Adolescent Reproductive Knowledge, Attitudes, and Beliefs and Future Fatherhood

Sexual and reproductive health-related knowledge, attitudes and support network of Italian adolescents

Objectives

What is the state of sexual and reproductive health (SRH) knowledge among teens? What about adolescents' attitudes toward SRH and the available supporting network?

Study design

A cross-sectional study conducted between April and May 2018.

Methods

An anonymous 36-item questionnaire on SRH knowledge, behaviors, and networks was developed, revised and validated by a multidisciplinary health professional team, then distributed to high school students in Udine (Italy).

Results

747 questionnaires were collected in five high schools; respondents were predominantly male, mean age 14.8 years; 48% of students have sufficient SRH knowledge (considered as above the mean value). Factors associated with higher knowledge levels were female sex, age, SES according to father's profession, first SRH information at age 11-13, Italy as country of origin, and attendance at a technical school.

Conclusions

Students' knowledge on SHR resulted relatively poor. Sex, school type and previous experience of sexuality education were the most important factor associated with SRH knowledge.

Early Sexual Debut and Neighborhood Social Environment in Latinx Youth

OBJECTIVES

To examine whether social aspects of the neighborhood environment are associated with early sexual initiation in a California agricultural community of predominantly Latinx adolescents.

METHODS

In a prospective cohort study of 599 eighth graders recruited from middle schools in Salinas, California (2015-2019), participants completed five interviews over 2 years. Social environment measures included neighborhood social dynamics (neighborhood disorder, social cohesion, and social network gang exposure); experiences of discrimination; and school connectedness. We estimated associations between baseline social environment and early sexual initiation (<15 years) using Poisson regression with robust standard errors. We compared contraceptive self-efficacy and attitudes by sexual initiation status using ANOVA.

RESULTS

Most youth were Latinx (94%) and age 13 (70%) at enrollment; 53% were female and 49% had a parent employed in agriculture. Additionally, 14% reported first vaginal sex before age 15. Neighborhood disorder (relative risk [RR], 1.13; 95% confidence interval [CI], 1.05-1.21), social network gang exposure (RR, 2.23; 95% CI, 1.49-3.33), and experiences of discrimination (RR, 1.67 [1-2 events versus none], 95% CI, 1.09-2.55; RR, 2.33 [3+ events versus none], 95% CI, 1.07-4.64) were associated with early sexual initiation. School connectedness was protective (RR, 0.44, 95% CI, 0.29-0.69). Youth who initiated sex before age 15 had more negative birth control attitudes and expressed lower motivation to use contraceptives.

CONCLUSIONS

Findings underscore opportunities to promote early adolescent sexual health through strengthening supportive and safe neighborhood environments with the promise of addressing disparities in unintended pregnancy and sexually transmitted infection rates in later adolescence.

Beliefs about HPV vaccination and awareness of vaccination status: Gender differences among Northern Italy adolescents

Human papillomavirus (HPV) is one of the most frequent sexually transmitted infectious agents worldwide, and it is responsible for a significant burden of cancers. The aim of this study was to evaluate HPV knowledge and awareness in a sample of Northeastern Italian adolescents and parental support available to them, in order to highlight potential room for improvement towards optimal HPV vaccination adherence. Between April and May 2018 an observational questionnaire-based study was conducted in 1st year students of secondary upper schools in Udine (Italy). We quantitatively evaluated HPV knowledge, awareness and parental support level of male and female adolescents. The contribution of sociodemographic characteristics to HPV vaccination knowledge and uptake were explored using Chi-Square or Fisher test and multivariate logistic. Knowledge about HPV vaccine resulted to be mostly insufficient among enrolled adolescents, with a worrying proportion of them believing that HPV vaccine was expected to prevent HIV/AIDS. Awareness about their vaccination status was poor, and more than half of them were not involved in HPV vaccine uptake deliberation. Girls performed better than boys in relation to knowledge, awareness and engagement. Our results support the hypothesis that HPV vaccine knowledge and uptake can be affected by some gender bias. Improvements in adolescent health education and vaccination strategies are needed to engage and finally protect both genders from HPV.

