at four months (OR: 16.9, CI = 2.48-115.7). Conclusions This study highlights the importance of developing and implementing more comprehensive SRH assessments and brief interventions for youth entering the justice system.
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Affiliation(s)
- Brooke Rosen
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, United States
- Department of Psychiatry and Behavioral Sciences, University of Washington, 1959 NE Pacific Street, Box 356560, Seattle, WA 98195, United States
| | - Emily Dauria
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, United States
- Department of Community and Behavioral Health Sciences, Graduate School of Public Health, University of Pittsburgh, United States
- Department of Psychiatry and Behavioral Sciences, Department of Psychiatry and Behavioral Sciences, 1001 Potrero Avenue, Building 5, Room 7M18, San Francisco, CA, 94110, United States
| | - Martha Shumway
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, United States
| | - Jaime Dumoit Smith
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, United States
- Department of Psychiatry and Behavioral Sciences, 1001 Potrero Avenue, Building 20, Suite 2100, San Francisco, CA 94110, United States
| | - Daphne Koinis-Mitchell
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Rhode Island Hospital Department of Psychiatry, 1 Hoppin St. Coro West, 2nd Floor, Providence, RI 02903, United States
- Department of Pediatrics, Warren Alpert Medical School of Brown University, Providence, RI, United States
| | - Marina Tolou-Shams
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, CA 94143, United States
- Department of Psychiatry and Behavioral Sciences, Department of Psychiatry and Behavioral Sciences, 1001 Potrero Avenue, Building 5, Room 7M18, San Francisco, CA, 94110, United States
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Offiong A, Powell TW, Gemmill A, Marcell AV. "I can try and plan, but still get pregnant": The complexity of pregnancy intentions and reproductive health decision-making for adolescents. J Adolesc 2021; 90:1-10. [PMID: 34058469 DOI: 10.1016/j.adolescence.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 05/08/2021] [Accepted: 05/12/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Teen pregnancy rates have declined in the United States; however, disparities continue to persist particularly among minority, low-income adolescents. A greater understanding of how pregnancy intentions are conceptualized for adolescents, and the role of the social context may illuminate reasons for disparities. The aim of this study was to expand the lens in which adolescents' perspectives of pregnancy are studied by exploring the contextual factors that frame how pregnancy intentions are developed among urban adolescents. METHODS Thirteen focus groups (N = 46) were conducted with male and female adolescents 15-19 years old in Baltimore, Maryland. Participants were recruited from local high schools, and focus groups were stratified by sex and age (15-17 and 18-19). A phenomenological approach was applied to analyze the data both deductively and inductively, allowing for themes to emerge and align within an existing conceptual framework. RESULTS Two themes identified were stated pregnancy intentions and shared schemas of sex and pregnancy. Participants discussed a range of pregnancy intentions and expressed five social perspectives which informed those intentions: sex is a gendered responsibility, teen pregnancy is cyclical and common, teen pregnancy is not a completely negative experience, having a child fulfills emotional and relational voids, and pregnancy should happen early, just not too early. CONCLUSION Pregnancy intentions for adolescents are expansive and driven by complex social perspectives set in their context. More consideration of the context is needed to provide and offer adolescents, particularly those of vulnerable communities, supports that align with their reproductive health needs.
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Affiliation(s)
- Asari Offiong
- Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, 21205, USA.
| | - Terrinieka W Powell
- Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Alison Gemmill
- Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, 21205, USA
| | - Arik V Marcell
- Bloomberg School of Public Health, Johns Hopkins University, 615 N. Wolfe Street, Baltimore, MD, 21205, USA; School of Medicine, Johns Hopkins University, 1800 Orleans Street, Baltimore, MD, 21287, USA
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Abstract
Teen pregnancy and parenting remain important public health issues in the United States and around the world. A significant proportion of teen parents reside with their families of origin, which may positively or negatively affect the family structure. Teen parents, defined as those 15 to 19 years of age, are at high risk for repeat births. Pediatricians can play an important role in the care of adolescent parents and their children. This clinical report updates a previous report on the care of adolescent parents and their children and addresses clinical management specific to this population, including updates on breastfeeding, prenatal management, and adjustments to parenthood. Challenges unique to teen parents and their children are reviewed, along with suggestions for the pediatrician on models for intervention and care.
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Affiliation(s)
- Makia E Powers
- Children's Healthcare of Atlanta and Morehouse School of Medicine, Atlanta, Georgia; and
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Mniszak C, O'Brien H, Greyson D, Chabot C, Shoveller J. “Nothing's available”: Young fathers’ experiences with unmet information needs and barriers to resolving them. Inf Process Manag 2020. [DOI: 10.1016/j.ipm.2019.102081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Selebalo-Bereng L, Patel CJ. Reasons for Abortion: Religion, Religiosity/Spirituality and Attitudes of Male Secondary School Youth in South Africa. JOURNAL OF RELIGION AND HEALTH 2019; 58:2298-2312. [PMID: 29344842 DOI: 10.1007/s10943-017-0547-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study focused on the relationship between religion, religiosity/spirituality (R/S), and attitudes of a sample of South African male secondary school youth toward women's rights to legal abortion in different situations. We distributed 400 self-administered questionnaires assessing the main variables (attitudes toward reasons for abortion and R/S) to the target sample in six different secondary schools in KwaZulu-Natal, South Africa. The responses of a final sample of 327 learners were then analyzed using the Statistical Package for the Social Sciences (SPSS) software. The findings revealed that religion and R/S play a role in the youths' attitudes toward abortion. While the Hindu subsample indicated higher overall support across the different scenarios, the Muslim subsample reported greater disapproval than the other groups on 'Elective reasons' and in instances of 'Objection by significant others.' The Christian youth had the most negative attitudes to abortion for 'Traumatic reasons' and 'When women's health/life' was threatened. Across the sample, higher R/S levels were linked with more negative attitudes toward reasons for abortion.
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Affiliation(s)
- Lebohang Selebalo-Bereng
- Discipline of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Cynthia Joan Patel
- Discipline of Psychology, School of Applied Human Sciences, University of KwaZulu-Natal, Durban, South Africa.
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Male Abortion Beneficiaries: Exploring the Long-Term Educational and Economic Associations of Abortion Among Men Who Report Teen Pregnancy. J Adolesc Health 2019; 65:520-526. [PMID: 31277990 PMCID: PMC6755038 DOI: 10.1016/j.jadohealth.2019.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 05/01/2019] [Accepted: 05/01/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of the study was to determine if men who report avoiding adolescent fatherhood through a partner's use of abortion have different socioeconomic outcomes than men who report a live birth during adolescence. METHODS We analyzed a subsample of men who reported a pregnancy before the age of 20 years that ended in either a live birth (n = 460) or abortion (n = 137) in the National Longitudinal Study of Adolescent to Adult Health. We used propensity score and exact matching of baseline characteristics from Wave I of the study completed in 1994 to compare college completion and income reported in Wave IV of the study completed between 2007 and 2008. RESULTS Among men who reported a live birth, 5.8% reported graduating from college, and 32.4% had any post-high school education compared with 22.1%, and 58.5% of men who reported a pregnancy ended in abortion. In the multivariable matching analysis, men whose adolescent pregnancies ended in abortion had an increased probability of graduating from college (average treatment effect = 8.6; p < .01) and completing any post-high school education in the treatment group (average treatment effect of the treated = 16.5; p < .001) than men whose adolescent pregnancies ended in live birth. We found a positive association between abortion and personal income only compared to men who did not reside with their child born during adolescence. CONCLUSION Women's use of abortion services were associated with educational benefits for men who report teen pregnancies.
