Alternative methods in the investigation of adolescents' sexual life

Effect of Parent-Daughter Communication about Sex on the Use of Less Effective Contraception among Women from Ages 15-24 Years in France

STUDY OBJECTIVE

Most women begin sexual activity as teenagers but nearly 20% of women in France younger than 25 years rely on less effective contraceptive methods (condoms or methods such as withdrawal or periodic abstinence). We sought to analyze the association with less effective contraception among women aged 15-24 years in France and communication about sex and contraception with their parents. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: The analyses focused on 713 sexually active women who did not currently want a child, were using contraception, and were interviewed in 2010 in a national cross-sectional probability survey (FEcondité CONtraception Dysfonctions sexuelles [FECOND]) when they were 15-24 years old. Associations between the use of less effective contraception, social and demographic characteristics, sexual activity, health characteristics, and communication with parents and friends about sexuality and contraception were tested with logistic regression models according to age group.

RESULTS AND CONCLUSION

Less effective contraception (condoms, and barrier or natural methods) is used more often by younger women: 27.5% of 15- to 19-year-old women and 14.7% of 20- to 24-year-old women (P < .001). After adjustment for demographic characteristics and aspects of their sex lives (regularity and frequency of intercourse), women who reported difficulty discussing contraception and sex with their mothers at age 15 years were more likely than those with easier communication to use less effective contraception (for those 15-19 years, odds ratio = 1.97; 95% confidence interval, 0.94-4.10, and for those 20-24 years, odds ratio = 2.36; 95% confidence interval, 1.31-4.26). Difficulty in communicating with their parents, especially their mothers, about sex, is associated with young women's choice of less effective contraception.

Social Context and Problem Factors among Youth with Juvenile Justice Involvement Histories

Youth with juvenile justice histories often reside in poorly resourced communities and report high rates of depression, gang involved networks, and STI-sexual related risk behaviors, compared to their counterparts. The primary aim of this study was to examine the relationship between social context (ie, a combined index score comprised of living in public housing, being a recipient of free school lunch, and witnessing community violence) and risk factors that are disproportionately worse for juvenile justice youth such as depression, gang involved networks and STI sexual risk behaviors. Data were collected from a sample of detained youth ages 14 to 16 (N = 489). Questions assessed demographics, social context, depression, gang-involved networks, and STI risk behaviors. Multiple logistic regression models, controlling for age, gender, race, school enrollment, and family social support, indicated that participants who reported poorer social context had double the odds of reporting being depressed; three times higher odds of being in a gang; three times higher odds of personally knowing a gang member; and double the odds of having engaged in STI-risk behaviors. These results provide significant information that can help service providers target certain profiles of youth with juvenile justice histories for early intervention initiatives.

Electronic self-report symptom and quality of life for adolescent patients with cancer: a feasibility study

BACKGROUND

Computerized symptom and quality of life (QoL) assessment has been tested and found feasible and acceptable in outpatient settings for adult patients with cancer, but has not been used often in pediatric oncology settings in the United States.

OBJECTIVE

The purpose of this pilot study was to evaluate the feasibility of an innovative, computerized symptom, and QoL assessment for adolescent patients who were being treated for cancer.

METHODS

A convenience sample of 40 adolescent patients with cancer, who were between 13 and 20 years old and able to communicate in English, agreed to participate. Each participant answered the Web-based Electronic Self-report Assessment-Cancer Adolescent Form on a wireless touch-screen computer just prior to a treatment visit in an ambulatory clinic setting. Descriptive frequencies and central tendency were used to describe sample characteristics and feasibility outcomes.

RESULTS

The computerized assessment was found to be feasible with regard to data completeness rates (>99%), acceptability (high), time to complete (30 minutes), and assistance required to complete (minimal).

CONCLUSION

The Electronic Self-report Assessment-Cancer Adolescent Form is a feasible approach for obtaining adolescent patients' self-report of cancer symptoms and QoL in an ambulatory setting.

