A review of risk and protective factors for adolescent sexual and reproductive health in developing countries: an update

Factors associated with HIV self-testing and PrEP use among Nigerian youth: Baseline outcomes of a pragmatic, stepped-wedge, cluster-randomized controlled trial

INTRODUCTION

Adolescents and young adults (AYA, 14-24 years) bear a disproportionate burden of new HIV infections in Nigeria and are more likely to have worse HIV outcomes compared to other age groups. However, little is known about their access to recommended sexual health care services, including HIV self-testing (HIVST), sexually transmitted infections (STI) testing, sexual behavior patterns, awareness and or access to pre-exposure prophylaxis (PrEP), and overall risk for HIV.

METHODS

We present a baseline analysis of the 4 Youth by Youth randomized controlled trial aimed to evaluate the uptake and sustainability of crowdsourced HIVST strategies led by and for young people across 14 states in Nigeria. None of the participants had received intervention at the time of completing this self-reported behavioral survey. We conducted a descriptive analysis to summarize participants' characteristics, sexual behavior, HIV testing, STI testing, and knowledge of PrEP and use across the study sample of the AYAs. We conducted a chi-square test, and the level of significance was set at ≤0.05.

RESULTS

A total of 1551 participants completed the baseline survey comprising males (777, 50.1 %) and females (774, 49.9 %). The majority (77 %) of the participants were students at enrollment. Very few of the participants had ever tested for syphilis, 47 (3.1 %), gonorrhea, 49 (3.2 %), chlamydia, 31 (2.0 %), and hepatitis B, 106 (6.9 %). 678 (43.8 %) of the participants reported to be sexually active at the time of enrolment into the study, of which about 38 % of them engaged in condomless sex. Paying for sex, alcohol use, and drug use are all significant sexual behaviors (p < 0.01). Only 14 (1 %) have ever used PrEP. 481 (31.4 %) have ever tested for HIV, and 104 (6.8 %) have ever used an HIV self-testing kit at baseline. 457 (38.6 %) were eligible for PrEP.

CONCLUSIONS

HIVST and STI uptake were low at baseline among the AYA in this study. Most AYAs also do not receive recommended sexual health care services, including STI testing services. This underlines the need for interventions to increase the uptake of HIV/STI prevention services among Nigerian AYA.

"Thanks to my activists Friends": a qualitative study of perspectives of young adults and professionals on the factors related to seeking support among victims of sexual violence in Spain

BACKGROUND

Sexual violence (SV) is a public health problem with high prevalence among the young population. The use of formal resources for SV care (e.g. institutional services) is low in this age group. This study applies a framework of health assets to identify the factors that positively influence the search for support for SV among young people, the functions of that support and the level of proximity as articulated by both young people and professionals.

METHODS

A qualitative study was conducted through 38 semi-structured interviews with young people and professionals from SV resource centers and/or care services for the young population in Spain. A thematic theoretical analysis was conducted, embedded in inductive insights emerging from the data, following a particular adaptation of the constant comparative method, under the grounded theory approach. This analysis was carried out by coding the interview transcripts with the support of Atlas.ti.

RESULTS

Young women identified assets, categorized as feminist, that they believe they are essential in the search for formal support services for SV. However, unlike young men, they considered the police and judicial system to be barriers and not assets. There were also differences between the young people and professionals in identifying assets. Young people also considered their partner and traditional media as health assets, in contrast to professionals who did not identify these as such valuable resources in the help-seeking process. Informal assets, such as family, friends and the internet are considered close resources. In contrast, specialized care services for gender-based violence/SV and the judicial and police systems were perceived as more distant resources among the young interviewees.

CONCLUSIONS

This study shows similarities and discrepancies among young women and men and SV response professionals in identifying assets for seeking SV support among youth. The study shows an inverse relationship between perceptions of proximity and the level of formality of the asset. This study also contributes to map the relationships and information exchanges between assets. It is advisable to inform professionals about the assets that professionals do not acknowledge, and about actions that allow young people to access formal resources.

A cross-sectional National Health and Nutrition Examination survey-based study of the association between systemic immune-inflammation index and blood urea nitrogen levels in United States adolescents

Blood urea nitrogen (BUN) level is one of the commonly used indicators to assess renal function and systemic immune-inflammatory status. In the adolescent population, changes in BUN levels may be associated with a variety of factors, including physiologic dehydration, lifestyle influences such as nutritional intake, physical activity, and possible endocrine or metabolic disorders. In recent years, more and more studies have shown that BUN levels are not only a reflection of kidney function, but it may also be related to the inflammatory state of the body. The Systemic Immune Inflammatory Index (SII) is a comprehensive index that takes into account platelet counts, neutrophil and lymphocyte counts, and is thought to be effective in reflecting the body's immune status and inflammatory response. However, research on the relationship between the two, SII and BUN, remains understudied in the adolescent population. The purpose of this study was to examine the relationship between SII and BUN levels in a population of American adolescents and to further analyze the factors that influence it. We conducted a cross-sectional study using data from the National Health and Nutrition Examination Survey (NHANES) database. Using descriptive statistics, correlation analysis, and regression analysis, we explored the relationship between SII and BUN levels. We found a significant negative correlation between SII and BUN levels, with BUN levels decreasing when SII levels increased (BUN as the dependent variable and SII as the outcome variable). We performed a multiple regression analysis of this relationship, controlling for possible confounders such as gender, age, race, and BMI, and found that this negative correlation remained significant. Our findings reveal an important relationship between SII and BUN levels and provide new perspectives for understanding adolescent health.

Associations of formal childcare use with health and human capital development for adolescent mothers and their children in South Africa: A cross-sectional study

AIM

This study aims to investigate associations of formal childcare with maternal and child outcomes in a large sample of adolescent mothers.

BACKGROUND

Forty percent of adolescent girls in Africa are mothers. Increasing evidence shows positive impacts of formal childcare use for adult women, but no known studies in the Global South examine associations for adolescent mothers and their children.

METHODS

We interviewed 1046 adolescent mothers and completed developmental assessments with their children (n = 1139) in South Africa's Eastern Cape between 2017 and 2019. Questionnaires measured childcare use, maternal and child outcomes and socio-demographic background variables. Using cross-sectional data, associations between formal childcare use and outcomes were estimated in multivariate multi-level analyses that accounted for individual-level and family-level clustering.

RESULTS

Childcare use was associated with higher odds of being in education or employment (AOR: 4.01, 95% CIs: 2.59-6.21, p < .001), grade promotion (AOR: 2.08, 95% CIs: 1.42-3.05, p < .001) and positive future ideation (AOR: 1.58, 95% CIs: 1.01-2.49, p = .047) but no differences in mental health. Childcare use was also associated with better parenting on all measures: positive parenting (AOR: 1.66, 95% CIs: 1.16-2.38, p = .006), better parental limit-setting (AOR: 2.00, 95% CIs: 1.37-2.93, p < .001) and better positive discipline (AOR: 1.77, 95% CIs: 1.21-2.59, p = .003). For the children, there were no differences in temperament or illness, but a significant interaction showed stronger associations between childcare use and better cognitive, language and motor scores with increasing child age (AOR: 5.04, 95% CIs: 1.59-15.96, p = .006).

CONCLUSIONS

Adolescent mothers might benefit substantially from formal childcare, but causal links need to be explored further. Childcare use was also associated with improved parenting and better child development over time, suggesting positive pathways for children. At an average of $9 per month, childcare provisions for adolescent mothers may offer low-cost opportunities to achieve high returns on health and human capital outcomes in Sub-Saharan African contexts.

Small-area estimation and analysis of HIV/AIDS indicators for precise geographical targeting of health interventions in Nigeria. a spatial microsimulation approach

BACKGROUND

Precise geographical targeting is well recognised as an indispensable intervention strategy for achieving many Sustainable Development Goals (SDGs). This is more cogent for health-related goals such as the reduction of the HIV/AIDS pandemic, which exhibits substantial spatial heterogeneity at various spatial scales (including at microscale levels). Despite the dire data limitations in Low and Middle Income Countries (LMICs), it is essential to produce fine-scale estimates of health-related indicators such as HIV/AIDS. Existing small-area estimates (SAEs) incorporate limited synthesis of the spatial and socio-behavioural aspects of the HIV/AIDS pandemic and/or are not adequately grounded in international indicator frameworks for sustainable development initiatives. They are, therefore, of limited policy-relevance, not least because of their inability to provide necessary fine-scale socio-spatial disaggregation of relevant indicators.

METHODS

The current study attempts to overcome these challenges through innovative utilisation of gridded demographic datasets for SAEs as well as the mapping of standard HIV/AIDS indicators in LMICs using spatial microsimulation (SMS).

RESULTS

The result is a spatially enriched synthetic individual-level population of the study area as well as microscale estimates of four standard HIV/AIDS and sexual behaviour indicators. The analysis of these indicators follows similar studies with the added advantage of mapping fine-grained spatial patterns to facilitate precise geographical targeting of relevant interventions. In doing so, the need to explicate socio-spatial variations through proper socioeconomic disaggregation of data is reiterated.

CONCLUSIONS

In addition to creating SAEs of standard health-related indicators from disparate multivariate data, the outputs make it possible to establish more robust links (even at individual levels) with other mesoscale models, thereby enabling spatial analytics to be more responsive to evidence-based policymaking in LMICs. It is hoped that international organisations concerned with producing SDG-related indicators for LMICs move towards SAEs of such metrics using methods like SMS.