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Can Teenage Men Be Targeted to Prevent Teenage Pregnancy? A Feasibility Cluster Randomised Controlled Intervention Trial in Schools. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2019; 19:1079-1090. [PMID: 30022356 PMCID: PMC6208578 DOI: 10.1007/s11121-018-0928-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The World Health Organisation advocates a direct focus on adolescent men in reducing adolescent pregnancy; however, no trials have been conducted. This trial (ISRCTN11632300; NCT02092480) determines whether a novel Relationship and Sexuality Educational intervention, If I Were Jack, is acceptable and feasible to implement in mixed sex UK classrooms. The intervention is a teacher-delivered intervention that emphasises male alongside female responsibility in preventing unintended pregnancies and is designed to prevent unprotected sex. The trial was a parallel-group cluster randomised controlled feasibility trial with embedded process and cost evaluation in eight secondary schools (unit of randomisation) among 831 pupils (mean age 14) in Northern Ireland, alongside a qualitative evaluation of transferability in ten schools in Scotland, Wales and England. The sampling strategy was a maximum variation quota sample designed to capture a range of school management types. Four schools were randomised to each arm and the control arm continued with usual practice. Study duration was 12 months (from November 2014), with follow-up 9 months post-baseline. Results demonstrated that the intervention was acceptable to schools, pupils and teachers, and could be feasibly implemented, cost-effectively, with minor enhancements. The between-group difference in incidence of unprotected sex (primary outcome at pupil level) of 1.3% (95% CI 0.5–2.2) by 9 months demonstrated a potential effect size consistent with those reported to have had meaningful impact on teenage pregnancy. The study responds to global health policy for a paradigm shift towards inclusion of men in the achievement of sexual and reproductive health goals in a practical way by demonstrating that a gender-sensitive as well as a gender transformative intervention targeting males to prevent teenage pregnancy is acceptable to adolescent men and women and implementable in formal education structures. If I Were Jack now merits further effectiveness testing.
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Socioecological risk factors associated with teen pregnancy or birth for young men: A scoping review. J Adolesc 2019; 74:130-145. [DOI: 10.1016/j.adolescence.2019.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 06/06/2019] [Accepted: 06/07/2019] [Indexed: 11/18/2022]
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Kane J, Lohan M, Kelly C. Adolescent men's attitudes and decision making in relation to pregnancy and pregnancy outcomes: An integrative review of the literature from 2010 to 2017. J Adolesc 2019; 72:23-31. [DOI: 10.1016/j.adolescence.2018.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 11/09/2018] [Accepted: 12/28/2018] [Indexed: 10/27/2022]
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Ott MA, Wells M, Imburgia TM, Yang Z, Tu W, Auerswald CL. The Sexual Health Needs of Adolescent Boys Involved in a Pregnancy. J Adolesc Health 2019; 64:537-540. [PMID: 30655121 PMCID: PMC7370313 DOI: 10.1016/j.jadohealth.2018.10.299] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 10/02/2018] [Accepted: 10/08/2018] [Indexed: 11/26/2022]
Abstract
PURPOSE Little is known about fatherhood in middle adolescence. To better understand their sexual health needs, we describe relationship characteristics, perception of masculinity, and associated sexually transmitted infection (STI) risk behaviors in a community-based sample of urban middle adolescent boys who have fathered a child or been involved with a pregnancy. METHODS We used venue-based sampling to recruit 339 boys (aged 14-17 years) in neighborhoods with high STI prevalence. We administered a brief survey on sexual relationship and pregnancy history, STI risk, juvenile justice involvement, and masculinity. RESULTS Fifteen percent had either fathered a child or been involved with a pregnancy. In multivariate analysis, controlling for age and ethnicity, adolescent fathers were more likely to be involved with juvenile justice and engage in STI risk behaviors. These included condom nonuse and partner checking a cell phone. Although of borderline significance, older partners, past STI testing, and drug or alcohol use at last sex improved model fit. CONCLUSION Adolescent fathers have distinct relational and sexual health needs. Their specific needs should be targeted by prevention programs.
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Affiliation(s)
- Mary A. Ott
- Division of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana,Address correspondence to: Mary A. Ott, M.D., M.A., Division of Adolescent Medicine, Indiana University School of Medicine, 410 West 10th Street, HS 1001, Indianapolis, IN 46202. (M.A. Ott)
| | - Matthew Wells
- Fort Wayne Medical Education Program, Family Medicine Residency, Fort Wayne, Indiana
| | - Teresa M. Imburgia
- Fort Wayne Medical Education Program, Family Medicine Residency, Fort Wayne, Indiana
| | - Ziyi Yang
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Wanzhu Tu
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana
| | - Colette L. Auerswald
- School of Public Health and Innovations for Youth (i4Y), University of California, Berkeley, California
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Long L, Han Y, Tong L, Chen Z. Association between condom use and perspectives on contraceptive responsibility in different sexual relationships among sexually active college students in China: A cross-sectional study. Medicine (Baltimore) 2019; 98:e13879. [PMID: 30608410 PMCID: PMC6344162 DOI: 10.1097/md.0000000000013879] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
China has increasing incidence of unplanned pregnancies among college students these years. Increasing students' sense of responsibility to protect sexual partners may help reduce the rate of unplanned pregnancies.A self-administered questionnaire was distributed to students from 3 colleges in Sichuan, China. Among them, 559 of male students and 267 of female students were included in this study. The questionnaire collected participants' characteristics, usage of condom, and investigated male and female students' perceptions of who should be responsible for contraception use.We found that relationship status was closely related to students perceiving responsibility for reproductive health and condom using. Male students who were in casual relationships during their most recent sexual encounter and shared responsibility for contraception were more likely to use condoms than other male students (P < .001). Female students who were in steady relationships during their most recent sexual encounter and shared responsibility for contraception were more likely to use condoms than other female students (P = .007). The multivariate analysis revealed condom use was associated with greater odds of sharing responsibility for contraceptive use in different types of sexual relationships.Improving students' attitudes toward responsibility for contraception may increase condom use among students at risk for unplanned pregnancies. Programs providing targeted health education and services may help reduce the rate of unplanned pregnancies among students in China.