Adolescent reproductive attitudes and knowledge effects on early adult unintended and nonmarital fertility across gender

Theory and evidence suggest strong short-term effects of attitudes toward, and knowledge about, reproduction on women's fertility. Adolescent attitudes and knowledge may also have longer-term implications about the contexts women perceive as appropriate for childbearing and their capacity to manage their preferences. Although previous research on men's fertility is limited, theory would suggest the links between adolescent attitudes and knowledge and subsequent fertility would also exist for men (though perhaps in different ways given the gendered meanings of sex, contraception, and reproduction). We analyze the relationship between reproductive attitudes and knowledge in adolescence and unintended and nonmarital first and second births in early adulthood, using the National Longitudinal Study of Adolescent to Adult Health (N = 9,431). Adolescent reproductive attitudes, especially life course consequences of early childbearing, predict the intendedness and marital status of first and second births. Adolescent reproductive knowledge is more often linked to the context of second births than first births. These associations vary by gender, but the overall results suggest that fertility schemas developed during adolescence predict behavior into early adulthood.

Development and validation of the reproductive health literacy questionnaire for Chinese unmarried youth

OBJECTIVES

This study aimed to develop and validate the reproductive health literacy questionnaire for Chinese unmarried youth aged 15-24.

METHODS

We conducted a validity and reliability study of the questionnaire through a cross-sectional survey and test-retest analysis in four districts in Shanghai between April and June 2017. A total of 1587 participants completed a self-administered questionnaire anonymously on-site and the trained investigators conducted quality check afterwards. Sixty participants among them completed the test-retest assessment with 2 weeks interval. The reliability was determined by internal consistency, spilt-half reliability and test-retest reliability. The construct validity was assessed by confirmatory factor analysis.

RESULTS

The 58-question reproductive health literacy questionnaire for Chinese unmarried youth demonstrated high internal consistency (Cronbach's α = 0.919), spilt-half reliability (Guttman splitting coefficient = 0.846) and test-retest reliability (correlation coefficient = 0.720). The confirmatory factor analysis showed that the construct of the questionnaire fitted well with the hypothetical model. The reproductive health literacy scores in unmarried girls aged 15-24 were higher than boys (P < 0.05) and college students who lived in rural areas when they were middle and high school obtained lower score than those living in cities and suburbs (P < 0.01).

CONCLUSION

The reproductive health literacy questionnaire for Chinese unmarried youth demonstrated good reliability and validity, which could potentially be used as an effective evaluation instrument to assess reproductive health literacy among Chinese young people.

Care of Adolescent Parents and Their Children

Teen pregnancy and parenting remain important public health issues in the United States and around the world. A significant proportion of teen parents reside with their families of origin, which may positively or negatively affect the family structure. Teen parents, defined as those 15 to 19 years of age, are at high risk for repeat births. Pediatricians can play an important role in the care of adolescent parents and their children. This clinical report updates a previous report on the care of adolescent parents and their children and addresses clinical management specific to this population, including updates on breastfeeding, prenatal management, and adjustments to parenthood. Challenges unique to teen parents and their children are reviewed, along with suggestions for the pediatrician on models for intervention and care.

Do Adolescent Sexual and Reproductive Attitudes and Knowledge Predict Men and Women's Adult Sexual Partnerships?

PURPOSE

Adolescence is a key stage for forming knowledge and attitudes about sex and reproduction that may have long-term implications for adult sexual behaviors. Gender differences in experiences and socialization processes may affect the links between adolescent characteristics and adult behaviors.

METHODS

By following adolescent virgins aged 15 years and older from wave I through wave IV of the National Longitudinal Study of Adolescent to Adult Health (n = 4,152), we test whether adolescent boys' and girls' knowledge about, and attitudes toward, sex and reproduction influence the number of lifetime different-sex sexual partners and the likelihood of having concurrent sexual partners in adulthood, using negative binomial regression and logistic regression, respectively. Models are run separately by gender.

RESULTS

Men and women who reported greater physical benefits of sex as adolescents reported more lifetime different-sex sexual partners and were more likely to have concurrent sexual partners in adulthood. For women, adolescent perceptions of more social costs to sex were linked to fewer lifetime sexual partners, whereas greater birth control confidence was linked to more sexual partners. Women who more strongly felt that avoiding sexually transmitted infections was a hassle during adolescence were less likely to have concurrent sexual partners as adults, and men who were more knowledgeable about condoms during adolescence were more likely to have concurrent sexual partners.

