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Di Gennaro F, Segala FV, Guido G, Poliseno M, De Santis L, Belati A, Santoro CR, Bottalico IF, Pellegrino C, Novara R, Frallonardo L, Cormio M, Camporeale M, Cotugno S, Giliberti V, Di Gregorio S, Totaro V, Catucci N, De Giosa A, Giusto R, Lanera IV, Angarano G, Lo Caputo S, Saracino A. Knowledge, attitudes, and practices about HIV and other sexually transmitted infections among High School students in Southern Italy: A cross-sectional survey. PLoS One 2024; 19:e0301297. [PMID: 38640112 PMCID: PMC11029632 DOI: 10.1371/journal.pone.0301297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 03/13/2024] [Indexed: 04/21/2024] Open
Abstract
High School students, recognized as a high-risk group for sexually transmitted infections (STIs), were the focal point of an educational campaign in Southern Italy to share information and good practices about STIs and HIV/AIDS. A baseline survey comprising 76 items was conducted via the REDCap platform to assess students' initial knowledge, attitudes, and practices (KAP) related to STIs and HIV/AIDS. Sociodemographic variables were also investigated. The association between variables and KAP score was assessed by Kruskal-Wallis' or Spearman's test, as appropriate. An ordinal regression model was built to estimate the effect size, reported as odds ratio (OR) with a 95% confidence interval (CI), for achieving higher KAP scores among students features. On a scale of 0 to 29, 1702 participants achieved a median KAP score of 14 points. Higher scores were predominantly reported by students from classical High Schools (OR 3.19, 95% C.I. 1.60-6.33, p<0.001). Additionally, elevated scores were associated with sexually active students (OR 1.48, 95% C.I. 1.12-1.96, p = 0.01), those vaccinated against Human Papilloma Virus (OR 2.47, 95% C.I. 1.89-3.24, p<0.001), those who had used emergency contraception (OR 1.56, 95% C.I. 1.09-2.24, p = 0.02, Table 2) and those obtaining information from TikTok (OR 1.62, 95% C.I. 1.14-2.30, p = 0.01). Conversely, being heterosexual was associated with an overall lower score (OR 0.48, 95% C.I. 0.32-0.73, p<0.001). High School students, often due to early sexual debut, seek information about HIV and STIs independently using social channels. However, the overall level of knowledge, attitudes, and practices remains low. Urgent school-based interventions are needed for this age group.
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Affiliation(s)
- Francesco Di Gennaro
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro," Bari, Italy
| | - Francesco Vladimiro Segala
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro," Bari, Italy
| | - Giacomo Guido
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro," Bari, Italy
| | - Mariacristina Poliseno
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro," Bari, Italy
| | - Laura De Santis
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro," Bari, Italy
| | - Alessandra Belati
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro," Bari, Italy
| | - Carmen Rita Santoro
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro," Bari, Italy
| | - Irene Francesca Bottalico
- Infection Diseases Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Carmen Pellegrino
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro," Bari, Italy
| | - Roberta Novara
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro," Bari, Italy
| | - Luisa Frallonardo
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro," Bari, Italy
| | - Mariangela Cormio
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro," Bari, Italy
| | - Michele Camporeale
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro," Bari, Italy
| | - Sergio Cotugno
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro," Bari, Italy
| | - Vincenzo Giliberti
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro," Bari, Italy
| | - Stefano Di Gregorio
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro," Bari, Italy
| | - Valentina Totaro
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro," Bari, Italy
| | | | | | | | | | | | - Sergio Lo Caputo
- Infection Diseases Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Annalisa Saracino
- Clinic of Infectious Diseases, Department of Precision and Regenerative Medicine and Ionian Area (DiMePRe-J), University of Bari "Aldo Moro," Bari, Italy
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Versloot-Swildens MC, de Graaf H, Twisk JWR, Popma A, Nauta-Jansen LMC. Effectiveness of a Comprehensive School-Based Sex Education Program for Young Adolescents in the Netherlands. J Youth Adolesc 2024; 53:998-1014. [PMID: 38055133 DOI: 10.1007/s10964-023-01903-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 11/11/2023] [Indexed: 12/07/2023]
Abstract
Most sexual education programs traditionally focused on providing sexual information regarding the risks of sex. However, current studies on sexual behavior in youth show a need for truly comprehensive sex education approaches with a sex-positive focus on sexuality, that effectively improve sexual competence. Therefore, in the current study the effectiveness of "Love is…", a four lesson school-based program based on the Sexual Interactional Competence model and Attitude-Social-Influence-Self-Efficacy-model was studied. A cluster-randomized controlled trial on the effectiveness of "Love is…" was conducted in 2018-2020. The sample consisted of 1160 adolescents in grades 8 and 9 from nine schools in the Netherlands. The sample was 48% female, 34% Dutch/Caucasian, 41% none-religious and 50% higher educated. They were randomized at class level into a program group [n = 32 classes; 567 students (Mage = 13.74 (SD = 0.74))] and a control group [n = 31 classes; 593 students (Mage = 13.86 (SD = 0.73))]. Results showed that "Love is…" increased sexual knowledge, that adolescents in the program group showed less cyber victim blaming attitudes and increased in communications skills after the program. In conclusion, the current study shows that "Love is…" was effective not only on the knowledge level, but also regarding sexual attitudes and competences. However, due to the developmental process of sexuality, there is a necessity to continue lessons in following grades through booster sessions by reinforcing competences as communicating comfortably about sexuality.On 12 November 2019 the study design and hypotheses were registered in the Dutch Trial Registration, number NL8150. ( https://onderzoekmetmensen.nl/nl/trial/26676 ).
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Affiliation(s)
- M C Versloot-Swildens
- Department of Child and Adolescent Psychiatry Amsterdam UMC, Amsterdam, the Netherlands.
| | - H de Graaf
- Rutgers, Dutch Centre of Expertise on Sexual and Reproductive Health and Rights, Utrecht, the Netherlands
| | - J W R Twisk
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, the Netherlands
| | - A Popma
- Department of Child and Adolescent Psychiatry Amsterdam UMC, Amsterdam, the Netherlands
| | - L M C Nauta-Jansen
- Department of Child and Adolescent Psychiatry Amsterdam UMC, Amsterdam, the Netherlands
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Wongsomboon V, Queiroz AAFLN, Avila AA, Mongrella M, Saber R, Li DH, Moskowitz DA, Mustanski B, Macapagal K. Acceptability of 'Humpr': An Online Tool to Educate Adolescent Sexual Minority Males About Sexual Networking Applications. JOURNAL OF SEX RESEARCH 2023:1-10. [PMID: 38016031 PMCID: PMC11130072 DOI: 10.1080/00224499.2023.2273935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
We examined the acceptability of Humpr - an interactive, online tool developed to educate adolescent sexual minority males (ASMM) about how to safely navigate sexual networking applications (SNA). We developed Humpr as part of a larger HIV intervention trial in the U.S. In Humpr, 218 ASMM aged 14-20 (Mage = 17.18) created a mock dating profile, explored simulated user profiles, learned health-related information (e.g. slang indicating HIV/STI risks and/or drug use intentions), and then gave feedback regarding acceptability of the tool. Results showed that Humpr was very well-received, with 94% overall approval rates. Reasons for liking Humpr were evenly split between liking it for educational and entertaining reasons. Participants praised Humpr for its realistic design and interactive interface that allowed them to engage and connect with the tool. The majority (61%) had used SNAs in the past, but many still reported learning something new from Humpr. Participants also appreciated the acknowledgment of SNA use in ASMM and how the education was implemented in an open and judgment-free way. Topics learned from Humpr included how to be safe on SNAs and warning signs for HIV/STI risks. Suggested areas of improvement included having an opt-out option for those who do not wish to participate for any reason (e.g. discomfort) and additional educational content (e.g. consequences of being a minor on SNAs). Taken together, the findings offer preliminary evidence for the potential educational benefits of digital tools like Humpr for ASMM with and without prior SNA exposure.
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Affiliation(s)
| | - Artur AFLN Queiroz
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, IL, USA
| | - Andrés Alvarado Avila
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, IL, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, IL, USA
| | - Melissa Mongrella
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, IL, USA
| | - Rana Saber
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, IL, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, IL, USA
| | - Dennis H. Li
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, IL, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, IL, USA
| | - David A. Moskowitz
- Department of Public Health Sciences, Biological Sciences Division, The University of Chicago, IL, USA
| | - Brian Mustanski
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, IL, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, IL, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, IL, USA
| | - Kathryn Macapagal
- Institute for Sexual and Gender Minority Health and Wellbeing, Northwestern University, IL, USA
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, IL, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, IL, USA
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DeMaria AL, Hughes-Wegner AT, Rogozinski F, Raff T, Szabo MM, Noel N. Developing, Implementing, and Evaluating a Campus-Wide Pharmacy Vending Machine Program. Health Promot Pract 2023; 24:950-955. [PMID: 35837814 DOI: 10.1177/15248399221098016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Lack of access to affordable, accessible, over-the-counter medications and health-related items affects school attendance, academic performance, and individual health. Increasing access through innovations, such as Pharmacy Vending Machines (PhVMs), may address the burdens students face in university settings. In January 2021, two PhVMs were placed on Purdue University's campus to increase access to affordable and dependable 24/7 family planning items, cold/flu remedies, and other popular over-the-counter pharmaceuticals. Based on the success of the initiative and growing student body, the program was expanded to include two additional machines in August 2021. In this article, we detail how Purdue University planned, implemented, and evaluated a campus-wide PhVM program, which was an interdisciplinary collaboration across students, faculty, and staff in the College of Health and Human Sciences and College of Pharmacy. Pharmaceutical product availability in convenient vending machines dispersed throughout a campus contributes to a solution for the increasing demand for health products among consumers in large geographic areas.
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Affiliation(s)
- Andrea L DeMaria
- Department of Public Health, Purdue University, West Lafayette, IN, USA
| | | | | | - Taylor Raff
- Department of Biological Sciences, Purdue University, West Lafayette, IN, USA
| | | | - Nicole Noel
- College of Pharmacy, Purdue University, West Lafayette, IN, USA
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Walsh S, Jenner E, Qaragholi N, Henley C, Demby H, Leger R, Burgess K. The Impact of a High School-Based Positive Youth Development Program on Sexual Health Outcomes: Results from a Randomized Controlled Trial. THE JOURNAL OF SCHOOL HEALTH 2022; 92:1155-1164. [PMID: 35932196 PMCID: PMC9804765 DOI: 10.1111/josh.13216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 06/28/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Although positive youth development (PYD) programs have demonstrated effectiveness in improving adolescent reproductive health outcomes, there is a lack of evidence on effective school-based interventions designed especially for high school settings. This study examined the efficacy of Peer Group Connection (PGC-HS), a school-based PYD program, in improving sexual health outcomes for high school participants. METHODS A total of 1523 ninth-grade students at 18 schools were randomly assigned to be offered PGC-HS or a classes-as-usual control condition during 2016 to 2017 and 2017 to 2018 school years. Impacts were assessed on three confirmatory and 6 exploratory outcomes via self-reported participant questionnaire data collected at the beginning of 10th grade. RESULTS Although the offer of PGC-HS had no statistically detectable effect on confirmatory behavioral outcomes (sexual initiation, frequency of sex, and number of sexual partners) at 10th grade follow-up, causal impact estimates indicate that PGC-HS participants were less likely than control participants to ever have had vaginal sex. PGC-HS participants also scored higher on decision-making skills and perceived connection to peer connectedness. CONCLUSIONS Results suggest that by building social and emotional skills and helping students form supportive peer relationships, PGC-HS may encourage students to make healthier choices and avoid risky behaviors during a critical period in high school, thus, reducing the risk of pregnancy.
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Affiliation(s)
- Sarah Walsh
- The Policy & Research Group8434 Oak StreetNew OrleansLA70118
| | - Eric Jenner
- The Policy & Research Group8434 Oak StreetNew OrleansLA70118
| | - Noor Qaragholi
- The Policy & Research Group, 8434 Oak Street, New Orleans, LA 70118; Johns Hopkins Bloomberg School of Public HealthBaltimore
| | - Catherine Henley
- The Policy & Research Group, 8434 Oak Street, New Orleans, LA 70118; Department of Epidemiology, University of WashingtonSeattleWA
| | - Hilary Demby
- The Policy & Research Group8434 Oak StreetNew OrleansLA70118
| | - Rebekah Leger
- The Policy & Research Group8434 Oak StreetNew OrleansLA70118
| | - Kelly Burgess
- The Policy & Research Group8434 Oak StreetNew OrleansLA70118
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Kamire V, Magut F, Khagayi S, Kambona C, Muttai H, Nganga L, Kwaro D, Joseph RH. HIV Risk Factors and Risk Perception Among Adolescent Girls and Young Women: Results From a Population-Based Survey in Western Kenya, 2018. J Acquir Immune Defic Syndr 2022; 91:17-25. [PMID: 35972852 PMCID: PMC9387564 DOI: 10.1097/qai.0000000000003021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 04/25/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND In sub-Saharan Africa, HIV prevalence in adolescent girls and young women (AGYW) is 2-fold to 3-fold higher than that in adolescent boys and young men. Understanding AGYW's perception of HIV risk is essential for HIV prevention efforts. METHODS We analyzed data from a HIV biobehavioral survey conducted in western Kenya in 2018. Data from AGYW aged 15-24 years who had a documented HIV status were included. We calculated weighted prevalence and evaluated factors associated with outcomes of interest (HIV infection and high risk perception) using generalized linear models to calculate prevalence ratios. RESULTS A total of 3828 AGYW were included; 63% were aged 15-19 years. HIV prevalence was 4.5% and 14.5% of sexually active AGYW had high risk perception. Over 70% of participants had accessed HIV testing and counseling in the past 12 months. Factors associated with both HIV infection and high risk perception included having an HIV-positive partner or partner with unknown status and having a sexually transmitted infection in the past 12 months. Having an older (by ≥10 years) partner was associated with HIV infection, but not high risk perception. Less than 30% of sexually active AGYW with 3 or more HIV risk factors had high perception of HIV risk. CONCLUSION Gaps in perceived HIV risk persist among AGYW in Kenya. High access to HIV testing and prevention services in this population highlights platforms through which AGYW may be reached with improved risk counseling, and to increase uptake of HIV prevention strategies.