Trends in Early Sexual Initiation and Its Association with Socio-Environmental Factors among Korean Adolescents

There has been no research on the trends in early sexual initiation associated with socio-environmental factors in Korea. This study aimed to examine the trends of early sexual initiation with various socio-environmental factors among adolescents. The Korea Youth Risk Behavior Web-based Survey data were used, and two pooled datasets extracted from the 2006-2008 and 2014-2016 waves were conducted and compared. In this study, early sexual initiation was defined as sexual intercourse at the age of 13 years or younger. The weighted percentage and 95% confidence interval reporting early sexual initiation were estimated, and multiple logistic regression was performed for each subgroup of socio-environmental variables with the 2006-2008 pooled data as a reference. Regardless of sex, the weighted percentage of adolescents with sexual experience who reported early sexual initiation increased in 2014-2016 with statistical significance in most cases. Moreover, the possibility of experiencing early sexual intercourse overtime was more prominent among girls than boys. While indifference to adolescent sexual behavior continues, more adolescents become involved in early sexual initiation. Socio-environmental considerations, such as the establishment of safe environments for adolescents' sexual activity, along with systematized monitoring mechanisms, should be administered.

Prevalence and factors associated with adolescent pregnancies in Zambia: a systematic review from 2000-2022

BACKGROUND

Adolescent pregnancy increases risk of short- and long-term adverse social and health outcomes for the adolescent mother and child. Zambia has high prevalence rates of adolescent pregnancy. However, the risk factors are varied and in need of further review and research. The study accordingly reviewed the prevalence and factors associated with adolescent pregnancy in Zambia.

METHODS

This systematic review was conducted following the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The review included original peer-reviewed research articles published from 2000 onwards in English, retrieved from Medline, EMBASE, CINAHL, and African Journals Online databases. Thematic synthesis was used in the analysis of the data extracted from the included studies.

RESULTS

Six research studies carried out in Zambia (two quantitative, two qualitative, and two mixed methods) were reviewed and included. Prevalence of adolescent pregnancy in Zambia ranged from 29 to 48%. Additionally, it was found that 29.1% of the country's adolescents, nationally, had given birth as of 2018. Factors at an individual's level such as early or child marriage, exposure to media, knowledge about sexual and reproductive health (SRH) and contraception, contraceptive use, as well as risky sexual behaviours were found to be significantly associated with adolescent pregnancy. Peer pressure, educational attainment, household wealth, and the power dynamics of the household head were identified as the major socio-economic factors alongside socio-cultural, gender and sexual norms amongst other environmental and contextual factors. Policy level factors identified were lack and limited access to SRH information and services by adolescents, including an enabling legal environment.

CONCLUSION

From the review, it was abundantly clear that a combination of individual, interpersonal, environmental, and an enabling legal/policy level factors significantly contribute to the high levels of adolescent pregnancy. There is a paucity of empirical research on the prevalence and determinants of adolescent pregnancy, which suggests an imperative need for large multi-site mixed methods studies to properly explore these and other determinants on a national scale, as well as the long-term implications of these pregnancies on adolescent mothers and babies. Multifaceted and multisectoral interventions which include improved access to education, economic empowerment, addressing gender and socio-cultural norms, should be implemented having due regard to the socio-cultural context which should ride on strong political will, failing which adolescent girls in Zambia will definitely be left behind.

Achieving the health and well-being Sustainable Development Goals among adolescent mothers and their children in South Africa: Cross-sectional analyses of a community-based mixed HIV-status cohort

The Sustainable Development Goals (SDGs) are a visionary and multi-sectoral agenda for human development. With less than a decade left to reach these targets, it is important to identify those at greatest risk of not meeting these ambitious targets. Adolescent mothers and their children are a highly vulnerable group. We mapped 35 SGD-related targets among 1,046 adolescent mothers and their oldest child (n = 1046). Questionnaires using validated scales were completed by 10- to 24-year-old adolescent girls and young women who had their first child before age 20 in an HIV-endemic district in the Eastern Cape province of South Africa. Maternal outcomes included 26 SDG-aligned indicators, while child-related outcomes included 9 indicators. Data was collected by trained researchers, following informed voluntary consent by the adolescent mothers and their caregivers. Frequencies and chi-square tests were conducted to compare progress along SDG-aligned indicators among adolescent mothers by HIV status. Overall, adolescent mothers reported low attainment of SDG-aligned indicators. While four in five adolescent mothers lived in poor households, nearly 93% accessed at least one social cash transfer and 80% accessed a child support grant for their children. Food security rates among adolescent mothers (71%) were lower than among their children (91%). Only two-thirds of adolescent mothers returned to school after childbirth, and only one-fifth were either studying or employed. Over half of adolescent mothers had experienced at least one type of violence (domestic, sexual or community). HIV-positive status was associated with higher rates of hunger and substance use, poorer school attendance, and higher rates of exposure to violence. Understanding progress and gaps in meeting the SDGs among highly vulnerable groups is critical, particularly for adolescent mothers and their children. These complex vulnerabilities suggest that programming for adolescent mothers must address their unique needs.

Environmental scan of mobile apps for promoting sexual and reproductive health of adolescents in low- and middle-income countries

Background

Adolescence is a period of emotional, mental, and physical change. To increase health seeking behaviors, reduce risky sexual behavior, and improve sexual and reproductive health (SRH) knowledge, adolescents require support and access to SRH services. Providing evidence-informed SRH knowledge to adolescents in low- and middle-income countries (LMICs) can be a challenge as they face unique barriers such as lack of confidentiality, fear of refusal, and stigma from cultural norms. Increasing availability of mobile apps necessitates a comprehensive evaluation of the quality and classification of these SRH mobile applications so that accurate and evidence-based information is reaching its users. Failure to provide SRH services can have damaging effects throughout their development.

Objective

Provide an overview of current adolescent SRH (ASRH) mobile applications targeting adolescents in LMICs by evaluating their quality and classifying their characteristics.

Methods

21 search terms related to ASRH mobile apps was developed. These terms were searched in the Apple IOS store and Google Play stores. Inclusion and exclusion criteria were used to screen these apps. Resulting apps were assessed using the Mobile App Rating Scale (MARS) tool. Data extracted was used to rank order each app and identify any gaps in quality.

Results

Search strategy yielded 2,165 mobile apps. Of these, only 8 were assessed using the MARS tool. Functionality subdomain scored highest at 4.6, while Information scored lowest at 2.5. None of the assessed apps contained information on the MARS items: Evidence base and Goals. Too Shy to Ask had the highest individual app mean score of 4.1, while e-SRHR scored lowest at 2.3.

Conclusions

The goal of this study is to classify and rate the quality of mobile apps designed to promote ASRH behaviors and knowledge in LMICs. Numerous apps were reviewed and all of them failed to provide evidence-based and goal oriented SRH information. Strengths include ease of use, navigation, and gestural designs. Weaknesses include evidence base, goals, willingness to pay, customization, and interactivity. These findings can be potentially used to guide future app development and educate decision makers responsible for policy changes.

Patterns of University Students' Risky Sexual Experiences and Their Characteristics

In Poland, there is little research on university students' risky sexual behaviours. Additionally, existing studies analyse the behaviours selectively and do not group them into clusters. Hence, effective prevention is impossible. The research aims to gather information regarding the prevalence, forms and clusters of students' risky sexual experiences. In 2019, a cross-sectional study was conducted in 12 universities in south-eastern Poland on a random sample (n = 2764). Fifteen risky sexual experiences, both condom-protected and unprotected, were analysed; they were mainly unprotected vaginal, oral, anal contacts; protected and unprotected sexual experiences while intoxicated and with unknown persons. Thanks Ward's hierarchical method, four inseparable clusters of students with similar risky experiences were distinguished. Their dominant features were: (A) (24% of interviewees)-drunk partners, (B) (4.8%)-partners intoxicated with drugs, (C) (3.1%)-partner abuse and exceeding partner sexual norms, (D) (17.8%)-the anonymity of partners and going beyond the convention. It was stated that 60.3% of the respondents do not belong to any of the identified clusters. Sex education and the promotion of student sexual health should be intensified; the development of attitudes of avoiding risky sexual behaviours and dealing with their consequences should be considered.

Sexual attitudes and associated factors of risky sexual behaviors among university students

INTRODUCTION

Risky sexual behaviors. Adequate awareness of reproductive health in young people is important because they are in the early years of fertility, and engaging in risky sexual behaviors is more probable. This study aimed to evaluate the sexual attitude and associated factors of risky sexual behaviors among girls and boys and the difference in sexual norms by gender among university students.

METHODS

A university-based study with a cross-sectional survey was conducted for 9 months in 2019. A total of 800 university students were studied by a random sampling technique using a self-administered structured questionnaire derived from the World Health Organization illustrative questionnaire to assess sexual attitudes among adolescents and young adults.

RESULTS

Most of the respondents were female and single. Girls were more religious, more frequently visited the cinemas and were more likely to discuss sex matters with family members than boys. There was no significant difference in the total score of sexual attitudes in girls and boys, and both genders had negative attitudes toward risky sexual behavior (42/72). Those who go to parties, bars, or movies are more likely to have risky sexual behavior. Being a religious person is an essential predictor of having less risky behavior (RR = 2.02, 95% CI = [0.96, 3.41]).

CONCLUSION

Being religious was a protective factor for engaging in risky sexual behavior. More interventions in schools and universities need to educate students to enhance awareness about the consequences of risky sexual behavior and reduce its rate.

