Female adolescents and onset of sexual intercourse: a theory-based review of research from 1984 to 1994

Factors Predictive of Behavioural and Emotional Dysfunction in Adolescents in a Secure Children's Home

The aim of the present study was to investigate what factors are predictive of behavioural and emotional dysfunction in adolescence. A sample of 60 young people accommodated under a welfare or youth custody service order in a UK secure children's home between 2016 and 2018 was used. Data regarding young people's Adverse Childhood Experiences (ACE's) history, scores on standard assessments and factors thought to indicate behavioural and emotional dysfunction were collected from file information. Correlations and regression models were used to analyse the data. Analyses found that young people in this setting had been exposed to more ACEs than the general population. Furthermore, signs of behavioural and emotional dysfunction as a result of exposure to ACE's appeared to be present from early adolescence. It was found that exposure to verbal and sexual abuse were the greatest predictors of involvement in risk incidents. The young person's substance misuse habits were the best predictor of the length of stay in the secure children's home. These findings may have policy implications and highlight the need for early interventions with young people exposed to ACE's.

AGE AT MENARCHE AND SEXUAL DEBUT AMONG YOUNG FILIPINO WOMEN

There has been a secular decline in age at menarche since the 19th century. Early-maturing women are more likely to have their sexual debut at a younger age, which in turn gives rise to a host of reproductive health and social problems. This study used data from five waves of National Demographic and Health Surveys conducted in the Philippines between 1993 and 2013 to examine the trends and socioeconomic differentials in age at menarche and sexual debut. The changing trend in age at menarche and sexual debut was examined across birth cohorts, and logistic regressions were used to identify the determinants of early sexual debut. In the Philippines, the mean and median ages at menarche declined from 13.2 years and 12.6 years, respectively, among young women born in 1973-1977, to 12.9 years and 12.3 years, respectively, among those born in 1993-1997. The proportion who had their sexual debut by age 20 increased from 41.2% for the 1968-1972 birth cohort to 53.4% for the 1988-1992 birth cohort. Filipino women with low education, from poor families and living in rural areas were more likely to have earlier sexual debut despite attaining menarche at a later age as compared with their higher educated counterparts, and those from wealthier families and urban areas. Logistic regression analysis showed that, besides marital status, women's education and age at menarche were important determinants of early sexual debut. However, ethnicity, place of residence and family wealth had no significant effects on age at menarche. An increasing proportion of young women were found to be having unprotected sexual debut and at a younger age, with health and social ramifications. Hence, apart from increasing the enrolment of girls in schools and discouraging teenage marriage, there is a need for social and health agencies to implement appropriate adolescent sexual and reproductive health programmes such as counselling and educational campaigns, as well as support services, to address sexual problems among the youth.

Role of Individual, Family, and Peers in Sexual Initiation Among Late Adolescents Attending Institutions of Higher Learning in Malaysia

This cross-sectional study aimed to determine the prevalence and the factors associated with sexual initiation among the late adolescents in 6 institutions of higher learning in Malaysia. A total of 1572 students completed self-administered questionnaires between April and September 2013. Hierarchical multivariate logistic regression analyses stratified by gender were employed to identify the correlates of sexual initiation. The analyses were further adjusted by sampling weights. The overall prevalence of sexual initiation was 9.8% (95% confidence interval [CI] = 8.3-11.6), 18.1% (95% CI = 15.1-21.5) among males, and 4.1% (95% CI = 2.9-5.9) among females. The risk factors identified in this study supported the influence of the individual, family, and peer factors in the social-ecological model on adolescents’ behaviors. The findings suggest the need for risk-reduction strategies aimed at the individual, family, and peer levels as well as the importance of gender-specific focus in assuring better outcomes.

Sexual risk behavior in young adulthood: broadening the scope beyond early sexual initiation

A robust link between early sexual initiation and sexual risk-taking behavior is reported in previous studies. The relationship may not be causal, however, as the effect of common risk factors is often not considered. The current study examined whether early initiation was a key predictor of risky sexual behavior in the 20s and 30s, over and above co-occurring individual and environmental factors. Data were drawn from the Seattle Social Development Project, a longitudinal panel of 808 youth. Early predictors (ages 10 to 15) and sexual risk taking (ages 21 to 24 and 30 to 33) were assessed prospectively. Early sexual initiation (before age 15) was entered into a series of probit regressions that also included family, neighborhood, peer, and individual risk factors. Although a positive bivariate relation between early sexual initiation and sexual risk taking was observed at both ages, the link did not persist when co-occurring risk factors were included. Behavioral disinhibition and antisocial peer influences emerged as the strongest predictors of sexual risk over and above early sexual initiation. These results suggest that early sexual initiation must be considered in the context of common antecedents; public health policy aimed at delaying sexual intercourse alone is unlikely to substantially reduce sexual risk behavior in young adulthood.