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Affiliation(s)
- Vivienne Kamire
- Kenya Medical Research Institute-Centre for Global Health Research (KEMRI-CGHR), Kenya
| | - Faith Magut
- Kenya Medical Research Institute-Centre for Global Health Research (KEMRI-CGHR), Kenya
| | - Sammy Khagayi
- Kenya Medical Research Institute-Centre for Global Health Research (KEMRI-CGHR), Kenya
| | - Caroline Kambona
- Division of Global HIV & TB (DGHT), Center for Global Health, United States Centers for Disease Control and Prevention (CDC) Kenya
| | - Hellen Muttai
- Division of Global HIV & TB (DGHT), Center for Global Health, United States Centers for Disease Control and Prevention (CDC) Kenya
| | - Lucy Nganga
- Division of Global HIV & TB (DGHT), Center for Global Health, United States Centers for Disease Control and Prevention (CDC) Kenya
| | - Daniel Kwaro
- Kenya Medical Research Institute-Centre for Global Health Research (KEMRI-CGHR), Kenya
| | - Rachael H. Joseph
- Division of Global HIV & TB (DGHT), Center for Global Health, United States Centers for Disease Control and Prevention (CDC) Kenya
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Ponsford R, Bragg S, Meiksin R, Tilouche N, Van Dyck L, Sturgess J, Allen E, Elbourne D, Hadley A, Lohan M, Mercer CH, Melendez Torres GJ, Morris S, Young H, Campbell R, Bonell C. Feasibility and acceptability of a whole-school social-marketing intervention to prevent unintended teenage pregnancies and promote sexual health: evidence for progression from a pilot to a phase III randomised trial in English secondary schools. Pilot Feasibility Stud 2022; 8:52. [PMID: 35246272 PMCID: PMC8895534 DOI: 10.1186/s40814-022-00971-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Accepted: 01/06/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Reducing unintended teenage pregnancy and promoting adolescent sexual health remains a priority in England. Both whole-school and social-marketing interventions are promising approaches to addressing these aims. However, such interventions have not been rigorously trialled in the UK and it is unclear if they are appropriate for delivery in English secondary schools. We developed and pilot trialled Positive Choices, a new whole-school social marketing intervention to address unintended teenage pregnancy and promote sexual health. Our aim was to assess the feasibility and acceptability of the intervention and trial methods in English secondary schools against pre-defined progression criteria (relating to randomisation, survey follow-up, intervention fidelity and acceptability and linkage to birth/abortion records) prior to carrying out a phase III trial of effectiveness and cost-effectiveness. METHODS Pilot RCT with integral process evaluation involving four intervention and two control schools in south-east England. The intervention comprised a student needs survey; a student/staff-led school health promotion council; a classroom curriculum for year-9 students (aged 13-14); whole-school student-led social-marketing activities; parent information; and a review of local and school-based sexual health services. Baseline surveys were conducted with year 8 (aged 12-13) in June 2018. Follow-up surveys were completed 12 months later. Process evaluation data included audio recording of staff training, surveys of trained staff, staff log books and researcher observations of intervention activities. Survey data from female students were linked to records of births and abortions to assess the feasibility of these constituting a phase III primary outcome. RESULTS All six schools were successfully randomised and retained in the trial. Response rates to the survey were above 80% in both arms at both baseline and follow-up. With the exception of the parent materials, the fidelity target for implementation of essential elements in three out of four schools was achieved. Student surveys indicated 80% acceptability among those who reported awareness of the programme and interviews with staff suggested strong acceptability. Linkage to birth/abortion records was feasible although none occurred among participants. CONCLUSIONS The criteria for progression to a phase III trial were met. Our data suggest that a whole-school social-marketing approach may be appropriate for topics that are clearly prioritised by schools. A phase III trial of this intervention is now warranted to establish effectiveness and cost-effectiveness. Births and terminations are not an appropriate primary outcome measure for such a trial. TRIAL REGISTRATION ISRCTN65324176.
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Affiliation(s)
- R Ponsford
- Department of Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - S Bragg
- Department of Education, Practice and Society, University College London, 20 Bedford Way, WC1H 0AL, London, UK
| | - R Meiksin
- Department of Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - N Tilouche
- Department of Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - L Van Dyck
- Clinical Trials Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - J Sturgess
- Clinical Trials Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - E Allen
- Clinical Trials Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - D Elbourne
- Clinical Trials Unit, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, UK
| | - A Hadley
- Teenage Pregnancy Knowledge Exchange, University of Bedfordshire, University Square, Luton, LU1 3JU, UK
| | - M Lohan
- School of Nursing and Midwifery, Queens University Belfast, University Road, Belfast, BT7 1NN, UK
| | - C H Mercer
- University College London, Gower Street, London, WC1E 6BT, UK
| | | | - S Morris
- Department of Health and Primary Care, University of Exeter, St Luke's Campus, Heavitree Road, Exeter, EX1 2LU, UK
| | - H Young
- School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, UK
| | - R Campbell
- School of Social and Community Medicine, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - C Bonell
- Department of Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
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Chan CT, Olivieri-Mui BL, Mayer KH. Associations between State-Level High School HIV Education Policies and Adolescent HIV Risk Behaviors. THE JOURNAL OF SCHOOL HEALTH 2022; 92:316-324. [PMID: 34951018 PMCID: PMC10069761 DOI: 10.1111/josh.13130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/02/2021] [Accepted: 07/08/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND School-based human immunodeficiency virus (HIV) education can reach most adolescents, but inconsistencies exist in state-level content policies. The purpose of this study was to evaluate the associations between state-level high school HIV education policies and adolescent HIV risk behaviors. METHODS This was a cross-sectional analysis of the 2019 Youth Risk Behavior Survey linked to the Guttmacher Institute Sex and HIV Education report. Logistic regression models examined the associations of state-level HIV education mandates and content policies with 3 HIV risk behaviors: (1) 4 or more lifetime sexual partners; (2) substance use before last sex; (3) condomless last sex. RESULTS Across 33 states, 128,986 high school students were included. Multivariable adjusted models demonstrated no associations between mandated HIV education and risk behaviors. Covering abstinence along with other safe sex options was associated with lower odds, whereas stressing abstinence was associated with higher odds of at least 4 lifetime sexual partners and condomless last sex. Discriminatory sexual orientation content was associated with increased condomless last sex; associations for all HIV risk behaviors were stronger among sexual minority youth. CONCLUSIONS Increased HIV risk behaviors associated with state policies stressing abstinence or requiring discriminatory sexual orientation content support the need for comprehensive and inclusive HIV education.
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Affiliation(s)
- Carrie T Chan
- Department of Epidemiology, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115
- Stanford Children's Health, 750 Welch Road Suite 212, Palo Alto, CA, 94304
- Department of Family Health Care Nursing, University of California San Francisco, 2 Koret Way, San Francisco, CA, 94131
| | - Brianne L Olivieri-Mui
- The Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Harvard Medical School, Boston, 1200 Centre Street, Roslindale, MA, 02131
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, 7 Haviland Street, Boston, MA, 02215
- Department of Medicine, Beth Israel Deaconess Medical Center/Harvard Medical School, 330 Brookline Avenue, Boston, MA, 02215
- Department of Global Health and Population, Harvard School of Public Health, 9 Bow Street, Cambridge, MA, 02138
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Ramírez-Villalobos D, Monterubio-Flores EA, Gonzalez-Vazquez TT, Molina-Rodríguez JF, Ruelas-González MG, Alcalde-Rabanal JE. Delaying sexual onset: outcome of a comprehensive sexuality education initiative for adolescents in public schools. BMC Public Health 2021; 21:1439. [PMID: 34289834 PMCID: PMC8296525 DOI: 10.1186/s12889-021-11388-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 06/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A common risk behavior in adolescence is the early initiation of unprotected sex that exposes adolescents to an unplanned pregnancy or sexually transmitted infections. Schools are an ideal place to strengthen adolescents' sexual knowledge and modify their behavior, guiding them to exercise responsible sexuality. The purpose of this article was to evaluate the knowledge of public secondary school teachers who received training in comprehensive education in sexuality (CES) and estimate the counseling's effect on students' sexual behavior. METHODS Seventy-five public school teachers were trained in participatory and innovative techniques for CES. The change in teacher knowledge (n = 75) was assessed before and after the training using t-tests, Wilcoxon ranks tests and a Generalized Estimate Equation model. The students' sexual and reproductive behavior was evaluated in intervention (n = 650) and comparison schools (n = 555). We fit a logistic regression model using the students' sexual debut as a dependent variable. RESULTS Teachers increased their knowledge of sexuality after training from 5.3 to 6.1 (p < 0.01). 83.3% of students in the intervention school reported using a contraceptive method in their last sexual relation, while 58.3% did so in the comparison schools. The students in comparison schools were 4.7 (p < 0.01) times more likely to start sexual initiation than students in the intervention schools. CONCLUSION Training in CES improved teachers' knowledge about sexual and reproductive health. Students who received counseling from teachers who were trained in participatory and innovative techniques for CES used more contraceptive protection and delayed sexual debut.
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Affiliation(s)
- Dolores Ramírez-Villalobos
- Center for Health Systems Research, National Institute of Public Health, Avenida Universidad 655, Colonia Santa María de Ahuacatitlán, 62100 Cuernavaca, Morelos Mexico
| | - Eric Alejandro Monterubio-Flores
- Center for Health and Nutrition Research, National Institute of Public Health, Avenida Universidad 655, Colonia Santa María de Ahuacatitlán, 62100 Cuernavaca, Morelos Mexico
| | - Tonatiuh Tomás Gonzalez-Vazquez
- Center for Health Systems Research, National Institute of Public Health, Avenida Universidad 655, Colonia Santa María de Ahuacatitlán, 62100 Cuernavaca, Morelos Mexico
| | - Juan Francisco Molina-Rodríguez
- Center for Health Systems Research, National Institute of Public Health, Avenida Universidad 655, Colonia Santa María de Ahuacatitlán, 62100 Cuernavaca, Morelos Mexico
| | - Ma. Guadalupe Ruelas-González
- Center for Evaluation and Survey Research, National Institute of Public Health, Av. Universidad 655, Colonia Santa María, 62100 Cuernavaca, Morelos México
| | - Jacqueline Elizabeth Alcalde-Rabanal
- Center for Health Systems Research, National Institute of Public Health, Avenida Universidad 655, Colonia Santa María de Ahuacatitlán, 62100 Cuernavaca, Morelos Mexico
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Lee MHM, Ganapathy S, Low SM, Chua CLQ, Chong SL, Ma E, Wong PCY. A review of child sexual abuse cases presenting to a paediatric emergency department. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2021; 50:527-535. [PMID: 34342333 DOI: 10.47102/annals-acadmedsg.2021127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Child sexual abuse (CSA) adversely affects a child's growth and well-being. This study aimed to describe the profile of children presenting to a tertiary paediatric emergency department(ED) with CSA. METHODS Children 0-16 years old presenting to KK Women's and Children's Hospital ED from June 2016 to August 2020 with sexual abuse were retrospectively reviewed. We performed a secondary analysis on girls and stratified them by age <13 and ≥13 years old. RESULTS There were 790 patients who made 833 visits for CSA. Victims were predominantly girls (747, 94.8%) and perpetrators were predominantly men (763, 96.6%). The abuse first occurred before the age of 13 years in 315 victims (39.9%). For 468 (59.2%), more than one incident occurred before presentation. Compared to girls ≥13 years old, girls <13 years old were more frequently abused by a family member (47.7% versus 8.0%, P<0.001) and abused in their own home (55.7% vs 21.0%, P<0.001). Among all children, parental divorce and the absence of one or both biological parents in the household were prevalent, with 287/783 (36.7%) having divorced parents, and only 374/784 (47.8%) residing with both biological parents. CONCLUSION The findings highlight common characteristics of CSA cases, and can aid the future identification and protection of vulnerable children. The fact that most children presented after more than one incident suggests the need to more closely monitor and protect potentially at-risk children.
