Male students' behaviour, knowledge, attitudes, and needs in sexual and reproductive health matters

Indifferent, ambiguous, or proactive? Young men's discourses on health service utilization for Chlamydia trachomatis detection in Stockholm, Sweden: A qualitative study

INTRODUCTION

Chlamydia trachomatis (C. trachomatis) infection is the most commonly reported sexually transmitted infection in Sweden and globally. C. trachomatis is often asymptomatic and if left untreated, could cause severe reproductive health issues. In Sweden, men test for C. trachomatis to a lesser extent than women.

AIM

To explore factors facilitating and constraining Swedish young men's health care utilization for C. trachomatis detection and treatment.

METHOD

A qualitative situational analysis study including data from 18 semi-structured interviews with men (21-30 years). Data collection took place in Stockholm County during 2018. A situational map was constructed to articulate the positions taken in the data within two continuums of variation representing men's risk perception and strategies to test for C. trachomatis.

RESULTS

Based on the informants' risk perception, strategies adopted to test and the role of social support, three different discourses and behaviours towards C. trachomatis testing were identified ranging from a) being indifferent about C. trachomatis -not testing, b) being ambivalent towards testing, to c) being proactive and testing regularly to assure disease free status. Several factors influenced young men's health care utilization for C. trachomatis detection, where the role of health services and the social support emerged as important factors to facilitate C. trachomatis testing for young men. In addition, endorsing traditional masculinity domains such as leaning on self-reliance, beliefs on invulnerability and framing men as more carefree with their sexual health than women delayed or hindered testing.

CONCLUSION

Testing must be promoted among those young men with indifferent or ambivalent discourses. Health systems aiming to increase testing among those at risk should take into consideration the positive role that young men's social support have, especially the level of social support coming from their peers. Additionally, endorsement of traditional masculinity values may delay or hinder testing.

Retracted: Family planning services use: A shared responsibility between men and women of reproductive age in Hubei province, China

OBJECTIVE

Effective use of family planning (FP) services significantly improves sexual and reproductive health of both women and men. Recently, the Chinese government has launched the two-child policy allowing families to have an additional child. This study aimed to explore the population's interest for FP services, unmet needs, and expectations.

METHODS

A cross-sectional study using stratified random sampling was conducted in 102 counties of Hubei province and 17 555 randomized individuals from rural, transitional, and urban areas were interviewed through a guided semi-structured questionnaire.

RESULTS

The Han ethnicity dominated our population and number of living children per family ranged from zero to six. Although 81% reported FP services and sexual and reproductive health (SRH) as a shared responsibility, the contraceptives used excluding condoms, were mainly intrauterine devices (76%), tubal ligation (16%), and vasectomy (8%). Although 24% of participants had a history of contraceptive failure, effective contraceptive use after failure among men remained lower (6% for tubal ligation and vasectomy) and 74% of naive contraceptive users strongly rejected vasectomy. Demographic factors, awareness of FP services/SRH, discussing and making joint decisions, and gender discrepancies were strongly associated with unmet FP services/SRH needs (P < 0.001).

CONCLUSION

Family planning services use roughly varied with the population's unmet needs and expectations, which should be considered to sustain the strategies.

Adolescents' Perspective on Their Sexual Knowledge and the Role of School in Addressing Emotions in Sex Education: An Exploratory Analysis of Two School Types in Austria

Sex education for adolescents should include building knowledge on the emotional, social and physical aspects of sexuality. This study aimed to find out how adolescents from two different school types perceived their own knowledge on sexual matters, the importance they placed on sex education in school, and how well they felt that emotional, social and physical issues were raised within the frame of sex education. A cross-sectional 74-item questionnaire survey was conducted among adolescents (n = 198, age 13-16 years) from two secondary schools and one polytechnic school in Austria. From the linear regression analyses, secondary school students felt more knowledgeable on sexual matters than polytechnic students (beta = -0.288, p = .005). Secondary school students had more knowledge on the biology of sexuality but were less informed of the emotional aspects and other topics masturbation [mean score (SD)] [2.42(1.24) vs 3.42(1.44); p < .001], forms of sexual contact [2.81(1.08) vs 3.54(1.22), p = .006] and dealing with love and sexual feelings in relationships [2.68(1.19) vs 3.33(2.60); p = .030] than polytechnic students. While teachers were considered important providers of sex education, a more varied and practical means of learning was desired. Sex education should allow for the interplay between fact and emotion using varied teaching and learning strategies.