IMPLICATIONS FOR PRACTICE

Screening for symptoms and QoL may be integrated during check-in procedures as routine assessment for adolescent cancer patients in ambulatory settings.

Increased risks of early sexual initiators: time makes a difference

Background Years since onset of sexual intercourse (YSSI) is a rarely used variable when studying adolescents’ sexual outcomes. The aim of this study is to evaluate the influence of YSSI on the adverse sexual outcomes of early sexual initiators. Methods: Data were drawn from the 2002 Swiss Multicenter Adolescent Survey on Health database, a nationally representative cross-sectional survey including 7429 adolescents in post-mandatory school aged 16–20 years. Only adolescents reporting sexual intercourse (SI) were included (n = 4388; 45% females) and categorised by age of onset of SI (early initiators, age <16: n = 1469, 44% females; and late initiators, age ≥16: n = 2919, 46% females). Analyses were done separately by gender. Groups were compared for personal characteristics at the bivariate level. We analysed three sexual outcomes (≥four sexual partners, pregnancy and condom non-use at last SI), controlling for all significant personal variables with two logistic regressions using first age, then YSSI as one of the confounding variables. Results are given as adjusted odds ratios (AOR) using late initiators as the reference category. Results: After adjusting for YSSI instead of age, negative sexual outcomes among early initiators were no longer significant, except for multiple sexual partners among females, although at a much lower level. Early initiators were less likely to report condom non-use at last SI when adjusting for YSSI (females: AOR = 0.59 [0.44–0.79], P < 0.001; males: AOR = 0.71 [0.50–1.00], P = 0.053). Conclusion: YSSI is an important explanatory variable when studying adolescents’ sexuality and needs to be included in future research on adolescents’ sexual health.

An exploratory study of patient attitudes towards symptom reporting in a primary care setting. Benefits for medical consultation and syndromic surveillance?

OBJECTIVES

The aim of this study was to investigate people's attitude towards providing symptom information electronically before a consultation. Specific areas investigated include a) attitudes and experiences with regards to acquisition of information related to symptoms, b) attitudes towards computer based communication of symptoms to the general practitioner and how they preferred to carry out such reporting, and c) attitudes towards storage, use and presentation of symptom-data in general, and particularly in a symptom based surveillance setting.

METHODS

Data was collected from 83 respondents by use of convenience sampling.

RESULTS

The respondents were familiar with using the Internet for health purposes, such as acquisition of information related to their symptoms prior to a consultation. The majority of respondents had a positive attitude towards providing information about their symptoms to the general practitioner's office as soon as possible after falling ill. Over half of the respondents preferred to use e-mail or a web-interface to perform this task. Eighty four percent were willing to have their symptom data stored in their EPR and 76 percent agreed that the general practitioner might access the symptoms together with the prevalence of matching diseases in order to assist the diagnostic process during the next consultation.

CONCLUSIONS

The results of this study support the applicability of electronically mediated pre-consultation systems both for improving primary care consultation and for use in symptom based surveillance, including real-time surveillance.

No change in adolescents' neglect on contraceptive use over two decades

PURPOSE

The sexual activity and contraceptive use is evaluated over 21 years amongst Danish adolescents in ninth grade.

METHODS

A repeated, cross-sectional questionnaire study in the municipality of Viborg, comparing the results of four consecutive surveys between 1986 and 2007.

RESULTS

In 2007, 40% of the pupils had sexual debut at an average age of 15.3 ± 1.5 years. At sexual debut condoms were used in 77% of the adolescents and the contraceptive pill in 15%. At their latest coitus 34% used any contraceptive pill as 27% of pupils changed from use of condom to the pill. Practical experience with condoms was found in 90% of both sexes at sexual debut. Fourteen percent of the adolescents used no contraception at all at debut in 2007, which is similar to 1986, 1993, and 2000. Eighteen percent of the pupils used no contraception at all at their last intercourse in 2007 and 2000.