CONCLUSIONS

Adolescent knowledge and attitudes about sex, contraception, and reproduction have implications for adult sexual behavior, but different aspects emerge as salient for men and women.

Nursing Scientific Production on Teenage Pregnancy: An Integrative Review

Objective: To identify, in the national and international scientific literature, the evidence produced by Nursing that provides subsidies to prevent teenage pregnancy. Material and method: An integrative literature review study, based on papers available in the PubMed, BVS, Scopus and Web of Science metabases, and in the Lilacs and BDEnf databases, in Portuguese, English and Spanish languages, published from January 2013 to March 2020. Results: According to the inclusion criteria, 13 articles were selected. The findings are presented in the categories “lower socio-economic conditions”, “knowledge, attitudes and cultural aspects” and “sexual education and specialized services”. Conclusions: Teenage pregnancy is strongly associated with poverty and other socio-economic issues. Gender relations, communication about sex education in the family and other cultural aspects were found in the discussions, which indicates their impact on this phenomenon. Interventions involving sex education are shown as an alternative to cope. The presence of the nurse at the places that assist or concentrate adolescents can be a great element to reduce pregnancy rates in this phase.

Dimensions of Reproductive Attitudes and Knowledge Related to Unintended Childbearing Among U.S. Adolescents and Young Adults

Measures of attitudes and knowledge predict reproductive behavior, such as unintended fertility among adolescents and young adults. However, there is little consensus as to the underlying dimensions these measures represent, how to compare findings across surveys using different measures, or how to interpret the concepts captured by existing measures. To guide future research on reproductive behavior, we propose an organizing framework for existing measures. We suggest that two overarching multidimensional concepts-reproductive attitudes and reproductive knowledge-can be applied to understand existing research using various measures. We adapt psychometric analytic techniques to analyze two data sets: the National Longitudinal Survey of Adolescent to Adult Health (Add Health) and the Relationship Dynamics and Social Life study (RDSL). Although the specific survey measures and sample composition of the two data sets are different, the dimensionality of the concepts and the content of the items used to measure their latent factors are remarkably consistent across the two data sets, and the factors are predictive of subsequent contraceptive behavior. However, some survey items do not seem strongly related to any dimension of either construct, and some dimensions of the two concepts appear to be poorly measured with existing survey questions. Nonetheless, we argue that the concepts of reproductive attitudes and reproductive knowledge are useful for categorizing and analyzing social psychological measures related to unintended fertility. The results can be used to guide secondary data analyses to predict reproductive behavior, compare results across data sets, and structure future data collection efforts.

Sexual and reproductive health literacy of school adolescents in Lao PDR

RATIONALE

Adolescent pregnancy in Lao PDR is the highest in Southeast Asia. It leads to negative health and social consequences in young people. It is anticipated that this problem is partly caused by limited sexual and reproductive health literacy (SRHL), leading to poor sexual and reproductive health (SRH) decisions. Based on the concept of health literacy, SRHL goes beyond knowledge and behavior and is the self-perceived ability of an individual to access the needed information, understand the information, appraise and apply the information into informed decision making for a good way to contribute to sexual and reproductive health. It is not only knowing (knowledge) and doing (behavior), but it is the process of individual's thought on an SRH problem before taking an action. The aim of this study was to measure SRHL among school-going adolescents aged 15-19 and to determine factors associated with SRHL.

METHOD

We conducted a cross-sectional study in rural and urban areas of Lao PDR in 2017. Respondents completed a self-administered questionnaire with five parts: socio-demographic, personal health, SRH knowledge and behavior, SRHL, and functional literacy. We calculated the SRHL score based on the HL-EU index and used descriptive statistics to determine the score and levels. Then we used bivariate statistics and multiple linear regression to identify factors associated with SRHL in these adolescents.

RESULT

Among 461 respondents, 65.5% had inadequate SRHL. Scores were positively and significantly associated with several factors, including: school location (β: 3.218; p<0.001), knowledge on SRH and attending SR class in school (p:0.010-p<0.001), and functional literacy on condoms, which reflected how respondents understood the use of condoms (β: 0.871; p<0.001).

CONCLUSION

Because most school adolescents had inadequate SRHL, comprehensive sexual education and enabling information as well as service access for adolescents are essential to ensure that adolescents can access, understand, appraise and apply good SRH knowledge in decision-making to benefit their own health.

