Parent-adolescent sex communication in China

Media Influence on Intergenerational Attitudes toward Non-Conventional Sexual Behaviors in Contemporary China: Evidence from Chinese General Social Survey

Objective

Within the context of rapid sociocultural transformation in Chinese society over recent decades, exploring intergenerational disparities in attitudes toward non-conventional sexual behaviors holds sociological significance. Employing a methodology akin to cultivation analysis, this study focuses on the potential influence of television and the internet in narrowing or widening attitudinal disparities between distinct age groups. This is achieved by comparing heavy users of these media to individuals with light media consumption.

Materials and Methods

In the present study, we utilized the 2017 wave of the Chinese General Social Survey, a dataset that is representative of the national demographic of China. Our objective was to explore the potential influence of both traditional media (TV) and new media (the internet) consumption on the attitudes of Chinese adults toward three forms of non-conventional sexual behavior, namely premarital, extramarital, and same-sex behaviors.

Results

Firstly, compared to television, the internet is more likely to contribute to the liberalization of sexual attitudes, though this influence is age sensitive. Secondly, regarding the attitudes toward premarital sex and same sex behaviors, television tends to sustain or create consensus across different generations, whereas the internet tends to widen attitudinal gaps. Lastly, probably due to the moralized nature of extramarital sex in the Chinese context, both television and the internet maintain or produce the conservative consensus, though heavy television viewing could widen the attitudinal gap between young people and the other two age groups.

Discussion and Conclusion

Our study reveals that for premarital sex and same-sex behaviors, heavy television viewing tends to foster or sustain intergenerational consensus, while frequent internet usage tends to augment intergenerational divergence or erode intergenerational agreements. However, the media's impact on intergenerational differences in attitudes toward extramarital sex exhibits distinctive features, likely stemming from the deeply moralized nature of extramarital affairs within Chinese society. To conclude, by conducting a comparative examination of various media landscapes, our research offers a mediated perspective that aids in comprehending the disparities in attitudes toward sexual behaviors across different generations in contemporary China.

Induced abortions among Chinese adolescent girls

BACKGROUND

Induced abortion among adolescent girls is a global public health issue and a serious challenge in China, but still remains under-examined. We aimed to examine the overall trend and characteristics of induced abortions among Chinese adolescent girls and to investigate the factors associated with induced abortion.

STUDY DESIGN

Based on the 2017 China Fertility Survey, this study examined the trend and characteristics of induced abortions among adolescent girls with statistical analysis and multiple indicators of descriptive statistics from period and cohort perspectives, including induced abortion proportion and rate, age-specific cumulative proportion, and age-specific cumulative number of induced abortions in adolescent girls.

RESULTS

Between 1996 and 2016, the proportion and rate of adolescent induced abortions first increased and then decreased, and the mean age at the time of induced abortions among adolescent girls declined. The cumulative proportion of women who had experienced induced abortion at the age of 15-19 in a cohort is less than 2.5% but shows an upward trend. Over 70% of all adolescent induced abortions are premarital. The proportion of women with unintended pregnancy experiences increased and is higher among rural, less educated, and ethnic minority women. Similarly, the prevalence of induced abortion is higher among adolescent girls who live in rural areas, are less educated, and come from ethnic minorities. The cumulative number of induced abortions and premarital abortions increased with later cohorts.

CONCLUSIONS

This study shows an upward trend in adolescent-induced abortion and a decline in the age at the time of the induced abortion. Women in later birth cohort have a higher proportion of having experienced adolescent induced abortion. Adolescent girls who live in rural areas, who are less educated, or who are from ethnic minorities, are more likely to undergo induced abortions at the age of 15-19. More appropriate educational efforts and interventions are urgently needed to reduce the incidence of adolescent induced abortions.

Ecological factors associated with child sexual abuse among 15- to 17-year-old adolescents in mainland China: implications for intervention

Background

Child sexual abuse is a major public health problem with adverse consequences for victims' physical, mental, and reproductive health. This cross-sectional study aimed to determine the prevalence of child sexual abuse and its associated factors among 15- to 17-year-old adolescents in mainland China.

Methods

From September 8, 2019 to January 17, 2020, a total of 48,660 participants were recruited by 58 colleges and universities across the whole country to complete the self-administered, structured, online questionnaire. This analysis was restricted to 3,215 adolescents aged between 15 and 17 years in mainland China. Chi-square tests and multivariate Logistic regression analyses were performed to identify individual, relationship, and community factors associated with child sexual abuse.

Results

The overall prevalence of child sexual abuse was 12.0%. More specifically, 13.0% of girls and 10.6% of boys reported that they were sexually abused prior to 18 years of age. At the individual level, being female, sexual minority identity, younger age, and higher levels of knowledge, skills and self-efficacy regarding condom use were significantly related to increased odds of reporting sexual abuse. At the relationship and community level, adolescents from disrupted families and those entering into a marriage, having casual sexual partners, and having first intercourse at a younger age were more likely to report sexual abuse. On the contrary, those who had never discussed sex-related topics with their family members at home and were offered school-based sexuality education later (vs. earlier) were less likely to report sexual abuse.