Sexual and reproductive health and rights of "last mile" adolescents: a scoping review

Globally, significant progress has been made in the realm of adolescent sexual and reproductive health. We conceptualised "last mile" adolescents as having two or more of the following factors of identity: refugee, Indigenous, 2SLGBTQIA+, out of school, rurally or remotely located, slum dwelling, incarcerated or previously incarcerated, HIV/AIDS infected, and living with a disability. We conducted a scoping review with an aim to synthesise evidence and identify research gaps in the literature pertaining to the sexual and reproductive health and rights (SRHR) of last mile adolescents. We conducted searches in three databases (Embase, Global Health, and Medline). Fifty-four publications met our inclusion criteria. Our results revealed that the state of evidence on the SRHR of last mile adolescents is poor. Very few studies used qualitative and mixed-method inquiry. The number of studies carried out in North America, Europe, and Oceania were limited. We found insufficient disaggregated data with respect to SRHR-related knowledge, behaviour, and access to services. Adopting an intersectional lens is critical to uncover the multiplicative effects of last mile adolescents' factors of identity on their SRHR. National data systems should be strengthened to enable the collection of quality disaggregated data which can play a vital role in identifying SRHR inequities affecting last mile adolescents. Research priorities should be realigned to generate data globally on the SRHR of last mile adolescents whose lives are marked by intersecting vulnerabilities.

Perspectives of Adolescents, Parents, Service Providers, and Teachers on Mobile Phone Use for Sexual Reproductive Health Education

Mobile health (mHealth) programs offer opportunities to improve the sexual and reproductive health (SRH) of adolescents by providing information. This paper reports the findings of a study carried out in Homabay County, Kenya, to assess stakeholders’ perspectives on access to and use of mobile phones by adolescents for SRH education. We aimed to establish whether mobile phones could facilitate access to SRH information by adolescents and the barriers to be addressed. This was a qualitative exploratory study involving adolescents, parents, teachers, health care workers, and community health volunteers. Data were collected through focus group discussions (FGDs) and key informant interviews (KIIs), and were analyzed through thematic and content analysis. Respondents lauded mHealth as an effective and efficient approach to adolescent SRH education with a potential to promote the learning of useful SRH information to influence their behavior formation. Respondents pointed out bottlenecks such as the limited ownership of and inequitable access to phones among adolescents, logistical barriers such as lack of electricity, internet connectivity, and the impact of phones on school performance, which must be addressed. The usefulness of mHealth in adolescent SRH education can be enhanced through inclusive program formulation and co-creation, implemented through safe spaces where adolescents would access information in groups, and supported by trained counselors.

The Relationship Between Sexual Intercourse Before the age of 13 and Alcohol, Tobacco, and Other Drug use among High School Students

Research has indicated that early sexual intercourse in high school is associated with poor health outcomes such as unintentional pregnancy and sexually transmitted infections (STIs). What is lacking in the research is an understanding of the relationship between even earlier sexual initiation (i.e., before the age of 13) and alcohol, tobacco, and other drug (ATOD) use behaviors. As such, the purpose of this study was to assess whether sexual intercourse younger than 13 years of age was predictive of ATOD use among students currently in high school. Data was derived from the 2015 Youth Risk Behavior Survey (n = 15,624). This national study is conducted every odd year, and is a representative sample of high school students in the United States. Logistic regression was used to determine the relationship between sexual initiation younger than 13 years of age and current ATOD use among high school students. The results of this study found that early sexual initiation was predictive of current high school ATOD use with students who had initiated early sexual intercourse having significantly higher prevalence rates among all variables measured. The results of this study indicates health education regarding ATOD use, as well as sexual health education should be introduced to US student at an earlier age. These results indicate that continued education is needed in the pre-teen years to prevent early health risk behaviors in our youth.

Transition in social risk factors and adolescent motherhood in low- income and middle- income countries: Evidence from Demographic and Health Survey data, 1996-2018

Understanding the dynamics of social risk factors in the occurrence of adolescent motherhood is vital in designing more appropriate prevention initiatives in low-income and middle-income countries (LMICs). We aimed this study to examine the transition of social risk factors and their association with adolescent motherhood in LMICs since the initiation of the MDGs. We analysed 119967 adolescent girls (15-19 years) from 40-nationally representative Demographic Health Surveys in 20 LMICs that had at least two surveys: a survey in 1996-2003(baseline, near MDGs started) and another in 2014-2018(endline). Adolescent motherhood (having a live birth or being pregnant before age 20) was the outcome of interest, whereas social risk factors including household wealth, girls' level of education, and area of residence were the exposures. The association between adolescent motherhood and the social risk factors, as well as changes in the strength of the association over time were observed using multilevel logistic regression analysis. On an average, the proportion of adolescent mothers without education decreased by -15·61% (95% CI: -16·84, -14·38), whereas the poorest adolescent mother increased by 5·87% (95% CI: 4·74, 7·00). The national prevalence of adolescent motherhood remained unchanged or increased in 55·00% (11/20) of the studied countries. Comparing baseline to endline, the overall adjusted odds ratio (AOR) of adolescent motherhood increased for both poorest (AOR = 1·42, 95% CI: 1·28, 1·59) and rural residences (AOR = 1·09, 95% CI: 1·01, 1·17), and decreased, but not statistically significant for the low level of education (AOR = 0·92, 95% CI: 0·84, 1·01 for no education). Our study concludes that social risk factors of the adolescent mother had shifted in different directions during MDGs and SDGs eras, and adolescent mothers remained more disadvantaged than non-mothers in LMICs. Efforts need to be enhanced to improve adolescent girls' education. Intervention should be prioritised in disadvantaged communities to delay adolescent first birth and prevent adolescent motherhood in LMICs.

Association between Teenage Pregnancy and Family Factors: An Analysis of the Philippine National Demographic and Health Survey 2017

Adolescence is a key developmental period in one’s life course; health-related behaviors of adolescents can be linked to lifelong consequences, which affect their future health. Previous studies highlight the role of family and its significant association with adolescents’ health. In East Asia and the Pacific, the Philippines is the only country that is showing an upward trend of teenage pregnancy while other countries in the region have declining teenage pregnancy rates. Against this backdrop, this study investigated the association between teenage pregnancy and family factors, specifically parent structure. Data for the study were extracted from the Philippine National Demographic and Health Survey 2017. All adolescent women aged 15–19 years old (n = 5120) were included in the analyses. The dependent variable was teenage pregnancy, while parent structure, defined as a presence or absence of parents in the domicile, was the exposure variable. Multivariable logistic regression was utilized in assessing the association of teenage pregnancy and family factors after adjusting for several potential confounders. Adolescent women were more likely to become pregnant as a teenager when they lived with neither parent (aOR = 4.57, 95% CI = 2.56–8.15), were closer to 19 years of age (aOR = 2.17, 95% CI = 1.91–2.46), had knowledge of contraception (aOR = 1.27, 95% CI = 1.22–1.32) and lived in a big family (aOR = 1.14, 95% CI = 1.09, 1.20). Furthermore, adolescent women who lived with neither parent and belonged to the poorest wealth quintile were more likely to become pregnant as a teenager (aOR = 3.55, 95% CI = 1.67–7.55). Conversely, educational attainment higher than secondary education (aOR = 0.08, 95% CI = 0.01–0.49) and those who belonged to the richest wealth quintile (aOR = 0.40, 95% CI = 0.18–0.92) exhibited a statistically inverse association with teenage pregnancy compared with those with no education and from the middle wealth quintile, respectively. Living with neither parent was found as a risk factor for teenage pregnancy. Furthermore, we found that several sociodemographic factors exhibited a non-uniform increment and reduction in the risk of teenage pregnancy.

Interventions to Promote a Healthy Sexuality among School Adolescents: A Scoping Review

Schools are particularly suitable contexts for the implementation of interventions focused on adolescent sexual behavior. Sexual education and promotion have a multidisciplinary nature. Nurses' role and the spectrum of the carried-out interventions is not clear. We aimed to identify interventions that promote a healthy sexuality among school adolescents. Our review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews and was registered in the Open Science Framework. Published articles on sexuality in adolescents in school contexts were considered. The research limitations included primary studies; access in full text in English, Spanish, or Portuguese; and no data publication limitation. Research was carried out on the EBSCOhost, PubMed, SciELO, and Web of Science platforms; gray literature and the bibliographies of selected articles were also searched. A total of 56 studies were included in the sample. The studies used a broad range of research methods, and 10 types of interventions were identified. Multi-interventional programs and socio-emotional interventions showed a greater impact on long-term behavioral changes, and continuity seemed to be a key factor. Long-term studies are needed to reach a consensus on the effectiveness of interventions. Nurses' particular role on the multidisciplinary teams was found to be a gap in the research, and must be further explored.

The pattern of romantic and sexual related experiences among Chinese young adolescents: an exploration with multi-group latent class analysis

Background

Studies on very young adolescents’ romantic and sexual experiences would help inform the context in which early sex arises. However, such studies are scant in China due to sparse data and cultural issues.

Method

This study used the GEAS baseline data conducted among1776 adolescents in Shanghai. Multi-group latent class analysis was used to explore adolescents’ romantic and sexual experiences patterns and subgroups. Multi-nominal logistic regression was performed to identify the factors distinguishing different subgroups subsequently.