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Affiliation(s)
- Lu Long
- Department of Epidemiology and Biostatistics, West China School of Public Health
| | - Yutong Han
- Department of Epidemiology and Biostatistics, West China School of Public Health
| | - Longxia Tong
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, Sichuan University
| | - Zhenhua Chen
- Chengdu Municipal Center for Disease Control and Prevention, Chengdu, Sichuan, China
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Cheng CM, Huang JH. Moderating Effects of Sexual Orientation and Gender Characteristic on Condom Use Intentions Among Boys' Senior High School Students in Taiwan: An Exploration Based on the Theory of Planned Behavior. JOURNAL OF SEX RESEARCH 2018; 55:902-914. [PMID: 29077518 DOI: 10.1080/00224499.2017.1372354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This study examined condom use intentions among adolescent boys in relation to the constructs of the Theory of Planned Behavior (TPB): attitude toward the behavior (ATB), subjective norm (SN), and perceived behavioral control (PBC). The potential moderating effects of sexual orientation and gender characteristic (masculine/feminine) were also explored. Anonymous survey data were collected from 929 students enrolled in a boys' senior high school in Taiwan (response rate: 89.9%). Multivariate logistic regression analyses found higher condom use intentions linked to more positive ATB (adjusted odds ratio [AOR] = 8.09) and supportive SN (AOR = 2.73), as well as high PBC under facilitating conditions (AOR = 2.04). Notably, nonheterosexual boys perceiving supportive SN (AOR = 0.23) or high support for condom use from teachers and health educators (AOR = 0.10 and 0.26, respectively) had lower condom use intentions than their heterosexual peers. By contrast, relatively feminine boys perceiving supportive SN (AOR = 2.06) or high support from close friends (AOR = 2.18) had higher condom use intentions than their masculine counterparts. In conclusion, ATB and SN were strongly linked to condom use intentions; PBC was significant only under facilitating conditions. Sexual orientation and gender characteristic had important moderating effects. These empirical findings could inform tailored health education programs to increase condom use intentions in the male student population.
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Affiliation(s)
- Chien-Mu Cheng
- a Master of Public Health Degree Program, College of Public Health , National Taiwan University
| | - Jiun-Hau Huang
- a Master of Public Health Degree Program, College of Public Health , National Taiwan University
- b Institute of Health Behaviors and Community Sciences, College of Public Health , National Taiwan University
- c Department of Public Health, College of Public Health , National Taiwan University
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Connor S, Edvardsson K, Spelten E. Male adolescents' role in pregnancy prevention and unintended pregnancy in rural Victoria: health care Professional's and educators' perspectives. BMC Pregnancy Childbirth 2018; 18:245. [PMID: 29914419 PMCID: PMC6007007 DOI: 10.1186/s12884-018-1886-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 06/06/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While there has been a steady decline in adolescent pregnancies worldwide and in Australia over the last three decades, Australian rates still rank third highest among developed countries. Adolescent pregnancies are defined as those that occur to girls between the ages of 15 and 19. The current pregnancy rate of 15 to 19 year old females rural Victoria is 21.19%, this is more than double the Victorian state rate of 8.2% and almost double the national Australian rate at 13.1% The aim of this study was to explore Health Care Professionals and Educator perspectives on these high adolescent pregnancy rates, with particular focus on the role of adolescent males, in a rural region in Victoria, Australia. METHODS A qualitative descriptive study using focus group discussion was undertaken with Health Care Providers and Educators (N = 8) in 2016. Data was analysed using thematic analysis. RESULTS Four themes emerged from analysis. The first, 'Gender Stereotyping' focused on the acceptance of traditional masculinities; the second 'Adolescent males as health consumers' was based on the consensus that adolescent males are poor consumers of health and 'invisible'; the third 'Complexity of Issues' identified that, particularly in a rural region, contributing issues are varied and complex; and the fourth 'Focus on Fatherhood', saw the participants diverge from the discussion about pregnancy prevention and the adolescent males' role in unintended pregnancy, and focus on the role adolescent males may have as unintended fathers. CONCLUSIONS Participants did not consider young males to be of importance in the prevention of adolescent pregnancy. There is a need to further explore the role of young males in pregnancy prevention, including what role traditional gender stereotyping, from health professionals' and young males' perspectives, plays in provision of adolescent sexual health services.
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Affiliation(s)
- S. Connor
- Department of Rural Nursing & Midwifery, La Trobe Rural Health School, Vic, Mildura, 3500 Australia
| | - K. Edvardsson
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Vic, Bundoora, 3086 Australia
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, 901 87 Umeå, SE Sweden
| | - E. Spelten
- Department of Public Health, La Trobe Rural Health School, Mildura, Vic 3500 Australia
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Hornberger LL, Breuner CC, Alderman EM, Garofalo R, Grubb LK, Powers ME, Upadhya KK, Wallace SB. Diagnosis of Pregnancy and Providing Options Counseling for the Adolescent Patient. Pediatrics 2017; 140:peds.2017-2273. [PMID: 28827383 DOI: 10.1542/peds.2017-2273] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The American Academy of Pediatrics policy statement "Options Counseling for the Pregnant Adolescent Patient" recommends the basic content of the pediatrician's counseling for an adolescent facing a new diagnosis of pregnancy. However, options counseling is just one aspect of what may be one of the more challenging scenarios in the pediatric office. Pediatricians must remain alert to the possibility of pregnancy among their adolescent female patients. When discovering symptoms suggestive of pregnancy, pediatricians must obtain a relevant history, perform diagnostic testing and properly interpret the results, and understand the significance of the results from the patient perspective and reveal them to the patient in a sensitive manner. If the patient is indeed pregnant, the pediatrician, in addition to providing comprehensive options counseling, may need to help recruit adult support for the patient and should offer continued assistance to the adolescent and her family after the office visit. All pediatricians should be aware of the legal aspects of adolescent reproductive care and the resources for pregnant adolescents in their communities. This clinical report presents a more comprehensive view of the evaluation and management of pregnancy in the adolescent patient and a context for options counseling.