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Affiliation(s)
- Magdalene H M Lee
- Department of Emergency Medicine, KK Women's and Children's Hospital, Singapore
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11
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Maina BW, Juma K, Igonya EK, Osindo J, Wao H, Kabiru CW. Effectiveness of school-based interventions in delaying sexual debut among adolescents in sub-Saharan Africa: a protocol for a systematic review and meta-analysis. BMJ Open 2021; 11:e044398. [PMID: 34020975 PMCID: PMC8144038 DOI: 10.1136/bmjopen-2020-044398] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 03/12/2021] [Accepted: 04/23/2021] [Indexed: 01/14/2023] Open
Abstract
INTRODUCTION Early sexual debut is associated with poor sexual and reproductive health outcomes across the life course. A majority of interventions aimed at delaying sexual debut among adolescents in sub-Saharan Africa (SSA) have been implemented in schools with mixed findings on the effectiveness of such interventions. This systematic review will summarise and synthesise existing evidence on the effectiveness of school-based interventions in delaying sexual debut among adolescents aged 10-19 years. METHODS AND ANALYSIS We will conduct a comprehensive database search of peer-reviewed studies published in PubMed, Scopus, Science Direct, Web of Science, HINARI and EBSCO (PsycINFO, Global Health, CINAHL) and in Cochrane library, National Institute of Health and Turning Research into Practice databases for ongoing studies yet to be published. All studies conducted in SSA between January 2009 and December 2020, regardless of the study design, will be included. Two authors will independently screen all retrieved records and relevant data on sexual debut extracted.Data will be pooled using the random effects model. Dichotomous outcomes will be reported as risk ratios and continuous data as mean difference at 95% CI. Heterogeneity will be assessed using the I² statistic. Findings will be presented in tables and charts, while providing a description of all included studies, themes and concepts drawn from literature. ETHICS AND DISSEMINATION Ethical approval is not required. The findings will be disseminated through peer-reviewed publications, presentations at relevant conferences and other convening focusing on adolescent sexual and reproductive health.
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Affiliation(s)
- Beatrice W Maina
- Population Dynamics and Reproductive Health, African Population and Health Research Center, Nairobi, Kenya
- School of Public Health, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
| | - Kenneth Juma
- Population Dynamics and Reproductive Health, African Population and Health Research Center, Nairobi, Kenya
| | - Emmy Kageha Igonya
- Population Dynamics and Reproductive Health, African Population and Health Research Center, Nairobi, Kenya
| | - Jane Osindo
- Research Capacity Strengthening, African Population and Health Research Center, Nairobi, Kenya
| | - Hesborn Wao
- Research Capacity Strengthening, African Population and Health Research Center, Nairobi, Kenya
| | - Caroline W Kabiru
- Research Capacity Strengthening, African Population and Health Research Center, Nairobi, Kenya
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Pakarinen M, Kylmä J, Helminen M, Suominen T. Attitudes, knowledge and sexual behavior among Finnish adolescents before and after an intervention. Health Promot Int 2021; 35:821-830. [PMID: 31436843 DOI: 10.1093/heapro/daz074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Adolescents are an important target group for sexual health promotion, and there are numerous programs and interventions carried out in this field. The aim of this study is to describe adolescents' attitudes, knowledge and sexual behavior before and after a sexual health promotion intervention. The intervention was developed in the study and consisted of three elements: (i) class-room session, (ii) information materials and (iii) free condom distribution. The study was carried out in eight randomly selected vocational schools in Finland. The participants were first year students aged 15-19 years. The data were collected using an electronic questionnaire before intervention (intervention baseline n = 500, control baseline n = 183) and two times after the intervention (intervention first follow-up n = 173/second follow-up n = 202, control first follow-up n = 115/second follow-up n = 46). There were significant differences before and after the intervention concerning better knowledge and more frequent testing for sexually transmitted infections (STIs). Schools are an important environment to reach adolescents during the phase where their sexual health is developing and there is an increased risk of STI transmission. More school-based interventions are therefore needed, and the results of this study can be utilized when developing sexual health promotion interventions among adolescents.
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Affiliation(s)
| | - Jari Kylmä
- Faculty of Social Sciences, Health Sciences
| | - Mika Helminen
- Faculty of Social Sciences, Health Sciences, Science Center, Tampere University Hospital, Tampere University, PL 100, 33014 Tampereen yliopisto, Tampere, Finland
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Ponsford R, Meiksin R, Bragg S, Crichton J, Emmerson L, Tancred T, Tilouche N, Morgan G, Gee P, Young H, Hadley A, Campbell R, Bonell C. Co-production of two whole-school sexual health interventions for English secondary schools: positive choices and project respect. Pilot Feasibility Stud 2021; 7:50. [PMID: 33597013 PMCID: PMC7888187 DOI: 10.1186/s40814-020-00752-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 12/16/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Whole-school interventions represent promising approaches to promoting adolescent sexual health, but they have not been rigorously trialled in the UK and it is unclear if such interventions are feasible for delivery in English secondary schools. The importance of involving intended beneficiaries, implementers and other key stakeholders in the co-production of such complex interventions prior to costly implementation and evaluation studies is widely recognised. However, practical accounts of such processes remain scarce. We report on co-production with specialist providers, students, school staff, and other practice and policy professionals of two new whole-school sexual heath interventions for implementation in English secondary schools. METHODS Formative qualitative inquiry involving 75 students aged 13-15 and 23 school staff. A group of young people trained to advise on public health research were consulted on three occasions. Twenty-three practitioners and policy-makers shared their views at a stakeholder event. Detailed written summaries of workshops and events were prepared and key themes identified to inform the design of each intervention. RESULTS Data confirmed acceptability of addressing unintended teenage pregnancy, sexual health and dating and relationships violence via multi-component whole-school interventions and of curriculum delivery by teachers (providing appropriate teacher selection). The need to enable flexibility for the timetabling of lessons and mode of parent communication; ensure content reflected the reality of young people's lives; and develop prescriptive teaching materials and robust school engagement strategies to reflect shrinking capacity for schools to implement public-health interventions were also highlighted and informed intervention refinements. Our research further points to some of the challenges and tensions involved in co-production where stakeholder capacity may be limited or their input may conflict with the logic of interventions or what is practicable within the constraints of a trial. CONCLUSIONS Multi-component, whole-school approaches to addressing sexual health that involve teacher delivered curriculum may be feasible for implementation in English secondary schools. They must be adaptable to individual school settings; involve careful teacher selection; limit additional burden on staff; and accurately reflect the realities of young people's lives. Co-production can reduce research waste and may be particularly useful for developing complex interventions, like whole-school sexual health interventions, that must be adaptable to varying institutional contexts and address needs that change rapidly. When co-producing, potential limitations in relation to the representativeness of participants, the 'depth' of engagement necessary as well as the burden on participants and how they will be recompensed must be carefully considered. Having well-defined, transparent procedures for incorporating stakeholder input from the outset are also essential. Formal feasibility testing of both co-produced interventions in English secondary schools via cluster RCT is warranted. TRIAL REGISTRATION Project Respect: ISRCTN12524938 . Positive Choices: ISRCTN65324176.
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Affiliation(s)
- Ruth Ponsford
- Department of Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
| | - Rebecca Meiksin
- Department of Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Sara Bragg
- Centre for Sociology of Education and Equity, UCL Institute of Education, 20 Bedford Way, London, WC1H 0AL, UK
| | - Joanna Crichton
- Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Lucy Emmerson
- Sex Education Forum, National Children's Bureau, 23 Mentmore Terrace, London, E8 3PN, UK
| | - Tara Tancred
- Centre for Maternal and Newborn Health, Liverpool School of Tropical Medicine, Pembroke Place, Liverpool, L3 5QA, UK
| | - Nerissa Tilouche
- Department of Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Gemma Morgan
- Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Pete Gee
- School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, UK
| | - Honor Young
- School of Social Sciences, Cardiff University, 1-3 Museum Place, Cardiff, CF10 3BD, UK
| | - Alison Hadley
- Teenage Pregnancy Knowledge Exchange, University of Bedfordshire, University Square, Luton, LU1 3JU, UK
| | - Rona Campbell
- Population Health Sciences, Bristol Medical School, University of Bristol, 39 Whatley Road, Bristol, BS8 2PS, UK
| | - Chris Bonell
- Department of Public Health, Environments & Society, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK
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14
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Ramos-Ortiz J, Strube OL, Kinman N, Meier S, DeMaria AL. Condom-vending machines in Italy: a qualitative exploration of gender differences to improve promotion and use. EUR J CONTRACEP REPR 2020; 25:456-464. [PMID: 32886016 DOI: 10.1080/13625187.2020.1810226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The purposes of this study were to explore gender differences in condom purchasing from condom-vending machines (CVMs) and identify ways to improve CVM promotion. METHODS Semi-structured interviews with 42 men and women aged 18-50 years (mean ± standard deviation, 29.1 ± 7.9) and living in or near Florence, Italy, were conducted between May and June 2019. Techniques from expanded grounded theory-guided data analysis allowed for a constant comparative approach to contextualise data and identify emergent themes. RESULTS Three themes emerged: (1) attitudes and barriers towards CVMs; (2) gender-specific purchasing influences and behaviours; and (3) CVM improvement and promotion. Women and men described varied concerns surrounding CVM purchasing, illuminating reasons for hesitancy. Focussing on CVM quality and improving product offerings were suggested by participants to increase use. CONCLUSION Findings offer practical recommendations to guide CVM messaging to increase access to and use of condoms and other personal care items. Men were cited as primary CVM users, expressing practical concerns surrounding CVMs, while, for women, CVM visibility was as much an advantage as a drawback. Reflecting consumer needs via diversified product offerings should be considered a priority for increased CVM use. Working to promote CVMs requires clear messaging that attends to gender norm limitations, details product safety and establishes CVMs as a reliable condom purchase outlet.
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Affiliation(s)
- Jaziel Ramos-Ortiz
- Division of Consumer Science, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
| | - Olivia L Strube
- School of Health Sciences, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
| | - Nicole Kinman
- School of Health Sciences, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
| | - Stephanie Meier
- Division of Consumer Science, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
| | - Andrea L DeMaria
- Department of Public Health, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
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Markham CM, Peskin MF, Baumler ER, Addy RC, Thiel MA, Laris BA, Baker K, Hernandez B, Shegog R, Coyle K, Emery ST. Socio-Ecological Factors Associated With Students' Perceived Impact of an Evidence-Based Sexual Health Education Curriculum. THE JOURNAL OF SCHOOL HEALTH 2020; 90:604-617. [PMID: 32510609 DOI: 10.1111/josh.12908] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 10/03/2019] [Accepted: 01/31/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Although schools often implement evidence-based sexual health education programs to address sexual and reproductive health disparities, multiple factors may influence program effectiveness. METHODS Using student-reported perceived impact measures as a proxy for program effectiveness, we employed a socio-ecological approach to examine student, teacher, school, and district factors associated with greater perceived impact of It's Your Game (IYG), an evidence-based middle school sexual health education program. The student sample was 58.7% female, 51.8% Hispanic, mean age 13.2 years, from 73 middle schools. We assessed students' (N = 4531) perceived impact of IYG on healthy decision-making (α = 0.75) and sexual communication (α = 0.71); satisfaction with IYG activities and teacher; and demographics. We assessed teachers' (N = 56) self-efficacy to teach IYG, perceived administrative support, implementation barriers, and demographics. School and district data were abstracted from state records. We used multilevel logistic regression to estimate associations between independent variables and student-reported perceived impact. RESULTS In final multivariate models, students' demographics (sex, β = 0.06, SE = 0.015), satisfaction with IYG (β = 0.21, SE = 0.012), and their IYG teacher (β = 0.18, SE = 0.013) (all p = .000) were significantly associated with perceived impact on healthy decision-making. Similar findings resulted for sexual communication. No other variables were significantly associated with perceived impact. CONCLUSIONS Helping schools select age-appropriate, culturally relevant programs, and facilitate supportive learning environments may enhance the perceived impact of sexual health education programs.