Results

There were gender differences in the lifetime prevalence for very young adolescents’ romantic and sexual-related behaviors. The Multi-group latent class analysis indicated that the participants could be classified into three classes: general group, early romance group, and sex exploratory group. Multi-nominal logistic regression showed youth in the early romance group were more likely to had friends of both gender, ever had a romantic relationship, and had more autonomy in deciding where to go than the general group; while male respondents in the sex exploratory group were older, ever had a romantic relationship, believed that boys should be more sexually active and more proactive than girls, had more autonomy on deciding where to go, and perceived less school connection and neighborhood cohesion. Female respondents in the sex exploratory group were older and less empowered in decision-making than the general group.

Conclusions

The result provides a picture of romantic and sexual behavior patterns among both gender of very young adolescents in China. Current sex education needs not only to be culturally appropriate but also to address the harm of gender inequality and stereotypes, as well as to provide accessible and supportive services to help young adolescents personalize their received information and strengthen their skills in communication, decision making, and critical thinking.

Studies on teenagers' romantic and sexual experiences would help to prevent early sex arises before it really takes place. However, such studies are limited, especially in China. The traditional culture thought that youth should not start romance before college. This study used the Global Early Adolescent Study Shanghai site baseline data collected among1776 teenagers to explore their romantic and sexual experiences patterns and identify the influencing factors. There were significant gender differences in teenagers’ romantic and sexual-related behaviors. According to the multi-group latent class analysis, we classified the teenagers into three classes: the general group, the early romance group, and the sex exploratory group. The multi-nominal logistic regression showed youth in the early romance group were more likely to had friends of both boys and girls, ever had boyfriend/girlfriend and were freer to go out than the general group; while boys in the sex exploratorygroup were older, ever had a boyfriend/girlfriend, believed it was normal for boys to be sexually active than girls, had more freedom to go out, and had less perception of care from school adults and neighborhood. Girls in the sex exploratory group were older and less likely to make decisions on their own. Given the result we found, we call for health researchers and educators to conduct sex education programs promoting more equal gender norms and provide services to help young adolescents get right information and strengthen their skills in communication, decision making and critical thinking.

Social and Behavioral Correlates of Adolescent Sexual Experience and Intention to Use Condoms in Northwestern Botswana

Adolescent sexual behavior is shaped by individual, social, and structural factors that can increase HIV-risk, unwanted pregnancy, and sexually transmitted disease. To inform the development of a comprehensive sexuality education program, 239 secondary school adolescents ages 14–19 in Maun, Botswana, completed a survey of sexual and reproductive health knowledge, attitudes, and behaviors in February–March 2020. Bivariate and multivariate analyses examined factors associated with sexual experience and perceived ability to insist on condoms. Approximately 21% of respondents reported having had sexual intercourse. More than half felt able to insist on condoms. Sources of information about human reproduction, alcohol use, attitudes about when sex is acceptable, and perceived sexual activity by one’s peers were predictive of sexual experience. Age, confidence in correct condom use, perceived acceptability of adolescent sex with condoms, and endorsement of prevailing gender norms were significantly associated with perceived ability to insist on condom use.

Level of Implementation Fidelity of Youth-Friendly Services in Northwest Ethiopia

Background

Youth-Friendly Services (YFS) is an evidence-based public health intervention aimed to reduce sexual and reproductive health problems among youth. To achieve the desired outcomes, YFS has to be implemented with a high level of fidelity. However, there is an evidence gap in its implementation with fidelity. Hence, the main objective of the study was to describe the level of implementation fidelity of YFS among public health centers in Central Gondar Zone, northwest Ethiopia. Therefore, this study investigated the level of implementation fidelity of YFS among public health centers in Central Gondar Zone, northwest Ethiopia.

Methods

An institutional-based cross-sectional study was conducted from September to December in 2019. A total of 1029 youths, who came to 11 health centers where YFS has been implemented were randomly selected. A validated tool, comprised of 65 Likert scaled items, designed to measure the three dimensions of fidelity was used to collect data. Face to face clients exit interview approach was used to collect the data. Summary statistics were calculated for each fidelity dimension first, and then the overall fidelity of implementation score was computed.

Results

Overall, only 48 (4.7%; 1.6–11.3%) of youth received the YFS with a high level of implementation fidelity. Whereas 770 (74.8%; 57.6–90.5%) and 211 (20.5%; 912.7–31.0%) of youth received the YFS with a medium and low level of implementation fidelity, respectively. Considering each fidelity dimension, 241 (23.4%) youth received the YFS with a high level of adherence, 212 (20.6%) received the YFS with a high level of the structural quality of care, 323 (31.4%) received the YFS with a high level of process quality of care, 508 (49.3%) received the YFS with a high level of outcome quality of care, and 114 (11.1%), received the YFS with a high level of participant responsiveness.

Conclusion

The identified low level of implementation fidelity of YFS indicates the urgent need to strengthen the YFS by the government and programmers. Further studies that can address barriers to the implementation fidelity of Youth-Friendly Services are recommended. In addition, further analysis to know the factors that may influence the fidelity of YFS are recommended.

Seeking synergies: understanding the evidence that links menstrual health and sexual and reproductive health and rights

Global efforts to improve menstrual health and sexual and reproductive health and rights (SRHR) are fundamentally intertwined and share similar goals for improving health and well-being and increasing gender equality. Historically, however, the two fields have operated independently and missed opportunities to build upon their biological and sociocultural linkages. Biological touchpoints connecting the two fields include genital tract infections, menstrual disorders, contraception, and menopause. From a sociocultural perspective, intersections occur in relation to the experience of puberty and menarche, gender norms and equity, education, gender-based violence, and transactional sex. We describe evidence linking menstrual health and SRHR and offer recommendations for integration that could strengthen the impact of both fields.

Trends in teenage motherhood in Ecuador: challenges and inequalities

OBJECTIVES

To describe trends in teenage motherhood (TM), based on the socioeconomic groups teenagers belong to, and factors related to their first experience of heterosexual intercourse (FEHI). We took into consideration women aged 20-24 years, comparing three surveys from 1999, 2004, and 2012.

METHODS

We obtained data from the Ecuadorian Demographic and Health Surveys about 4,696 women aged 20-24 years who had given birth as teenagers. Prevalence ratios and their confidence intervals (95% CI) were calculated to estimate changes in socioeconomic inequalities and factors related to the FEHI.

RESULTS

The prevalence of TM increased from 48% in 1999 to 60% in 2012 among women with complete primary education. The social gradient among socioeconomic groups were sustained. We detected no changes in the socioeconomic inequalities characterizing TM, and in the factors related to the FEHI across the three studies in Ecuador.

CONCLUSIONS

Socioeconomic inequalities in TM and disadvantageous circumstances at FEHI remained unchanged for 14 years. Some factors are vital for reducing teenage motherhood in Ecuador: gender-equitable economic development, access to comprehensive-sexual education, contraception, health services, and safe abortion.

Early sexual debut: A multi-country, sex-stratified analysis in sub-Saharan Africa

This study examined outcomes associated with early sexual debut in five sub-Saharan African countries for males and females, separately. We employed Violence Against Children Surveys (VACS) from Kenya, Malawi, Nigeria, Tanzania, and Uganda, restricting samples to males and females age 18-24 years. Early sexual debut was defined as having one's first sexual intercourse before 15. Logistic, Ordinary Least Squares, and Poisson regressions were utilised to estimate associations between early sexual debut and outcomes across four ecological domains: individual, family, peer/partner, and community. Regressions were stratified by sex. The prevalence of early sexual debut ranged from 8.6% in Tanzania to 17.7% in Malawi. Males were more likely to report early sexual debut in Kenya (16.3%, compared to 6.7% for females; P < 0.001) and Uganda (15%, compared to 10.4% for females; P = 0.037). In Nigeria, 14.5% of females reported early sexual debut, compared to 5.4% of males (P < 0.001). Early sexual debut was associated with only one outcome in the individual and family domains, and was most consistently associated with outcomes in the peer/partner domain. Differences in these relationships for males and females suggest programs and policies working to reduce early sexual debut and promote healthy sexual relationships among young adolescents should thoughtfully consider framing messaging through a gendered lens.

Female adolescents' reproductive health decision-making capacity and contraceptive use in sub-Saharan Africa: What does the future hold?

INTRODUCTION

Given the social, economic, and health consequences of early parenthood, unintended pregnancy, and the risks of HIV infection and subsequent transmission, there is an urgent need to understand how adolescents make sexual and reproductive decisions regarding contraceptive use. This study sought to assess the association between female adolescents' reproductive health decision-making capacity and their contraceptive usage.

MATERIALS AND METHODS

Data was obtained from pooled current Demographic and Health Surveys (DHS) conducted in 32 countries in sub-Saharan Africa (SSA). The unit of analysis for this study was adolescents in sexual unions [n = 15,858]. Bivariate and multivariable analyses were conducted using Pearson chi-square tests and binary logistic regression respectively. All analyses were performed using STATA version 14.2. Results were presented using Odds Ratios [OR] and adjusted Odds Ratios [AOR]. Statistical significance was set at p<0.05.