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Affiliation(s)
| | - Cora C. Breuner
- Division of Adolescent Medicine, Children’s Mercy Hospital and Clinics, Kansas City, Missouri
| | - Elizabeth M. Alderman
- Division of Adolescent Medicine, Children’s Mercy Hospital and Clinics, Kansas City, Missouri
| | - Robert Garofalo
- Division of Adolescent Medicine, Children’s Mercy Hospital and Clinics, Kansas City, Missouri
| | - Laura K. Grubb
- Division of Adolescent Medicine, Children’s Mercy Hospital and Clinics, Kansas City, Missouri
| | - Makia E. Powers
- Division of Adolescent Medicine, Children’s Mercy Hospital and Clinics, Kansas City, Missouri
| | - Krishna Kumari Upadhya
- Division of Adolescent Medicine, Children’s Mercy Hospital and Clinics, Kansas City, Missouri
| | - Stephenie B. Wallace
- Division of Adolescent Medicine, Children’s Mercy Hospital and Clinics, Kansas City, Missouri
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Hirz AE, Avila JL, Gipson JD. The role of men in induced abortion decision making in an urban area of the Philippines. Int J Gynaecol Obstet 2017; 138:267-271. [PMID: 28504833 DOI: 10.1002/ijgo.12211] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 03/20/2017] [Accepted: 05/11/2017] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To understand beliefs about unintended pregnancy and abortion, and perceptions about male roles related to pregnancy decision-making among men in the Philippines. METHODS Qualitative data were collected during in-depth interviews and focus group discussions with men in an urban area of the Philippines between October 2007 and July 2008. Interview participants were purposively sampled from a local survey based on their having reported being "afraid or troubled" or "afraid and planned to terminate" in response to a recent pregnancy. Focus group participants were selected from the same communities. Data were analyzed using the constant comparative method. RESULTS In-depth interview data from 15 men-each interviewed twice-and five focus group discussions were included. Male interview participants reported feeling morally responsible for the pregnancy and as wanting to avoid the "sin" of induced abortion; however, they were concerned about being able to support a family financially. Participants expressed resentment towards partners who attempted or completed an induced abortion without their knowledge. In such cases, men would disparage their partner and cease interacting with them to avoid the "sin" of induced abortion. CONCLUSION Participants described negative feelings towards women seeking induced abortions, and their own desire to avoid associated "sin". This highlights the effects of unintended pregnancy and induced abortion on young Filipino men, including their own experience of abortion stigma.
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Affiliation(s)
- Alanna E Hirz
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, CA, USA
| | | | - Jessica D Gipson
- Department of Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles, CA, USA
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Lohan M, Aventin Á, Maguire L, Curran R, McDowell C, Agus A, Donaldson C, Clarke M, Linden M, Kelly C, McDaid L, Dunne L, O’Halloran P. Increasing boys’ and girls’ intentions to avoid teenage pregnancy: a cluster randomised controlled feasibility trial of an interactive video drama-based intervention in post-primary schools in Northern Ireland. PUBLIC HEALTH RESEARCH 2017. [DOI: 10.3310/phr05010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundAdolescent men have a vital yet neglected role in reducing unintended teenage pregnancy (UTP). There is a need for gender-sensitive educational interventions.ObjectivesTo determine the value and feasibility of conducting an effectiveness trial of theIf I Were JackRelationship and Sexuality Education (RSE) intervention in a convenience quota sample of post-primary schools in Northern Ireland. Secondary objectives were to assess acceptability to schools, pupils (male/female, aged 14–15 years) and parents/guardians; to identify optimal delivery structures and systems; to establish participation rates and reach, including equality of engagement of different socioeconomic and religious types; to assess trial recruitment and retention rates; to assess variation in normal RSE practice; to refine survey instruments; to assess differences in outcomes for male and female pupils; to identify potential effect sizes that might be detected in an effectiveness trial and estimate appropriate sample size for that trial; and to identify costs of delivery and pilot methods for assessing cost-effectiveness.DesignCluster randomised Phase II feasibility trial with an embedded process and economic evaluation.InterventionA teacher-delivered classroom-based RSE resource – an interactive video drama (IVD) with classroom materials, teacher training and an information session for parents – to immerse young people in a hypothetical scenario of Jack, a teenager whose girlfriend is unintentionally pregnant. It addresses gender inequalities in RSE by focusing on young men and is designed to increase intentions to avoid UTP by encouraging young people to delay sexual intercourse and to use contraception consistently in sexual relationships.Main outcome measuresAbstinence from sexual intercourse (delaying initiation of sex or returning to abstinence) or avoidance of unprotected sexual intercourse (consistent correct use of contraception). Secondary outcomes included Knowledge, Attitudes, Skills and Intentions.ResultsThe intervention proved acceptable to schools, pupils and parents, as evidenced through positive process evaluation. One minor refinement to the parental component was required, namely the replacement of the teacher-led face-to-face information session for parents by online videos designed to deliver the intervention to parents/guardians into their home. School recruitment was successful (target 25%, achieved 38%). No school dropped out. Pupil retention was successful (target 85%, achieved 93%). The between-group difference in incidence of unprotected sex of 1.3% (95% confidence interval 0.55% to 2.2%) by 9 months demonstrated an effect size consistent with those reported to have had meaningful impact on UTP rates (resulting in an achievable sample size of 66 schools at Phase III). Survey instruments showed high acceptability and reliability of measures (Cronbach’s alpha: 0.5–0.7). Economic evaluation at Phase III is feasible because it was possible to (1) identify costs of deliveringIf I Were Jack(mean cost per pupil, including training of teachers, was calculated as £13.66); and (2) develop a framework for assessing cost-effectiveness.ConclusionTrial methods were appropriate, and recruitment and retention of schools and pupils was satisfactory, successfully demonstrating all criteria for progression to a main trial. The perceived value of culture- and gender-sensitive public health interventions has been highlighted.Future workProgression to a Phase III effectiveness trial.Trial registrationCurrent Controlled Trials ISRCTN99459996.FundingThis project was funded by the NIHR Public Health Research programme and will be published in full inPublic Health Research; Vol. 5, No. 1. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Maria Lohan
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK
| | - Áine Aventin
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK
| | - Lisa Maguire
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
| | - Rhonda Curran
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK
| | | | - Ashley Agus
- Northern Ireland Clinical Trials Unit, Belfast, UK
| | - Cam Donaldson
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Mike Clarke
- Centre for Public Health, Queen’s University Belfast, Belfast, UK
| | - Mark Linden
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK
| | - Carmel Kelly
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK
| | - Lisa McDaid
- Medical Research Council/Chief Scientist Office (MRC/CSO) Social & Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Laura Dunne
- School of Education, Queen’s University Belfast, Belfast, UK
| | - Peter O’Halloran
- School of Nursing and Midwifery, Queen’s University Belfast, Belfast, UK
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Thomas Farrell C, Clyde A, Katta M, Bolland J. The impact of sexuality concerns on teenage pregnancy: a consequence of heteronormativity? CULTURE, HEALTH & SEXUALITY 2017; 19:135-149. [PMID: 27624812 DOI: 10.1080/13691058.2016.1212405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In countries such as the USA, a substantial percentage of teenage pregnancies are intentional, and desire for pregnancy increases risk. Black US Americans have been found to be less accepting of homosexuality than their non-Black peers, which may result in minority ethnic teenagers demonstrating heterosexual orientation through attempting pregnancy. Young, socioeconomically disadvantaged African Americans were surveyed longitudinally regarding attitudes about their sexuality, pregnancy intentions and other psychosocial factors. Young people who reported being somewhat concerned about their sexual orientation were nearly four times more likely to report attempting pregnancy compared to those who were not at all concerned. This relationship held true while accounting for the significant effect of religion, sense of community, hopelessness and numerous demographic factors. The current study suggests that uncertainty regarding sexual orientation, potentially due to social stigma, may impact pregnancy attempts among young Black people from disadvantaged communities.