Individual and environmental predictors of health risk behaviours among Dutch adolescents: the HBSC study

OBJECTIVE

To examine unique and common predictors of tobacco smoking, binge drinking, cannabis smoking, early sexual intercourse and multiple health risk behaviours.

STUDY DESIGN

Cross-sectional survey study.

METHODS

The Dutch Health Behaviour in School-aged Children (HBSC) study was used to provide data on 1742 adolescents aged 15 and 16 years of age. This study focused on a variety of individual and environmental predictors of health risk behaviours, tapping into four domains (mental health, family, peers and school), retrieved by adolescent self-reports and corrected for sociodemographic variables. Logistic and linear regression analyses were performed.

RESULTS

Unique predictors (i.e., gender, low and very low education level, general health, hyperactivity problems, conduct problems, incomplete family, religion, knowledge of mother, parental rules on alcohol drinking, time spent with friends, number of friends, perceived tobacco use of classmates, truancy) were identified. In addition, common predictors (i.e., permissive rules on alcohol drinking and much time spent with friends) were also identified, explaining an increase in engagement in all investigated health risk behaviours in adolescence, including multiple risk behaviours.

CONCLUSIONS

A prevention strategy targeting restrictive parenting and time spent with friends may be effective to reduce/discourage engagement in health risk behaviours.

Brief report: Pregnant by age 15 years and substance use initiation among US adolescent girls

We examined substance use onset and associations with pregnancy by age 15 years. Participants were girls ages 15 years or younger (weighted n = 8319) from the 1999-2003 Youth Risk Behavior Surveillance System (YRBS). Multivariable logistic regression examined pregnancy as a function of substance use onset (i.e., age 10 years or younger, 11-12, 13-14, and age 15 years) for alcohol, cigarettes and marijuana, controlling for race/ethnicity and metropolitan location. Of girls pregnant by age 15 years (3% of the sample, weighted n = 243), 16% had smoked marijuana by age 10 years and over 20% had smoked cigarettes and initiated alcohol use by age 10 years. In the multivariable analysis, marijuana use by age 14 years and/or cigarette smoking by age 12 years clearly distinguished girls who became pregnant by age 15 years and is perhaps due to a common underlying risk factor.

Adolescent Sexual Abstinence: A Test of an Integrative Theoretical Framework

The purpose of this study was to test an integrative theoretical framework in explaining adolescents’ sexual abstinence and intentions to remain abstinent and refine the framework to reflect which elements contribute more powerfully to the explanation of abstinence and intentions. We administered an anonymous, theory-based questionnaire to two nonrandom samples of seventh- and eighth-graders ( n = 451 and 447, respectively). Measurement modeling provided sufficient evidence for establishing construct validity. A refined structural equation model demonstrated good fit. Pro-abstinence standards predicted stronger beliefs toward staying abstinent, stronger perceptions that others endorse pro-abstinence norms, and a greater self-efficacy to remain sexually abstinent until marriage. In turn, beliefs, norms, and self-efficacy were predictive of intentions, which predicted sexual abstinence at a later time point. Similar findings emerged in a replication using a second set of sample data. Results suggest that this integrative theoretical framework is useful in explaining adolescents’ intention and their subsequent sexual abstinence.

Predictors of sexual debut at age 16 or younger

The present study examined the extent to which variables within the self system (i.e., symptoms of alcohol dependence and conduct disorder, gender, race, and metropolitan status) and the familial system (i.e., having an alcohol dependent biological parent or second-degree relative, religious background, educational background of parents, and being born to a teenage mother) were associated with sexual debut at 16 years old or earlier. Participants were 1,054 biological relatives, aged 18-25 years, of alcohol dependent probands who participated in the Collaborative Study on the Genetics of Alcoholism project. Comparison participants (N = 234) without alcohol dependent biological parents were also evaluated. Clinical and sociodemographic variables were assessed by structured, personal interviews. Parental history of alcohol dependence was evaluated by direct interview of parents in most cases and family history in uninterviewed parents. In a multivariate survival analysis, increased risk of becoming sexually active at 16 years of age or earlier was significantly associated with 6 of the 10 predictor variables, including race, one or more alcohol dependence symptoms, and/or one or more conduct disorder symptoms. Having an alcohol dependent biological parent or second-degree relative (e.g., aunt, uncle, or grandparent), educational background of mother, and being born to a teenage mother were also significantly associated with increased risk. These results provide evidence that specific variables in the self and familial systems of influence are important in predicting sexual debut at 16 years old or earlier.