Conclusion

Multilevel prevention programs and strategies, including targeting adolescents with high-risk characteristics, educating young children and their parents about child sexual abuse prevention and optimizing the involvement of parents, school, community, society and government in comprehensive sexuality education, should be taken to reduce child sexual abuse among 15- to 17-year-old adolescents.

Knowledge level and access barriers related to sexual and reproductive health information among youth with disabilities in China: a cross-sectional study

BACKGROUND

Youth with disabilities have the same right to sexual and reproductive health (SRH) as their peers without disabilities. However, their needs and rights are often ignored. Little is known about the knowledge, needs and access barriers related to SRH information among youth with different types of disabilities in China.

METHODS

A cross-sectional survey was carried out among 473 unmarried youth aged 15-24 with visual, hearing, physical disabilities in both urban and rural areas in China.

RESULTS

Out of a maximum possible score of 100, respondent's median score ranged from 30 to 50 for knowledge related to sexual physiology, STIs/HIV/AIDS and contraception. For these three categories of knowledge, respondents with hearing and physical disabilities or from rural areas scored lower than their counterparts with visual disabilities or from urban areas. The multivariate analyses showed that the residential area and education level were strong correlates of knowledge among respondents with visual and hearing disabilities. Other significant correlates were age for respondents with visual impairment and physical impairment, and single child status in the family and father's education level for respondents with hearing impairment. Sources of and barriers and preferences in accessing SRH information differed by type of disabilities, residential areas and gender. In general, school teachers were the primary and most preferred sources of SRH knowledge, followed by the Internet, peers/friends and parents. Unaware of where to get accurate information and feeling embarrassed to seek information were the two most frequently mentioned barriers in accessing SRH information.

CONCLUSION

Respondents had poor knowledge of SRH and limited access to SRH information, especially those from rural areas. Efforts should be made to promote school and family-based sexuality education tailored for youth with different types of disabilities.

Timing of Sexuality Education: Hong Kong Preteens' Perception of Sexual Health

Although young people want to know more about sexuality, they do not feel they have received what they need to learn. In Chinese societies, scant research has solicited direct input from the youth to obtain their views on sexuality education (SE) deliverables. We found research gaps in the lack of Chinese preteens' input regarding SE timing, knowledge perception, learning readiness, and preteens' reasons for obtaining information about sexual health. In Hong Kong, a not-for-profit agency collected data from Chinese preadolescents who expressed opinions through a general survey. This agency surveyed students from 24 primary schools and provided anonymous secondary data for this team to analyze further. Among 4569 fifth- and sixth-grade students (average 11 years old), girls were more likely than boys to seek sex-related information from teachers, library books, and mothers. In contrast, boys were more likely than girls to obtain information from friends, pornographic comics, and the internet. Logistic regression analysis indicated that gender, age, instructional sources, openness to sexual health knowledge, and perceived and actual levels of knowledge predicted preteens' desire to receive SE earlier in grade school. Girls and older students were significantly more likely to report their preference to receive SE in an earlier grade. We recommend that preteens and their parents be encouraged to collaborate with teachers to participate in school-based SE programming.

Sexual-Related Knowledge, School and Family Sexuality Education and Its Association with Experience of Sexual Intercourse among Vocational Secondary School Students in China

Objectives: To investigate the associations between sexual-related knowledge, access to school and family sexuality education, and the experience of sexual intercourse, in order to make recommendations on sexuality education for vocational secondary school students in China. Methods: A cross-sectional study was conducted among 3180 vocational secondary school students in the Shanghai municipality and the Shaanxi province, China. Data were collected through an online, electronic questionnaire, which included socio-demographics, sexual-related knowledge, sources of information, and sexual-related behaviors. Results: The score on sexual-related knowledge among girls (53.8) is higher than that of boys (48.8), and that of participants from Shanghai (55.2) is higher than their counterparts from Shaanxi (47.6). The proportions of girls (70% and 41.7%, respectively) and participants from Shanghai (65% and 35.7%, respectively) who reported acquiring sexual information from their schools/teachers and parents are higher than that of boys (54.3% and 21.0%, respectively) and their counterparts from Shaanxi (59.7% and 27.4%, respectively). About 6% of participants had experienced sexual intercourse and 10% had watched porn actively. Experience of sexual intercourse was associated with higher sexual-related knowledge scores (OR = 1.01, 95% CI: 1.00–1.02) and active porn watching (OR = 2.63, 95% CI: 1.79–3.84) but was not associated with school and family sexuality education. Conclusions: Vocational secondary school students had poor sexual knowledge and inadequate school and family sexuality education. School and family-based comprehensive sexuality education should be promoted among vocational secondary school students.