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Affiliation(s)
- C Thomas Farrell
- a Department of Public Health , Western Kentucky University , Bowling Green , USA
| | - Alexis Clyde
- b School of Medicine , University of Texas Southwestern , Dallas , USA
| | - Madhuri Katta
- a Department of Public Health , Western Kentucky University , Bowling Green , USA
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Aziato L, Hindin MJ, Maya ET, Manu A, Amuasi SA, Lawerh RM, Ankomah A. Adolescents' Responses to an Unintended Pregnancy in Ghana: A Qualitative Study. J Pediatr Adolesc Gynecol 2016; 29:653-658. [PMID: 27346553 DOI: 10.1016/j.jpag.2016.06.005] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 06/10/2016] [Accepted: 06/13/2016] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE To investigate the experiences and perceptions of adolescents who have experienced a recent pregnancy and undergone a termination of pregnancy. DESIGN A vignette-based focus group approach was used to have adolescents reflect on scenarios that happen to others during an unwanted pregnancy. SETTING The study was conducted in public health facilities in the 3 major urban areas of Ghana-Accra, Kumasi, and Tamale. PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES Adolescents, aged 10-19 years, who had a recent termination of pregnancy were recruited from public health facilities in the 3 sites. Fifteen focus groups were conducted and digitally recorded in English, Twi, Ga, and Dagbani. Transcripts were transcribed and translated, and thematic analysis was used for the analysis. RESULTS Adolescents reported that the characters in the vignettes would feel sadness, depression, and regret from an unintended pregnancy and some male partners would "deny" the pregnancy or suggest an abortion. They suggested some parents would "be angry" and "sack" their children for becoming pregnant while others would "support" them. Parents might send the pregnant girl to a distant friend or grandparents until she delivers to avoid shame and gossip. Health professionals might encourage the pregnant girl or insult/gossip about the girl. CONCLUSION Adolescent unintended pregnancies in Ghana are met with a range of reactions and these reactions influence the pregnancy choices young women make for continuation or termination of pregnancy.
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Affiliation(s)
- Lydia Aziato
- Department of Adult Health, School of Nursing, College of Health Sciences, University of Ghana, Accra, Ghana.
| | - Michelle J Hindin
- World Health Organization, Department of Reproductive Health, Geneva, Switzerland
| | - Ernest Tei Maya
- Department of Population Family and Reproductive Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Abubakar Manu
- Department of Population Family and Reproductive Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Susan Ama Amuasi
- Department of Population Family and Reproductive Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Rachel Mahoe Lawerh
- Department of Organization and Human Resource Management, University of Ghana Business School, Accra, Ghana
| | - Augustine Ankomah
- Department of Population Family and Reproductive Health, School of Public Health, College of Health Sciences, University of Ghana, Accra, Ghana
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Templeton M, Lohan M, Kelly C, Lundy L. A systematic review and qualitative synthesis of adolescents' views of sexual readiness. J Adv Nurs 2016; 73:1288-1301. [PMID: 27862186 DOI: 10.1111/jan.13207] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2016] [Indexed: 12/01/2022]
Abstract
AIM The aim of this study was to synthesize the qualitative evidence investigating adolescents' views on heterosexual readiness. BACKGROUND Adolescents' understandings of sexual readiness are often missing in research and debates on sexual health and related concepts like sexual consent. Research to date has predominantly focussed on age and socio-cultural predictors of sexual debut, thus failing to explain how adolescents themselves conceptualize their readiness for heterosexual relations. DESIGN A systematic review and thematic synthesis of qualitative evidence. DATA SOURCES CINAHL, Psychinfo, PubMed, Web of science were searched, 1985-Feb 2016. REVIEW METHODS Critical Appraisal Skills Programme checklist was used to assess methodological quality. A thematic synthesis focused on commonalities and variations in the data from included studies on adolescents' perspectives of their readiness for sex. RESULTS Sixteen studies were included. Themes identified were: social learning, relationships and implications for sexual health promotion and practice. CONCLUSIONS Adolescents may not view initiating sex as problematic, focusing instead on the rewards sex brings and less on health concerns. Adolescents tend to reproduce dominant gender norms of masculinity and femininity in communication about sexual decision-making, which are sometimes influenced by social scripts of career aspirations and ethnic identity. Age was also significant in adolescents' accounts. Early adolescence is a critical period when understandings of gender equality become embedded, thus an opportunity to engage adolescents in critiquing ideas about gender equality and sexual rights. Further research exploring adolescents' understandings of sexual readiness is required. We recommend a participatory approach to support the inclusion of adolescent voices to inform contextually relevant sexual health promotion strategies.
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Affiliation(s)
| | - Maria Lohan
- School of Nursing and Midwifery, Queen's University Belfast, UK
| | - Carmel Kelly
- School of Nursing and Midwifery, Queen's University Belfast, UK
| | - Laura Lundy
- School of Social Sciences, Education and Social Work, Queen's University Belfast, UK
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Rodriguez VJ, Spence A, Monda M, Potter J, Jones D. Couples Living with HIV. J Int Assoc Provid AIDS Care 2016; 16:133-139. [PMID: 26467783 DOI: 10.1177/2325957415612127] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Desires to have children are not lessened by a woman's HIV status. Couples may lack information to conceive safely, and men may be especially uninformed. This study examined reproductive intentions, practices, and attitudes among men in HIV-infected couples, including attitudes regarding the perceived risk of vertical and horizontal transmission, safer conception, and preconception planning. METHODS Men ( n = 12) in HIV-infected couples were interviewed regarding reproductive intentions, attitudes, and knowledge and qualitative assessments were coded for dominant themes. RESULTS Themes primarily addressed concerns about the health of the baby, men's involvement in pregnancy, safer conception, concerns about HIV transmission and antiretroviral therapy, and HIV infection. Men lacked information on safer conception and newer HIV prevention strategies, such as pre-exposure prophylaxis (PrEP). DISCUSSION Gaps in knowledge regarding preconception practices among men in HIV-infected couples were identified. Results highlight men's desire for involvement in preconception planning, and opportunities for providers to facilitate this practice and to increase patient education and the use of PrEP are discussed.
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Affiliation(s)
- Violeta J Rodriguez
- 1 Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Andrew Spence
- 1 Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Mallory Monda
- 1 Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - JoNell Potter
- 2 Department of Obstetrics and Gynecology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Deborah Jones
- 1 Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
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Herrman JW, Moore C, Rahmer B. Focus on Teen Men: Evaluating the Effectiveness of the Wise Guys Program. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2016; 29:37-43. [PMID: 26991126 DOI: 10.1111/jcap.12133] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PROBLEM Many interventions designed to promote safe sexual behaviors in teens focus on young women. Wise Guys is one curricular intervention designed to foster safe sexual practices in young men. This study assessed knowledge, attitude, and behavioral changes as the result of Wise Guys. METHODS This pre/posttest descriptive study measured changes in knowledge, attitudes, and sexual behaviors in 159 young men. FINDINGS This study detected limited knowledge and attitude changes but yielded statistically significant differences in safe sexual behaviors and likelihood to talk with parents or guardians about sexuality and dating. CONCLUSIONS This study revealed important benefits of Wise Guys and proposed future mixed methods research to ensure that authentic teen voices inform programming. Nurses working with adolescents may find this information valuable as they address sexual health issues in their work.