Adolescents' perceptions of sexual health education programs: An integrative review

INTRODUCTION

Adolescents are key stakeholders in sexual health education, yet they are rarely consulted when developing sexual health programs. Their voices are integral to improving the delivery of relevant and appropriate school-based sexual health education to promote safer adolescent sexual behaviors.

METHODS

An integrative review was conducted utilizing three databases: Cumulative Index of Nursing and Allied Health Literature (CINAHL) Complete, PubMed, and Education Resources Information Center (ERIC). The PRISMA and matrix method were used to search the literature and synthesize the findings from 16 articles regarding adolescent perceptions of school-based sexual health education.

RESULTS

The main themes that emerged from this review included: (a) factors influencing adolescent perceptions of sexual health education programs, (b) characteristics of good sexual health education programs, and (c) areas of improvement in sexual health education programs.

CONCLUSION

Adolescents overwhelmingly requested honest, comprehensive content delivered by nonjudgmental, well-educated health professionals in a comfortable environment.

Exploring the Barriers to Sexual and Reproductive Health Education for Men in Iran: A Qualitative Study

Background

Considering the obvious reasons for the necessity of men's sexual and reproductive health education, the present qualitative study aims to identify and contextualize the barriers to sexual and reproductive health education to men in Iran.

Materials and Methods

This qualitative research was conducted using conventional procedures of content analysis. A total of 34 participants consisting of authorities in health organizations, healthcare providers, clergies, and adult men in a general population were interviewed in two large cities of Iran including Tehran and Mashhad in 2016. Purposive sampling continued until data saturation was ensured. Data were collected through individual in-depth semi-structured interviews. All interviews were tape-recorded and transcribed in verbatim. Finally, the data were analyzed using conventional qualitative content analysis.

Results

Participants' experiences were categorized into three main themes including (1) individual barriers, (2) sociocultural barriers, and (3) structural barriers along with seven subthemes including low perceived threat, unwillingness to learn, sociocultural taboos, family's lack of knowledge and malperformance, policy-making barriers, executive barriers, and health system deficiency barriers.

Conclusions

Considering the results obtained, many barriers to men's sexual and reproductive health education could be eliminated through overcoming the individual and structural barriers and sociocultural taboos, as major obstacles. The findings suggest overcoming these barriers and promoting men's health require raising awareness overcoming sociocultural taboos. In this regard, policy-makers should provide sexual and reproductive health education programs and create opportunities and facilities along with appropriate learning environments for men.

Prevalence of and disparities in HIV-related sexual risk behaviours among Chinese youth in relation to sexual orientation: a cross-sectional study

Background: The aim of this study was to calculate the prevalence rate of HIV-related sexual risk behaviours (HSRB) among Chinese youth and determine whether there was an association between sexual orientation and HSRB. Methods: This study used a nationally representative survey of youth aged 15-24 years in China. Population numbers, prevalence, and proportions were calculated where appropriate. χ2 tests were used to determine the difference within categorical variables. Multivariate logistic regression was used to calculate the adjusted odd ratios (AOR) and 95% confidence interval (CI). Results: The rate of any HSRB among sexually active youth was 79.43%, and the most common HSRB was lack of condom use during the first sexual experience (66.02%). After adjusting for demographic and socioeconomic variables (sex, age, residence, living with parents or not, father's education and annual family income), non-heterosexual orientation was found to significantly increase the odds of HSRB (AOR = 2.42, 95% CI: 1.16-5.05). Conclusions: Non-heterosexual youth are at a higher risk of partaking in HSRB. The high prevalence of HSRB indicates the insufficiency of sex education for Chinese youth, especially for non-heterosexual youth. Greater efforts should be made to increase reproductive and sexual health services for Chinese youth.