Gender Differences in Sex Education in China: A Structural Topic Modeling Analysis Based on Online Knowledge Community Zhihu

Considering the traditional concept of sex in China's official discourse and lack of social support system for sex education in China, burgeoning Internet knowledge community serves as an important forum for unprepared Chinese young parents to discuss and improve sex education. In this study, we conducted a structural topic modeling analysis of sex education discussions on Zhihu, the biggest online knowledge community in China. We found attention towards sex education are biased in China, where basic sexual terminologies are mentioned, but other important topics such as reproductive health, emotional attachment, and gender identity are insufficient or even absent, failing to fulfill the goal of Comprehensive Sexuality Education (CSE). This study paid special attention to gender differences in discussants, expected educators, and expected receivers of sex education. Findings show that boys are not considered as important sex education objects as girls, although many of them suffered from sexual assault and sexual diseases. They are always mentioned as roles that offend women rather than promoting or protecting themselves through sexual knowledge. Most discussants and expected educators of sex education are women, reflecting men's lack of attention to sex education issues as both individuals and fathers.

Factors Contributing to Mother-Daughter Talk about Sexual Health Education in an Iranian Urban Adolescent Population

Background:

Parent–adolescent dialog on sexual issues reduces high-risk sexual behavior in adolescents. However, many adolescents are deprived of such training. Several factors may affect the sexual dialog between parents and adolescents. This study aimed to investigate the factors associated with mother–adolescent daughter dialog on sexual health matters in Iran.

Materials and Methods:

This cross-sectional study was carried out on 363 female adolescents aged 14-18 years in Ahvaz-Iran, between June 2015 and January 2016. Data collection was conducted utilizing multi-stage cluster sampling in high schools using the Parent–adolescent sexual dialog questionnaire and the parent–adolescent general dialogue questionnaire. The validity of the questionnaires was confirmed using content and face validity and their reliability was confirmed through internal consistency. The data were analyzed using descriptive statistics, Pearson's correlation coefficient, independent one-sample and two-sample t-tests, one-way ANOVA, and Post-HOC (Duncan) test.

Results:

The mean score of mother–daughter sexual dialog had a significant relationship with mother's education (F = 4.03, p > 0.003), adolescent's major (F = 4.48, p < 0.004), mother–daughter general communication (p < 0.001), and emotional relationship with parents (F = 6.47, p < 0.002). The more is the mother–daughter general communication, the more will be their sexual communication (p < 0.001). There was no relationship between the score of mother–daughter sexual communication and the age of mother or adolescent, parents' job, parents' marital status, and having sisters (p = 0.86).

Conclusions:

Some demographic characteristics of parents and adolescents, and the parent–adolescent emotional relationship can affect the communication between them about sexual issues. So efforts to enhance this communication should consider these factors as mediator variables.

HPV vaccine acceptability and willingness-related factors among Chinese adolescents: a nation-wide study

BACKGROUND

Adolescents are the primary target population for human papillomavirus (HPV) vaccination. The objective of this study is to explore the acceptability of HPV vaccines and evaluate factors related to willingness to be vaccinated among Chinese adolescents.

METHODS

A nation-wide survey was conducted across 14 schools in mainland China. The questionnaire consisted of questions relating to socio-demographic characteristics, knowledge of adolescent sexual health, cervical cancer, HPV and HPV-related disease, and students' willingness to be vaccinated. Chi-square tests and multivariable logistic regression were conducted in the data analysis.

RESULTS

A total of 4,062 students participated in this study. Among them, only 17.1% of students reported having heard of HPV vaccines; however, 67.3% were willing to receive the HPV vaccine. Multivariable regression analysis showed that students who were from rural areas, have received sexual health education, have heard of cervical cancer or HPV vaccine, have a positive attitude toward vaccination, reported they were at the risk of developing cervical cancer, and those who value their parents' and teachers' opinions were more willing to receive HPV vaccination.

CONCLUSIONS

Awareness about the HPV vaccine is low among Chinese adolescents. The factors that most related to willingness to vaccinate among Chinese adolescents were school location, education about vaccination, HPV, and HPV vaccines. Integrating health education on HPV vaccination into existing school-based sexual health curricula may be an effective way to increase HPV vaccination coverage in mainland China.

Premarital Pregnancy in China: Cohort Trends and Educational Gradients

In China, premarital sexual and reproductive behavior is seldom considered and poorly understood. Increases in premarital pregnancy are thought to not only illuminate a decoupling of marriage and sexual/reproductive behavior but also serve as a key feature of family change in East Asia. This study assesses change across cohorts in the likelihood of premarital pregnancy and the extent to which change differs by educational attainment. Drawing on the 2017 China Fertility Survey, we apply a discrete-time, competing-risk survival analysis to a nationally representative sample of 221,990 women born between 1960 and 1999. Women born in the 1980s and 1990s are more likely than those born in the 1960s and 1970s to experience a pregnancy prior to first marriage. This cohort trend is driven by increases in premarital pregnancy among women with a high school education or less. The less educated women and their college counterparts increasingly diverge in the likelihood of experiencing a premarital pregnancy. The diverging patterns of premarital pregnancy underscore the urgency to shift the focus of China's family planning programs from fertility control to reproductive health, with an emphasis on providing information and services to disadvantaged unmarried individuals.