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Affiliation(s)
- Christine M Markham
- The University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin Street, Houston, TX, 77030
| | - Melissa F Peskin
- The University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin Street, Houston, TX, 77030
| | | | - Robert C Addy
- The University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin Street, Houston, TX, 77030
| | | | - B A Laris
- ETR, 100 Enterprise Way, Suite G300, Scotts Valley, CA, 95066
| | - Kimberly Baker
- The University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin Street, Houston, TX, 77030
| | - Belinda Hernandez
- The University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin Street, Houston, TX, 77030
| | - Ross Shegog
- The University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin Street, Houston, TX, 77030
| | - Karin Coyle
- ETR, 100 Enterprise Way, Suite G300, Scotts Valley, CA, 95066
| | - Susan Tortolero Emery
- The University of Texas Health Science Center at Houston School of Public Health, 7000 Fannin Street, Houston, TX, 77030
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Ngoc Do H, Ngoc Nguyen D, Quynh Thi Nguyen H, Tuan Nguyen A, Duy Nguyen H, Phuong Bui T, Bich Thi Vu T, Thanh Le K, Tuan Nguyen D, Tat Nguyen C, Gia Vu L, Thu Vu G, Xuan Tran B, A. Latkin C, C. M. Ho R, S. H. Ho C. Patterns of Risky Sexual Behaviors and Associated Factors among Youths and Adolescents in Vietnam. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E1903. [PMID: 32183402 PMCID: PMC7143552 DOI: 10.3390/ijerph17061903] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 03/07/2020] [Accepted: 03/12/2020] [Indexed: 12/18/2022]
Abstract
Youths and adolescents are vulnerable to HIV/STIs from unprotected sex. Promotion of young population's awareness about risky sexual behaviors is essential to develop contextualized interventions. A cross-sectional study was conducted in five Vietnamese provinces to document current attitudes and practices regarding sexual behaviors among youths. The information on sociodemographic characteristics, substance use, and sexual behaviors was collected via self-reported questionnaires. The factors associated with risky sexual behaviors were identified by the multivariate logistic regression. Among the 1200 participants, 73.5% reported having sex in their lifetime, and 48.1% used condoms at their latest sexual intercourse. Participants in urban areas were more likely not to intend to use condoms and had a higher unintended pregnancy rate than in rural areas. Older age was positively associated with not wanting to use and not using condoms. Substance-using participants were more likely to not use condoms. The participants taking alcohol or other stimulants before sex had a higher likelihood of unintended pregnancy. Respondents' attitudes and practices regarding sexual behaviors were associated with gender and employment. This study indicated that young population's awareness in Vietnam is high, however, risky sexual behaviors also remain common. Sex-related educational programs about the consequences of substance use, multiple sex partners, and unprotected sex should be developed.
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Affiliation(s)
- Ha Ngoc Do
- Youth Research Institute, Ho Chi Minh Communist Youth Union, Hanoi 100000, Vietnam;
| | - Diep Ngoc Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam;
- Faculty of Pharmacy, Duy Tan University, Da Nang 550000, Vietnam
| | - Hoa Quynh Thi Nguyen
- Department of Research on Youth Culture and Lifestyle, Youth Research Institute, Ho Chi Minh Communist Youth Union, Hanoi 100000, Vietnam; (H.Q.T.N.); (A.T.N.)
| | - Anh Tuan Nguyen
- Department of Research on Youth Culture and Lifestyle, Youth Research Institute, Ho Chi Minh Communist Youth Union, Hanoi 100000, Vietnam; (H.Q.T.N.); (A.T.N.)
| | - Hiep Duy Nguyen
- Department of Research on Children’s issues, Youth Research Institute, Ho Chi Minh Communist Youth Union, Hanoi 100000, Vietnam; (H.D.N.); (T.P.B.)
| | - Thanh Phuong Bui
- Department of Research on Children’s issues, Youth Research Institute, Ho Chi Minh Communist Youth Union, Hanoi 100000, Vietnam; (H.D.N.); (T.P.B.)
| | - Thao Bich Thi Vu
- Department of Research on Youth’s Organisations and Youth Campaign, Youth Research Institute, Ho Chi Minh Communist Youth Union, Hanoi 100000, Vietnam; (T.B.T.V.); (K.T.L.)
| | - Khiet Thanh Le
- Department of Research on Youth’s Organisations and Youth Campaign, Youth Research Institute, Ho Chi Minh Communist Youth Union, Hanoi 100000, Vietnam; (T.B.T.V.); (K.T.L.)
| | - Dung Tuan Nguyen
- Department of Research on Youth and Legal issues, Youth Research Institute, Ho Chi Minh Communist Youth Union, Hanoi 100000, Vietnam;
| | - Cuong Tat Nguyen
- Institute for Global Health Innovations, Duy Tan University, Da Nang 550000, Vietnam;
- Faculty of Medicine, Duy Tan University, Da Nang 550000, Vietnam
| | - Linh Gia Vu
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam; (L.G.V.); (G.T.V.)
| | - Giang Thu Vu
- Center of Excellence in Evidence-based Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam; (L.G.V.); (G.T.V.)
| | - Bach Xuan Tran
- Institute for Preventive Medicine and Public Health, Hanoi Medical University, Hanoi 100000, Vietnam;
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA;
| | - Carl A. Latkin
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD 21205, USA;
| | - Roger C. M. Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119228, Singapore;
- Institute for Health Innovation and Technology (iHealthtech), National University of Singapore, Singapore 119077, Singapore
- Center of Excellence in Behavioral Medicine, Nguyen Tat Thanh University, Ho Chi Minh City 700000, Vietnam
| | - Cyrus S. H. Ho
- Department of Psychological Medicine, National University Hospital, Singapore 119074, Singapore;
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Alhassan N, Dodoo FNA. Predictors of primary and secondary sexual abstinence among never-married youth in urban poor Accra, Ghana. Reprod Health 2020; 17:28. [PMID: 32085788 PMCID: PMC7035703 DOI: 10.1186/s12978-020-0885-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 02/14/2020] [Indexed: 11/13/2022] Open
Abstract
Background Sexual abstinence is a key component of the strategy to address unwanted pregnancies, sexually transmitted infections and HIV among youth in sub-Sahara Africa. But contextual pressures make abstaining from sex a formidable task for urban poor youth in the sub-region. Nevertheless, some youth in these settings still manage to resist the pressure to initiate sex early, while others choose abstinence after an initial sexual debut. Few studies in the sub-region have examined sexual abstinence among urban poor youth. We therefore examined the factors that predict primary and secondary sexual abstinence among youth in urban poor Accra. The findings highlight the protective factors associated with sexual intercourse and should help to address the needs of youth at risk of unprotected sex. Methods The study analysed pooled data from two rounds of the Urban Health and Poverty Survey. The surveys analysed were conducted in 2011 and 2013. The analysis was restricted to unmarried youth between age 20 and 24 years. The total sample comprised 235 female and male youth. We conducted multinomial logistic regression analysis to examine the predictors of primary and secondary abstinence relative to current sexual intercourse. Results The results showed that being female, sexual communication with only fathers, sexual communication with only friends and slum residence were negatively associated with primary sexual abstinence. Contrarily, being in school, attaching importance to religion, residing in a household that received social support and sexual communication with both parents were positively associated with primary abstinence. Regarding secondary abstinence, only the sexual communication variables had significant effects. Sexual communication with both parents positively predicted secondary abstinence while communication with fathers-only and friends-only had a negative effect. Conclusion Sexual abstinence is predicted by factors which range from individual through household factors to the locality of residence. Despite the importance of all the predictors, the study found that sexual communication with both parents was the only factor that predicted a higher likelihood of both primary and secondary sexual abstinence. We therefore recommend sexual communication between parents and youth as a key strategy for promoting sexual abstinence among urban poor youth in Accra, Ghana.
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Affiliation(s)
- Nurudeen Alhassan
- African Institute for Development Policy (AFIDEP), Area 6, Plot 6/3, P. O. Box, 31024, Lilongwe, Malawi.
| | - F Nii-Amoo Dodoo
- The Pennsylvania State University, Pennsylvania, USA.,University of Ghana, Accra, Ghana
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Bellizzi S, Pichierri G, Menchini L, Barry J, Sotgiu G, Bassat Q. The impact of underuse of modern methods of contraception among adolescents with unintended pregnancies in 12 low- and middle-income countries. J Glob Health 2020; 9:020429. [PMID: 31673342 PMCID: PMC6815657 DOI: 10.7189/jogh.09.020429] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background In spite of the last decade increase in availability of contraception, around half of the annual 21 million pregnancies notified in low- and middle-income countries in individuals aged 15-19 years are unintended. We sought to explore the contribution of the underuse of modern methods of contraception (MMC) to the annual incidence of unintended pregnancies among adolescent women. Methods We used Demographic and Health Survey (DHS) data from 12 low- and middle-income countries. The pooled analysis exploring the risk of unintended pregnancy included 7268 adolescent women with a current unintended pregnancy and 121 894 currently not pregnant 15- to 19-year-old sexually active women who did not desire pregnancy. For each country and the pooled analysis, the odds ratio of unintended pregnancy was calculated in relation to the type of contraception (MMC, Traditional Methods, and No Contraception). Expected unintended pregnancies and population attributable fraction (PAF) of unintended pregnancies attributable to not using MMC were calculated for each country. Results The use of traditional methods was associated with a 3.4 (95% confidence interval (CI) = 2.1-4.7) time increased odds of having an undesired pregnancy compared with the use of MMC of contraception while not using any method of contraception was associated with a 4.6 (95% CI = 2.6-6.6) times increased odds. The population attributable fraction (PAF) of not using MMC accounted for 86.8% of the estimated unintended pregnancies (9 464 654 in total in the 12 countries) in the pooled analysis. PAF ranged from 65.8% (1 022 154) for Bangladesh to 95.1% (540 176) for Niger and the estimated number of unintended pregnancies because of the use of traditional methods or non-use of contraception ranged from 18 638 in Namibia to 4 303 872 in India. Conclusions Eight million out of 9.5 million unintended pregnancies occurring annually in twelve countries could have been prevented with the optimal use of MMC of contraception. MMC need to be further supported in order to further prevent unintended pregnancies globally.
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Affiliation(s)
- Saverio Bellizzi
- Partnership for Maternal, Newborn & Child Health, Geneva, Switzerland
| | - Giuseppe Pichierri
- Kingston Hospital NHS Foundation Trust, Galsworthy Road, Kingston upon Thames, UK
| | | | - Jessica Barry
- WHO Eastern Mediterranean Regional Office, Cairo, Egypt
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medical, Surgical and Experimental Sciences, University of Sassari, Italy
| | - Quique Bassat
- ISGlobal, Hospital Clínic - Universitat de Barcelona, Barcelona, Spain.,Centro de Investigação em Saúde de Manhiça (CISM), Maputo, Mozambique.,ICREA, Barcelona, Spain.,Pediatric Infectious Diseases Unit, Pediatrics Department, Hospital Sant Joan de Déu (University of Barcelona), Barcelona, Spain
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19
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Nunu WN, Makhado L, Mabunda JT, Lebese RT. Strategies to facilitate safe sexual practices in adolescents through integrated health systems in selected districts of Zimbabwe: a mixed method study protocol. Reprod Health 2020; 17:20. [PMID: 32005263 PMCID: PMC6995095 DOI: 10.1186/s12978-020-0862-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 01/14/2020] [Indexed: 01/08/2023] Open
Abstract
Background Zimbabwe has the highest teenage pregnancy rate in Sub Saharan Africa. Human Immunodeficiency Virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) prevalence in adolescents that are from tribes that perform cultural initiations and subscribe to certain norms are higher than the national prevalence which is estimated at 12% (18 and 13.6% respectively) in Zimbabwe. Indigenous Health Systems (IHSs) and Modern Health Systems (MHSs) in Zimbabwe run parallel thereby introducing challenges in the management of adolescent sexual health due to conflicts. This study seeks to develop strategies that will facilitate the integration of IHSs and MHS in Mberengwa and Umguza districts. Methods This research will be conducted in two phases. The first phase would utilise a concurrent triangulation mixed methods design with both qualitative and quantitative approaches. The findings from the qualitative and quantitative approaches would be merged through a comparison of findings side by side. The second phase would focus on the development and validation of strategies that would facilitate the integration of IHSs and MHSs. The Strength, Weakness, Opportunity and Threat (SWOT) analysis would be applied on interfaced findings from phase one. The Basic Logic and the Build, Overcome, Explore and Minimise (BOEM) models would then be used to develop strategies based on the SWOT findings. The developed strategies would be validated through the application of Delphi technique and administration of checklist to selected key stakeholders through organised workshops. Discussion There have been no known studies found in the literature that explores the possibility and developed strategies of integrating IHSs and MHSs so as to promote safe sexual practices in adolescents. Most programs on sexual health have ignored the role of IHSs and MHSs in influencing safe sexual practices leading to them failing to attain desired goals. A lot of emphases has been targeted at minimising the spread of Sexually Transmitted Infections (STIs) through advocating for utilisation MHSs rather than focussing on an integrating systems that are meant to manage Adolescent Sexual Health (ASH) related issues. The study protocol was approved by the University of Venda Ethics Committee Registration (SHS/19/PH/17/2608) on the 26th of August 2019.
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Affiliation(s)
- Wilfred Njabulo Nunu
- Department of Public Health, School of Health Sciences, University of Venda, Thohoyandou, South Africa. .,Department of Environmental Science and Health, Faculty of Applied Sciences, National University of Science and Technology, Bulawayo, Zimbabwe.
| | - Lufuno Makhado
- Department of Public Health, School of Health Sciences, University of Venda, Thohoyandou, South Africa
| | - Jabu Tsakani Mabunda
- Department of Public Health, School of Health Sciences, University of Venda, Thohoyandou, South Africa
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20
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Zhang L, Finan LJ, Bersamin M, Fisher DA. Sexual Orientation-Based Depression and Suicidality Health Disparities: The Protective Role of School-Based Health Centers. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2020; 30 Suppl 1:134-142. [PMID: 30230104 PMCID: PMC6430702 DOI: 10.1111/jora.12454] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
This study's purpose was to examine whether school-based health centers (SBHCs) support mental health indicators among sexual minority youth (SMY). Data came from the 2015 Oregon Healthy Teens Survey with 13,608 11th graders in 137 public high schools in Oregon. Regression results revealed significant SBHC by SMY status interactions indicating relative reductions in likelihood of depressive episodes (30%), suicidal ideation (34%), and suicide attempts (43%) among SMY in schools with SBHCs. SMY students in SBHC schools reported lower likelihood of a past-year depressive episode, suicidal ideation, and suicide attempt versus those attending non-SBHC schools. Conversely, no differences in these outcomes were observed for non-SMY by SBHC status. SBHCs may help reduce mental health disparities among SMY, a marginalized, underserved population.
