Adolescents and sexually transmitted diseases: diagnosis, developmental issues, and prevention

A meta-analytic review of the relationship between adolescent risky sexual behavior and impulsivity across gender, age, and race

BACKGROUND

Impulsivity is frequently included as a risk factor in models of adolescent sexual risk-taking; however, findings on the magnitude of association between impulsivity and risky sexual behavior are variable across studies. The aims of the current meta-analysis were to examine (1) how specific impulsivity traits relate to specific risky sexual behaviors in adolescents, and (2) how the impulsivity-risky sex relationship might differ across gender, age, and race.

METHOD

Eighty-one studies were meta-analyzed using a random effects model to examine the overall impulsivity-risky sex relationship and relationships among specific impulsivity traits and risky sexual behaviors.

RESULTS

Overall, results revealed a significant, yet small, association between impulsivity and adolescent risky sexual behavior (r=0.19, p<0.001) that did not differ across impulsivity trait. A pattern of stronger effects was associated with risky sexual behaviors as compared to negative outcomes related to these behaviors. Gender moderated the overall relationship (β=0.22, p=0.04), such that effect sizes were significantly larger in samples with more females. Age, race, study design, and sample type did not moderate the relationship, although there was a pattern suggesting smaller effects for adolescents in juvenile detention settings.

CONCLUSIONS

Adolescent samples with more females showed a larger impulsivity-risky sex relationship, suggesting that impulsivity may be a more important risk factor for risky sex among adolescent females. Research and treatment should consider gender differences when investigating the role of impulsivity in adolescent sexual risk-taking.

Risk factors for sexually transmitted diseases in northern Thai adolescents: an audio-computer-assisted self-interview with noninvasive specimen collection

BACKGROUND

Previous studies of sexual behavior and sexually transmitted diseases (STDs) in Thai adolescents may have been limited by participation bias and underreporting of stigmatized behaviors.

GOAL

The goal was to increase knowledge about risk behaviors and STDs among youths in Thailand.

STUDY DESIGN

Students aged 15 to 21 years completed an audio-computer-assisted self-interview. Oral fluid was tested for HIV antibodies and urine was tested for Chlamydia trachomatis and Neisseria gonorrhoeae nucleic acids with polymerase chain reaction.

RESULTS

Of 1736 invited students, 1725 (99.4%) agreed to participate. Overall, C trachomatis infection was detected in 49 (2.8%), and there were five cases (0.3%) each of infection with N gonorrhoeae and HIV. Among those who reported sexual intercourse, the prevalence of chlamydial infection was 3.7% among men and 6.1% among women. Logistic regression analysis showed age-adjusted factors associated with chlamydial infection among men to be parents' occupation in agriculture, having sold sex, having a sex partner who had been pregnant, and the number of casual sex partners during lifetime. Among women, age-adjusted factors were parents' occupation in agriculture, number of casual partners during lifetime, having an older sex partner, and perception of higher HIV infection risk.

CONCLUSION

These adolescents had high rates of unprotected intercourse and are at risk for STDs. Prevention programs should emphasize use of effective contraceptive methods, including condom use; reducing the number of sex partners (stressing the risk a partner of older age may pose to female adolescents); and reducing engagement in commercial sex.

Sexually transmitted infection. A challenge for nurses working with adolescents

Sexually active adolescents have high rates of STIs and many barriers to prevention and treatment because of developmental immaturity, difficulty with access to health care, and need for confidential care. Serious health consequences of STIs may occur many years after infection, further compounding adolescents' ability to link cause and effect. Nurses who are committed to the challenge of providing services for adolescents to prevent STIs can help by providing access to confidential care and promoting sexual health. High-risk youth require intensive preventive efforts. Nurses are in an ideal position to meet this challenge in their roles as providers, counselors, and sexuality educators in individual health care encounters and in prevention programs in clinics, schools, and community centers. Effective STI prevention programs should apply theories of behavior change, incorporate adolescents' attitudes and beliefs, and solicit input from the adolescents themselves.

Adolescents and sexually transmitted diseases

Pediatricians with busy practices have limited time to spend with each patient. But because much of adolescent morbidity and mortality is related to behavioral issues, time and energy are crucial to providing effective counseling and care to adolescents. Many barriers to provision of services to adolescents exist, including time, space, décor, office hours, office fees, and support personnel. Despite these barriers to care of adolescents and, in particular, sexually active adolescents, the need for pediatricians to provide these services is clear. Services include anticipatory guidance and counseling about developing sexuality and sexual behaviors, as well as management of health consequences of sexual behavior. Primary care providers have an opportunity to assist adolescents to develop mature and healthy sexual relationships. This necessitates a full understanding of each patient's unique situation, listening to adolescents' concerns, and honest and straightforward discussion of sensitive information. Beginning the process of discussion of sexuality and relationships early in the pediatric years may help adolescents and their parents to develop healthy sexual attitudes and behaviors.

GAPS: an opportunity for nurse practitioners to promote the health of adolescents through clinical preventive services

Today the leading causes of morbidity and mortality among adolescents originates in social and behavioral determinants. Thus much of adolescent death and disability can be attributed to preventable risk factors. In response, clinical preventive services have been developed by the American Medical Association to shift the focus of care to prevention. Guidelines for Adolescent Preventive Services recommendations address delivery of health services, health guidance, screening, and immunizations. Nurse practitioners are uniquely positioned to promote health and improve the quality of care delivered to adolescents. The purpose of this article is to describe the Guidelines for Adolescent Preventive Services model for clinical preventive services and the role of the nurse practitioner in implementation.