Sexual and reproductive health communication between parents and high school adolescents in Vientiane Prefecture, Lao PDR

BACKGROUND

Adolescent health has become a priority on the global health agenda. Parent-adolescent communication regarding sexual and reproductive health (SRH) issues can help to reduce adolescent risk-taking sexual behaviours.

OBJECTIVE

This study was to describe the situation of SRH communication, and to determine the factors associated with SRH communication between high school students and their parents in Vientiane Capital prefecture, Lao PDR.

METHODS

A multistage sampling technique was applied. A self-administered questionnaire was implemented among a sample of 384 high school students aged 14-17 in Vientiane. SRH communication in this study was recorded as the frequency with which adolescents discussed with their parents at least four topics on SRH issues during a six-month period prior to the interview. Data were entered and analysed using Epi Data software version 6.0 and STATA software version 14.2.

RESULTS

Slightly more than one-fifth of the students (21.3%) communicated with parents on SRH issues. The multivariate logistic regression model showed that being a male adolescent (AOR = 2.1; 95% CI 1.2 to 3.5), urban school locations (AOR = 0.2; 95% CI 0.1 to 0.5), a mature father (AOR = 1.7; 95% CI 1.0 to 2.9), positive attitudes towards general communication with parents (AOR = 2.2; 95% CI 1.1 to 4.2) and accessibility to multiple SRH information sources (AOR = 5.2; 95% CI 2.4 to 11.4) were significantly associated with adolescent-parent communication on SRH issues.

CONCLUSION

This study showed that student-parent communication on SRH issues was low, so policymakers should develop programs to improve SRH communication skills in all schools and encourage open discussion among family members, especially with respect to the participation of adolescent girls. The positive attitudes of students and multiple sources of SRH information were also important factors in improving SRH communication.

Factors Related to Chinese Parents' HPV Vaccination Intention for Children

Objectives: Successful human papilloma virus (HPV) vaccine delivery depends heavily on parents' attitudes, perceptions, and willingness to have their children vaccinated. In this study, we assessed parental knowledge, attitudes, and beliefs about the HPV vaccine, and examine factors associated with willingness to have eligible children receive HPV vaccination. Methods: From a community health center serving Chinese members in the Greater Philadelphia area, 110 Chinese-American parents with at least one child aged 11 to 18 who had not received HPV vaccine were recruited. Data were collected in face-to-face interviews. Results: Chinese-American parents generally lacked knowledge on HPV and the HPV vaccine, yet had a moderately high level of intention to vaccinate their children against HPV. Ordinal logistic regression results indicated that knowledge, whether or not to involve children, doctor influence, and time lived in the United States were significantly and independently related to parental intention to have their children vaccinated against HPV. Conclusion: Interventions should make efforts to raise awareness of HPV and promote vaccination in doctors' offices. The lower level of parental intention among relatively recent immigrants indicated the necessity to target this population in public health campaigns and intervention efforts.

Consequence-based communication about adolescent romantic experience between parents and adolescents: A qualitative study underpinned by social constructionism

Chinese adolescents are increasingly engaging in romantic experiences and high-risk sexual behaviors within a rapidly-changing cultural and socio-economic context. Parental communication about sexuality has been recognized as protective for adolescents to make informed decisions about sexual practice. In this study, we explored what was discussed about adolescent romantic experience between parents and adolescents in China. Twenty-seven parents and 38 adolescents from a northern-eastern city of China were interviewed. Interviews were transcribed verbatim and thematically analyzed using a social constructionism framework. Four themes were identified: (i) detriments of romantic experience to education and future prospect; (ii) health and sociocultural risks of romantic and sexual engagement; (iii) ways of handling romantic experience; and (iv) marriage and family building. The messages were mainly prohibitive and consequence oriented in nature, and lacked specific romantic and sexual information. These messages reflected sociocultural beliefs in education, sexuality, marriage, and family in China, but did not meet the needs of current adolescents. External support from health professionals, such as nurses, is important for parents and adolescents to improve their sexual knowledge and communication skills.

Young people's parental discussion about sexual and reproductive health issues and its associated factors in Awabel woreda, Northwest Ethiopia

BACKGROUND

In Ethiopia besides the very low health seeking behavior of young people, they do not have access to sexual and reproductive health information and even the existing health services are adult-centered. Furthermore, health providers are not well equipped in addressing young people sexual and reproductive health needs. Therefore, parent-young people discussion about sexual and reproductive health issues are crucial in increasing their awareness and reduces their risky sexual behaviors. This study was aimed to assess young people's parental discussion about sexual and reproductive health issues and its associated factors in Awabel woreda, Northwest Ethiopia.

METHODS

A community based cross-sectional study was conducted among 781 young people aged 10-24 years in Awabel Woreda, Northwest Ethiopia. A pre-tested structured interview administered questionnaire was used for the data collection. The collected data were entered using Epi Data 3.1 and analyzed using SPSS for windows version 21.