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Affiliation(s)
- Lei Zhang
- Pacific Institute for Research and Evaluation
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21
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Stoner MCD, Neilands TB, Kahn K, Hughes JP, Gómez-Olivé FX, Twine R, Tollman S, Laeyendecker O, MacPhail C, Ahern J, Lippman SA, Pettifor A. Multilevel Measures of Education and Pathways to Incident Herpes Simplex Virus Type 2 in Adolescent Girls and Young Women in South Africa. J Adolesc Health 2019; 65:723-729. [PMID: 31521513 PMCID: PMC6874764 DOI: 10.1016/j.jadohealth.2019.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/30/2019] [Accepted: 06/24/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Schooling is associated with a lower risk of Herpes simplex virus type 2 (HSV-2) in adolescent girls and young women, but there is little understanding of the pathways underlying this relationship. METHODS We used data from adolescent girls and young women in South Africa enrolled in the HIV Prevention Trials Network 068 study. We tested a structural equation model where individual household and community education measures were associated directly and indirectly with incident HSV-2 through HIV knowledge, future aspirations, age-disparate partnerships, sex in the last 12 months, and condomless sex. RESULTS Community, household, and individual measures of schooling were all associated with incident HSV-2 infection through mediated pathways that increased the likelihood of having sex. Low school attendance (<80% of school days) increased the likelihood of having sex through increased age-disparate partnerships and reduced future aspirations. Fewer community years of education increased the likelihood of having sex through increased age-disparate partnerships. Parental education level was indirectly associated with HSV-2 overall, although we could not identify the individual pathways that were responsible for this association. CONCLUSIONS Community and individual schooling interventions may reduce the risk of HSV-2 infection by influencing the likelihood of having sex, partner age, and future aspirations.
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Affiliation(s)
- Marie C D Stoner
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina.
| | - Torsten B Neilands
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Kathleen Kahn
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana; Epidemiology and Global Health Unit, Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, Washington; Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - F Xavier Gómez-Olivé
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; INDEPTH Network, Accra, Ghana
| | - Rhian Twine
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Oliver Laeyendecker
- Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Baltimore, Maryland
| | - Catherine MacPhail
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; School of Health and Society, University of Wollongong, New South Wales, Australia; Wits Reproductive Health and HIV Research Institute, University of the Witwatersrand, Johannesburg, South Africa
| | - Jennifer Ahern
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California
| | - Sheri A Lippman
- Department of Medicine, University of California, San Francisco, San Francisco, California; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Audrey Pettifor
- Carolina Population Center, University of North Carolina, Chapel Hill, North Carolina; MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
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22
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Mensch BS, Grant MJ, Soler-Hampejsek E, Kelly CA, Chalasani S, Hewett PC. Does schooling protect sexual health? The association between three measures of education and STIs among adolescents in Malawi. POPULATION STUDIES 2019; 74:241-261. [PMID: 31619138 PMCID: PMC7162723 DOI: 10.1080/00324728.2019.1656282] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
While multiple studies have documented shifting educational gradients in HIV prevalence, less attention has been given to the effect of school participation and academic skills on infection during adolescence. Using the Malawi Schooling and Adolescent Study, a longitudinal survey that followed 2,649 young people aged 14-17 at baseline from 2007 to 2013, we estimate the effect of three education variables: school enrolment, grade attainment, and academic skills-numeracy and Chichewa literacy-on herpes simplex virus type 2 (HSV-2) and HIV incidence using interval-censored survival analysis. We find that grade attainment is significantly associated with lower rates of both HSV-2 and HIV among girls, and is negatively associated with HSV-2 but not HIV among boys. School enrolment and academic skills are not significantly associated with sexually transmitted infections (STIs) for boys or girls in our final models. Efforts to encourage school progression in high-prevalence settings in sub-Saharan Africa could well reduce, or at least postpone, acquisition of STIs.
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23
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Hattakitpanichakul K, Phuphaibul R, Phumonsakul S, Viwatwongkasem C. Effectiveness of the Dual Approach Program to promote sexual abstinence in Thai early female adolescents and improve parent-daughter sexual communication. JOURNAL OF HEALTH RESEARCH 2019. [DOI: 10.1108/jhr-09-2018-0090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose
The purpose of this paper is to examine the effectiveness of abstinence-based sexual education programs delivered in parallel to Thai parents and their early adolescent daughters to promote sexual abstinence and improve communication regarding sexual topics between them and their parents.
Design/methodology/approach
A quasi-experimental design included groups of parent/daughter dyads; Group 1 (controls) (n=40), Group 2 Adolescent Program (n=40) and Group 3 Adolescent Parent Program (APP) (n=42). Outcome measures included parent–adolescent communications and adolescents’ sexual abstinence cognitions and intent to abstain from sexual behaviors, measured at five and nine weeks post-programs.
Findings
Generalized estimating equation analyses indicated that the dual program (APP) was more effective in increasing parental communication with their daughters compared with Group 1 (p-value<0.05) and only the daughters in the APP program reported more positive subjective norms, sense of perceived behavioral control and intent to abstain than did Group 1 (p-value<0.05).
Originality/value
The overarching goal of supporting the development of family environments where female adolescents are able to talk about sexuality is essential for adolescent sexual health promotion. The data provide further evidence that a dual program with simultaneous parent and female adolescent interactive activities over three sessions is superior compared with programs that target either the parents or the adolescents only. Hence, further replication with more parent–daughter dyads and then within more diverse cultures and populations is warranted. Developing and testing a similarly structured program for parents and sons is also required.
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24
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Mirzazadeh A, Biggs MA, Viitanen A, Horvath H, Wang LY, Dunville R, Barrios LC, Kahn JG, Marseille E. Do School-Based Programs Prevent HIV and Other Sexually Transmitted Infections in Adolescents? A Systematic Review and Meta-analysis. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2019; 19:490-506. [PMID: 28786046 DOI: 10.1007/s11121-017-0830-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We systematically reviewed the literature to assess the effectiveness of school-based programs to prevent HIV and other sexually transmitted infections (STI) among adolescents in the USA. We searched six databases including PubMed for studies published through May 2017. Eligible studies included youth ages 10-19 years and assessed any school-based programs in the USA that reported changes in HIV/STI incidence or testing. We used Cochrane tool to assess the risk of bias and GRADE to determine the evidence quality for each outcome. Three RCTs and six non-RCTs, describing seven interventions, met study inclusion criteria. No study reported changes in HIV incidence or prevalence. One comprehensive intervention, assessed in a non-RCT and delivered to pre-teens, reduced STI incidence into adulthood (RR 0.36, 95% CI 0.23-0.56). A non-RCT examining chlamydia and gonorrhea incidence before and after a condom availability program found a significant effect at the city level among young men 3 years later (RR 0.43, 95% CI 0.23-0.80). The remaining four interventions found no effect. The effect on STI prevalence was also not significant (pooled RR 0.83 from two non-RCTs, RR 0.70 from one RCT). Only one non-RCT showed an increase in HIV testing (RR 3.19, 95% CI 1.24-8.24). The quality of evidence for all outcomes was very low. Studies, including the RCTs, were of low methodological quality and had mixed findings, thus offering no persuasive evidence for the effectiveness of school-based programs. The most effective intervention spanned 6 years, was a social development-based intervention with multiple components, rather than a sex education program, and started in first grade.
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Affiliation(s)
- Ali Mirzazadeh
- School of Medicine, Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA. .,Global Health Sciences, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.
| | - M Antonia Biggs
- Department of Obstetrics, Gynecology and Reproductive Sciences, Advancing New Standards in Reproductive Health (ANSIRH), Bixby Center for Global Reproductive Health, University of California, San Francisco, 1330 Broadway, Suite 1100, Oakland, CA, 94612, USA
| | - Amanda Viitanen
- Global Health Sciences, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
| | - Hacsi Horvath
- School of Medicine, Department of Epidemiology and Biostatistics, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.,Global Health Sciences, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA
| | - Li Yan Wang
- Division of Adolescent and School Health, U.S. Centers for Disease Control and Prevention, Office of Infectious Diseases, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA, 30329, USA
| | - Richard Dunville
- Division of Adolescent and School Health, U.S. Centers for Disease Control and Prevention, Office of Infectious Diseases, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA, 30329, USA
| | - Lisa C Barrios
- Division of Adolescent and School Health, U.S. Centers for Disease Control and Prevention, Office of Infectious Diseases, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA, 30329, USA
| | - James G Kahn
- Global Health Sciences, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA.,Global Health Economics Consortium, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94158, USA
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25
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Peterson AJ, Donze M, Allen E, Bonell C. Effects of Interventions Addressing School Environments or Educational Assets on Adolescent Sexual Health: Systematic Review and Meta-analysis. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2019; 51:91-107. [PMID: 31108026 DOI: 10.1363/psrh.12102] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 01/07/2019] [Accepted: 01/23/2019] [Indexed: 06/09/2023]
Abstract
CONTEXT School-based interventions that aim to modify sexual health knowledge, attitudes and behaviors have mixed and often unsustained effects on adolescent sexual health outcomes. However, observational evidence suggests that broader school-related factors, such as school climate and academic attainment, can influence outcomes. METHODS Nine databases were searched in July 2017 for randomized and quasi-experimental evaluations of interventions addressing school-level environment or student-level educational assets, to examine whether such interventions can promote young people's sexual health. Searches were limited to studies published since 1990 but were not restricted by language. Studies were assessed for risk of bias and synthesized narratively and meta-analytically. RESULTS Searches yielded 11 evaluations, published from 1999 to 2016, of interventions related to school-level environment or student-level educational assets. Because of inconsistent reporting, the risk of bias was not clear for most studies, and meta-analysis was possible for only one outcome. The meta-analysis of three randomized trials provided some evidence that school-environment interventions may delay sexual debut (pooled odds ratio, 0.5). Narrative synthesis of the remaining outcomes found mixed results, but suggests that interventions addressing school-level environment may delay sexual debut and that those addressing student-level educational assets may reduce risk of pregnancy and STDs. CONCLUSIONS Additional and more rigorous evidence is needed to assess the probability that interventions addressing school-related factors are effective and to provide better understanding of the mechanisms by which they may work to improve adolescent sexual health.
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Affiliation(s)
- Amy J Peterson
- Program Manager, ETR, Scotts Valley, CA
- Doctoral Degree Candidate, Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London
| | - Melissa Donze
- City Research Scientist, Division of Epidemiology, New York City Department of Health and Mental Hygiene, New York
| | - Elizabeth Allen
- Professor, Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London
| | - Chris Bonell
- Professor, Department of Public Health Sociology, London School of Hygiene and Tropical Medicine, London
- Head, Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London
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26
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Pakarinen M, Kylmä J, Helminen M, Suominen T. Vocational school students' self-evaluations of a sexual health promotion intervention. Scand J Caring Sci 2019; 33:857-867. [PMID: 30888080 DOI: 10.1111/scs.12682] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 02/24/2019] [Indexed: 11/29/2022]
Abstract
Sexually transmitted infections (STIs) continue to pose a health risk among adolescents. School is therefore a logical place for promoting sexual health through interventions, but previous research has not examined student's self-evaluations of these interventions. The purpose of this study was to examine students' self-evaluations of a sexual health promotion intervention carried out in four randomly selected vocational schools in Finland in the year 2011. The participants (n = 168) were first-year students aged 15-19 years. The intervention (11 weeks) consisted of three components: (i) a teacher-delivered classroom lesson about sexual health, (ii) information materials about sexual health and (iii) free condom distribution in the school corridors. An electronic questionnaire was developed and administered to the students after the intervention. The participants' evaluations of the intervention were fairly positive. Almost all of the participants were at least partly satisfied with the classroom lesson. They mostly reported learning new information about STIs and sexuality. Information material was also read and participants self-evaluated themselves as having learned from the materials. Free condoms were obtained and the students felt that the condom distribution was useful. Sexual health promotion interventions might in the future include the classroom lesson, information material and free condom distribution components used in this study.