Factors associated with early menarche: results from the French Health Behaviour in School-aged Children (HBSC) study

Background

Puberty is a transition period making physiological development a challenge adolescents have to face. Early pubertal development could be associated with higher risks of poor health. Our objective was to examine risk behaviours, physical and psychological determinants associated with early menarche (<11 years).

Methods

Early menarche was assessed in the Health Behaviour in School-aged Children French cross-sectional survey. Data were collected in 2006 by anonymous self-reported standardized questionnaire from a nationally representative sample of 1072 15 years old girls in school classrooms. Family environment, school experience, physical and psychological factors, risk behaviours (substance use and sexual initiation) were recorded. Logistic regression models were applied (analysing for crude and adjusted relationships between early menarche and risk behaviours controlled for family context).

Results

Median age at menarche was 13.0 years; 57 girls (5.3%) were early-matured. Controlled for familial environment, early menarche was associated with having had more than two life-drunkenness episodes (adjusted OR = 2.5 [1.3-4.6]), early sexual initiation (adjusted OR = 2.8 [1.3-6.0]) and overweight (adjusted OR = 7.3 [3.6-14.9]).

Conclusion

Early-maturing girls may affiliate with older adolescents, hence engage in risk behaviours linked to their appearance rather than their maturity level. Factors associated with early menarche highlight the need to focus attention on early-matured girls to prevent further health problems linked to risk behaviours.

Early pubertal onset and its relationship with sexual risk taking, substance use and anti-social behaviour: a preliminary cross-sectional study

Background

In many countries age at pubertal onset has declined substantially. Relatively little attention has been paid to how this decline may affect adolescent behaviours such as substance use, violence and unprotected sex and consequently impact on public health.

Methods

In the UK, two opportunistic samples (aged 16-45 years), paper-based (n = 976) and online (n = 1117), examined factors associated with earlier pubertal onset and whether earlier age of onset predicted sexual risk-taking, substance use and anti-social behaviours during early adolescence.

Results

Overall, 45.6% of females reported menarche ≤ 12 years and 53.3% of males were categorised as having pubertal onset ≤ 11 years. For both sexes earlier pubertal onset was associated with poorer parental socio-economic status. Other pre-pubertal predictors of early onset were being overweight, more childhood illnesses (females) and younger age at time of survey (males). For both sexes earlier puberty predicted having drunk alcohol, been drunk, smoked and used drugs <14 years as well as having a sexual debut and unprotected sex <16 years. Males with earlier pubertal onset were more likely to report fighting and aggressive responses to emotional upset during early adolescence while females were more likely to report being bullied and having taken more time off school.

Conclusion

Results provide sufficient evidence for changes in age of pubertal onset to be further explored as a potential influence on trends in adolescent risk behaviours. Further insight into the relationship between early puberty and both obesity and socio-economic status may help inform early interventions to tackle the development of risk behaviours and health inequalities during early adolescence.

Sexual and reproductive health of adolescents in Belgium, the Czech Republic, Estonia and Portugal

OBJECTIVES

This pilot study, within the REPROSTAT 2 Project, aimed at investigating the sexual and reproductive health (SRH) of school-based youths in four countries of the European Union.

METHODS

Students of either sex, aged between 16 and 19 years and entering grade 10, 11 or 12 during the 2005-2006 school year participated in a cross sectional survey. A structured questionnaire was administered to a convenience sample of students from selected schools in Belgium, the Czech Republic, Estonia and Portugal.

RESULTS

In each country, more than three quarters of respondents had previously had a boyfriend or girlfriend and almost half had heterosexual intercourse. More than 85% of sexually experienced youths in each country had used contraception at coital debut. Mean age at coital debut varied between 15.2 (Belgium) and 16.4 years (Czech Republic). While 51% of respondents in Estonia knew of Chlamydia trachomatis infection, the corresponding figure in Portugal was only 12%.

CONCLUSIONS

Sexual activity is common among school-going youths in all four countries. This highlights the need for Member States to systematically collect indicators of SRH in this population. Use of a common measurement framework can inform the establishment of common targets for joint initiatives such as reducing teenage pregnancy and STIs in adolescents.