CONCLUSION

Knowledge about and use of condoms is substantial amongst adolescents already at sexual debut. A shift is confirmed from condoms at first coitus to more frequent use of the pill later on. A considerable number of pupils (10-20%) are neither protected against sexually transmitted infections nor pregnancy at first or later intercourse.

Sexual activity among Turkish adolescents: once more the distinguished male

The mean age of first sexual intercourse in Western countries is around 17 years and decreasing. Although Turkey is a bridge between East and West, embracing different cultures, little data are available on sexual issues in the population.

METHODS

A questionnaire was administered to all students in the study year 2004-2005, collecting demographic data, sexual activities, sexual and contraceptive attitudes, and contraceptive knowledge. Of 7,657 applicants invited, 3,970 questionnaires could be analyzed.

RESULTS

Median age of the participants was 18 years (48.0% female, 52% male). Median age at first sexual intercourse was 17 years for females and 16 years for males. 46.5% of the males and 3.0% of the females had sexual intercourse experience. While 68% of the girls had their first sexual intercourse with their lovers, this ratio was 44.8 % for males (Chi square = 59.963, p <.001). Significantly more girls than boys were planning to have their sexual partner as future spouses (Chi square = 55.569, p <.001). Three fourth of the males approved premarital sex for males; this ratio was reversed for females (Chi square = 574.838, p <.001). Although both sexes disapproved premarital sexual intercourse of women, girls were significantly more conservative in this regard (78.6% vs. 92.5%) (Chi square = 110.460, p <.001).

CONCLUSION

Although the adolescent sexual intercourse rate in Turkey is low compared with Western countries, there is a tendency to increase. Therefore, sexual education is needed. When augmenting sexual education programs in undergraduate education, gender difference and cultural factors should be further evaluated.

Exploring the mediating mechanism between gender-based violence and biologically confirmed Chlamydia among detained adolescent girls

The study examined several behavioral mechanisms that link gender-based violence (GBV) to STD among detained, sexually active adolescent girls. Girls (N = 198) were recruited from eight youth detention facilities. Measures were assessed using audiocomputer-assisted self-interviewing. DNA amplification was conducted to assess for chlamydia. Thirty-one percent had experienced GBV and 15% tested positive for chlamydia. GBV was related to chlamydia directly and indirectly through condom failures and through having sexual intercourse while high on drugs and/or alcohol. The study found that sexual risk reduction programs may benefit this population by addressing the role of GBV and its association with STD-associated behaviors.

Factors that adolescent males take into account in decisions about an unplanned pregnancy

Little is known about what factors adolescent males consider important when making decisions concerning the resolution of an unplanned pregnancy with a teenage partner. Young men's influence on pregnancy outcome decisions can play an important part in the subsequent psychological adjustment of the female. The present report draws on data from a larger study with teenage males [Condon, J. T., Corkindale, C. J., Russell, A., & Quinlivan, J. A. (2006). Processes and factors underlying adolescent males' attitudes and decision-making in relation to an unplanned pregnancy. Journal of Youth and Adolescence, 35, 447-458], and extends the findings of that study. Using a 25-item scale embedded in an electronic role-play, data were obtained from 330 male Australian school students on their priorities and concerns in relation to possible outcomes of a partner's pregnancy. Common factors taken into account by almost the entire adolescent sample related to the negative effects of becoming a teenage father. The differences between participants were identified using cluster analysis, which produced three groupings. The majority group was characterised as 'well-balanced' (80.6%), and the two minority groups as 'unwilling/unready' (10.9%) and 'family-centred' (8.5%). Group membership was strongly predictive of the males' final decision regarding the hypothetical pregnancy outcome. Understanding adolescent attitudes and beliefs when faced with this decision may assist practitioners in their guidance of the young couple and help prevent negative psychological sequelae.