RESULTS

In the past 6 months, about one quarter, 25.3% of young people had a parental discussion about sexual and reproductive health issues. Young people who reside in urban areas were more likely to discuss on sexual and reproductive health issues with their parents [AOR = 2.44, 95% CI: 1.54-3.89]. Similarly, being male was more likely to have a parental discussion about sexual and reproductive health issues than females [AOR = 1.63, 95% CI: 1.11-2.38]. Furthermore, the odds of parent-young people discussion about SRH matters was more likely among young people aged 20-24 years [AOR = 4.57, 95% CI: 2.13-9.82], living with fathers [AOR = 2.46, 95% CI: 1.20-5.04] and had attained a primary level of education [AOR = 2.89, 95% CI: 1.22-6.87]. Parents lack of interest to discuss, feeling ashamed and culturally not acceptable to talk about sexual matters were found to deter young people's in discussing sexual and reproductive health matters.

CONCLUSION

Parent-young people discussion about sexual and reproductive health is very low and there are different hindering factors. And therefore, young people's sexual and reproductive health programs or policies should be designed in addressing the cultural and societal factors besides the individual or behavioral factors.

Parent-Adolescent Sexual and Reproductive Health Communication Is Very Limited and Associated with Adolescent Poor Behavioral Beliefs and Subjective Norms: Evidence from a Community Based Cross-Sectional Study in Eastern Ethiopia

Introduction

While parent-adolescent sexual and reproductive health (SRH) communication is one potential source of SRH information for adolescents, it appears to be inadequately practiced in Ethiopia. This study was designed to investigate the factors that limit or improve parent-adolescent SRH communication in Harar, Eastern Ethiopia.

Methods

A community based cross-sectional study was done on 4,559 adolescents of age 13–18. SRH communication was measured using a nine-item scale whose response ranged from “not at all” to “always.” Summated composite score ranging from 0–36 was generated; higher score indicates high SRH communication. A median value of the composite score was 4 out of the possible 36 with an Interquartile Range (IQR) of 7. Respondents were ranked as very poor, poor and satisfactory communicators based on 33rd and 67th percentiles values. Generalized ordered logit model was applied to investigate the factors associated with SRH communication.

Results

Results showed that the adolescents who were more likely to practice poor-very poor/very poor SRH communication were those who had poor behavioral beliefs on and poor subjective norms of communicating sexual issues with parents and those who perceived their parents’ reproductive health (RH) knowledge as poor. Nonetheless, the probability of poor-very poor/very poor SRH communication was less with high adolescent-parent communication quality, television co-viewing and discussions, and self-disclosure.

Conclusions

Curtailing the adolescents’ underlying poor beliefs and norms, and improving adolescent-parent communication quality, self-disclosure, and television co-viewing and discussions are essential to engage the parents in sexual and reproductive health education of the adolescents.

Adolescent-parent communication on sexual and reproductive health issues among high school students in Dire Dawa, Eastern Ethiopia: a cross sectional study

Background

Sexual and reproductive health communications are most likely promoting healthy sexual development and reduce sexual risks. Communication is the principal means for parents to transmit sexual values, beliefs, expectations and knowledge to their adolescents. However, there is a paucity of evidence about adolescent parent communication in Ethiopia. This study aimed to determine adolescent-parent communication on sexual and reproductive health issues and associated factors among high school students in Dire Dawa, Eastern Ethiopia.

Methods

Institution based cross sectional study was conducted among high school students in Dire Dawa administrative council from February to March 2011. Simple random sampling technique was used to select 695 students from 9–12 grades. Qualitative data were collected through focus group discussion separately for female and male parents. Data were entered in Epi info version 3.5.1 and analyzed by SPSS version 16.1. Logistic regression with OR and 95% confidence interval was used to identify the independent predictors of adolescent parent communication.

Results

Thirty seven percent of students had ever discussed on at least two sexual and reproductive health topics with their parents. Of which, majority of student preferred to discuss with their peers than parent. Condom use during first intercourse was associated with having communication about sexual and reproductive health [AOR = 1.9, 95% CI: 1.0, 3.8]. Cultural taboo, shame and lack of communication skill were reasons that hinder communication between parent and adolescent about sexual matters.

Conclusion

Communication on sexual and reproductive health issue between adolescent and their parent was low. School based education is important to improve adolescent parent communication about sexual and reproductive health issues.

Electronic supplementary material

The online version of this article (doi:10.1186/1742-4755-11-77) contains supplementary material, which is available to authorized users.

Predictors of premarital sexual activity among unmarried youth in Vientiane, Lao PDR: the role of parent-youth interactions and peer influence

Research indicates that adolescents in low-income countries have an early sexual debut and engage in risky sexual behaviours. Few studies in low-income countries however, have explored the factors that influence young people's sexual behaviours. This study examined individual, family and peer-level factors associated with premarital sexual behaviours in the Lao People's Democratic Republic (PDR). A cross-sectional survey was undertaken with unmarried youth aged 18 to 24 years (N = 1200) in Vientiane Capital City. Logistic regression models, controlling for confounding variables, were employed to test for the contribution of factors influencing premarital sexual activity. Most respondents held positive attitudes towards premarital sex, with males having more liberal attitudes than females (mean score of 2.68 vs. 2.32, p < 0.001). Prevalence of premarital sexual activity was higher among males than females (44.7% and 19.2%, respectively). Predictors of premarital sex for males were age, sexual attitudes, perceived parental expectations regarding sex, dating and peer influence. For females, predictors were father's level of education, parent-youth sexual communication, peer influence and liberal sexual attitudes. The results highlight the role of parent-youth interaction and peer influence. The results suggest the need for a range of strategies at the individual, peer and family level, as well as a gender-specific focus.