Age at menarche and first pregnancy among psychosocially at-risk adolescents

We sought to determine which factors influence the association between menarche and conception among adolescent study participants (n = 1030), who demonstrated an earlier age of menarche than did national samples. Age at first sexual intercourse (coitarche) mediated the relationship between age at menarche and first pregnancy among White girls, whereas gynecologic age at coitarche (age at coitarche minus age at menarche) and age at menarche explained the timing of the first pregnancy among Black and Hispanic girls. Pregnancy prevention interventions to delay coitarche should also include reproductive education and contraception.

Gender, mature appearance, alcohol use, and dating as correlates of sexual partner accumulation from ages 16-26 years

PURPOSE

To determine growth in sexual partnering from age 16-26 years, and to test whether biological and social factors launched these growth patterns.

METHODS

A prospective design was used. Participants were 176 young people (47% female) followed from birth to age 26 years. Sexual partnering was measured as the accumulated number of different sexual intercourse partners at ages 16, 19, 23, and 26 years. Physical appearance of maturity, alcohol use, and dating were measured at ages 13-16 via observations, interviews, and questionnaires.

RESULTS

Mature appearance at age 13 years, use of alcohol more than monthly at age 16, and a history of a steady romantic partner before age 16 were each associated with a greater number of sexual intercourse partners by age 16. However a more mature appearance, more frequent alcohol use, and greater dating involvement did not foreshadow a steeper accumulation of sexual partners between ages 16 and 26. Only gender had such a "growth" influence, with males accruing sexual partners more rapidly from the ages of 16-26 years when compared with females.

CONCLUSIONS

Adolescents had accumulated a higher number of sexual partners by age 16 years when they looked older, drank alcohol more frequently, and were more involved with dating in early to middle adolescence. Also male gender was associated with accumulation of sexual partners more rapidly between ages 16 and 26 years, and there was little indication that the accumulation of different sexual partners had begun to slow by age 26 for the average participant.

Psychosocial predictors of sexual initiation and high-risk sexual behaviors in early adolescence

BACKGROUND

This longitudinal study examined psychosocial factors associated with risky sexual behavior in early adolescence.

METHODS

Data were collected through a self-report survey, the Social and Health Assessment (SAHA), which was administered in three waves between 2001 and 2003 to a cohort of incoming sixth grade students in the public school system (149 classes at 17 middle and high schools, N = 1,175) of a small northeastern city in the United States.We first examined whether internalizing and externalizing problems in sixth grade, and the rate of change in these factors during middle school, were predictive of sexual initiation two years later, when most of the sample was in eighth grade. We then assessed whether internalizing and externalizing problems in sixth grade, and the rate of change in these factors during middle school, were predictive of engaging in high risk sexual behavior over the subsequent two years.

RESULTS

Externalizing factors are more predictive of sexual risk in early adolescence than are internalizing factors. Specifically, substance use and violent delinquency over the course of middle school were associated with higher, while anxiety with lower, sexual initiation rates during middle school. Additionally, increased substance use over the course of middle school was associated with greater likelihood of engaging in high risk sexual behavior.

CONCLUSION

By identifying particular psychosocial risk factors among young adolescents, the findings of this study have implications for designing multi-dimensional programs aimed at preventing health-compromising sexual behavior among young teens.

Communication as a protective factor: evaluation of a life skills HIV/AIDS prevention program for Mexican elementary-school students

Literature suggests that communication is a protective factor against high-risk sexual behavior. This study assessed the impact of a fourth-grade communication-centered life skills program on attitudes, norms, self-efficacy, behaviors, and intentions toward communication about difficult subjects. Participants included 1,581 low-income Mexican elementary-school children, divided into experimental and control groups. Teachers were trained to replicate the program as part of the school curriculum over 15 to 20 weeks. Students completed self-report questionnaires before and after the program. Multilevel analyses demonstrated the program's statistically significant positive impact on communication about attitudes, self-efficacy, intentions, and behavior; perception of sociocultural norms regarding communication transformed as a result of the program. Gender significantly predicted differences in communication: with respect to attitudes, self-efficacy, and intentions. The results show that early intervention programs targeting communication about difficult subjects can prevent risky sexual behavior and its consequences (e.g., HIV/AIDS) and influence perception of norms and gender roles.

Predictors of adolescent sexual behavior and intention: a theory-guided systematic review

PURPOSE

To better understand why adolescents initiate sexual activity at early ages, we conducted a systematic literature review guided by eight key elements outlined in an integrative theoretical framework.

