Concepts of risk among young Swedes tested negative for HIV in primary care

Associations between externalizing behavior problems and risky sexual behaviors in adolescence: Attachment as a mediator

INTRODUCTION

Risky sexual behaviors in adolescence are associated with negative health and psychological functioning outcomes. Although the association between behavior problems and risky sexual behaviors is well established, addressing these problems requires understanding the mechanisms that help explain this association. Adolescent attachment, while related to risky sexual behavior, has not been extensively explored as an outcome of childhood externalizing problems. The two objectives of this study were to explore the links between parental and peer attachment and risky sexual behaviors and to examine the mediating effect of attachment on the links between behavior problems and risky sexual behaviors.

METHODS

Five hundred and ninety-eight French-Canadian adolescents (46.2% girls), Mage at T1 = 13.23; Mage at T2 = 14.28; Mage at T3 = 17.35) participated in this longitudinal study.

RESULTS

The quality of parental attachment at T2 was significantly and negatively associated with risky sexual behaviors 3 years later, at T3. More specifically, a lower quality parental attachment relationship was associated with having nonexclusive partners as well as with inconsistent condom use. Finally, parental attachment (T2) was a significant mediator between behavior problems (T1) and risky sexual behaviors (T3), but only for younger adolescents.

CONCLUSIONS

Findings suggest that in addition to behavior problems in adolescence, the quality of parental attachment relationships may help in understanding risky sexual behaviors in adolescence.

Being "Good in Bed"-Body Concerns, Self-Perceptions, and Gender Expectations Among Swedish Heterosexual Female and Male Senior High-School Students

We investigated gender differences regarding body perceptions, self-perceptions, values and expectations in sexual situations, and factors associated with expectations, among Swedish heterosexual female and male high-school students. A total of 2,765 students (aged 18 to 22) completed questionnaires. Women reported lower satisfaction with themselves and their body appearance (p < 0.001), and felt more inferior to their partner (p < 0.001). Men felt more superior to their partner, and felt higher expectations (p < 0.001). Male sex, difficulty saying no to sex, dissatisfaction with the body, feeling inferior or superior to partner, and considering partner's satisfaction as more important, were all associated with feeling expectations during sex.

"Sexual pleasure on equal terms": young women's ideal sexual situations

OBJECTIVE

The aim of this study was to identify young women's ideal images of sexual situations and expectations on themselves in sexual situations.

STUDY DESIGN

We conducted audio-taped qualitative individual interviews with 14 women aged 14 to 20 years, visiting two youth centers in Sweden. Data were analysed with constant comparative analysis, the basis of grounded theory methodology.

RESULTS

The women's ideal sexual situations in heterosexual practice were characterized by sexual pleasure on equal terms, implying that no one dominates and both partners get pleasure. There were obstacles to reaching this ideal, such as influences from social norms and demands, and experiences of the partner's "own run". An incentive to reach the ideal sexual situation was the wish to experience the well of pleasure.

CONCLUSIONS

Our research further accentuates the importance of finding ways to focus on the complexity of unequal gender norms in youth heterosexuality. A better understanding of these cognitions is essential and useful among professionals working with youths' sexual health.

The effect of drug and sexual risk behaviours with social network and non-network members on homeless youths' sexually transmissible infections and HIV testing

BACKGROUND

The study examined whether engaging in drug and sexual risk behaviours with social network and non-network members (strangers) differentially affected the decision to test for sexually transmissible infections (STIs) and HIV.

METHODS

A cross-sectional survey was conducted among 249 homeless youths aged 14-21 years.

RESULTS

Multivariate analyses revealed that females were over three times more likely than males to test for STIs (adjusted odds ratio (AOR) = 3.34; 95% confidence interval (CI) = 1.54-7.25). For every one unit increase in age, there was a 37% increase in the likelihood of having tested for STIs (AOR = 1.37; 95% CI = 1.12-1.68). Youths who had sex after using alcohol and drugs with strangers were approximately 3.5 times more likely to have tested for STIs (AOR = 3.45; 95% CI = 1.38-8.61). For every one unit increase in age, there was a 26% increase in the likelihood of having tested for HIV (AOR = 1.26; 95% CI = 1.05-1.51). Youths who had sex with a stranger after using alcohol or drugs were over three times more likely to test for HIV (AOR = 3.22; 95% CI = 1.42-7.31). No social network variables reached significance for STI or HIV testing.

CONCLUSIONS

Being older and engaging in drug and sexual risk behaviours with strangers are important correlates of STI and HIV testing. Females are more likely than males to be tested for STIs. Engaging in risky behaviours with social network members was not a key factor in deciding whether to be tested.

From gender bias to gender awareness in medical education

Gender is an essential determinant of health and illness. Gender awareness in doctors contributes to equity and equality in health and aims towards better health for men and women. Nevertheless, gender has largely been ignored in medicine. First, it is stated that medicine was 'gender blind' by not considering gender whenever relevant. Secondly, medicine is said to be 'male biased' because the largest body of knowledge on health and illness is about men and their health. Thirdly, gender role ideology negatively influences treatment and health outcomes. Finally, gender inequality has been overlooked as a determinant of health and illness. The uptake of gender issues in medical education brings about specific challenges for several reasons. For instance, the political-ideological connotations of gender issues create resistance especially in traditionalists in medical schools. Secondly, it is necessary to clarify which gender issues must be integrated in which domains. Also, some are interdisciplinary issues and as such more difficult to integrate. Finally, schools need assistance with implementation. The integration of psychosocial issues along with biomedical ones in clinical cases, the dissemination of literature and education material, staff education, and efforts towards structural embedding of gender in curricula are determining factors for successful implementation. Gender equity is not a spontaneous process. Medical education provides specific opportunities that may contribute to transformation for medical schools educate future doctors for future patients in future settings. Consequently, future benefits legitimize the integration of gender as a qualitative investment in medical education.