A quarter century of HIV prevention intervention efforts among children and adolescents across the globe

In 1988 a group of pediatricians, developmental, clinical, child and social psychologists, anthropologists and health educators began researching in Baltimore, Maryland, on an Human Immunodefiency Virus (HIV) prevention intervention, Focus on Youth (FOY). Over the next 25 years, the questions being addressed by FOY reflected those of the global HIV research experience. During the first phase, the questions being addressed by the broader research community included: Can HIV risk behaviors be purposefully impacted by behavioral interventions? If so, how do successful interventions differ from those that are not effective? Are theory-based interventions more likely to be effective than information-only-based interventions? Can theories be translated into culturally and developmentally appropriate interventions including those that are appropriate for children and adolescents? Should parents be involved – and if so, how? During its next phase, the FOY team increasingly became concerned with a disturbing reality. A large number of interventions had been developed and some had been shown to have evidence of impact. But virtually all of these interventions had been conducted in the USA or Europe. The questions facing researchers included: With the global burden of HIV disproportionately impacting low- and middle-income countries (LMIC), especially those in southern Africa, the Caribbean and parts of Asia, what is known about the effectiveness of western-based interventions in these culturally, racially and economically disparate settings? With the exciting proliferation of interventions, federal agencies in the USA and international agencies including Joint United Nations Programme on HIV/AIDS realized the importance of assessing the research portfolio and developing metrics of effectiveness. The questions during this phase included: What is an “effective” intervention? How are effective interventions implemented in a new setting? This phase merged with the next phase as researchers and public health workers realized that the dissemination to a new community of an intervention developed and found to be effective in one community requires change. The central questions during this time included: What changes or kinds of changes can be made to an intervention without undermining its effectiveness? What aspects of an intervention cannot be changed without potentially undermining its effectiveness? What constitutes a “change”? Who should be involved in this decision-making? These efforts culminated in our current phase, one focused on implementation. We must learn more about the factors that allow an intervention to survive and thrive and selectively target these critical factors. The main objective of this paper is to review our experiences and lessons learned in developing, implementing and evaluating FOY in a wide range of socio-cultural settings over the past quarter of century.

Sexual communication, safer sex self-efficacy, and condom use among young Chinese migrants in Beijing, China

Mediation effect of sexual communication on the relationship between safer sex self-efficacy and condom use was tested among 307 homosexually active migrant men, 376 heterosexually active migrant men, and 265 heterosexually active migrant women. The study found certain aspects of sexual communication mediated the effect of self-efficacy on condom use among the three samples. The findings underscored the importance of including components that promote safer sex self-efficacy and sexual communication in HIV prevention interventions for Chinese migrants.

Prevalence and correlates of sexual behaviors among university students: a study in Hefei, China

Background

In China, sexual health and behaviors of young people have become a growing public concern but few studies have been conducted to investigate the prevalence and psychosocial correlates of the phenomenon.

Methods

A self-reported questionnaire survey on youth sexual behaviors was conducted among 1,500 university students in 2011 at Hefei, a middle-size city in eastern China. A total of 1,403 students (age = 20.30 ± 1.27 years) completed the questionnaire with a high response rate of 93.5%.

Results

Among the respondents, 12.6% (15.4% of male versus 8.6% of female) students reported having pre-marital heterosexual intercourse; 10.8% (10.5% of males versus 11.2% females) had oral sex; 2.7% (3.4% of males versus 1.7% females) reported same-sex activities; 46% (70.3% of males versus 10.8% of females) reported masturbation behaviors; 57.4% (86.2% of males versus 15.6% females) students viewed pornography. In terms of sexual communication about sexual knowledge acquisition, 13.7% (10.7% of males versus 18% of females) talked to their parents about sex; 7.1% (6.1% of males versus 8.4% of females) students reported having conversation with parents on contraception. About forcing sexual behavior, 2.7% (4% of males versus 0.9% of females) reported forcing their sexual partners to have sex, and 1.9% (2.4% of males versus 1.2% of females) reported being forced to have sex. Gender was found to be significant predictor of sexual behaviors in university students: males reported more sexual behaviors including sexual fantasy, heterosexual intercourse, masturbation, viewing pornography and talking about sex with friends. Several correlates of sexual behaviors were identified for students of different gender separately. For males, having romantic relationships, past sex education experiences, low educational aspirations, time spent on the Internet, and urban native settings were significantly associated with more sexual behaviors. For female students, having romantic relationships and urban native settings predicted sexual behaviors.