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Affiliation(s)
- Marja Pakarinen
- Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland
| | - Jari Kylmä
- Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland
| | - Mika Helminen
- Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland.,Research, Development and Innovation Centre, Tampere University Hospital, Tampere, Finland
| | - Tarja Suominen
- Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland
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27
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de Looze M, Madkour AS, Huijts T, Moreau N, Currie C. Country-Level Gender Equality and Adolescents' Contraceptive Use in Europe, Canada and Israel: Findings from 33 Countries. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2019; 51:43-53. [PMID: 30817858 PMCID: PMC6996477 DOI: 10.1363/psrh.12090] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Revised: 11/21/2018] [Accepted: 11/26/2018] [Indexed: 05/30/2023]
Abstract
CONTEXT Although an association between gender equality and contraceptive use has been confirmed among adult samples, few studies have explored this relationship among adolescents. An examination of whether adolescents' contraceptive use is more prevalent in countries with higher levels of gender equality is needed to fill this gap. METHODS Nationally representative data from 33 countries that participated in the 2013-2014 Health Behaviour in School-Aged Children study and country-level measures of gender equality-using the 2014 Global Gender Gap Index-were analyzed. Multilevel multinomial logistic regression analyses were employed to assess associations between gender equality and contraceptive use (condom only, pill only and dual methods) at last intercourse as reported by 4,071 females and 4,110 males aged 14-16. RESULTS Increasing gender equality was positively associated with contraceptive use among both males and females. For every 0.1-point increase on the equality scale, the likelihood of condom use at last intercourse rose (odds ratio, 2.1 for females), as did the likelihood of pill use (6.5 and 9.6, respectively, for males and females) and dual method use (2.1 and 5.6, respectively). Associations with pill use and dual use remained significant after national wealth and income inequality were controlled for. Overall, associations were stronger for females than for males. CONCLUSIONS More research is needed to identify potential causal pathways and mechanisms through which gender equality and adolescents' contraceptive use may influence one another.
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Affiliation(s)
- Margaretha de Looze
- Assistant professor, Department of Inter disciplinary Social Science, Faculty of Social and Behavioural SciencesUtrecht UniversityUtrechtthe Netherlands
| | - Aubrey S. Madkour
- Associate professor, Department of Global Community Health and Behavioral SciencesTulane University School of Public Health and Tropical MedicineNew Orleans
| | - Tim Huijts
- Researcher, Research Centre for Education and the Labour Market, School of Business and EconomicsMaastricht UniversityMaastrichtthe Netherlands
| | - Nathalie Moreau
- Researcher, Service d'Information Promotion Education Santé, School of Public HealthUniversité Libre de BruxellesBrusselsBelgium
| | - Candace Currie
- Professor, Child and Adolescent Health Research Unit, WHO Collaborating Centre for International Child and Adolescent Health Policy, School of MedicineUniversity of St. AndrewsSt. AndrewsScotland
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28
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Andrzejewski J, Liddon N, Leonard S. Condom Availability Programs in Schools: A Review of the Literature. Am J Health Promot 2019; 33:457-467. [PMID: 30068218 PMCID: PMC6540114 DOI: 10.1177/0890117118791118] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This review synthesizes findings from the peer-reviewed evaluation literature on condom availability programs (CAPs) in secondary schools. DATA SOURCE Peer-reviewed evaluation literature indexed in MEDLINE, EMBASE, PsychINFO, ERIC, CINAHL, Sociological Abstracts, SCOPUS, and POPLINE. STUDY INCLUSION AND EXCLUSION CRITERIA Manuscripts had to be, written in English, and report evaluation data from a US school-based CAP. DATA EXTRACTION Articles were coded independently by 2 authors. Discrepancies were resolved through open discussion. DATA SYNTHESIS We grouped findings into outcome evaluation and process evaluation findings. Outcome evaluation findings included sexually transmitted infections (STIs), pregnancy rates, condom use, contraception use, sexual risk, and substance use. Process evaluation findings included awareness of CAPs, attitudes toward CAPs, attitudes toward condoms, and receipt of education and instruction. RESULTS Of the 138 citations reviewed, 12 articles published between 1995 and 2012 met the inclusion criteria, representing 8 programs. Evaluations indicate CAPs yield condom acquisition rates between 23% and 48%, have mixed results related to condom use, and are not associated with increases in sexual and other risk behaviors. One program found CAPs were associated with a decrease in a combined rate of chlamydia and gonorrhea. One program found no association between CAPs and unintended pregnancy. Students' attitudes toward CAPs were favorable and awareness was high. CONCLUSIONS Condom availability programs are accepted by students and can be an appropriate and relevant school-based intervention for teens. Condom availability programs can increase condom use, but more evaluations are needed on CAP impact on rates of HIV, STIs, and unintended pregnancy.
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Affiliation(s)
| | - Nicole Liddon
- 2 Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sandra Leonard
- 2 Division of Adolescent and School Health, Centers for Disease Control and Prevention, Atlanta, GA, USA
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29
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Cameron S, Cooper M, Kerr Y, Mahmood T. EBCOG position statement - Public health role of sexual health and relationships education. Eur J Obstet Gynecol Reprod Biol 2019; 234:223-224. [PMID: 30683456 DOI: 10.1016/j.ejogrb.2019.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 01/03/2019] [Indexed: 10/27/2022]
Abstract
Sexual and relationship education should be part of educational curriculum in early teenage years. The young people should be provided with evidence based education to reduce the risks of untimed pregnancies and sexually transmitted infections.
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Affiliation(s)
| | | | | | - Tahir Mahmood
- Victoria Hospital, Kirkcaldy, Scotland and Chair of EBCOG Standards of Care and Position Statements Working Group, United Kingdom.
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30
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Cognitive precursors to adolescents' reproductive health: Exploring the role of school-based health services. Prev Med 2018; 116:75-80. [PMID: 30171965 PMCID: PMC6319918 DOI: 10.1016/j.ypmed.2018.08.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 08/23/2018] [Accepted: 08/28/2018] [Indexed: 11/20/2022]
Abstract
The goal of this study was to examine associations between the number of school-based health services (SBHS) provided and the cognitive precursors to adolescents' reproductive health, including birth control self-efficacy, motivation to use birth control, attitudes toward birth control, and contraception knowledge. Further, this study examined whether these associations varied by adolescents' age, gender, socioeconomic status (SES), and race/ethnicity. Data were drawn from two waves of Add Health, a longitudinal survey of a nationally representative sample of U.S. adolescents (1994-96). Results from hierarchical linear regression models indicated that the number of SBHS interacted with adolescents' age to predict birth control self-efficacy, such that a greater number of SBHS were associated with greater birth control self-efficacy among 15-year-old adolescents. Findings also indicated that a greater number of SBHS were associated with lower reported birth control motivation. Although access to a greater number of health services in school settings had some effect, study findings suggest that simply increasing the number or range of health services provided may not be the most effective method for supporting diverse adolescents' reproductive health. This information is important for schools as it highlights the need for SBHS to be health outcome specific and can be used to inform initiatives related to adolescents' reproductive health.
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Eitle D, Thorsen M. School Contextual Factors and Race Differences in Adolescent Sexual Behaviors. INTERNATIONAL JOURNAL OF SEXUAL HEALTH : OFFICIAL JOURNAL OF THE WORLD ASSOCIATION FOR SEXUAL HEALTH 2018; 30:309-322. [PMID: 31435455 PMCID: PMC6703826 DOI: 10.1080/19317611.2018.1502226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 06/11/2018] [Accepted: 07/15/2018] [Indexed: 06/01/2023]
Abstract
While there exist a voluminous number of studies examining predictors of adolescent sexual behavior, few studies have explored the role of the school social context in influencing teen sexual activity generally and specifically, the role that school contextual factors play in helping understand race differences in risky sexual behaviors. Using data from a nationally-representative school-based survey of American youth in grades 7-12, we find support for our core hypothesis that school contextual factors are associated with risky sexual behavior, number of sexual partners, and ever having sex, albeit it nuanced ways and that such factors cannot account for much of the race gap in adolescent sexual behavior. We interpret these findings to be more supportive of a social contagion model (versus a school climate model).
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Affiliation(s)
- David Eitle
- Montana State University, Department of Sociology & Anthropology, Wilson 2-127, P.O. Box 172380, Bozeman, MT 59717
| | - Maggie Thorsen
- Montana State University, Department of Sociology & Anthropology. Wilson 2-122
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Langmagne S, Tenkorang EY, Asampong E, Osafo J, Bingenheimer JB. Approaches to Regulating Adolescent Sexual Behavior in Ghana: Qualitative Evidence from Somanya and Adidome. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:1779-1790. [PMID: 29616424 DOI: 10.1007/s10508-018-1161-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 12/27/2017] [Accepted: 01/25/2018] [Indexed: 06/08/2023]
Abstract
This article examines perceptions of why HIV infection is severe among adolescents in Somanya and less so in Adidome-two seemingly similar communities in Ghana-through analysis of the social control measures employed by these communities to regulate adolescent sexual initiation. Using focus group discussions with parents and caregivers of adolescent children, the study found that parents in Somanya and Adidome used different regulatory mechanisms to influence adolescent sexual initiation. While parents in Somanya relied largely on parental monitoring, parents in Adidome depended more on a combination of neighborhood monitoring and community barriers (informal rules) to control adolescent sexual onset. The study findings showed that contextual factors (socioeconomic and cultural) shaped the social realities of people in these two communities accounting for the differences in HIV prevalence.
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Affiliation(s)
- Susan Langmagne
- Department of Sociology, University of Saskatchewan, Saskatoon, SK, S7N 5A5, Canada.
| | - Eric Y Tenkorang
- Department of Sociology, Memorial University, St. John's, NL, Canada
| | - Emmanuel Asampong
- Department of Social and Behavioural Sciences, School of Public Health, University of Ghana, Accra, Ghana
| | - Joseph Osafo
- Department of Psychology, University of Ghana, Accra, Ghana
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Mwangi M, Waruru A, Waruiru W, Gichangi A, Toroitich-Ruto C, Kim AA. Factors associated with unsafe sex among Kenyan youth: Results from a nationally representative population-based survey. EAST AFRICAN JOURNAL OF APPLIED HEALTH MONITORING AND EVALUATION 2018; 2:25-37. [PMID: 31149660 PMCID: PMC6537612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Understanding sexual risk among youth can inform the design of effective HIV prevention interventions. METHODS The 2012 Kenya AIDS Indicator Survey was a nationally representative population-based survey. We administered a questionnaire and collected blood samples for HIV testing. We examined factors associated with unsafe sex among unmarried youth aged 15-19 and 20-24 years. RESULTS Of 2,090 unmarried youth aged 15-19 years, 33.3% (95% confidence interval [CI] 30.6-36.1) had ever had sex. Among those, 66.0% (95% CI 61.3-70.7) had sex in the past year (sexually active), and of these, 38.7% (95% 33.4 -44.0) reported unsafe sex. No differences were observed in unsafe sex by sex. Factors associated with increased adjusted odds of unsafe sex among youth aged 15-19 years were residence in Central province; having primary or lower education; sexual debut before age 15 years; ever receiving money, gifts or favours for sex (transactional sex); multiple sexual partners in the past year; and low self-perceived risk of HIV. Of the 1,079 unmarried youth aged 20-24 years, 77.2% (95% CI 74.2-80.2) had ever had sex. Of these, 73.1% (95% CI69.8-76.3) were sexually active, and 24.1% (95% CI 18.1-30.1) of women and 31.9% (95% CI 26.4-37.5) of men reported unsafe sex in the past year. Factors associated with increased adjusted odds of unsafe sex among youth aged 20-24 years were primary or lower education, transactional sex and multiple partners in the past year. CONCLUSION Unsafe sex is common among Kenyan youth, especially those aged 15-19 years. HIV prevention efforts need to target youth, support educational progression and economic empowerment.
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Affiliation(s)
- Mary Mwangi
- Divison of Global HIV/AIDS, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Anthony Waruru
- Divison of Global HIV/AIDS, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Wanjiru Waruiru
- Institute for Global Health Sciences, University of California, San Francisco, California, United States of America
| | - Anthony Gichangi
- Divison of Global HIV/AIDS, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Cathy Toroitich-Ruto
- Divison of Global HIV/AIDS, US Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Andrea A. Kim
- Divison of Global HIV/AIDS, US Centers for Disease Control and Prevention, Nairobi, Kenya
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Abstract
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.
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Human papillomavirus knowledge and vaccine acceptability among adolescents in a Greek region. Public Health 2017; 152:145-152. [DOI: 10.1016/j.puhe.2017.07.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 07/26/2017] [Accepted: 07/30/2017] [Indexed: 11/22/2022]
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Teye-Kwadjo E, Kagee A, Swart H. Determinants of condom use among heterosexual young men and women in southeastern Ghana: a mediation analysis. PSYCHOLOGY & SEXUALITY 2017. [DOI: 10.1080/19419899.2017.1391870] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Ashraf Kagee
- Department of Psychology, Stellenbosch University, Matieland, South Africa
| | - Hermann Swart
- Department of Psychology, Stellenbosch University, Matieland, South Africa
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Smith TE, Panisch LS, Malespin T, Pereira MG. Evaluating Effectiveness of Abstinence Education. JOURNAL OF EVIDENCE-INFORMED SOCIAL WORK 2017; 14:360-367. [PMID: 28665180 DOI: 10.1080/23761407.2017.1340860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE This study examined the effectiveness of an abstinence education program that was sensitive to federally mandated curriculum and measures. METHODS The intervention was delivered to 5,772 middle school and high school students. Effectiveness was assessed by a measure that was anchored on A-H themes, which are components of federally mandated curricular components of abstinence education. To better understand the relationship of different variables and determine the significance of student's improvements on the A-H measure scores, the ANCOVA was used with the pretest score and age as covariates and the use of gender and ethnicity as fixed factors in the analysis. RESULTS While controlling for the effects of the pretest, the analyses showed that age and gender were main effects but that ethnicity did not prove to be related to the outcome scores. Results demonstrated that the effectiveness of the program decreased as adolescent boys aged. There were no significant interactions in the gender and ethnicity variables. CONCLUSIONS The findings of this study will be beneficial to program developers in understanding what variations and demographics are most receptive to this particular abstinence-only education model. Further studies in this area are needed to evaluate the effectiveness of currently available programs.