What do we know about sexual and reproductive health of adolescents in Europe?

OBJECTIVES

Acceptance of sexual and reproductive health as fundamental to the sustainable development of societies has allowed for creation of new reproductive health programmes and policies. WHO sexual and reproductive health (SRH) strategies were developed in the WHO Regional Office for Europe (2001), as well as globally (2004). Adolescent SRH is important in both strategies. Despite these commitments, adolescents remain vulnerable to poor reproductive health. The goal of this paper is to analyse the current status of SRH of adolescents in Europe.

METHODS

Key reproductive health indicators were chosen. Information was obtained from published studies, databases and questionnaires sent to WHO reproductive health counterparts within the health ministries in the Member States of the WHO European Region.

RESULTS

Pregnancy rate, age at first sexual intercourse, contraceptive use at first and last intercourse, contraceptive prevalence, HIV knowledge, and STI rates vary widely according to the population considered. Gender difference and lack of information pertaining to SRH of all adolescent populations are other key findings.

CONCLUSIONS

While the SRH of most European adolescents is good, they remain a vulnerable population. Lack of standardized reproductive indicators and age specific aggregate data make it difficult to accurately assess the situation in individual countries or perform cross country comparison.

Condom misuse among adjudicated girls: associations with laboratory-confirmed chlamydia and gonorrhea

OBJECTIVES

To identify the prevalence of condom use errors among detained female teens and to test two inter-related hypotheses concerning condom failure.

METHODS

A cross-sectional survey of 134 female teens recruited within eight detention facilities. Measures were collected using audio-computer assisted self-interviewing. Assessment for the presence of C. trachomatis and N. gonorrhoeae was also conducted.

RESULTS

Five forms of condom use errors/problems were common: not discussing condom use with the partner (34.3%), not having a condom when one was desired (48.5%), starting sex before application (21.6%), removing condoms before sex concludes (26.9%), and breakage (32.8%). Significant, associations were found between condom errors/problems and drug/alcohol use. Errors/problems with condom use were significantly higher among teens diagnosed with an sexually transmitted disease (STD) (P = 0.039 for an index measure; P = 0.022 for a single-item measure).

CONCLUSIONS

Findings suggest that detained female teens may have experienced multiple condom use error and problems thereby increasing their vulnerability to STD acquisition.

The prevalence of unwanted and unlawful sexual experiences reported by Danish adolescents: results from a national youth survey in 2002

AIM

To obtain current data about child sexual abuse in Denmark and to assess abused children's own perception of early sexual experiences, which are unlawful according to the Danish Penal Code.

METHODS

Multimedia computer-based self-administered questionnaires (CASI) were completed by a national representative sample of 15-16-y-olds. Child sexual abuse was defined according to the penal code and measured by questions defining specific sexual activities, the relationship between the older person and the child, and the youth's own perception of the incident.

RESULTS

Among 5829 respondents, 11% reported unlawful sexual experiences, 7% of boys and 16% of girls. Only 1% of boys and 4% of girls felt that they "definitely" or "maybe" had been sexually abused.

CONCLUSION

A relatively high percentage of Danish adolescents have early, unlawful sexual experiences. However, young people's own perception of sexual abuse tends to differ from that of the authorities, or their tolerance of abusive incidents is high. Gender differences were found in factors predicting perception of abuse.

Teacher connectedness and health-related outcomes among detained adolescents

PURPOSE

Data were collected from a convenience sample of 550 detained adolescents (ages 14-18 years) to explore the association between adolescents' perception of teacher connectedness and a range of health risk behaviors, such as gang membership, use of in alcohol, drugs, and tobacco, and engagement in sexual risk behaviors prior to detainment.

METHODS

Participants answered survey questions using audio-computer assisted self-interviewing procedures that assessed demographic, pro-social, problem, and drug and sexual risk behaviors.