Knowledge of human papillomavirus and attitudes to vaccination among Swedish high school students

The aim of the study was to investigate knowledge of and attitudes to sexually transmitted infection (STI) and STI prevention with special focus on human papillomavirus (HPV) and the new vaccine against HPV, among 16-year-old high school students in a Swedish context. A study-specific questionnaire was distributed to 572 first year high school students from five different high schools in a medium-sized town in Sweden. The students lacked knowledge of HPV and its association with cervical cancer. Similarly, their knowledge of the new vaccine was limited. Their attitude to condom use when having sex with a new partner was positive, but decreased if oral contraceptives were used and if they were vaccinated against an STI. The main source of information was the school, followed by youth clinics and the media. The results highlight the clinical importance for school nurses and personnel at youth clinics to inform adolescents about HPV and its association with cancer.

"Couldn't you have done just as well without the screening?". A qualitative study of benefits from screening as perceived by people without a high cardiovascular risk score

OBJECTIVE

To explore how individuals whose health screening does not reveal a high cardiovascular risk score (CRS) interpret and respond to this result.

DESIGN

Qualitative semi-structured interviews. Purposeful sampling reflected variations in age, gender, and self-rated health within the sample. Analysis and interpretation were informed by the Health Belief Model concerning individuals' cues to act when told there is a health threat, and by Hollnagel and Malterud's theories about personal self-assessed health resources.

SETTING

Participants were recruited among participants without a high cardiovascular risk score in a Danish health-screening project.

SUBJECTS

Seven men and 15 women aged 36-50 years with a low or moderate cardiovascular risk score.

RESULTS

The screening confirmed the participants' feeling of being in good health and they put emphasis on this acquired peace of mind. Participants used the results to eliminate worries and confirm their lifestyle up to now but were aware that the results gave no guarantee that there was nothing the matter elsewhere. Some paid a price for the reassurance since they had to undergo further examinations, had unfulfilled expectations, or were irritated at not being left in peace with their reassurance.

CONCLUSION

Screened individuals who were shown not to have a high risk score appear to be reassured and confirmed in their own feeling of being healthy, and to be aware of the limitations of the screening. Consideration should be given to the possible risk of creating either insecurity or over-complacency through population screening.

When do adolescents become smokers? Annual seven-year population-based follow-up of tobacco habits among 2000 Swedish pupils--an open cohort study

OBJECTIVE

To follow the development of a class of pupils' tobacco habits for seven years, and to study differences in tobacco use between girls and boys.

SETTING

Kronoberg County in southern Sweden.

SUBJECTS

All the approximately 2000 pupils were followed from approximately age 12 to approximately age 18.

DESIGN

Yearly cross-sectional surveys from 1994 to 2000. Each year, the pupils filled in an established tobacco questionnaire. They did it anonymously in the classroom.

MAIN OUTCOME MEASURES

Percentage of smokers, number of cigarettes smoked per day, and percentage of pupils using "snus", the Swedish variety of oral moist snuff.

RESULTS

From grade 6 of compulsory school to grade 12 of upper secondary school, the proportion of daily smokers rose, from 0.2% to 22% for girls and from 0.5% to 14% for boys. Among both genders, the increase occurred mainly between grades 7 and 10, and from grade 10 onwards the daily smokers were the largest group of smokers. Starting from grade 9, boys had higher total tobacco consumption than girls, as a result of their increased use of "snus", and at the end of the study 39% of the boys used tobacco compared with 34% of the girls.

CONCLUSION

Studying young people's tobacco habits over time gives an understanding of when preventive measures should be implemented. In order for these to influence attitudes, they should be put in place well before tobacco is introduced.

Risk-taking behaviour is more frequent in teenage girls with multiple sexual partners

OBJECTIVE

To investigate associations between sexual behaviour and risk-taking health behaviour among adolescent females in our changing sexual culture.

DESIGN

A questionnaire study. Girls who had had multiple sexual partners (at least five in their lifetime or four during the last six months) were compared with those with fewer partners. Logistic regression was applied.

SETTING

The Adolescent Clinic, a primary healthcare unit in the city of Tampere, Finland.

SUBJECTS

A sample of 247 female clients aged 15-18 years who had experienced sexual intercourse.

MAIN OUTCOME MEASURES

Contraceptive practices, substance use, and sexual attitudes.

RESULTS

Girls with multiple sexual partners (n = 69) and the reference group (n = 178) did not differ from each other significantly by age, age at menarche, or educational status. In univariate analysis, age at sexual debut, contraceptive practices, and various substance uses were strongly associated with having multiple sexual partners. Ever-use of emergency contraception was marginally associated, while ever-use of conventional hormonal contraception or condoms was not. In multivariate analysis, low age at sexual debut (OR 8.75 for age 11-13), omitting contraception at the most recent intercourse (OR 3.48), ever-use of withdrawal as a contraceptive method (OR 2.34), and repeated use of drugs (OR 4.10) were associated with having multiple sexual partners.

CONCLUSION

Different types of risk-taking behaviour are still interlinked. In discussions with adolescents showing one type of risk behaviour health service providers should make an effort to identify other modes of risk-taking.