METHODS

Using the matrix method for literature reviews, we extracted-from 69 published studies-statistically significant and nonsignificant findings (related to the attempted prediction/explanation of adolescents' sexual behavior and intention) and organized them using the various integrative model elements. We also assessed these publications' methodological quality including each study's deployment of theory, appropriate design, and data analytic/reporting techniques.

RESULTS

Three integrative theoretical framework elements-intention, perceived norms, and an environmental constraint variable, time home alone-emerged as stable predictors of sexual behavior outcomes in this body of literature. This analysis revealed, however, a literature that has remained rather stagnant regarding its methodological quality, over time.

CONCLUSIONS

Implications for adolescent sexual health promotion practice and research are discussed.

Stages of sexual readiness and six-month stage progression among African American pre-teens

We examined the range of sexual intentions and behaviors preceding sexual initiation among 211 African-American pre-teens assigned to the control arm of a longitudinal community-based intervention trial. Stage of sexual readiness was assessed using the stage of change construct from the Transtheoretical Model, and patterns of stage movement during a 6-month period were examined. Overall, 90% of participants were in precontemplation at baseline, with the proportion of participants in this stage declining with each year of age. There was substantial stability in stage of sexual readiness during the 6-month period (87% stable). While definitive conclusions regarding exact patterns of movement are not yet possible, stage movement does not appear to be linear for all pre-teens, and there is evidence of both stage progression and regression. We present emerging patterns of stage movement, which suggest potential variation by age, gender, and baseline stage, and discuss potential implications.

Self-esteem and social adjustment in young women with Turner syndrome--influence of pubertal management and sexuality: population-based cohort study

CONTEXT

Pediatric management of patients with Turner syndrome focuses on height, frequently resulting in a delay of pubertal induction. The influence of pubertal management on psychosocial adjustment and sex life has not been evaluated in Turner syndrome patients.

OBJECTIVE

The objective of the study was to identify the determinants of self-esteem, social adjustment, and initiation of sex life in patients with Turner syndrome, particularly those related to pubertal management.

DESIGN

This was a prospective evaluation, the StaTur study.

SETTING

The study was conducted with a population-based registry of GH-treated patients.

PARTICIPANTS

Participants included 566 young adult women with Turner syndrome, aged 22.6 +/- 2.6 yr (range, 18.3-31.2).

MAIN OUTCOME MEASURES

Measures used in the study were Coopersmith's Self-Esteem Inventory, Social Adjustment Scale Self-Report, questions on sexual experience, and extensive data on pediatric management.

RESULTS

Low self-esteem was associated with otological involvement and limited sexual experience. Low social adjustment was associated with lower paternal socioeconomic class and an absence of sexual experience. Late age at first kiss or date was associated with cardiac involvement and a lack of spontaneous pubertal development. Age at first sexual intercourse was related to age at puberty and paternal socioeconomic class. Delayed induction of puberty had a long-lasting effect on sex life. Height and height gain due to GH treatment had no effect on outcomes.

CONCLUSIONS

Puberty should be induced at a physiologically appropriate age in patients with Turner syndrome to optimize self-esteem, social adjustment, and initiation of the patient's sex life. Therapeutic interventions altering normal pubertal development in other groups of patients should be reconsidered in light of these findings.

Self-esteem and adolescent sexual behaviors, attitudes, and intentions: a systematic review

PURPOSE

This review systematically examined the relationship between self-esteem and adolescents' sexual behaviors, attitudes, and intentions, as empirically investigated by researchers over the last 20 years.

METHODS

Based on the Matrix Method for systematic reviews, five electronic databases and reference lists of published studies were searched. Thirty-eight (n = 38) publications met specific inclusion and exclusion criteria and comprised the final sample. Each study was assigned a methodological quality score (MQS; maximum = 20 points). Each study's empirical test of the relationship between self-esteem and sexual behaviors/attitudes/intentions was counted as a single finding and was classified as exhibiting an inverse linear relationship, no statistically significant linear relationship, or a positive linear relationship.

RESULTS

A total of 189 findings (average = 4.97/publication, range 1-28) were analyzed. Most findings (n = 138, 73%) consisted of tests of self-esteem and sexual behaviors. Regarding the nature of the relationship between self-esteem and the various behavior/attitude/intention variables, 62% of behavior findings and 72% of the attitudinal findings exhibited no statistically significant association. All of the intention-related findings exhibited some type of relationship (either positive or inverse). Studies' average MQS was 11.71 (SD = 1.60). Higher quality studies yielded findings of positive or absence of relationship (Cramer's V = .329, p = .001).