U.S. Men's Perceptions and Experiences of Emergency Contraceptives

Research suggests that men should be included in reproductive health decision making to help enhance positive health outcomes for their partners. Men affect the use of contraception and what method is used. Men's decisions may be affected by different factors such as gender, education, and the nature of their sexual relationship. A qualitative study was conducted to explore males' experiences and perceptions about emergency contraception (EC), and the meanings males assign to EC. Semistructured in-depth focus groups were held with 15 men who engage in heterosexual activity recruited from a university setting in the United States. Participants expressed egalitarian views of the contraception decision-making processes, a sense of responsibility regarding reproductive decision making, and that society has a negative stigma toward those who use EC. However, there was a lack of knowledge regarding the copper intrauterine device, which was not viewed as a method of EC. Exploring the role and needs of men in reproductive health care discussions and research is an important and growing area. Recommendations are provided for health care practitioners, policy, and future research around men and EC.

An evaluation of male partners' perceptions of antenatal classes in a national health service hospital: implications for service provision in london

Few studies have considered whether the gender of educator or same-gender classes have any influence on the participation of male partners, and even fewer studies have examined any factors that limit attendance from ethnic minority groups. The objective of this study was to investigate male partners' initial experience and associated factors that limit attendance. Data were collected by means of a questionnaire given to 69 male partners in North London. In total, 49 male partners preferred to attend the same class with their partners even if all male forums were offered. The gender of the educator had no influence on their participation. Comments from 23 participants from three different ethnic minority groups indicated that they preferred to have a separate class from their partners.

Age-related variation in sexual behaviours among heterosexual men residing in Brazil, Mexico and the USA

OBJECTIVE

To compare the prevalence of demographic characteristics and sexual behaviours across age groups and to estimate their significance in predicting sexual risk factors by age cohort.

METHODS

This cohort study examined sexually transmitted infection (STI) prevalence among heterosexual men in Brazil, Mexico and the USA (N=3047). Participants completed a sexual risk factor questionnaire and were tested for chlamydia, gonorrhoea, syphilis and genital herpes. We examined sexual risk in the study population through a composite measure of STI positivity by age cohort (young: 18-30 years; middle-aged: 31-44 years; older: 45-70 years). Multivariable logistic regression models were used to generate adjusted odds ratios (AORs) and 95% confidence intervals (CIs).

RESULTS

We found that STI positivity varied significantly by age group among heterosexual men by a number of covariates. In younger men, having more advanced education had a protective effect (16 years: AOR=0.37, 95% CI 0.15- 0.92), whereas higher numbers of sexual partners elevated the risk for STIs (20-49 partners: AOR=2.06, 95% CI 1.04-4.06; ≥ 50 partners: AOR=4.33, 95% CI 1.74-10.76). Middle-aged men who were black (AOR=1.64, 95% CI 1.10-2.42) and divorced/separated/widowed (AOR=1.91, 95% CI 1.21-3.02) had an increased risk for a positive STI test. Among older men, a younger age at first vaginal sexual encounter (AOR=3.75, 95% CI 1.45-9.74) and a history of exchanging sex for money or drugs heightened STI risk (AOR=2.30, 95% CI 1.0-5.04).

CONCLUSIONS

These findings demonstrate that age-related life experiences among heterosexual men influence sexual risk and STI transmission. This topic warrants further investigation to support the development and implementation of targeted interventions that may potentially reduce adverse sexual health outcomes.

Sexually transmitted infections and their impact on the reproductive health of children and teenagers

The authors present the results of recent studies concerning of the epidemiology of sexually transmitted infections (STIs) in children and teenagers in the Russian Federation and abroad. The authors describe social factors contributing to the propagation of STIs among the underage. They also analyze the key directions in the prevention programs to prevent propagation of STIs among young people.