RESULTS

Multiple logistic regression analyses controlling for demographic and socioeconomic status, truancy, number of days in the detention center, and family factors indicated that adolescents who reported low teacher connectedness, relative to their peers reporting high teacher connectedness, were twice as likely to use marijuana and amphetamines, and twice as likely to be sexually active, have sex while high on alcohol or drugs, have a partner who was high on alcohol or other drugs during sex, and have multiple sexual partners.

CONCLUSIONS

The association between teacher connectedness and adolescents' health risk behaviors prior to detainment suggests that school-based interventions that enhance the school environment, particularly teachers' skills and training to enhance and maximize the effectiveness of their student interactions, may be one strategy for reducing health risk behaviors and their associated adverse health outcomes among youth at high risk.

Internet-administered adolescent health questionnaires compared with a paper version in a randomized study

PURPOSE

To assess whether the scores of an Internet-administered adolescent health questionnaire (using two different interfaces) are equivalent to those obtained via paper and pencil (P&P). Furthermore, it compares adolescents' evaluations of modes of administration.

METHODS

We randomly assigned 591 adolescents (aged 13-17 years) from five secondary schools within their classes to one of the two Internet interfaces (multiple items vs. one item per screen) or P&P. Adolescents completed questionnaires on psychosocial well-being (KIVPA), self-reported problems, health care utilization, and health-related behavior and supplementary evaluation surveys (on the given health questionnaire mode) in the computer classrooms. Differences in questionnaire scores among administration modes were analyzed by the Student's t-test and Wald test.

RESULTS

Response rate was 96% (n = 565). Adolescents in the Internet one-item mode more frequently reported satisfaction with appearance compared with the Internet multiple-items mode (p </= .01). The Internet group had more adolescents reporting that they have a sufficient number of friends than those in the paper mode (p </= .01). The Internet mode received more favorable evaluations than P&P. The multiple items per screen format was favored over the one item per screen format on perceived speed of the administration mode.

CONCLUSIONS

Health questionnaires via Internet were positively evaluated and generally resulted in equal scores of health status/health behavior compared with the P&P mode. We recommend further research with other questionnaires, and in other settings as well with regard to score equivalence between web-based and P&P-administered questionnaires.

Lack of recent condom use among detained adolescent males: a multilevel investigation

OBJECTIVE

To investigate multiple levels of influence with respect to the lack of recent condom use among a high risk sample of adolescent males recruited from short term detention facilities.

METHODS

A cross sectional survey of 231 adolescent males serving, predominantly, short term detention sentences. Assessments were conducted using audiocomputer assisted self interviewing. Condom use during the most recent sexual event was assessed as well as 20 potential correlates of not using condoms. Correlates were assessed within five levels of causation: personal, relational, peer affiliation, family, and societal.

RESULTS

Nine correlates achieved bivariate significance (p<0.05). Of these, the personal level correlates were particularly important in a multivariate model. The motivation subscale from the Condom Barriers Scale was the strongest multivariate correlate of recent condom use. Adolescents scoring below the median were about 3.4 times more likely to report lack of recent condom use (p=0.0006). Adolescents indicating they had ever caused a pregnancy were about 2.5 times more likely to report lack of condom use (p=0.02). Finally, those reporting their peers did not use condoms were about twice as likely to report lack of use (p=0.048).

CONCLUSION

Upon investigating multiple levels of potential influence on condom use, the multivariate findings suggest that personal level factors may be the most important determinant of non-use among adolescent males in short term detention facilities. Although structural changes may be needed to influence some forms of safer sex behaviour, direct intervention with adolescent males may be justified to favourably alter determinants of condom use.

Health risk factors among detained adolescent females

OBJECTIVES

To identify the prevalence of health risk factors among a sample of detained adolescent females and determine whether there are racial/ethnic differences.

DESIGN AND SETTING

A cross-sectional survey of 197 adolescent females (aged 14 to 18 years) recruited within eight detention facilities.