CONCLUSIONS

If most findings exhibit no association between self-esteem and adolescent sexual behaviors/attitudes/intentions, questions are inevitably raised whether the emphasis placed on self-esteem by public health professionals is innocuous. Recommendations for methodological improvement of this body of research are also presented.

Parent-child communication processes: preventing children's health-risk behavior

PURPOSE

Review individual, family, and environmental factors that predict health-risk behavior among children and to propose parent-child communication processes as a mechanism to mediate them.

CONCLUSIONS

Improving parent-child communication processes may: reduce individual risk factors, such as poor academic achievement or self-esteem; modify parenting practices such as providing regulation and structure and acting as models of health behavior; and facilitate discussion about factors that lead to involvement in health-risk behaviors.

PRACTICE IMPLICATIONS

Assessment strategies to identify youth at risk for health-risk behavior are recommended and community-based strategies to improve communication among parents and children need development.

Early to bed: a study of adaptation among sexually active urban adolescent girls younger than age sixteen

OBJECTIVE

To examine the association between sexual activity among urban adolescent girls and four global measures of psychosocial adaptation (academic motivation, school achievement, depressive symptoms, and expectations about the future).

METHOD

Data derived from the Social and Health Assessment, a self-report survey administered in 1998 to students in the public school system in New Haven, CT (149 classes at 17 middle and high schools).

RESULTS

Of 1,413 respondents (57% black, 28% Hispanic; mean age 13.4 +/- 1.7 years), 414 (29%) acknowledged prior sexual intercourse; the proportions of sexually active girls in 6th, 8th, and 10th grades were 14%, 30%, and 50%, respectively. In multivariate analyses of covariance, sexual activity was significantly associated with all four measures of psychosocial adaptation (p < .001). Other correlates of at least one measure of maladaptation included socioeconomic status, sensation seeking, and lower school grade (p < .001 for each), peer pressure (p < .01), and black ethnicity, and the interaction of sexual activity by lower school grade (p < .05 for each).

CONCLUSIONS

Compared with their sexually naive peers, sexually active adolescent girls had lower scores on global measures of psychosocial adaptation. These findings have clinical, policy, and research relevance to a vulnerable population at high risk of teenage pregnancy and sexually transmitted diseases.

Development of a scale to measure adolescents' beliefs and attitudes about postponing sexual initiation

PURPOSE

To develop a scale to measure adolescent beliefs and attitudes about postponing sexual initiation (PSI).

METHODS

A theory-based, 12-item scale measuring beliefs about PSI was developed and administered via a mailed questionnaire to those participants in an ongoing longitudinal cohort study of adolescents who had not yet initiated sexual intercourse. Internal consistency reliability, content validity, factorial validity, and construct validity were assessed using cross-sectional data.

RESULTS

Mean age for boys was 14.4 (+/- 1.6) years and for girls 14.3 (+/-1.6) years (range 11 to 19 years), and 93% of respondents were white. The beliefs about PSI rated as most important by both girls and boys were concern about pregnancy and sexually transmitted infection. Cronbach alpha for the scale was 0.83 for girls and 0.88 for boys. Exploratory factor analysis demonstrated that the items loaded on four factors consistent with the theoretical basis of the model and confirmatory factor analysis demonstrated good fit of the overall model. The PSI scale score was associated with hypothesized sociodemographic, psychological, and behavioral variables, supporting construct validity of the scale. A higher score was associated with female gender; age < or = 14 years; higher global and social self-esteem; more frequent attendance at religious services; less peer pressure to have sexual intercourse; nonuse of alcohol, illicit drugs, and cigarettes; and no intention to initiate sexual intercourse in the next year.

CONCLUSIONS

The PSI scale demonstrated satisfactory psychometric properties. Future research is needed to evaluate the utility of this scale in predicting sexual initiation and in interventions aimed at postponing sexual initiation.

Pubertal timing, sexual behaviour and self-reported depression in middle adolescence

The associations between pubertal timing, sexual activity and self-reported depression were analysed in a population sample of 17,082 girls and 15,922 boys aged 14-16 as a par of a classroom survey. Pubertal timing was assessed by age at onset of menstruation (menarche) or ejaculations (oigarche). Sexual experiences elicited included kissing, light petting, heavy petting and intercourse. Self-reported depression was measured by the 13-item Beck Depression Inventory. Among girls, self-reported depression was associated with early puberty and intimate sexual relationship. Among boys depression was associated with very early and late puberty and experience of intercourse. Early puberty is a risk factor for self-reported depression. Intimate sexual relationships in middle adolescent are likely to indicate problems in adolescent development rather than successful adolescent passage.