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Affiliation(s)
- Thomas E Smith
- a College of Social Work , Florida State University , Tallahassee , Florida , USA
| | - Lisa S Panisch
- b School of Social Work , University of Texas at Austin , Austin , Texas , USA
| | - Thallia Malespin
- c School of Law , Villanova University , Villanova , Pennsylvania , USA
| | - M Graça Pereira
- d School of Psychology , University of Minho , Braga , Portugal
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Peskin MF, Hernandez BF, Gabay EK, Cuccaro P, Li DH, Ratliff E, Reed-Hirsch K, Rivera Y, Johnson-Baker K, Emery ST, Shegog R. Using Intervention Mapping for Program Design and Production of iCHAMPSS: An Online Decision Support System to Increase Adoption, Implementation, and Maintenance of Evidence-Based Sexual Health Programs. Front Public Health 2017; 5:203. [PMID: 28848729 PMCID: PMC5554483 DOI: 10.3389/fpubh.2017.00203] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 07/25/2017] [Indexed: 12/02/2022] Open
Abstract
In Texas and across the United States, unintended pregnancy, HIV, and sexually transmitted infections (STIs) among adolescents remain serious public health issues. Sexual risk-taking behaviors, including early sexual initiation, contribute to these public health problems. Over 35 sexual health evidence-based programs (EBPs) have been shown to reduce sexual risk behaviors and/or prevent teen pregnancies or STIs. Because more than half of these EBPs are designed for schools, they could reach and impact a considerable number of adolescents if implemented in these settings. Most schools across the U.S. and in Texas, however, do not implement these programs. U.S. school districts face many barriers to the successful dissemination (i.e., adoption, implementation, and maintenance) of sexual health EBPs, including lack of knowledge about EBPs and where to find them, perceived lack of support from school administrators and parents, lack of guidance regarding the adoption process, competing priorities, and lack of specialized training on sexual health. Therefore, this paper describes how we used intervention mapping (Steps 3 and 4, in particular), a systematic design framework that uses theory, empirical evidence, and input from the community to develop CHoosing And Maintaining Effective Programs for Sex Education in Schools (iCHAMPSS), an online decision support system to help school districts adopt, implement, and maintain sexual health EBPs. Guided by this systematic intervention design approach, iCHAMPSS has the potential to increase dissemination of sexual health EBPs in school settings.
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Affiliation(s)
- Melissa F Peskin
- University of Texas Health Science at Houston School of Public Health, Houston, TX, United States
| | - Belinda F Hernandez
- University of Texas Health Science at Houston School of Public Health, Houston, TX, United States
| | - Efrat K Gabay
- University of Texas Health Science at Houston School of Public Health, Houston, TX, United States
| | - Paula Cuccaro
- University of Texas Health Science at Houston School of Public Health, Houston, TX, United States
| | - Dennis H Li
- Northwestern University, Chicago, IL, United States
| | - Eric Ratliff
- University of Texas Health Science at Houston School of Public Health, Houston, TX, United States
| | | | - Yanneth Rivera
- University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Kimberly Johnson-Baker
- University of Texas Health Science at Houston School of Public Health, Houston, TX, United States
| | - Susan Tortolero Emery
- University of Texas Health Science at Houston School of Public Health, Houston, TX, United States
| | - Ross Shegog
- University of Texas Health Science at Houston School of Public Health, Houston, TX, United States
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Ševčíková A, Blinka L, Daneback K. Sexting as a predictor of sexual behavior in a sample of Czech adolescents. EUROPEAN JOURNAL OF DEVELOPMENTAL PSYCHOLOGY 2017. [DOI: 10.1080/17405629.2017.1295842] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Anna Ševčíková
- Faculty of Social Studies, Institute for Research on Children, Youth and Family, Masaryk University, Brno, the Czech Republic
| | - Lukas Blinka
- Faculty of Social Studies, Institute for Research on Children, Youth and Family, Masaryk University, Brno, the Czech Republic
| | - Kristian Daneback
- Department of Social Work, University of Gothenburg, Göteborg, Sweden
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D'Cruz J, Santa Maria D, Dube S, Markham C, McLaughlin J, Wilkerson JM, Peskin MF, Tortolero S, Shegog R. Promoting Parent-Child Sexual Health Dialogue with an Intergenerational Game: Parent and Youth Perspectives. Games Health J 2017; 4:113-22. [PMID: 26181805 DOI: 10.1089/g4h.2014.0080] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Sexual health discussions between parents and their preadolescent youth can delay sexual debut and increase condom and contraceptive use. However, parents frequently report being uncomfortable talking with their youth about sex, often reporting a lack of self-efficacy and skills to inform and motivate responsible decision making by youth. Intergenerational games may support parent-youth sexual health communication. The purpose of this study was to explore parent and youth perspectives on a proposed intergenerational game designed to increase effective parent-youth sexual health communication and skills training. MATERIALS AND METHODS Eight focus groups were conducted: four with parents (n=20) and four with their 11-14-year-old youth (n=19), to identify similarities and differences in perspectives on gaming context, delivery channel, content, and design (components, features, and function) that might facilitate dyadic sexual health communication. RESULTS Participants concurred that a sex education game could improve communication while being responsive to family time constraints. They affirmed the demand for an immersive story-based educational adventure game using mobile platforms and flexible communication modalities. Emergent themes informed the development of a features inventory (including educational and gaming strategies, communication components, channel, and setting) and upper-level program flow to guide future game development. CONCLUSIONS This study supports the potential of a game to be a viable medium to bring a shared dyadic sexual health educational experience to parents and youth that could engage them in a motivationally appealing way to meaningfully impact their sexual health communication and youth sexual risk behaviors.
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Affiliation(s)
- Jina D'Cruz
- 1 Center for Health Promotion and Prevention Research, University of Texas Health Science Center , Houston, Texas
| | - Diane Santa Maria
- 1 Center for Health Promotion and Prevention Research, University of Texas Health Science Center , Houston, Texas
| | - Sara Dube
- 1 Center for Health Promotion and Prevention Research, University of Texas Health Science Center , Houston, Texas
| | - Christine Markham
- 1 Center for Health Promotion and Prevention Research, University of Texas Health Science Center , Houston, Texas
| | | | - Johnny M Wilkerson
- 1 Center for Health Promotion and Prevention Research, University of Texas Health Science Center , Houston, Texas
| | - Melissa F Peskin
- 1 Center for Health Promotion and Prevention Research, University of Texas Health Science Center , Houston, Texas
| | - Susan Tortolero
- 1 Center for Health Promotion and Prevention Research, University of Texas Health Science Center , Houston, Texas
| | - Ross Shegog
- 1 Center for Health Promotion and Prevention Research, University of Texas Health Science Center , Houston, Texas
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Genz N, Meincke SMK, Carret MLV, Corrêa ACL, Alves CN. SEXUALLY TRANSMITTED DISEASES: KNOWLEDGE AND SEXUAL BEHAVIOR OF ADOLESCENTS. TEXTO & CONTEXTO ENFERMAGEM 2017. [DOI: 10.1590/0104-07072017005100015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to evaluate the sexual knowledge and behavior of adolescents about Sexually Transmitted Diseases. Method: a descriptive, observational and quantitative study with a convenience sample of 532 adolescents aged between 10 and 19 years old. An individual questionnaire on sexually transmitted diseases was applied. The STATA 11.1 program was used for data analysis. Results: 89.2% of the teenage girls and 90.3% of the teenage boys were able to properly define the concept of a STD. Condom use is the most efficient method for STD prevention for 98.5% of the girls and 98.9% of the boys. However, 37.1% of the girls and 30.5% of the boys mentioned the use of contraceptives as a preventive method for sexually transmitted diseases. Conclusion: it is important to carry out educational actions together with schools on topics such as sexuality and reproductive health.
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Martinez-Donate AP, Blumberg EJ, Hovell MF, Sipan CL, Zellner JA, Hughes S. Risk for HIV Infection Among Adolescents in the Border City of Tijuana, Mexico. HISPANIC JOURNAL OF BEHAVIORAL SCIENCES 2016. [DOI: 10.1177/0739986304269167] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Previous studies have suggested high rates of HIV infection and other sexually transmitted infections in theU.S.–Mexico border region. However, no information is available on the risk for HIV infection among Mexican adolescents living in this geographic area. This study examines the prevalence of HIV risk practices and psychosocial correlates among 370 high school students in the border city of Tijuana, Mexico, by gender and age group. The results indicate substantial risk for HIV infection among Tijuana youth due to unprotected sexual practices, lifetime rates of pregnancy and sexually transmitted infections, and needle-sharing practices, mostly related to tattooing and body piercing. These findings suggest the need for HIV prevention programs for Tijuana adolescents. These programs must be culturally sensitive and tailored to meet the needs of the different age and gender groups in this region.
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Affiliation(s)
| | | | | | | | | | - Suzanne Hughes
- Center for Behavioral Epidemiology and Community Health, San Diego State University
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Madkour AS, Xie Y, Harville EW. Availability of Reproductive Health Care Services at Schools and Subsequent Birth Outcomes Among Adolescent Mothers. THE JOURNAL OF SCHOOL HEALTH 2016; 86:488-494. [PMID: 27246673 PMCID: PMC4890609 DOI: 10.1111/josh.12399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 09/28/2015] [Accepted: 03/06/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Adverse birth outcomes are more common among adolescent versus adult mothers, but little is known about school-based services that may improve birth outcomes in this group. METHODS Data from Waves I and IV of the National Longitudinal Study of Adolescent Health were analyzed. Girls and women who gave birth to singleton live infants after Wave I and before age 20, were still in secondary school while pregnant, and had complete data (N = 402) were included. Mothers reported infants' birthweight and gestational age. School administrators reported whether family planning counseling, diagnostic screening (including sexually transmitted diseases [STDs]), STD treatment, and prenatal/postpartum health care were provided on-site at school at Wave I. Multilevel models adjusted for individual and school characteristics were conducted. RESULTS Few schools offered reproductive health care services on-site. In multilevel analyses, availability of family planning counseling (Est. β = 0.21, 95% confidence interval [CI] 0.04-0.38 p < 0.05) and prenatal/postpartum health care (Est. β = 0.21, 95% CI 0.02-0.40 p < 0.05) were significantly associated with increased infant birthweight. No services examined were significantly associated with increased gestational age. CONCLUSIONS Some school-based reproductive health services may improve subsequent birth outcomes among adolescent mothers. Future analyses should examine the mechanisms by which services impact birth outcomes.
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Affiliation(s)
- Aubrey S Madkour
- Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2200, New Orleans, LA 70112.
| | - Yiqiong Xie
- Payer and Provider Research, HealthCore, Inc., 123 Justison Street, Suite 200, Wilmington, DE 19801.
| | - Emily W Harville
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, 1440 Canal Street, Suite 2000, New Orleans, LA 70112.
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Sohn A, Chun S. Gender Differences in Sexual Behavior and Condom-related Behaviours and Attitudes among Korean Youths. Asia Pac J Public Health 2016; 19:45-52. [DOI: 10.1177/10105395070190020801] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We examined gender differences in sexual behaviours, condom-related behaviours and attitudes to premarital sex in order to identify gender differences in young Korean singles aged 19 to 30 years. This study was based on data from the 2003 national survey of attitudes and behaviours towards AIDS in the Korean adult population, which contains information on a national sample of the general population aged 19 to 59 years. We selected 501 unmarried subjects between the ages of 19-30 from 1,995 respondents. The selection criterion for the subjects' age was based on the 2003 Korean mean age for marriage which was 29.8 for men and 27.0 for women. Gender differentials in sexual behaviour, condom use and related attitudes toward condom use were assessed. Although men initiated sexual practice earlier and had more multiple partners than women, both genders were equally likely to have engaged in inconsistent condom use, even when having sex with a high risk partner. These findings suggest that sex education focusing on condom use should be included in the school curricula. Implementation of early sexual education should start before the students initiate sexual activity to give them a chance to prepare gradu ally. Asia Pac J Public Health 2007; 19(2): 45-52.
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Affiliation(s)
- A. Sohn
- Graduate School of Health Sciences and Social Welfare,
Sahmyook University, Seoul, South Korea,
| | - S.S. Chun
- Graduate School of Health Sciences and Social Welfare,
Sahmyook University, Seoul, South Korea
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45
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Exploratory trial of a school-based alcohol prevention intervention with a family component. HEALTH EDUCATION 2016. [DOI: 10.1108/he-01-2015-0005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– Involvement of parents/carers may increase effectiveness of primary school-based alcohol-misuse prevention projects through strengthening family-based protective factors, but rates of parental engagement are typically low. This paper reports findings from an exploratory trial of a school-based prevention intervention – Kids, Adults Together (KAT), based on the Social Development Model, which aimed to promote pro-social family communication in order to prevent alcohol misuse, and incorporated strategies to engage parents/carers. The purpose of this paper is to assess the feasibility and value of conducting an effectiveness trial of KAT.