OUTCOME MEASURES

Thirty-five measures, comprising four domains, were assessed. Domains were sex-related risk factors, violence-related risk factors, selected mental health issues, and substance abuse behaviors. Measures were collected using audio-computer-assisted self-interviewing. A biological assessment for the presence of Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis was also conducted.

RESULTS

Several health risk factors were especially prominent. Mean age of sexual debut was 13 years. The mean number of sex partners (lifetime) was 8.8. Twenty percent tested positive for an STD, and 32.2% had ever been pregnant. Of those reporting sexual activity, 33.9% had not used any form of contraception in the past 2 months and about 40% reported having recent sex with a casual partner. More than 40% reported that a friend had been beaten, attacked, or hurt by others in the past year. More than one half had witnessed violence (past year) and nearly 30% had ever belonged to a gang. Forty percent had thought about committing suicide in the past 2 months, with 35% informing someone of their intent, and 25% attempting suicide. Recent use of illegal substances was common. Correlations between the four domains were significant (p < 0.03), but weak. With some notable exceptions (STD prevalence, trading sex for money, witnessing violence), no difference was found between minority and nonminority adolescents with respect to risk factors. After creating an index of all the risk factors, a normal distribution was obtained (mean number of factors, 10.3; standard deviation, 5.0).

CONCLUSIONS

Preventive medicine programs for adolescent females within detention facilities are warranted. Our evidence suggests that health risk behaviors in this population may be quite diverse; therefore, these programs should be broad in scope and that depth of the programs should vary as a function of risk level.

Child and adolescent HIV risk: familial and cultural perspectives

The authors' goal is to review and integrate theory and research focused on the impact of the family, within a cultural perspective, on HIV prevention in childhood and adolescence. Families' impact on adolescents' HIV risk and prevention is examined through the lens of culture, focusing on the individual adolescent factors and family-level influences that converge to determine adolescents' HIV risk status. Family-based risk and health socialization during childhood and adolescence is theoretically and empirically evaluated, from developmental, cultural, and communication perspectives. The influence of families on adolescents' HIV knowledge, risk, and prevention strategies is explored from a developmental perspective. Finally, a future research agenda, focused on remaining issues that affect the ability to understand and modify HIV risk in adolescence, is outlined.

Adjudication history and African American adolescents' risk for acquiring sexually transmitted diseases: an exploratory analysis

BACKGROUND

Little is known about sexually transmitted disease (STD) risk behavior among adjudicated African American adolescents.

GOAL

The goal of the study was to compare STD-associated risk profiles of African American adolescents reporting a history of adjudication and those not reporting adjudication.

STUDY DESIGN

A cross-sectional survey of 304 African American adolescent males and females (aged 15-21 years) was conducted. Adolescents were recruited from primary care clinics and through outreach activities.

RESULTS

Twenty-six percent of the adolescents reported adjudication. After adjusting for gender, adjudicated adolescents were about 3.6 and 4.5 times, respectively, more likely than nonadjudicated adolescents to report ever having one of three STDs (gonorrhea, chlamydia, and trichomoniasis) or to report having one of these in the past 90 days. Reporting recent sex with someone known or suspected of having an STD was about nine times more likely among adjudicated adolescents, and they were about 2.6 times more likely than their nonadjudicated counterparts to report using drugs or alcohol during their last sexual experience and 2.2 times more likely to report frequent sex in the past 90 days.

CONCLUSIONS

African American adolescents with a history of adjudication may have greater risk for acquisition of STDs than their peers not reporting adjudication.

Prevalence and dimensions of sexual orientation in Swiss adolescents: a cross-sectional survey of 16 to 20-year-old students

AIM

Sexual orientation plays an important part in building identity during adolescence. The aim of this study was to describe patterns of sexual orientation, including sexual attraction, fantasies, affiliations and behaviour.

METHODS

The study was based on the analysis of data from computerized self-administered questionnaires of a Swiss national survey on the sexual life of 16 to 20-year-old adolescents (n = 2,075 girls and 2,208 boys.).