Conclusion

Sexual behavior among University students in China is not uncommon, although there are limited ways for students to acquire sex-related knowledge: male students showed significantly more sexual behaviors than female students. Having romantic relationships and more time spent online were important predictors of sexual behaviors among university students. To guide healthy sexual behaviors in young people, comprehensive sex education programs that provide necessary sexual health knowledge about safe sex should be developed and implemented in universities in China, particularly for students who have romantic relationships and those who spend long periods of time on the Internet.

Parent-adolescent communication about sex in rural India: U.S.-India collaboration to prevent adolescent HIV

In this article, we examine parent-adolescent communication about sex among rural Indian youth and their parents. We conducted in-depth interviews (N = 40) with mothers, fathers, and adolescent boys and girls aged 14 to 18 years in a rural community in Maharashtra, India. In the context of key cultural factors, including gender-related norms, we explore issues of sexual health and critically assess widely held beliefs that Indian parents are unwilling or unable to discuss sex-related topics with their children. Our findings suggest that despite communication barriers, e.g., lack of knowledge and cultural proscriptions, Indian families are interested in and willing to communicate about sex-related topics. Future research should seek to determine the viability of family-based HIV prevention interventions for Indian adolescents.

Media's contribution to sexual knowledge, attitudes, and behaviors for adolescents and young adults in three Asian cities

PURPOSE

Evidence in western countries indicates that the media have associations with adolescents' and young people's sexual behavior that may be as important as family, school, and peers. In this new study of Asian adolescents and young adults in the three cities of Hanoi, Shanghai, and Taipei, the associations between exposure to sexual content in the media and adolescents' and young adults' sex-related knowledge, attitudes, and behaviors are explored in societies with traditional Confucian culture, but at different stages in the process of modernization.

METHODS

The data are from a questionnaire-based cross-sectional study conducted from 2006 to 2007, where a sample of 17,016 adolescents and young adults aged 15-24 years from Shanghai, Hanoi, and Taipei completed face-to-face interviews coupled with computer-assisted self-interviews for sensitive questions. For the objectives of this article, analysis was restricted to the 16,554 unmarried respondents. Exposure to sexual content in the mass media (including the Internet and traditional media), pornographic videos, and a preference for western/Asian movies/videos were the main media influence measures. Sex-related knowledge, premarital sexual permissiveness (PSP), and sex-related behaviors were the main outcome measures. The impact of each of four contexts including family, peer, school, and media on sex-related knowledge, attitudes, and behaviors were assessed using multiple linear regression stratified by gender and city, controlling for age, urban/rural residence, education, and economic status. The change in adjusted R(2) from the multiple linear regression analysis was adopted to indicate the contribution of family, peer, school, and media variables to respondents' sex-related knowledge, attitudes, and behaviors.

RESULTS

The contextual factors, including family, peer, school, and media, explained 30%-50% of the variance in sex-related knowledge, 8%-22% of the variance in PSP, and 32%-41% of the variance in sex-related behaviors. Media variables explained 13%-24% of the variance in sexual knowledge, 3%-13% in PSP, and 3%-13% in sex-related behaviors, which was comparable with that of family, peer, and school variables. These associations differed by city and gender.

CONCLUSIONS

Access to and use of mass media and the messages they present are influential factors on sex-related knowledge, attitudes, and behaviors of unmarried Asian adolescents and young adults, and should be considered in future research and intervention programs attempting to improve reproductive health outcomes.

Parent-teen communication about sex in urban Thai families

This study describes sexual communication among Thai parents and their teens and identifies variables related to communication about sex in urban Thai families. Data were derived from 420 families whose teenage children ages 13-14 years were randomly selected using the probability proportional to size technique. Interviews were conducted with 1 parent and 1 teenage child in each family. In-depth interviews were also conducted in 30 parents and teens drawn from the same 420 families. Results showed that parents were most likely to talk with their teens about body changes and dating; however, less discussion about sex-related issues, birth control, and HIV/AIDS occurred. More daughters than sons reported frequent discussions with their parents about sex. Parents who believed their teens had been involved in sexual activity were more likely to talk about HIV/AIDS and the difficulty of teenagers having babies, instead of talking about sexual intercourse or when to start having sex. Multiple regression analysis indicated that gender of the child (female), parental religiosity, and parental perception of teen sexual activity were significant predictors of increased sexual communication in Thai families. The findings suggest a need for approaches designed to facilitate communication skills about sex-related issues among Thai parents.

Parent-youth communication and concordance between parents and adolescents on reported engagement in social relationships and sexually intimate behaviors in Hanoi and Khanh Hoa Province, Vietnam

PURPOSE

Parent-child communication is associated with positive outcomes for youths' engagement in sexual behaviors. Limited data are available regarding parent-child communication in transitional countries. We present data from Vietnamese parent-youth dyads on parent reproductive health (RH) knowledge, comfort of communication, frequency of talk, and discordancy between youths' reported and parents' perceptions for engagement in relationships and sexually intimate behaviors.