RESULTS

The results showed that 68.66% of adolescents in SSA had the capacity to make reproductive health decisions. The overall prevalence of contraceptive use was 18.87%, ranging from 1.84% in Chad to 45.75% in Zimbabwe. Adolescents who had the capacity to take reproductive health decisions had higher odds of using contraceptives [AOR = 1.47; CI = 1.31-1.65, p < 0.001]. The odds of contraceptive use among female adolescents increased with age, with those aged 19 years having the highest likelihood of using contraceptives [AOR = 3.12; CI = 2.27-34.29, p < 0.001]. Further, the higher the level of education, the more likely female adolescents will use contraceptives, and this was more predominant among those with secondary/higher education [AOR = 2.50; CI = 2.11-2.96, p < 0.001]. Female adolescents who were cohabiting had higher odds of using contraceptives, compared to those who were married [AOR = 1.69; CI = 1.47-1.95, p < 0.001]. The odds of contraceptive use was highest among female adolescents from the richest wealth quintile, compared to those from the poorest wealth quintile [AOR = 1.65; CI = 1.35-2.01, p<0.001]. Conversely, female adolescents in rural areas were less likely to use contraceptives, compared to those in urban areas [AOR = 0.78; CI = 0.69-0.89, p < 0.001].

CONCLUSION

The use of general and modern contraceptives among adolescents in SSA remains low. Therefore, there is a need to strengthen existing efforts on contraceptives usage among adolescents in SSA. This goal can be achieved by empowering these young females, particularly those in the rural areas where the level of literacy is very low to take positive reproductive health decisions to prevent unintended teenage pregnancy, HIV/AIDs and other sexually transmitted infections. This approach would help reduce maternal mortality and early childbirth in studied SSA countries.

Adolescent pregnancy and social norms in Zambia

Early pregnancy occurs frequently in Zambia and is considered a public health issue. The aim of this study was to improve understanding of how gendered sexual norms make young unmarried girls vulnerable to unintended pregnancies in a specific context. It combined individual interviews and focus group discussions with girls and boys aged 13-18 years and the parents of other young people of this same age, with peer interviews with girls aged 13-20 years at four sites in the southern province of Zambia. For girls, sexual relationships and early pregnancies were at odds with dominant norms and were consistently met with disapproval because they led to economic difficulties for young women and their parents, school dropouts and health problems for the young woman and her baby. Lack of resources and insufficient knowledge about sexuality and reproduction, together with gender norms governing sexual behaviour and contraceptive use, combine to place adolescent girls in a vulnerable position with respect to unintended pregnancy.

Access to Adolescent Pregnancy Prevention Information and Services in Ghana: A Community-Based Case-Control Study

Background: Pregnancy among girls 10-19 years remains a challenge that requires critical resolution all over the world. Despite this worrying sexual phenomenon, research pertaining to prevention information and related services in Sub-Saharan nations like Ghana is sparse. This study sought to determine the influence of access to pregnancy prevention information and services on adolescent pregnancy in the Komenda-Edina-Eguafo-Abrem Municipality in the Central Region of Ghana. Methods and Results: Adopting a matched case-control research design with a 1:1 mapping, female adolescents aged between 15 and 19 years in the KEEA Municipality were selected using a facility based sampling technique. Results from both bivariate and multivariate analyses revealed that non-pregnant adolescents were about two times more likely to have access to pregnancy prevention information from health workers compared to pregnant adolescents [OR = 0.57, 95% CI = (0.33-0.96), p = 0.036]. Likewise, pregnant adolescents were five times more likely to have access to pregnancy prevention information from media compared to non-pregnant adolescents [OR = 5.44, 95% CI = (2.64-11.23), p = 0.000]. Additionally, non-pregnant adolescents were two times more likely to receive information on pregnancy prevention from school compared to pregnant adolescents [OR = 0.48, 95% CI = (0.28-0.81), p = 0.006]. Conclusion: Sexuality and reproductive health (SRH) programme organizers should target specific intervention programmes that focus on training health workers and/or other analogous staff to enhance their awareness, attitudes, and skills to more effectively meet with the specific needs of adolescents. Specific health workers training and redesign of health facilities to foster more adolescent user friendly working environment (e.g., extension in operational times, reduction in fees of SRH services, transforming physical design to promote privacy or confidentiality) ought to be encouraged. Different media outreach programmes should also combine other community level events [e.g., informative methods through schools (e.g., focus group discussions, participatory learning), assisting connections to health services, community information network (e.g., use of sirens)] to provide well-tailored advocacy that would help modify SRH and sociocultural norms that hinder positive sexual behaviors among young people.

Strength-based interventions for HIV prevention and sexual risk reduction among girls and young women: A resilience-focused systematic review

Despite significant public health efforts, girls and young women still face gender-specific barriers to achieving optimal physical and mental health. Public health interventions have historically addressed the health needs of girls and young women using risk-focused, or deficit-based, approaches. Emerging research in public health and prevention provides an alternative approach, focusing instead on strengths and resilience. However, evidence remains limited regarding strength-based interventions to improve health outcomes for young women, including outcomes within the critically important areas of sexual and reproductive health. To address this gap in evidence, this review analyses the evidence base for intervention research using a strength-based resilience-focused approach to reduce HIV and sexual risk for girls and young women globally. A systematic search of published literature identified 35 articles, representing 25 unique interventions (N = 25). These interventions employed in-person, and other engaging methods, to deliver intervention content aimed at fostering resilience and changing sexual risk behaviours. Results also highlight gaps in measurement and study design, as well as variation in geographic setting and level of behaviour change. This review draws attention to the potential growth of strength-based intervention research, and offers future directions for developing and expanding research on resilience as an urgent global public health priority.

Perceptions and intervention preferences of Moroccan adolescents, parents, and teachers regarding risks and protective factors for risky sexual behaviors leading to sexually transmitted infections in adolescents: qualitative findings

BACKGROUND

Sexual choices and practices of adolescents living in conservative societies, including Morocco, can be influenced either positively or negatively by the prevailing contextual and social norms. These norms not only limit the access to reproductive health information and services but also lead to abstinence among devout adolescents. Thus, identifying contextual risks and protective factors of risky sexual behaviors leading to sexually transmitted infections (STIs) in adolescents, as well as exploring perceptions of adolescents, parents and teachers regarding effective intervention preferences could improve the sexual health of adolescents.

METHODS

We conducted a qualitative study using focus group discussions (FGDs) based on the socio-ecological model as a theoretical framework. Sample groups of adolescents, parents, and teachers were selected from two public middle schools (disadvantaged and advantaged according to socio-economic level) in Taza city, Morocco, from May to July 2016. Participants were polled on protective factors and perceived facilitators of risky sexual behaviors leading to sexually transmitted infections (STIs) in adolescents as well on their perception of intervention preferences to reduce the risks. Three sets of data were initially formed, coded, and analyzed using thematic analysis.

RESULTS

Seventeen FGDs were conducted, including 8 groups of adolescents (28 boys and 28 girls, 14-16 years old), 5 groups of parents (21 males and 5 females), and 4 groups of teachers (13 males and 5 females). Five overall themes seemed to influence risky sexual behaviors in adolescents: (1) risky sexual practices and STIs; (2) the adolescent's social domain; (3) the role of school; (4) media, including internet and social media; and (5) socio-cultural norms. Participants also suggested a number of possible interventions to improve the sexual health of adolescents and to reduce the risk of STIs, which could be applied at multiple levels.

CONCLUSIONS

Successful intervention programs should target the multifaceted factors affecting the adolescent's sexual behaviors, from the individual to the societal level. Allowing parents, teachers, and adolescents to work together could help reduce the socio-cultural and personal barriers that prevent effective communication about sexuality. Furthermore, schools can play a vital role in reducing risky sexual behaviors and STI acquisition rates in adolescents by promoting sex education in school curriculum and encouraging adolescents to engage in extracurricular activities and awareness campaigns.

Risky sexual behaviors and their association with overweight and obesity among adolescent students: a cross-sectional study

OBJECTIVE

To determine the prevalence of risky sexual behavior and its association with overweight and obesity among adolescent students.

METHODS

This is a cross-sectional study, conducted in public schools with adolescents aged 12 to 17 years. We used the questionnaire Youth Risk Behavior Survey. The body mass index percentiles were calculated by means of table from the Center for Control and Prevention of Diseases. Possible associations were assessed using the χ2 test and binary logistic regression model. The odds ratio and 95%CI were calculated.

RESULTS

We evaluated 1,169 students, and 33.9% reported having had sexual intercourse. Of those, 33% did not use a condom during their last intercourse, and 32.7% had had four or more sexual partners thus far. Regarding nutritional status, 15.3% were overweight or obese. In relation to the non-use of condoms, we observed only an association with the number of lifetime sexual partners (OR: 0.50; 95%CI: 0.28-0.88). The number of lifetime sexual partners was associated with males (OR: 9.17; 95%CI: 4.16-20.22), sexual debut age at 13 years or less (OR: 2.51; 95%CI: 1.23-5.13) and drinking alcohol or using drugs before the last intercourse (OR: 6.16; 95%CI: 2.14-17.73).

CONCLUSION

Risky sexual behavior rates were high and no association was found between risky sexual behaviors and overweight and obesity.

Sexual Risk Behavior: a Multi-System Model of Risk and Protective Factors in South African Adolescents

Adolescent sexual risk behavior has typically been studied within singular, isolated systems. Using a multi-system approach, this study examined a combination of individual, proximal, and distal factors in relation to sexual risk behavior among adolescents. A large cross-sectional sample of 2561 adolescent (M_age = 14.92, SD_age = 1.70) males (n = 1282) and females in Grades 8 (n = 1225) and 10 completed a range of self-report measures. Hierarchical ordinal logistic regression results supported a multi-system perspective of adolescent sexual risk behavior. Although individual and peer levels were identified as the primary contributors to the final model, a range of factors at varying levels of proximity to the individual were associated with sexual risk behavior. Specifically, being male, black, attaining increased age, greater alcohol use (individual level), parent risk behavior (family/home level), and peer risk behavior, feeling more pressure from peers to have sex (peer level), and lower social cohesion (community level) were associated with increased sexual risk behavior. These findings suggest multiple individual, proximal, and distal factors are salient to understanding sexual risk behavior among adolescents. Implications of the findings for interventions targeting the prevention of adolescent sexual risk behavior are discussed.