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Affiliation(s)
| | | | - Brian Rahmer
- Department of Family and Community Medicine, Christiana Care Health System, Newark, DE, USA
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Garcia JR, Seibold-Simpson SM, Massey SG, Merriwether AM. Casual Sex: Integrating Social, Behavioral, and Sexual Health Research. ACTA ACUST UNITED AC 2015. [DOI: 10.1007/978-3-319-17341-2_12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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Aventin Á, Lohan M, O'Halloran P, Henderson M. Design and development of a film-based intervention about teenage men and unintended pregnancy: applying the Medical Research Council framework in practice. EVALUATION AND PROGRAM PLANNING 2015; 49:19-30. [PMID: 25483572 DOI: 10.1016/j.evalprogplan.2014.11.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 08/27/2014] [Accepted: 11/10/2014] [Indexed: 06/04/2023]
Abstract
Following the UK Medical Research Council's (MRC) guidelines for the development and evaluation of complex interventions, this study aimed to design, develop and optimise an educational intervention about young men and unintended teenage pregnancy based around an interactive film. The process involved identification of the relevant evidence base, development of a theoretical understanding of the phenomenon of unintended teenage pregnancy in relation to young men, and exploratory mixed methods research. The result was an evidence-based, theory-informed, user-endorsed intervention designed to meet the much neglected pregnancy education needs of teenage men and intended to increase both boys' and girls' intentions to avoid an unplanned pregnancy during adolescence. In prioritising the development phase, this paper addresses a gap in the literature on the processes of research-informed intervention design. It illustrates the application of the MRC guidelines in practice while offering a critique and additional guidance to programme developers on the MRC prescribed processes of developing interventions. Key lessons learned were: (1) know and engage the target population and engage gatekeepers in addressing contextual complexities; (2) know the targeted behaviours and model a process of change; and (3) look beyond development to evaluation and implementation.
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Affiliation(s)
- Áine Aventin
- School of Nursing & Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK.
| | - Maria Lohan
- School of Nursing & Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK.
| | - Peter O'Halloran
- School of Nursing & Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK.
| | - Marion Henderson
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, Scotland UK.
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Chiavegatto Filho ADP, Kawachi I. Income inequality is associated with adolescent fertility in Brazil: a longitudinal multilevel analysis of 5,565 municipalities. BMC Public Health 2015; 15:103. [PMID: 25884433 PMCID: PMC4334765 DOI: 10.1186/s12889-015-1369-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 01/07/2015] [Indexed: 11/17/2022] Open
Abstract
Background Brazil has one of the highest adolescent fertility rates in the world. Income inequality has been frequently linked to overall adolescent health, but studies that analyzed its association with adolescent fertility have been performed only in developed countries. Brazil, in the past decade, has presented a rare combination of increasing per capita income and decreasing income inequality, which could influence future desirable pathways for other countries. Methods We analyzed every live birth from 2000 and from 2010 in each of the 5,565 municipalities of Brazil, a total of 6,049,864 births, which included 1,247,145 (20.6%) births from women aged 15 to 19. Income inequality was assessed by the Gini Coefficient and adolescent fertility by the ratio between the number of live births from women aged 15 to 19 and the number of women aged 15 to 19, calculated for each municipality. We first applied multilevel models separately for 2000 and 2010 to test the cross-sectional association between income inequality and adolescent fertility. We then fitted longitudinal first-differences multilevel models to control for time-invariant effects. We also performed a sensitivity analysis to include only municipality with satisfactory birth record coverage. Results Our results indicate a consistent and positive association between income inequality and adolescent fertility. After controlling for per capita income, college access, youth homicide rate and adult fertility, higher income inequality was significantly associated with higher adolescent fertility for both 2000 and 2010. The longitudinal multilevel models found similar results. The sensitivity analysis indicated that the results for the association between income inequality and adolescent fertility were robust. Adult fertility was also significantly associated with adolescent fertility in the cross-sectional and longitudinal models. Conclusion Income inequality is expected to be a leading concern for most countries in the near future. Our results suggest that changes in income inequality are positively and consistently associated with changes in adolescent fertility.
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Affiliation(s)
| | - Ichiro Kawachi
- University of São Paulo, Av Dr. Arnaldo, 715 01255-000, São Paulo, Brazil.
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Lohan M, Aventin Á, Oliffe JL, Han CS, Bottorff JL. Knowledge translation in men's health research: development and delivery of content for use online. J Med Internet Res 2015; 17:e31. [PMID: 25642787 PMCID: PMC4327186 DOI: 10.2196/jmir.3881] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 11/04/2014] [Accepted: 11/23/2014] [Indexed: 02/04/2023] Open
Abstract
Background Men can be hard to reach with face-to-face health-related information, while increasingly, research shows that they are seeking health information from online sources. Recognizing this trend, there is merit in developing innovative online knowledge translation (KT) strategies capable of translating research on men’s health into engaging health promotion materials. While the concept of KT has become a new mantra for researchers wishing to bridge the gap between research evidence and improved health outcomes, little is written about the process, necessary skills, and best practices by which researchers can develop online knowledge translation. Objective Our aim was to illustrate some of the processes and challenges involved in, and potential value of, developing research knowledge online to promote men’s health. Methods We present experiences of KT across two case studies of men’s health. First, we describe a study that uses interactive Web apps to translate knowledge relating to Canadian men’s depression. Through a range of mechanisms, study findings were repackaged with the explicit aim of raising awareness and reducing the stigma associated with men’s depression and/or help-seeking. Second, we describe an educational resource for teenage men about unintended pregnancy, developed for delivery in the formal Relationship and Sexuality Education school curricula of Ireland, Northern Ireland (United Kingdom), and South Australia. The intervention is based around a Web-based interactive film drama entitled “If I Were Jack”. Results For each case study, we describe the KT process and strategies that aided development of credible and well-received online content focused on men’s health promotion. In both case studies, the original research generated the inspiration for the interactive online content and the core development strategy was working with a multidisciplinary team to develop this material through arts-based approaches. In both cases also, there is an acknowledgment of the need for gender and culturally sensitive information. Both aimed to engage men by disrupting stereotypes about men, while simultaneously addressing men through authentic voices and faces. Finally, in both case studies we draw attention to the need to think beyond placement of content online to delivery to target audiences from the outset. Conclusions The case studies highlight some of the new skills required by academics in the emerging paradigm of translational research and contribute to the nascent literature on KT. Our approach to online KT was to go beyond dissemination and diffusion to actively repackage research knowledge through arts-based approaches (videos and film scripts) as health promotion tools, with optimal appeal, to target male audiences. Our findings highlight the importance of developing a multidisciplinary team to inform the design of content, the importance of adaptation to context, both in terms of the national implementation context and consideration of gender-specific needs, and an integrated implementation and evaluation framework in all KT work.
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Affiliation(s)
- Maria Lohan
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, United Kingdom.