Design/methodology/approach
– The study was a parallel-group cluster randomised exploratory trial with an embedded process evaluation. The study took place in south Wales, UK, and involved nine primary schools, 367 pupils in Years 5/6 (aged 9-11 years) and their parents/carers and teachers. Questionnaires were completed by pupils at baseline and four month follow-up, and by parents at six month follow-up.
Findings
– Overall KAT was delivered with good fidelity, but two of five intervention schools withdrew from the study without completing implementation. In total, 50 per cent of eligible parents participated in the intervention, and KAT had good acceptability among pupils, parents and teachers. However, a number of “progression to effectiveness trial” criteria were not met. Intermediate outcomes on family communication (hypothesised to prevent alcohol misuse) showed insufficient evidence of an intervention effect. Difficulties were encountered in identifying age appropriate outcome measures for primary school-age children, particularly in relation to family communication processes. The study was unable to find comprehensive methodological guidance on exploratory trials.
Research limitations/implications
– It would not be appropriate to conduct an effectiveness trial as key progression criteria relating to intervention and trial feasibility were not met. There is a need for new measures of family communication which are suitable for primary school-age children, and more guidance on the design and conduct of exploratory/feasibility trials.
Originality/value
– KAT achieved high rates of parental involvement, and its theoretical framework and processes could be adapted by other interventions which experience difficulties with recruitment of parents/carers.
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Craft LR, Brandt HM, Prince M. Sustaining Teen Pregnancy Prevention Programs in Schools: Needs and Barriers Identified by School Leaders. THE JOURNAL OF SCHOOL HEALTH 2016; 86:258-265. [PMID: 26930237 DOI: 10.1111/josh.12376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 11/07/2014] [Accepted: 11/07/2014] [Indexed: 06/05/2023]
Abstract
BACKGROUND To reduce teen pregnancy rates, prevention programs must be consistently available to large numbers of youth. However, prevention efforts have been historically conducted with little emphasis on ensuring program sustainability. This study examined the needs and barriers to sustaining teen pregnancy prevention (TPP) programming in schools after grant funding has ended, as identified by school leadership. METHODS A total of 11 qualitative interviews were conducted between June and September 2012 with middle school leaders from 11 schools involved in current implementation of a TPP program in South Carolina. Interviews were audio-recorded, transcribed verbatim, and thematically coded. RESULTS Identified needs and barriers to sustainability varied across schools. Common barriers to program sustainability included: lack of materials and supplies, insufficient funding (at the school and district level), lack of support and/or parental opposition, and other school/district priorities. School leaders also identified several needs to continue TPP programming, including: continued funding, trainings, outcome/effectiveness data to support the program, and regularly updated curriculum. CONCLUSION Schools with greater perceived needs and barriers may be less likely to sustain. Knowledge gained through this research may be used to inform future interventions and sustainability planning efforts, allowing us to maximize prevention programming.
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Affiliation(s)
- Lesley R Craft
- South Carolina Campaign to Prevent Teen Pregnancy, 1331 Elmwood Avenue, Suite 140, Columbia, SC 29201.
| | - Heather M Brandt
- Department of Health Promotion, Education, and Behavior, Statewide Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208.
| | - Mary Prince
- Science and Planning, South Carolina Campaign to Prevent Teen Pregnancy, 1331 Elmwood Avenue, Suite 140, Columbia, SC 29201.
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Oringanje C, Meremikwu MM, Eko H, Esu E, Meremikwu A, Ehiri JE. Interventions for preventing unintended pregnancies among adolescents. Cochrane Database Syst Rev 2016; 2:CD005215. [PMID: 26839116 PMCID: PMC8730506 DOI: 10.1002/14651858.cd005215.pub3] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Unintended pregnancy among adolescents represents an important public health challenge in high-income countries, as well as middle- and low-income countries. Numerous prevention strategies such as health education, skills-building and improving accessibility to contraceptives have been employed by countries across the world, in an effort to address this problem. However, there is uncertainty regarding the effects of these interventions, hence the need to review the evidence-base. OBJECTIVES To assess the effects of primary prevention interventions (school-based, community/home-based, clinic-based, and faith-based) on unintended pregnancies among adolescents. SEARCH METHODS We searched all relevant studies regardless of language or publication status up to November 2015. We searched the Cochrane Fertility Regulation Group Specialised trial register, The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2015 Issue 11), MEDLINE, EMBASE, LILACS, Social Science Citation Index and Science Citation Index, Dissertations Abstracts Online, The Gray Literature Network, HealthStar, PsycINFO, CINAHL and POPLINE and the reference lists of articles. SELECTION CRITERIA We included both individual and cluster randomised controlled trials (RCTs) evaluating any interventions that aimed to increase knowledge and attitudes relating to risk of unintended pregnancies, promote delay in the initiation of sexual intercourse and encourage consistent use of birth control methods to reduce unintended pregnancies in adolescents aged 10 years to 19 years. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial eligibility and risk of bias, and extracted data. Where appropriate, binary outcomes were pooled using a random-effects model with a 95% confidence interval (Cl). Where appropriate, we combined data in meta-analyses and assessed the quality of the evidence using the GRADE approach. MAIN RESULTS We included 53 RCTs that enrolled 105,368 adolescents. Participants were ethnically diverse. Eighteen studies randomised individuals, 32 randomised clusters (schools (20), classrooms (6), and communities/neighbourhoods (6). Three studies were mixed (individually and cluster randomised). The length of follow up varied from three months to seven years with more than 12 months being the most common duration. Four trials were conducted in low- and middle- income countries, and all others were conducted in high-income countries. Multiple interventionsResults showed that multiple interventions (combination of educational and contraceptive-promoting interventions) lowered the risk of unintended pregnancy among adolescents significantly (RR 0.66, 95% CI 0.50 to 0.87; 4 individual RCTs, 1905 participants, moderate quality evidence. However, this reduction was not statistically significant from cluster RCTs. Evidence on the possible effects of interventions on secondary outcomes (initiation of sexual intercourse, use of birth control methods, abortion, childbirth, sexually transmitted diseases) was not conclusive.Methodological strengths included a relatively large sample size and statistical control for baseline differences, while limitations included lack of biological outcomes, possible self-report bias, analysis neglecting clustered randomisation and the use of different statistical tests in reporting outcomes. Educational interventionsEducational interventions were unlikely to significantly delay the initiation of sexual intercourse among adolescents compared to controls (RR 0.95, 95% CI 0.71 to 1.27; 2 studies, 672 participants, low quality evidence).Educational interventions significantly increased reported condom use at last sex in adolescents compared to controls who did not receive the intervention (RR 1.18, 95% CI 1.06 to 1.32; 2 studies, 1431 participants, moderate quality evidence).However, it is not clear if the educational interventions had any effect on unintended pregnancy as this was not reported by any of the included studies. Contraceptive-promoting interventionsFor adolescents who received contraceptive-promoting interventions, there was little or no difference in the risk of unintended first pregnancy compared to controls (RR 1.01, 95% CI 0.81 to 1.26; 2 studies, 3,440 participants, moderate quality evidence).The use of hormonal contraceptives was significantly higher in adolescents in the intervention group compared to those in the control group (RR 2.22, 95% CI 1.07 to 4.62; 2 studies, 3,091 participants, high quality evidence) AUTHORS' CONCLUSIONS A combination of educational and contraceptive-promoting interventions appears to reduce unintended pregnancy among adolescents. Evidence for programme effects on biological measures is limited. The variability in study populations, interventions and outcomes of included trials, and the paucity of studies directly comparing different interventions preclude a definitive conclusion regarding which type of intervention is most effective.
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Affiliation(s)
- Chioma Oringanje
- University of TucsonGIDP Entomology and Insect ScienceTucsonArizonaUSA85721
| | - Martin M Meremikwu
- University of Calabar Teaching HospitalDepartment of PaediatricsPMB 1115CalabarCross River StateNigeria
| | - Hokehe Eko
- St. Georges University School of Medicine1 East Main Street, Suite 233, Bay ShoreNew YorkUSA11706
| | - Ekpereonne Esu
- University of CalabarDepartment of Public HealthCalabarNigeria540271
| | - Anne Meremikwu
- University of CalabarDepartment of Curriculum and TeachingCalabarCross River StateNigeria
| | - John E Ehiri
- University of Arizona, Mel & Enid Zuckerman College of Public HealthDivision of Health Promotion Sciences1295 N. Martin Avenue A256Campus POB: 245163TucsonArizonaUSAAZ 85724
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Bersamin M, Garbers S, Gold MA, Heitel J, Martin K, Fisher DA, Santelli J. Measuring Success: Evaluation Designs and Approaches to Assessing the Impact of School-Based Health Centers. J Adolesc Health 2016; 58:3-10. [PMID: 26707224 PMCID: PMC4693147 DOI: 10.1016/j.jadohealth.2015.09.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 09/08/2015] [Accepted: 09/08/2015] [Indexed: 10/22/2022]
Abstract
Since the founding of the first school-based health centers (SBHCs) >45 years ago, researchers have attempted to measure their impact on child and adolescent physical and mental health and academic outcomes. A review of the literature finds that SBHC evaluation studies have been diverse, encompassing different outcomes and varying target populations, study periods, methodological designs, and scales. A complex picture emerges of the impact of SBHCs on health outcomes, which may be a function of the specific health outcomes examined, the health needs of specific communities and schools, the characteristics of the individuals assessed, and/or the specific constellation of SBHC services. SBHC evaluations face numerous challenges that affect the interpretation of evaluation findings, including maturation, self-selection, low statistical power, and displacement effects. Using novel approaches such as implementing a multipronged approach to maximize participation, entering-class proxy-baseline design, propensity score methods, data set linkage, and multisite collaboration may mitigate documented challenges in SBHC evaluation.
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Affiliation(s)
- Melina Bersamin
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, California.
| | - Samantha Garbers
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York, New York
| | - Melanie A Gold
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York, New York; Department of Pediatrics, Columbia University Medical Center, New York, New York; School Based Health Centers, New York-Presbyterian Hospital, New York, New York
| | - Jennifer Heitel
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York, New York
| | - Kathryn Martin
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York, New York
| | - Deborah A Fisher
- Pacific Institute for Research and Evaluation, Calverton, Maryland
| | - John Santelli
- Heilbrunn Department of Population & Family Health, Columbia University Mailman School of Public Health, New York, New York
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Abstract
Numerous studies have documented the determinants of sexual behavior among adolescents in less-developed countries, yet relatively little is known about the influence of social contexts such as school and neighborhood. Using two waves of data from a school-based longitudinal survey conducted in Malawi from 2011-13, this study advances our understanding of the relationship between school-level socioeconomic contexts and adolescents' sexual activity. The results from two-level multinomial logistic regression models suggest that high socioeconomic composition of the student body in school decreases the odds of initiation of sexual activity, independent of other important features of schools and individual-level characteristics. This study also finds that the association between school socioeconomic composition and sexual activity is statistically significant among male adolescents but not female adolescents, suggesting that schools' socioeconomic contexts may be more relevant to male adolescents' initiation of sexual activity.
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Affiliation(s)
- Jinho Kim
- Doctoral student, Department of Sociology, University of Wisconsin-Madison, 8128 William H. Sewell Social Sciences Building, 1180 Observatory Drive, Madison, WI 53706.
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Mahmodi Y, Valiee S. A clinical trial of the effect of sexual health education on the quality of life of married Muslim women in Iran. Women Birth 2015; 29:e18-22. [PMID: 26303453 DOI: 10.1016/j.wombi.2015.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2015] [Revised: 07/29/2015] [Accepted: 08/03/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Marital satisfaction is one of the key factors affecting women's holistic health. AIM The present study was conducted to evaluate the effect of sexual health education on the quality of life in married women. METHODS The present controlled clinical trial was conducted with a pretest-posttest design on a study population of 60 women (aged 20-45) admitted to select health centres affiliated to Tehran University of Medical Sciences. Samples were selected through convenience sampling and randomly allocated to an intervention group (n=30) and a control group (n=30). The data collection tool was the WHOQOL completed by participants first in the pretest and then in the follow-up posttest (after 2 months). The intervention group received sexual health education, while no interventions were provided to the control group. Data were analysed in SPSS-16 using the paired t-test and the independent t-test. FINDINGS Participants were matched in the two groups in terms of demographic variables such as age, occupation, age at marriage, duration of marriage, residential status and income level. At the baseline, no significant differences were observed between the intervention group (77.35±9.36) and the control group (75.64±8.32) in terms of the quality of life score (P=0.26). After the intervention, the quality of life score was 94.3±6.54 in the intervention group and 74.2±7.33 in the control group, making for a significant difference (P<0.01). CONCLUSION Based on the findings, sexual health education can help women improve their sexual health through promoting sexual and marital satisfaction and consequently improve their quality of life.
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Affiliation(s)
- Yaghob Mahmodi
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Sina Valiee
- Social Determinants of Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran.
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