Barriers to contraceptive use among adolescents in two semi-rural Nicaraguan communities

Objective To identify barriers to contraceptive use among adolescents in two neighboring semi-rural communities in Nicaragua. Methods We recruited and surveyed a convenience sample of 287 adolescents, ages 15-19 years old, in July and August, 2013 about barriers to contraceptive use. We compared adolescents by gender, sexually active status (sexual intercourse in the previous year) and frequency of contraceptive use. Results More than 40% (43.5%) of the adolescents surveyed reported that they had ever had sexual intercourse. The likelihood of ever having had sexual intercourse differed based on gender, relationship status, sexual activity of peers, and the presence of a father in the home. Contraceptive use was low and female adolescents were more likely than their male counterparts to report never or rarely using contraceptives (46.5% vs. 21.4%, p < 0.007). Contraceptive use for females was positively associated with discussing contraception with a healthcare professional (HCP) [adjusted odds ratio (AOR) 13.32; 95% confidence interval (CI) 1.35-139.98] and a family member (AOR 4.64; 95% CI 1.09-19.72). Reasons for non-use also varied significantly by gender. Low rates of contraceptive use in these two semi-rural Nicaraguan communities appear to be primarily related to gender norms, social stigma, and poor communication about family planning. Conclusions Interventions that focus on promoting gender equality and encouraging adolescent communication with HCPs, schools, families, and partners are imperative to combating adolescent pregnancy in Nicaragua and countries worldwide.

Adolescent Girls' Agency Significantly Correlates With Favorable Social Norms in Ethiopia-Implications for Improving Sexual and Reproductive Health of Young Adolescents

PURPOSE

This study investigates the relationship between adolescent girls' agency and social norms regarding early marriage, girls' education, and nutrition in West Hararghe, Ethiopia.

METHODS

We conducted a cross-sectional study involving adolescent girls aged between 13 and 17 years in 2016. A two-stage cluster sampling procedure was followed to identify eligible respondents at the household level. A total of 114 clusters in four districts and 30 households from each cluster were randomly selected. Data were collected using a structured and pretested questionnaire. The agency composite score was measured based on 21 previously validated items. Descriptive and injunctive norm composite scores regarding education, marriage, and nutrition were constructed based on context-relevant items. The weighted mean and standard errors were calculated for the agency and social norms composite scores. The relationship between girls' agency and descriptive and injunctive norms were examined using a multivariable linear regression model that accounted for a complex sample survey design.

RESULTS

A total of 3,186 adolescent girls participated in this study. The multivariable linear regression analysis revealed that adolescent girls' agency score significantly and favorably associated with education (β = .19, p < .001), marriage (β = .13, p < .01), and nutrition (β = .20, p < .01) descriptive norms after adjusting for individual and household characteristics. Similarly, adolescent girls' agency was significantly and favorably associated with marriage (β = .21, p < .001) injunctive norms; however, positive injunctive norms around education (β = .09, p > .05) and nutrition (β = .12, p > .05) did not have a statistically significant association with girls' agency. The domains of agency scale related to the belief in women's health rights related to contraception use and the belief in women's right to refuse sex showed poor prosocial views.

CONCLUSIONS

Favorable descriptive and injunctive norms around marriage were significantly associated with greater adolescent girls' agency, which indicates the need to incorporate interventions that address social norms in efforts aimed to enhance adolescent girls' sexual and reproductive health status. Furthermore, attention should be given to monitor which domain of agency is improved by the interventions.

Scaling-up Normative Change Interventions for Adolescent and Youth Reproductive Health: An Examination of the Evidence

Adolescent and youth reproductive health (AYRH) outcomes are influenced by factors beyond individual control. Increasingly, interventions are seeking to influence community-level normative change to support healthy AYRH behaviors. While evidence is growing of the effectiveness of AYRH interventions that include normative change components, understanding on how to achieve scale-up and wider impact of these programs remains limited. We analyzed peer-reviewed and gray literature from 2000 to 2017 describing 42 AYRH interventions with community-based normative change components that have scaled-up in low/middle-income countries. Only 13 of 42 interventions had significant scale-up documentation. We compared scale-up strategies, scale-up facilitators and barriers, and identified recommendations for future programs. All 13 interventions addressed individual, interpersonal, and community-level outcomes, such as community attitudes and behaviors related to AYRH. Scale-up strategies included expansion via new organizations, adapting original intervention designs, and institutionalization of activities into public-sector and/or nongovernmental organization structures. Four overarching factors facilitated or inhibited scale-up processes: availability of financial and human resources, transferability of intervention designs and materials, substantive community and government-sector partnerships, and monitoring capacity. Scaling-up multifaceted normative change interventions is possible but not well documented. The global AYRH community should prioritize documentation of scale-up processes and measurement to build evidence and inform future programming.

Early adolescent childbearing in Colombia: time-trends and consequences

Teenage childbearing has been increasing, especially among girls aged 10 to 14 years, slowing the improvements in public health and propelling social marginalization. The objective of this article is to study adolescent pregnancy in Colombia and suggest possible policy interventions. The study comprises univariate and multivariate analyses that examine trends and correlates of teenage childbirth and related infant mortality in Colombia between 2001-2011 using complete vital statistics. The study compares, by relative risk analysis as well, two groups of teenage mothers, aged 10 to 14 years and 15 to 19 years, with a reference group of mothers aged 20 to 34 years. During the study period, the average of annual birth rates increased 2.6% and 0.8% in mothers aged 10 to 14 years, and 15 to 19 years respectively, whereas it declined at an average rate of 0.2% annually for mothers aged 20 to 35 years. Simultaneously, while the overall rate declined, the infant mortality rate (IMR) of the youngest group was consistently higher during the entire period compared to the IMR of older groups. Compared with the other groups, mothers aged from 10 to 14 were more likely to be unmarried, rural, indigenous or afro-descendant, and have less access to health care. The study demonstrates that early teenage childbirth is a growing challenge at least in Colombia. These mothers are at higher risk of losing their babies while being poor and remaining poor. The study suggests the need for policy that targets appropriate education and health care to poor girls as early as age 10 and even younger.

Understanding young women's experiences of gender inequality in Lucknow, Uttar Pradesh through story circles

Gender inequality poses grave consequences for young women's health and wellbeing. The aim of this study was to understand how gender influences the lives of young women living in urban slums of Lucknow, Uttar Pradesh, India using story circles as a research methodology. Narrative-based participatory methods like story circles (which involves sharing individual stories in a group circle on a given topic) can provide the nuance and detail needed to understand young people's experiences, build trust between participants and researchers, and offer spaces to speak about culturally sensitive subjects. Six story circle sessions were conducted with 50 young women (aged 15-24) in Lucknow. Sessions were audio-recorded, transcribed, and coded. Transcriptions were analysed to identify the following salient themes, all of which act as mechanisms of gender inequality: mobility restrictions, rampant sexual harassment in the community, limited educational and work opportunities, and the utmost prioritization of marriage for young women.

Association between sociodemographic characteristics and sexual behaviors among a nationally representative sample of adolescent students in Brazil

Although low socioeconomic status (SES) adolescents suffer from higher rates of adverse sexual and reproductive health outcomes, evidence on the association between SES and sexual behaviors has been less consistent. A cross-sectional analysis of the association between sociodemographic characteristics (household wealth, maternal education and race/ethnicity) and sexual behaviors (sexual initiation, multiple sexual partners, inconsistent condom use and inconsistent contraceptive use) of Brazilian adolescents was carried out using the 2015 Brazilian National Survey of School Health (PeNSE), a nationally representative school-based survey of 102,301 adolescents. Analyses included multivariable logistic models, which accounted for geographic and family characteristics. About 27.5% of adolescents were sexually initiated. Household wealth was associated with female sexual initiation, while race/ethnicity was associated with condom use and multiple sexual partners among males. For instance, black males had 35% higher odds of having multiple partners (aOR = 1.35, 95%CI: 1.13-1.62), but 22% lower odds of condom use (aOR = 0.78, 95%CI: 0.65-0.94), compared to white males. Frequent parental supervision was positively related to condom use (females, aOR = 1.28, 95%CI: 1.10-1.49; and males, aOR = 1.33, 95%CI: 1.18- 1.49). Results show the complex relationship between SES and sexual behaviors. Researchers should pay attention to gender, racial and social norms salient to adolescent sexual behaviors, as they can influence data collection and results. National policies should also support active parental supervision, since it can be a protective factor.

Pregnancy and early motherhood among adolescents in five East African countries: a multi-level analysis of risk and protective factors

BACKGROUND

Adolescent pregnancy remains a major challenge in both developed and developing countries. Early and unintended pregnancies among adolescents are associated with several adverse health, educational, social and economic outcomes. The aim of this study was to identify the contextual factors that influence adolescent pregnancy and early motherhood in five East African countries.