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Kågesten A, Bajos N, Bohet A, Moreau C. Male experiences of unintended pregnancy: characteristics and prevalence. Hum Reprod 2014; 30:186-96. [PMID: 25316449 DOI: 10.1093/humrep/deu259] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
STUDY QUESTION What are the characteristics and circumstances of pregnancies men report as unintended in France? SUMMARY ANSWER Pregnancies reported as unintended were most prevalent among young men with insecure financial situations, less stable relationships and inconsistent use of contraception or false assumptions about their partner's use of contraception. WHAT IS KNOWN ALREADY Efforts to involve men in family planning have increased over the last decade; however, little is known about factors associated with men's pregnancy intentions and associated contraceptive behaviours. STUDY DESIGN, SIZE, DURATION The data presented in this study were drawn from the nationally representative FECOND study, a population-based survey conducted in France in 2010. The sample comprised 8675 individuals (3373 men), aged 15-49 years, who responded to a telephone interview about socio-demographics and topics related to sexual and reproductive health. The total refusal rate was 20%. PARTICIPANTS/MATERIALS, SETTING, METHODS This study included 2997 men, of whom 664 reported 893 recent pregnancies (in the 5 years preceding the survey). Multivariate Poisson's regression with population-averaged marginal effects was applied to assess the individual and contextual factors associated with men's intentions for recent pregnancies. The contraceptive circumstances leading to the unintended pregnancies were also assessed. MAIN RESULTS AND THE ROLE OF CHANCE Of all heterosexually active men, 5% reported they had experienced an unintended pregnancy with a partner in the last 5 years. A total of 20% of recent pregnancies reported by men were qualified to be unintended, of which 45% ended in induced abortion. Of pregnancies following a previous unintended pregnancy, 68% were themselves unintended. Among all heterosexually active men, recent experience of an unintended pregnancy was related to age, mother's education, age at first sex, parity, contraceptive method history, lifetime number of female partners and the relationship situation at the time of survey. Recent unintended pregnancies were also related to pregnancy order and to the financial and professional situation at the time of conception. The majority of unintended pregnancies occurred when men or their partners were using contraceptives; 58% of contraceptive users considered that the pregnancy was due to inconsistent use and 39% considered that it resulted from method failure. Half of the non-users who reported an unintended pregnancy thought that their partner was using a contraceptive method. The relative risk of non-use of a contraceptive method during the month of conception of a recent unintended pregnancy was higher among those without a high school degree (IRR = 2.9, CI 1.6, 5.2) and higher among men for whom the pregnancy interfered with education (IRR = 1.8, CI 1.0, 3.1) or work (IRR = 1.9, CI 1.1, 3.6). LIMITATIONS, REASONS FOR CAUTION From the perspective of men, the unintended pregnancy rates may be underestimated due to a combination of underreporting of abortion and post-rationalization of birth intentions. Our use of a dichotomous measure of unintended pregnancy is unlikely to fully capture the multidimensional construct of pregnancy intentions. WIDER IMPLICATION OF THE FINDINGS These results call for gender-inclusive family planning programmes, which fully engage men as active participants in their own rights. STUDY FUNDING/COMPETING INTERESTS The FECOND study was supported by a grant from the French Ministry of Health, a grant from the French National Agency of Research (#ANR-08-BLAN-0286-01; PIs N.B., C.M.), and funding from National Institute of Health and Medical Research (INSERM) and the National Institute for Demographic Research (INED). None of the authors have competing interests.
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Affiliation(s)
- Anna Kågesten
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA
| | - Nathalie Bajos
- Gender, Sexual and Reproductive Health, CESP Centre for Research in Epidemiology and Population Health, U1018, Inserm, F-94807 Kremlin Bicêtre, France Université Paris Sud 11, UMRS 1018, F-94807 Kremlin Bicêtre, France Institut National d'Etudes Démographiques, F-75020 Paris, France
| | - Aline Bohet
- Gender, Sexual and Reproductive Health, CESP Centre for Research in Epidemiology and Population Health, U1018, Inserm, F-94807 Kremlin Bicêtre, France
| | - Caroline Moreau
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205, USA Gender, Sexual and Reproductive Health, CESP Centre for Research in Epidemiology and Population Health, U1018, Inserm, F-94807 Kremlin Bicêtre, France
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Fedorowicz AR, Hellerstedt WL, Schreiner PJ, Bolland JM. Associations of adolescent hopelessness and self-worth with pregnancy attempts and pregnancy desire. Am J Public Health 2014; 104:e133-40. [PMID: 24922147 PMCID: PMC4103254 DOI: 10.2105/ajph.2014.301914] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the associations of pregnancy desire (ambivalence or happiness about a pregnancy in the next year) and recent pregnancy attempts with hopelessness and self-worth among low-income adolescents. METHODS To evaluate independent associations among the study variables, we conducted gender-stratified multivariable logistic regression analyses with data derived from 2285 sexually experienced 9- to 18-year-old participants in the Mobile Youth Survey between 2006 and 2009. RESULTS Fifty-seven percent of youths reported a desire for pregnancy and 9% reported pregnancy attempts. In multivariable analyses, hopelessness was positively associated and self-worth was negatively associated with pregnancy attempts among both female and male youths. Hopelessness was weakly associated (P = .05) with pregnancy desire among female youths. CONCLUSIONS The negative association of self-worth and the positive association of hopelessness with pregnancy attempts among young men as well as young women and the association of hopelessness with pregnancy desire among young women raise questions about why pregnancy is apparently valued by youths who rate their social and cognitive competence as low and who live in an environment with few options for material success.
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Affiliation(s)
- Anna R Fedorowicz
- At the time of the study, Anna R. Fedorowicz, Wendy L. Hellerstedt, and Pamela J. Schreiner were with the Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis. John M. Bolland was with the College of Human Environmental Sciences, University of Alabama, Tuscaloosa
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Mitchell EMH, Heumann S, Araujo A, Adesse L, Halpern CT. Brazilian adolescents' knowledge and beliefs about abortion methods: a school-based internet inquiry. BMC WOMENS HEALTH 2014; 14:27. [PMID: 24521075 PMCID: PMC3924906 DOI: 10.1186/1472-6874-14-27] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 01/29/2014] [Indexed: 11/17/2022]
Abstract
Background Internet surveys that draw from traditionally generated samples provide the unique conditions to engage adolescents in exploration of sensitive health topics. Methods We examined awareness of unwanted pregnancy, abortion behaviour, methods, and attitudes toward specific legal indications for abortion via a school-based internet survey among 378 adolescents aged 12–21 years in three Rio de Janeiro public schools. Results Forty-five percent knew peers who had undergone an abortion. Most students (66.0%) did not disclose abortion method knowledge. However, girls (aOR 4.2, 95% CI 2.4-7.2), those who had experienced their sexual debut (aOR1.76, 95% CI 1.1-3.0), and those attending a prestigious magnet school (aOR 2.7 95% CI 1.4-6.3) were more likely to report methods. Most abortion methods (79.3%) reported were ineffective, obsolete, and/or unsafe. Herbs (e.g. marijuana tea), over-the-counter medications, surgical procedures, foreign objects and blunt trauma were reported. Most techniques (85.2%) were perceived to be dangerous, including methods recommended by the World Health Organization. A majority (61.4%) supported Brazil’s existing law permitting abortion in the case of rape. There was no association between gender, age, sexual debut, parental education or socioeconomic status and attitudes toward legal abortion. However, students at the magnet school supported twice as many legal indications (2.7, SE.27) suggesting a likely role of peers and/or educators in shaping abortion views. Conclusions Abortion knowledge and attitudes are not driven simply by age, religion or class, but rather a complex interplay that includes both social spaces and gender. Prevention of abortion morbidity and mortality among adolescents requires comprehensive sexuality and reproductive health education that includes factual distinctions between safe and unsafe abortion methods.