METHODS

The cohort included 185 randomly selected parent-youth dyads in four communes in Hanoi and Khanh Hoa Province. Descriptive and comparative analysis included chi-squared tests, independent samples t-tests, and ANOVA. Linear regression analysis was used to assess relationships between parental knowledge, level of comfort, frequency of talk, and discordancy.

RESULTS

Seventy-six percent of parents and 44% of youth were female. The mean age of youth was 17.2 years. The mean score for parental "RH knowledge" was 24.74 (SD, 3.84; range, 15-34). Lower parental RH knowledge was positively associated with lower levels of education (F = 2.983; df, 184; p = .014). Data indicate a linear model in which knowledge is related to "comfort" (β = .17; p = .048), and "comfort" to frequency of "talk" (β = .6; p < .0001). Frequency of "talk" is not related to parents' discordant perceptions regarding their child's reported involvement in relationships (β = .002; p = .79) or sexual touching (β = .57; p = .60).

CONCLUSIONS

Parent and youth in Vietnam are engaged in limited communication about RH. There is a need for more data to assess the effect of these communication patterns on youths' engagement in sexual behaviors and for development of family-centered interventions to increase parental knowledge and skills for positive communication.

India-US collaboration to prevent adolescent HIV infection: the feasibility of a family-based HIV-prevention intervention for rural Indian youth

BACKGROUND

Despite the centrality of family in Indian society, relatively little is known about family-based communication concerning sexual behaviour and HIV/AIDS in rural Indian families. To date, very few family-based adolescent HIV-prevention interventions have been developed for rural Indian youth. This study conducted formative research with youth aged 14 to18 years and their parents in order to assess the feasibility of conducting a family-based HIV-prevention intervention for rural Indian adolescents.

METHODS

Eight focus groups were conducted (n = 46) with mothers, fathers, adolescent females and adolescent males (two focus groups were held for each of the four groups). All focus groups consisted of same-gender participants. Adolescents aged 14 to18 years old and their parents were recruited from a tribal community in rural Maharashtra, India. Focus group transcripts were content analyzed to identify themes related to family perceptions about HIV/AIDS and participation in a family-based intervention to reduce adolescent vulnerability to HIV infection.

RESULTS

Six primary thematic areas were identified: (1) family knowledge about HIV/AIDS; (2) family perceptions about adolescent vulnerability to HIV infection; (3) feasibility of a family-based programme to prevent adolescent HIV infection; (4) barriers to participation; (5) recruitment and retention strategies; and (6) preferred content for an adolescent HIV prevention intervention.

CONCLUSION

Despite suggestions that family-based approaches to preventing adolescent HIV infection may be culturally inappropriate, our results suggest that a family-based intervention to prevent adolescent HIV infection is feasible if it: (1) provides families with comprehensive HIV prevention strategies and knowledge; (2) addresses barriers to participation; (3) is adolescent friendly, flexible and convenient; and (4) is developmentally and culturally appropriate for rural Indian families.

Parent-adolescent communication about sex in Morelos, Mexico: does it impact sexual behaviour?

OBJECTIVES

Parent-adolescent communication about sexuality has been shown to influence adolescents' sexual behaviour. This study aims to describe communication about sex between Mexican parents and adolescents, and its relation to age at first intercourse and condom use.

METHODS

Cross-sectional study with self-administered questionnaires of first year students at 23 high schools. Communication was divided into three themes: biological aspects, risks associated with sexual behaviour, and prevention. For sexually active adolescents, discussion timing was determined to have occurred prior to, or after sexual initiation. Analysis included logistic regression models stratifying by discussion timing.

RESULTS

Overall 5,461 questionnaires were analysed. Among male respondents 24.3% and among females 10.6% stated that they were sexually active. As many as 83.1% reported having spoken with parents about sexual relations. Communication was more common with mothers. Discussions about risk and prevention prior to sexual initiation was associated with condom use at first intercourse (Odds ratio [OR] = 2.05); late discussion was associated with younger age (<15) at first intercourse (OR = 3.51).

CONCLUSIONS

Communication before onset of sexual activity about risk and prevention is associated with safe sex practices. Improving parent-adolescent communication is a poorly studied strategy to influence adolescents' behaviour. Interventions should promote early parent-adolescent communication.

"They have opened our mouths": increasing women's skills and motivation for sexual communication with young people in rural South Africa

Communication between parents and young people about sex has been identified as a positive influence on young people's sexual behavior. This article presents findings from South Africa, where a social intervention to reduce levels of HIV and intimate partner violence actively promoted sexual communication between adults and young people. We assessed this component of the program using quantitative and qualitative methods, collecting data through surveys, direct observation, interviews, and focus group discussions. Women participating in intervention activities reported sexual communication with children significantly more often than matched women in the control group (80.3% vs. 49.4%, adjusted risk ratio 1.59 (1.31-1.93). The content of communication with young people also appears to have shifted from vague admonitions about the dangers of sex to concrete messages about reducing risks. The congruence between these findings and existing literature on parent-child sexual communication suggests that conceptual frameworks and programs from developed settings can be adapted effectively for resource-poor contexts.