A Qualitative Assessment to Understand the Barriers and Enablers Affecting Contraceptive Use Among Adolescent Male Emergency Department Patients

Early fatherhood is common in the United States (U.S.). The emergency department (ED) plays a disproportionate role in serving patients with unmet reproductive and sexual health needs. With 8 million adolescent males visiting U.S. EDs annually, the ED is a potential site to implement interventions to minimize early fatherhood and unintended teenage pregnancy. Little is known about how adolescent male ED patients perceive and behave in sexual relationships and how they influence contraceptive decision making. The objective of this study was to identify the barriers and enablers affecting contraceptive and condom use among adolescent male ED patients. Semistructured interviews were conducted with males aged 14-19 in one urban ED. Enrollment continued until saturation of key themes. Interviews were recorded, transcribed, and coded based on thematic analysis using NVivo 10. The Social Ecological Model was used to organize and understand themes. Participants ( n = 24) were predominantly 18-19 years (63%) and Hispanic (92%). Most (71%) had sex ≤3 months prior but infrequently used a condom at last intercourse (42%). The primary barrier influencing contraceptive use was lack of knowledge of effective contraceptives. Other barriers consisted of perceived gender roles, poor partner communication, and little relationship with a primary provider. Enablers included intention not to get a partner pregnant, school-based sexual health education, normalcy to use condoms, and a trustworthy confidante. The identified barriers and enablers influencing adolescent males' perspectives toward contraceptives should be addressed if designing future ED-based pregnancy prevention interventions targeting teen males.

Adolescent Reproductive and Contraceptive Knowledge and Attitudes and Adult Contraceptive Behavior

Objectives Ineffective and inconsistent contraceptive use is common among adults, perhaps due to limited knowledge about reproduction and unfavorable attitudes toward contraception. Knowledge and attitudes are first developed in adolescence. We test whether adolescent knowledge and attitudes have long-term implications for adult contraceptive behavior. Methods Using the National Longitudinal Survey of Adolescent to Adult Health, our analytical sample (n = 6662) consists of those asked sex and contraception questions at Wave I (1995; students aged 15 and older) and who were sexually active and not pregnant at the time of the Wave IV (2007-2008) survey. We examined whether adolescent attitudes toward contraception, knowledge of condoms and reproduction, and confidence in contraceptive knowledge were predictive of adult contraceptive efficacy and consistency using logistic regression. Results In models adjusted for a range of socioeconomic, demographic, and life course factors, favorable attitudes toward contraception in adolescence increased the odds (aOR 1.21, CI 1.08-1.36) of using more effective methods rather than a less effective or no method of contraception in adulthood, as did more accurate condom knowledge (aOR 1.07, CI 1.00-1.14) and more accurate reproductive knowledge (aOR 1.07, CI 1.00-1.13). Adolescents with more favorable attitudes toward contraception also used contraception more consistently as adults (aOR 1.27, CI 1.14-1.43), as did those with more accurate condom knowledge (aOR 1.10, CI 1.03-1.18). Conclusions Attitudes towards contraception and knowledge about condoms and reproduction acquired during adolescence are predictive of adult contraceptive behavior. Results suggest that comprehensive sex education during adolescence could improve effective contraceptive behavior throughout the life course.

Teenage pregnancy prevention: the role of young men

PURPOSE OF REVIEW

Although teenage pregnancy is declining in many parts of the world, it remains associated with considerable social, health, and economic outcomes. Pregnancy prevention efforts focus primarily on young women, with minimal attention to young men. This review highlights recent literature pertaining to the role of young men in pregnancy prevention.

RECENT FINDINGS

Young men have varying views on contraception as well as which partner(s) should be responsible for its use. Limited contraception knowledge reduces young men's sexual health communication as well as their contraception use. Healthcare providers play a major role as one of the main sources of sexual health information for young men, but there are gaps in young men's sexual health care so new guidelines have emerged.

SUMMARY

Recent literature highlights young men's range of views on contraception as well as their low sexual health knowledge and sexual health communication. To address teenage pregnancy and improve young men's overall wellness, healthcare providers should routinely address sexual health. Healthcare providers may use our newly proposed acronym, HIS BESTT, (Hello. Initiate. Sexual health assessment. Both condoms and female dependent methods. Examine genitals. STI screening. Talking to partner(s). Talking to parent(s) or guardians), to incorporate current clinical recommendations.