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Affiliation(s)
- Ellen M H Mitchell
- Amsterdam Institute for Global Health & Development, Amsterdam, Netherlands.
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Lohan M, Aventin Á, Maguire L, Clarke M, Linden M, McDaid L. Feasibility trial of a film-based educational intervention for increasing boys' and girls' intentions to avoid teenage pregnancy: Study protocol. INTERNATIONAL JOURNAL OF EDUCATIONAL RESEARCH 2014; 68:35-45. [PMID: 25284956 PMCID: PMC4183752 DOI: 10.1016/j.ijer.2014.08.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 08/13/2014] [Accepted: 08/16/2014] [Indexed: 06/03/2023]
Abstract
The World Health Organisation, amongst others, recognises that adolescent men have a vital yet neglected role in reducing teenage pregnancies and that there is a pressing need for educational interventions designed especially for them. This study seeks to fill this gap by determining the feasibility of conducting an effectiveness trial of the If I Were Jack intervention in post-primary schools. This 4-week intervention aims to increase teenagers' intentions to avoid unintended pregnancy and addresses gender inequalities in sex education by explicitly focusing on young men. A cluster randomised feasibility trial with embedded process evaluation will determine: recruitment, participation and retention rates; quality of implementation; acceptability and feasibility of the intervention and trial procedures; and costs.
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Affiliation(s)
- Maria Lohan
- School of Nursing and Midwifery, Queen's University Belfast, Northern Ireland/Scotland, United Kingdom
| | - Áine Aventin
- School of Nursing and Midwifery, Queen's University Belfast, Northern Ireland/Scotland, United Kingdom
| | - Lisa Maguire
- Centre for Public Health, Queen's University Belfast, United Kingdom
| | - Mike Clarke
- Centre for Public Health, Queen's University Belfast, United Kingdom
| | - Mark Linden
- School of Nursing and Midwifery, Queen's University Belfast, Northern Ireland/Scotland, United Kingdom
| | - Lisa McDaid
- MRC/CSO Social & Public Health Sciences Unit, University of Glasgow, United Kingdom
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Factors associated with condom use among male college students in Wuhan, China. PLoS One 2012; 7:e51782. [PMID: 23272167 PMCID: PMC3525661 DOI: 10.1371/journal.pone.0051782] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2012] [Accepted: 11/06/2012] [Indexed: 12/02/2022] Open
Abstract
Background Using condoms consistently could prevent unintended pregnancy among young people. This study highlights multiple domains of influence on condom use among male college students in China, including knowledge, attitudes, health services utility on condom use and reproductive health information sources. Methodology/Principal Findings To identify factors associated with condom use in Chinese male college students, we examined a sample of 870 sexually experienced male students in seven colleges in Wuhan, China, 2009. 535 (61.5%) of 870 male students reported condom use during their most recent sexual encounter. Male students with steady partners were more likely to use condoms than students with casual partners (adjusted OR = 3.11, 95%CI 2.30–4.20). And positive attitudes toward contraceptive responsibility were associated with greater odds of condom use (adjusted OR = 1.40, 95%CI 1.02–1.92). Only 54(6.2%) and 83(9.5%) of respondents reported that free condoms and reproductive health counseling were available at the student health center. Providing free condoms and reproductive health counseling at the student health central were associated with increased condom use among college students (both P<0.05). In addition, students who gained reproductive health information mainly through websites, television and radio programs were more likely to use condoms than through school education (all P<0.05). Conclusions Improving attitudes of male students toward contraceptive responsibility, providing proper reproductive health information through mass media and making free condoms and reproductive health counseling available in school may help increase condom use among college students in China.
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Abstract
Teen pregnancy and parenting remain an important public health issue in the United States and the world, and many children live with their adolescent parents alone or as part of an extended family. A significant proportion of teen parents reside with their family of origin, significantly affecting the multigenerational family structure. Repeated births to teen parents are also common. This clinical report updates a previous policy statement on care of the adolescent parent and their children and addresses medical and psychosocial risks specific to this population. Challenges unique to teen parents and their children are reviewed, along with suggestions for the pediatrician on models for intervention and care.
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Lehti V, Sourander A, Sillanmäki L, Helenius H, Tamminen T, Kumpulainen K, Almqvist F. Psychosocial factors associated with becoming a young father in Finland: a nationwide longitudinal study. BMC Public Health 2012; 12:560. [PMID: 22838840 PMCID: PMC3412728 DOI: 10.1186/1471-2458-12-560] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Accepted: 07/27/2012] [Indexed: 11/21/2022] Open
Abstract
Background Little is known about the characteristics of boys who become fathers at young age. Some studies have suggested that antisocial adolescents are more likely to be young fathers. The aim of this study was to examine the associations of psychosocial factors in childhood with becoming a young father, and to assess if they are independent of criminal behavior in adolescence. Methods The baseline assessment in 1989 included 2,946 boys born in 1981. Information about psychiatric symptoms at age eight was collected with Rutter questionnaires from parents and teachers and with the Child Depression Inventory from the children themselves. Data on criminal offenses at age 16–20 was collected from a police register. Register-based follow-up data on becoming a father under the age of 22 was available for 2,721 boys. Results The factors measured at age eight, which were associated with becoming a young father independently of adolescent criminality, were conduct problems, being born to a young father and having a mother with a low educational level. Having repeatedly committed criminal offences in adolescence was associated with becoming a young father independently of psychosocial factors in childhood. Conclusions Antisocial tendencies both in childhood and adolescence are associated with becoming a young father. They should be taken into consideration when designing preventive or supportive interventions.
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Affiliation(s)
- Venla Lehti
- Department of Child Psychiatry, University of Turku, Turku, Finland
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Lohan M, Cruise S, O’Halloran P, Alderdice F, Hyde A. Adolescent men’s attitudes and decision-making in relation to an unplanned pregnancy. Responses to an interactive video drama. Soc Sci Med 2011; 72:1507-14. [PMID: 21511378 DOI: 10.1016/j.socscimed.2011.02.044] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Revised: 01/25/2011] [Accepted: 02/23/2011] [Indexed: 11/26/2022]
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