Risk-taking sexual behaviour and self-reported depression in middle adolescence--a school-based survey

BACKGROUND

Early sexual activity has been widely studied in the context of pregnancies, substance use and antisocial behaviour, but the aspects of psychosexual health have received less attention.

AIM

To study the associations of early sexual activity and self-reported depression.

SETTING

A school survey in Finland in 1999 and 2000 in the eighth and ninth grades.

METHODS

Adolescents with experience of sexual intercourse were studied (11,793 girls and 10,443 boys, mean age 15.5 years). Scores of 8 or more in the Beck Depression Inventory were regarded as indicative of self-reported depression. Associations with sexual behaviour variables were analysed using logistic regression models.

RESULTS

In both genders, self-reported depression increased in proportion to the number of sexual partners and with the non-use of contraception. A higher number of coital experiences correlated with depression only among boys. Adjusting for age and age at menarche/oigarche did not affect the associations detected. In stepwise logistic regression, an increasing number of partners increased the risk for self-reported depression [for boys with at least five partners odds ratio (OR) 2.5, 95% confidence intervals (CI) 2.2-3.0, and for girls OR 2.7, 95% CI 2.3-3.2]. Boys and girls who did not use contraception showed roughly twice as high a risk as contraceptive users. However, girls with five or more coital experiences had a significantly lower risk for depression compared to girls with only one sexual intercourse.

CONCLUSIONS

Multiple sexual partners and non-use of contraception may reflect a depressive disorder in both genders. While adolescent health service providers should be aware of the risk for depression among sexually active adolescents, the sexual health of depressed adolescents also warrants special attention.

Sociodemographic differences in the occurrence of teenage pregnancies in Finland in 1987-1998: a follow up study

STUDY OBJECTIVE

To analyse sociodemographic differences in the occurrence of pregnancies to 14 to 19 year olds and changes in these differences from 1987 to 1998.

DESIGN

Follow up of adolescent survey respondents using registers.

SETTING AND SUBJECTS

The dataset includes information on all registered pregnancies (abortions, births, and miscarriages, n=2743) of the female respondents (n=28 914) to the Adolescent Health and Lifestyle Survey (AHLS) from 1987 to 1998. In the AHLS, self administered questionnaires were mailed every second year to independent samples of 12, 14, 16, and 18 year olds representative for Finland.

MAIN OUTCOME MEASURE

Relative risk (hazard) of becoming pregnant at teenage.

MAIN RESULTS

Girls from lower socioeconomic background had a higher pregnancy risk. Girls who did not live with both parents at the baseline survey had higher pregnancy risk than those who did, and girls who lived in a stepfamily had a higher risk than those who lived in a one parent family. Swedish speaking girls had a lower pregnancy risk than the Finnish speaking girls. There was no systematic change from 1987 to 1998 in most sociodemographic differentials in the teenage pregnancy risk, however, there was some increase in the differences by family structure. Changes in the sociodemographic structure did not explain the levelling off of the downward trend in teenage pregnancy risk, nor did the regional socioeconomic differences explain regional differentials in teenage pregnancy risk.

CONCLUSION

Although the reduction of socioeconomic and regional differences has been a general objective in Finnish social and health policies, the relative differences in teenage pregnancies have not decreased.

Mothers' influence on the timing of first sex among 14- and 15-year-olds

PURPOSE

To better understand maternal influence on the timing of first sex for adolescents.

METHODS

Using data from the National Longitudinal Study of Adolescent Health, Cox proportional hazard models were used to assess the association between maternal characteristics and the timing of first sex. Matched dyads of mothers and their adolescent children were used.

RESULTS

Of the 2,006 adolescents aged 14 and 15 years who reported to be virgins, 95 males (10.8%) and 162 females (15.8%) indicated they had initiated sex within the follow-up period, 1 year later. For males, few variables beyond the controls used in the models were predictive of timing of first sexual intercourse. For females, mother's satisfaction with her relationship with her daughter (hazard ratio =.62), mother's strong disapproval of her daughter having sex (hazard ratio =.56), and frequency of communication with the parents of her daughter's friends were associated with later sexual debut (hazard ratio =.88).

CONCLUSION

Based on the variables in the model, mothers' values and beliefs and relationship satisfaction have more influence on daughters than on sons.