METHODS

We use DHS data from five East African countries to examine trends and risk factors associated with adolescent pregnancy. DHS surveys collect detailed information on individual and household characteristics, sexual behavior, contraception, and related reproductive behaviors. Our analysis focuses on a weighted subsample of adolescent's age 15-19 years (Kenya, 5820; Tanzania, 2904; Uganda, 4263; Malawi, 5263; Zambia, 3675). Multilevel logistic regression analysis was used to identify the net effects of individual, household and community level contextual variables on adolescent pregnancy after adjusting for potential confounders.

RESULTS

Adolescent pregnancy and early motherhood is common in the five countries, ranging from 18% among adolescents in Kenya (2014) to 29% in Malawi (2016) and Zambia (2014). Although all five countries experienced a decline in adolescent pregnancy since 1990, the declines have been largely inconsistent. More than half of the adolescent's most recent pregnancies and or births in these countries were unintended. The regression analysis found that educational attainment, age at first sex, household wealth, family structure and exposure to media were significantly associated with adolescent pregnancy in at least one of the five countries after adjusting for socio-demographic factors.

CONCLUSION

The study highlights the importance of considering multi-sectoral approaches to addressing adolescent pregnancy. Broader development programs that have positive impacts on girls educational and employment opportunities may potentially influence their agency and decision-making around if and when to have children. Likewise, policies and programs that promote access to and uptake of adolescent sexual and reproductive health services are required to reduce barriers to the use of adolescent Sexual and Reproductive Health (SRH) services.

Out of school female adolescent employment status and sexually transmitted infections (STIs) risk in Uganda: is it a plausible relationship?

BACKGROUND

High prevalence of Sexually Transmitted Infections (STIs) among adolescents is a serious public health concern. Although many factors are attributed to adolescents' risk of STI infections, the association between out of school adolescents' employment status and STIs has not been thoroughly explored in Uganda, yet many adolescents are known to be employed. Consequently, the extent to which adolescents' employment status may be a risk factor for unprotected sex and STIs among female adolescents is unclear. This study examines the association between female out of school adolescents' employment status and STI status using the Uganda Demographic and Health Survey (UDHS) data for 2016.

METHODS

Both descriptive and multilevel binary logistic regressions were used to analyse the data. The descriptive statistics provided an overview of the association between the two main variables while the multilevel binary logistic estimated the relationship between employment status and STI status, while controlling for other fixed factors and community random factors.

RESULTS

Compared to female adolescents who were not employed or not working, the odds of reporting positive STIs were significantly higher for female adolescents who were working but received no pay (1.801(95% CI = 1.105-2.936), were self-employed in agriculture (1.502 (95% CI = 1.003-2.250) and who did manual jobs (2.258(95% CI = 1.429-3.568) whether skilled or not. Likewise, female adolescents who had two or more lifetime sexual partners (11.679 (95% CI = 1.254-2.248) had significantly higher odds of reporting STIs than those who had only one lifetime sexual partner.

CONCLUSION

Out of school female adolescents who are employed in various types of low wage employments are at greater risk of exposure to STIs than their counterparts who do not work in Uganda. Instead of being a protective factor against the risk of STIs, their employment may expose them to risky sexual behaviour and STIs, given the vulnerabilities female adolescents who have dropped out of school tend to report. Therefore, the provision of decent employment opportunities for these females may provide an avenue for instructional scaffolding to build the life skills and empower these females so that they are better able to reduce their exposure to STIs.

Reproductive consequences of unwanted sexual debut among young adult women from Metro Cebu, Philippines

The circumstances surrounding sexual debut influence subsequent sexual and reproductive outcomes. We analysed longitudinal data from 397 women who participated in the Cebu Longitudinal Health and Nutrition Survey in Cebu, Philippines, to examine associations between unwanted first sex and number of pregnancies, unintended pregnancy, and use of modern contraception. 72% of women reported unwanted first sex. Women whose first sex was unwanted had increased odds of unintended pregnancy compared to women whose first sex was wanted (aOR = 2.2, 95% CI 1.3, 3.6). Nationally representative surveys should include culturally relevant questions about sexual debut to inform public health programmes aimed at improving sexual/reproductive health.

Early Childbearing, School Attainment, and Cognitive Skills: Evidence From Madagascar

Female secondary school attendance has recently increased in sub-Saharan Africa, and so has the risk of becoming pregnant while attending school. We analyze the impact of teenage pregnancy on young women’s human capital using longitudinal data in Madagascar that capture the transition from adolescence to adulthood for a cohort aged 21–24 in 2012, first interviewed in 2004. We find that early childbearing increases the likelihood of dropping out of school and decreases the chances of completing secondary school. This pregnancy-related school dropout also has a detrimental impact on standardized test scores in math and French. We instrument early pregnancy with the young woman’s community-level access and her exposure to condoms since age 15 after controlling for pre-fertility socioeconomic conditions. Our results are robust to different specifications that address potential endogeneity of program placement and instrument validity.

Individual- and Family-Level Determinants of Risky Sexual Behavior Among Swedish- and Foreign-Born Young Adults 18-30 Years of Age, Residing in Skåne, Sweden

In Sweden, various public health interventions have been performed to reduce risky sexual behaviors among young people and promote safer and positive approaches to sexuality, while attempting to bridge the gap between the less privileged or more vulnerable young people and their more privileged peers. This study aimed to compare the individual- and familial-level determinants of risky sexual behavior among foreign-born and Swedish-born young adults 18-30 years of age residing in Skåne, the south of Sweden. This was a cross-sectional study that used a questionnaire to collect data from 2968 randomly selected respondents between 18 and 30 years between January and March 2013. The associations were analyzed using chi-square tests, and simple and multiple logistic regression analyses. Younger age, i.e., individual-level factor, and living with only one parent or another person while growing up, i.e., familial-level factor, increased the risk of engaging in sexual risk taking for both Swedish- and foreign-born youth. Male gender was related to a higher risk of engaging in sexual risk-taking behaviors among foreign-born youth but was not as important as influence on sexual risk taking among Swedish-born youth. Parental education level, on the other hand, was significantly associated with sexual intercourse on the "first night" and early sexual debut solely among Swedish-born youth. Condom use was not associated with any family-level factor among both Swedish-born and foreign-born youth. The design of sexual reproductive health and rights messages and interventions to target risky sexual behavior among Swedish youth should take into consideration immigration status (for example, being Swedish-born or foreign-born), individual- and family-level characteristics, as well as the type of behavioral change or outcome desired.

Assessing the reach and effectiveness of mHealth: evidence from a reproductive health program for adolescent girls in Ghana

BACKGROUND

While mobile health (mHealth) programs are increasingly used to provide health information and deliver interventions, little is known regarding the relative reach and effectiveness of these programs across sociodemographic characteristics. We use data from a recent trial of a text-messaging intervention on adolescent sexual and reproductive health (SRH) to assess the degree to which mHealth programs reach target adolescent subpopulations who may be at higher risk of poor SRH outcomes.

METHODS

The study was conducted among girls aged 14-24 in 22 secondary schools in Accra, Ghana. The mHealth intervention was an interactive mobile phone quiz in which participants could win phone credit for texting correct answers to SRH questions. We use detailed data on individuals' level of engagement with the program, SRH knowledge scores, and self-reported pregnancy collected as part of the original trial to assess the extent to which engagement and program impact vary across parental education, sexual experience, SRH knowledge deficit, and parental support.

RESULTS

Eighty-one percent of participants engaged with the mHealth program, with no evidence that the program disproportionally reached better-off groups. The program was effective at increasing knowledge of SRH across all strata. Higher levels of engagement were associated with higher knowledge scores up to year later. There was no significant impact of the program on self-reported pregnancy within subgroups.

CONCLUSION

mHealth programs for adolescents have the potential to engage and increase SRH knowledge of adolescent girls across sociodemographic strata, including those who may be at higher risk of poor SRH outcomes.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02031575 . Registered 07 Jan 2014.

Gender Differences in Sexual Behaviors in Korean Adolescents

PURPOSE

The purposes of this study were to identify whether there are gender differences in sexual behaviors among Korean adolescents and to explore the factors that influence safe sex practices across both sexes.

METHODS

A secondary analysis was conducted using nationally representative data obtained from the 2014 Youth Risk Behavior Web-based Survey. Sample consisted of 3,210 adolescents who had experience of sexual intercourse. The dependent variable in this study was practicing safe sex. The independent variables included a range of individual, family, and school factors.

RESULTS

Female adolescents were less likely to practice safe sex (i.e., always using a condom). Individual (smoking, no drinking before sexual intercourse), family (living with parents, higher allowance per week) and school factors (non-coeducational school students, had received school-based sex education) were significant predictors of practicing safe sex in males. In contrast, family (lower economic status) and school factors (middle school students) predicted practicing safe sex among female adolescents.

CONCLUSION

We demonstrated that gender plays an important role in the sexual behavior of adolescents. The findings of this study indicate a need to design and implement gender-specific interventions.

Structural model of factors relating to the health promotion behavior of reproductive health among Indonesian adolescents

Objectives

We aim to explore the factors related to the health promotion behavior of reproductive health (RH) among Indonesian adolescents via structural equation modeling.

Methods

A cross-sectional quantitative study was used to measure 108 adolescents aged 12–16 years. We employed a self-administered questionnaire developed from the health promotion model (HPM) and the empowerment model (EM) on the basis of self-efficacy to determine the factors related to health promotion in maintaining RH behavior. Structural equation modeling (SEM) was used to examine relationships among the variables. The Analysis of Moment Structures (AMOS) approach was used to evaluate if the proposed model is suitable for the data based on goodness-of-fit indices.