RESULTS

Overall, 95.0% of girls and 96.2% of boys described themselves as predominantly heterosexual; 1.4% of girls and 1.7% of boys as predominantly homosexual or bisexual; and 2.8% of teenagers (girls: 3.6%; boys: 2.1%) were "unsure" of their sexual orientation. The reported prevalence of homosexual attraction (girls: 2.0%; boys: 2.9%) exceeded homosexual fantasies (girls: 0.4%; boys: 0.5%) and affiliations (girls: 0.3%; boys: 0.5%). Among the 4205 respondents, 31 girls (1.5% of girls) and 56 boys (2.5% of boys) reported sexual behaviour (experience or penetrative intercourse) with a person of the same sex. Among 1.5% of girls and 2.5% of boys who reported sexual behaviour with a person of the same sex, 65% of boys and 80% of girls nevertheless considered themselves as heterosexual.

CONCLUSION

For a comprehensive understanding of sexual orientation in adolescence a differentiated look at dimensions of sexual orientation is indispensable. This applies to clinical settings, public health and research.

Emergency contraception among teenagers in Switzerland: a cross-sectional survey on the sexuality of 16- to 20-year-olds

PURPOSE

To describe and analyze emergency contraception (EC) awareness and use among sexually active Swiss teenagers.

METHODS

Anonymous computerized questionnaires were distributed to a national representative sample of 4283 in-school adolescents (aged 16 to 20 years) in high schools and professional centers. Young people who were sexually active (51.5% of the sample: 1058 girls and 1073 boys) responded to questions on EC awareness and use and on sexual perception, attitude, and behaviors. Univariate analyses and multiple regression analyses were used to describe EC awareness and use and their correlates.

RESULTS

Most of the sexually active girls (89.3%) and boys (75.2%) knew of the existence of EC. Of girls, 20% reported having used EC, and the majority of them used it only once (64.1%) or twice (18.5%). EC awareness was positively associated with the father's level of education (girls: odd ratio 5.18) and the scholastic curriculum of the respondent. Gender differences in the correlates of EC awareness demonstrate that girls who had a confidant or a group of friends or boys of Swiss nationality and those who have had the opportunity to discuss the issue of contraception declare greater awareness of EC. EC use was higher among girls who lived in urban areas (odds ratio 1.91) and occasionally had unprotected intercourse. We did not find any significant difference in the profile of multiple vs. one-time users.

CONCLUSION

EC awareness and use should be improved through better information and accessibility, especially among teenagers who place themselves in at-risk situations.

Cross-cultural surveys of adolescent health and behavior: progress and problems

Adolescent health surveys administered in different countries or regions often are described as cross-cultural. Although most include youth of different ethnic and cultural groups, few attempt to define these constructs or to collect data that allow their characterization. This paper explores four challenges shared by large-scale surveys of adolescent health-related behaviors and beliefs. First, adolescent health investigators have used the terms culture and ethnicity loosely. The growing interest in contextual analysis demands standardization of the definitions as they apply to adolescents, followed by correct usage of the terms. Hypotheses regarding the associations between race, ethnicity, culture, health-related behaviors, and health outcomes should be clearly stated and incorporated into conceptual models. Second, cross-cultural analyses are interpretable only when the study designs and sampling methods provide adequate representation of cultural and ethnic minorities and when the survey items allow differentiation of factors related to race, ethnicity, culture, and socioeconomic factors. Third, cross-cultural research may expose traditions, beliefs, and behaviors that are supported by one population yet criticized by another. Investigators must recognize their own personal biases and must work collaboratively to analyze and interpret their data correctly. Fourth, generalizations about cultural/ethnic comparisons can evoke powerful emotional reactions. Interpretation and dissemination of research findings should be done sensitively and with the help of experts from the cultural/ethnic groups that have been studied.