Adolescent sexual risk behavior: a multi-system perspective

Adolescents are at high risk for a number of negative health consequences associated with early and unsafe sexual activity, including infection with human immunodeficiency virus, other sexually transmitted diseases, and unintended pregnancy. As a result, researchers have attempted to identify those factors that influence adolescent sexual risk behavior so that meaningful prevention and intervention programs may be developed. We propose that research efforts so far have been hampered by the adoption of models and perspectives that are narrow and do not adequately capture the complexity associated with the adolescent sexual experience. In this article, we review the recent literature (i.e., 1990-1999) pertaining to the correlates of adolescent sexual risk-taking, and organize the findings into a multisystemic perspective. Factors from the self, family, and extrafamilial systems of influence are discussed. We also consider several methodological problems that limit the literature's current scope, and consider implications of the adoption of a multisystemic framework for future research endeavors. We conclude with a discussion of the implications of the available research for practitioners working to reduce sexual risk behavior among adolescents.

Relationship between adolescent-parental communication and initiation of first intercourse by adolescents

OBJECTIVE

To examine the level of communication between parents and adolescents and correlate the findings with onset of sexual intercourse.

METHODS

This was a 10-year longitudinal study. Subjects filled out questionnaires at the time of each health supervision visit. The data in this article were harvested at enrollment and at the 5-year point. Comparisons of adolescent-parental communication were first compared between the virginal and nonvirginal groups at the initiation of the study. The results were then confirmed by adding data from patients in the virginal group who converted over the first 5 years of the study to the nonvirginal group. Two hundred and three patients, aged 12-21 years, were studied from a pediatrician's practice panel in Middleton, Wisconsin. The questionnaires inquired about grades and activities school, relationship with siblings and parents at home, and risk-taking behaviors involving alcohol, drugs, and sex with peers. Statistical analysis included the Student's t-test to determine the mean difference between groups. Fisher's exact test was used to evaluate the association of variables to the status of patients' sexual activity at enrollment. Multiple logistic regression was conducted on the initial enrollment data to examine the association between the initial covariates and patients' sexual status.

RESULTS

During the initial survey, 172 enrolled patients were in the virginal group and 31 in the nonvirginal group. The virginal group had a higher rating of communication with their parents after adjusting for age (p <.001). To verify these findings, we examined an additional 29 patients in the virginal group who converted to nonvirginal status during the first 5 years of the study. We then compared the level of adolescent-parental communication between the subgroup who converted to nonvirginal status with the level of communication of the subgroup who remained virgins. Even after correcting for age, communication with the mother was significantly better in patients who maintained their virginal status (p <.01).

CONCLUSIONS

Teenagers who perceive that they have a better level of communication with their parents are less likely to engage in sexual intercourse.

The determinants of sexual intercourse before age 16

PURPOSE

To identify risk and protective factors for initiation of sexual intercourse before age 16 years at the level of the individual, family, and school.

METHODS

A longitudinal study based on a cohort of 1020 people born in Dunedin, New Zealand in 1972/73 and followed up to age 21 years. Demographic characteristics of the sample were similar to the New Zealand population of that age, except that a smaller proportion (3%) were Maori or Pacific Island Polynesian. Information on individual, family and school factors was collected by interview with parents at ages 3, 5, 7 and 9 years and then by postal questionnaire two-yearly up to 15 years. Subjects were assessed two-yearly from age 3 years and interviewed about their behaviours and ambitions at ages 11, 13, and 15 years. Questions about age at first intercourse were asked by computer at age 21 years. Multivariate logistic regression was used to model associations with age of first intercourse less than 16 years.

RESULTS

Data on age at first intercourse were available for 926/1020 (91%) of surviving members of the cohort assembled at age 3 years. Overall 27.5% of males and 31.7% of females reported sexual intercourse before age 16 years. In multivariate analyses the independent predictors for early sexual initiation for males were: not having outside home interests at age 13 years, no religious activity at age 11 years, not being attached to school at age 15 years, a low reading score, and a diagnosis of conduct disorder in early adolescence. For females, independent predictors were: socioeconomic status in the middle range, mother having her first child before age 20 years, IQ in the middle range, not being attached to school, being in trouble at school, planning to leave school early, cigarette smoking and higher self-esteem score.

CONCLUSIONS

Individual and school factors appear to be more important than family composition or socioeconomic status in the decision to have sexual intercourse before age 16 years. The lowering of age at first intercourse may be partly a cohort effect related to high rates of teenage childbearing in the mothers' generation, and to changes in social acceptability of early sexual behaviour.