Results

The model is appropriate for the data. Three interrelationships emerge among independent variables (P > 0.05), namely, personal and cognitive behaviors (r = −0.01), cognitive and health promotion behaviors (r = 0.09), and affective and health promotion behaviors (r = −0.17). The strongest relationship is between empowerment and health promotion behavior (r = 0.72). Affection (interpersonal and situational influences), immediate competing demands and preferences, and empowerment (participation and control) are directly related to RH behavior maintenance. Meanwhile, willingness of adolescents, prior related behavior, personal factor, and commitment to a plan of action are indirectly related to RH behavior maintenance. The model explains 43.9% of the variance in maintaining RH behavior.

Conclusions

The HPM and EM models help determine the factors related to RH behavior maintenance among adolescents. Intervention to promote RH among Indonesian adolescents should begin from the level of child–parent–health care professional encounter for empowering the RH of adolescents.

Cross-sectional study of female sex workers in Soweto, South Africa: Factors associated with HIV infection

INTRODUCTION

In South Africa, the rate of HIV in the sex worker (SW) population is exceedingly high, but critical gaps exist in our understanding of SWs and the factors that make them vulnerable to HIV. This study aimed to estimate HIV prevalence among female sex workers (FSWs) in Soweto, South Africa, and to describe their sexual behavior and other factors associated with HIV infection.

METHODS

A cross-sectional, respondent-driven sampling (RDS) recruitment methodology was used to enroll 508 FSWs based in Soweto. Data were collected using a survey instrument, followed by two HIV rapid tests. Raw and RDS adjusted data were analyzed using a chi-squared test of association and multivariate logistic regression to show factors associated with HIV infection.

FINDINGS

HIV prevalence among FSWs was 53.6% (95% CI 47.5-59.9). FSWs were almost exclusively based in taverns (85.6%) and hostels (52.0%). Less than a quarter (24.4%) were under 25 years of age. Non-partner violence was reported by 55.5%, 59.6% of whom were HIV-infected. Advancing age, incomplete secondary schooling, migrancy and multiple clients increased the likelihood of HIV acquisition: >30 years of age was associated with a 4.9 times (95% CI 2.6-9.3) increased likelihood of HIV; incomplete secondary schooling almost tripled the likelihood (AOR 2.8, 95% CI 1.6-5.0); being born outside of the Gauteng province increased the likelihood of HIV 2.3 times (95% CI 1.3-4.0); and having more than five clients per day almost doubled the likelihood (AOR 1.9, 95% CI 1.1-3.2).

CONCLUSION

Our findings highlight the extreme vulnerability of FSWs to HIV. Advancing age, limited education and multiple clients were risk factors associated with HIV, strongly driven by a combination of structural, biological and behavioral determinants. Evidence suggests that interventions need to be carefully tailored to the varying profiles of SW populations across South Africa. Soweto could be considered a microcosm of South Africa in terms of the epidemic of violence and HIV experienced by the SW population, which is influenced by factors often beyond an individual level of control. While describing a hitherto largely undocumented population of FSWs, our findings confirm the urgent need to scale up innovative HIV prevention and treatment programs for this population.

Ethnicity, gender and risky sexual behaviour among Nigeria youth: an alternative explanation

BACKGROUND

While studies in demography and public health have acknowledged the role of ethnic differences, the influence of ethnicity on youth sexual behaviour in Nigeria has received little or no attention. It is important to know how cultural norms and gender roles, which vary by ethnicity, may promote or prevent risky behaviour. Such information could provide insights into previously undetected sexual behaviour in multi-ethnic situations.

METHODS

The Nigeria Demographic and Health Surveys (NDHS) for 2003, 2008 and 2013 were pooled to examine the relationship between ethnicity and youth sexual reproductive health, proxied by age at sexual debut, multiple sexual partners (MSP) and condom use at last sexual activity, among the 6304 females and 1549 males who reported being sexually active in the four weeks preceding the survey. Multivariate analysis using a Cox proportional hazard regression model was used to determine the risk factors for early sexual activity among young people (15-24). Logistic regression was used to predict condom use at last sexual activity and MSP.

RESULTS

The median age at first sexual activity was 16 for females and 17 for males. 43% of male youths used condoms in their last sexual activity, compared to only 16% among females and a higher number of males (81%) had multiple sexual partners compared to females (35%). For females, elevated risks of first sex was higher among Hausa/Fulanis aged 15-19 and elevated risk of first sex was higher among Yoruba males.

CONCLUSION

This study provides further evidence that in order to promote protective sexual behaviours among youth in Nigeria, social, cultural and gender-specific tactics should be put in place for the prevention of HIV and other STIs.

Knowledge and Usage of Emergency Contraceptives Among University Students in Ghana

Contraceptive use is an important strategy for the prevention of unwanted pregnancy and avoidance of induced abortion. Of all the contraception methods, emergency contraceptive (EC) offers the last chance to achieve this. However, few studies have documented the use of EC among young people in Ghana. This study explored knowledge and usage of EC as well as the factors associated with it among University of Cape Coast students. Data were obtained on the knowledge and usage of ECs among University of Cape Coast students in 2013. Logistic regression analysis was used to investigate the association between students' socio-demographic characteristics and EC knowledge and use. More male students (72%) than females (59%) were sexually active. Fifty-seven percent of the respondents had ever heard of EC and 36% had ever used EC. Although males were more likely to be sexually active, females were more likely to have knowledge of EC use compared to males. The study underscores the need to increase awareness regarding EC among University students in order to offer them the opportunity that EC provides if other forms of contraceptives are missed.

Community social capital on the timing of sexual debut and teen birth in Nicaragua: a multilevel approach

Background

Community attributes have been gradually recognized as critical determinants shaping sexual behaviors in young population; nevertheless, most of the published studies were conducted in high income countries. The study aims to examine the association between community social capital with the time to sexual onset and to first birth in Central America.

Methods

Building upon the 2011/12 Demographic and Health Survey conducted in Nicaragua, we identified a sample of 2766 community-dwelling female adolescents aged 15 to 19 years. Multilevel survival analyses were performed to estimate the risks linked with three domains of community social capital (i.e., norms, resource and social network).

Results

Higher prevalence of female sexual debut (norms) and higher proportion of secondary school or higher education (resource) in the community are associated with an earlier age of sexual debut by 47 % (p < 0.05) and 16 %, respectively (p < 0.001). Living in a community with a high proportion of females having a child increases the hazard of teen birth (p < 0.001) and resource is negatively associated with teen childbearing (p < 0.05). Residential stability and community religious composition (social network) were not linked with teen-onset sex and birth.

Conclusions

The norm and resource aspects of social capital appeared differentially associated with adolescent sexual and reproductive behaviors. Interventions aiming to tackle unfavorable sexual and reproductive outcomes in young people should be devised and implemented with integration of social process.

"It is challenging… oh, nobody likes it!": a qualitative study exploring Mozambican adolescents and young adults' experiences with contraception

Background

By focusing upon formal sex education programmes, the Mozambican government has significantly enhanced the general health of adolescents and young adults. However, when it comes to contraception, little is known about how adolescents and young adults actually behave.

Methods

Based upon a qualitative study in two settings in Maputo province – Ndlavela and Boane – this paper explores the knowledge and practices of contraception among adolescents and young adults. A total of four focus group discussions, 16 in-depth interviews, four informal conversations, and observations were equally divided between both study sites.

Results

Discrepancies between what adolescents and young adults know and what they do quickly became evident. Ambivalent and contradictory practices concerning contraceptive use was the result. As well, young people had numerous interpretations of risk-taking when not using contraceptives. These inconsistencies are influenced by social and medical barriers such as restricted dialogue on sexuality among adolescents and young adults and their parents and peers. Additionally, ideas about indigenous contraceptives, notions of masculinity and femininity, misconceptions and fear of the side effects of contraceptives, make people of all ages wary of modern birth control. Other barriers include imposed contraceptive choice – meaning no choice, overly technical medical language used at clinics and the absence of healthcare workers more attuned to the needs of adolescents and young adults.

Conclusions

Adolescents and young adults have numerous – often erroneous – opinions about contraception, leading to inconsistent use as well as vague perceptions of risk-taking. Moreover, social norms and cultural gender roles often contradict and hinder risk-avoiding behaviour. Therefore, in order to improve young people’s health, policymakers must address the reasons behind this ambivalence and inconsistency.

Determinants and Correlates of Preventive Behaviors at First Sex With a First Partner and Second Partner: Analysis of the FECOND Study

PURPOSE

This study explores transitions in contraceptive use in early sexual life in France and has three objectives: describe predictors of contraceptive use at first sex with first and second partners, describe contraceptive trajectories in these partnerships, and test associations between use at first sex and switching in first partnership on use with second partner.

METHODS

Our analyses include 1,823 participants, aged 15-29 years, of the 2010 French national sexual health survey who reported at least two lifetime sexual partners and a subset of 1,593 people who report contraceptive use throughout their first partnership. We use logistic regression and generalized estimating equation models to investigate the three objectives.

RESULTS

Our results reveal a decline in contraceptive use between first and second partner, driven primarily by decreases in condom use, from 87.9% to 79.5% between first and second partner. This is partially offset by an increase in use of effective methods (from 7.8% to 38.1%), particularly by women. Any method use and discontinuation with first partner were predictors of patterns with second partner.

CONCLUSIONS

Analysis of early transitions in contraceptive use of adolescents in early sexual life reveals shifts from sexually transmitted infection to pregnancy prevention and an increase in unprotected sex.