Gynecologic knowledge is low in college men and women

STUDY OBJECTIVE

Although men may influence women's reproductive choices, little is known about men's knowledge regarding gynecologic matters (eg, sex, anatomy, and contraception). This study aimed to evaluate the level of gynecologic knowledge among college students, particularly to investigate the differences in knowledge between men and women.

DESIGN, SETTING, PARTICIPANTS

We administered a survey to assess knowledge of sex, contraception, and female anatomy to college students at a Midwestern university during the spring 2010 semester.

INTERVENTIONS AND MAIN OUTCOME MEASURES

The survey included demographic and behavioral questions, 9 general gynecology knowledge items, and 11 female anatomy items. A total gynecology score was generated by summing the correct responses to 20 items.

RESULTS

The 236 respondents included 98 men and 138 women (aged 18-36 years). Women scored higher than men on 19 of 20 individual items, with mean total scores of 13.4 vs 10.1 (P < .01). There was a trend for gynecologic knowledge to be higher among those who reported having had been STI tested (P = .13), and whose parents had discussed anatomy with them (P = .07). In multivariable modeling, being male was associated with lower mean knowledge scores, whereas increasing age and having a parent who discussed anatomy were associated with greater knowledge scores, even while controlling for having a gynecologist parent, multiple sexual partners, and prior STI testing.

CONCLUSIONS

College men have lower gynecologic knowledge than women. Increasing age and having a parent who discussed anatomy with them served as predictors of higher knowledge scores. Because men influence women's reproductive choices, efforts to increase men's knowledge are needed.

Qualitative interviews with adolescents about "friends-with-benefits" relationships

OBJECTIVE

To describe the thoughts, reflections, and experiences of friends-with-benefits relationships among a group of Swedish adolescents.

DESIGN AND SAMPLE

A qualitative study with an explorative and descriptive design. Eight adolescents, aged 16-18, were interviewed.

MEASURES

Individual in-depth interviews were undertaken. Data were analyzed using latent content analysis.

RESULTS

The informants involved themselves in Friends-with-benefits (FWB) relationships to find physical and psychological intimacy without any expectations or demands. FWB relationships were perceived to have more advantages when the partner was a close friend with whom an informant felt comfortable. There was ambivalence about the legitimacy of romantic feelings in an FWB relationship, although it was quite common. Sexual concurrency was common and often accepted. Sexual risk-taking behavior involving the use of alcohol and a lack of contraception was considered common in FWB relationships. Informants requested more education and support as regards their sexual behavior.

CONCLUSIONS

FWB relationships were often initiated to find physical and psychological intimacy with no expectations or demands. Advantages such as sexual concurrency and no demands were central. A deeper understanding of how adolescents think and reason about sexuality and relationships can make a difference when working to improve young people's sexual and reproductive health.

Early onset of sexual intercourse is an indicator for hazardous lifestyle and problematic life situation

BACKGROUND

In public health efforts, knowledge about risk-groups is important for creating societal conditions to ensure good health on equal terms.

AIM

To investigate differences in lifestyle and perceived health among 15-year-old teenagers with experience of sexual intercourse (self-defined) and same-aged teenagers without experience of sexual intercourse.

METHODS

A two-cluster questionnaire study among 15-year-old Swedish students (n = 2170) in 2009/10. Chi-squared test was used to identify differences between three groups: teenagers who had not had sexual intercourse; teenagers who had had sexual intercourse at age of 14 or younger; and teenagers who had had intercourse at an age of 15.

RESULTS

Thirty-two per cent (n = 334) of girls and 31% (n = 324) of boys had had sexual intercourse. Teenagers with experience of sexual intercourse at 15 years or younger used more tobacco, alcohol and illicit drugs than same-aged teenagers without intercourse experience did. Furthermore, teenagers with experience of intercourse, especially those with a debut at 14 year or younger, had less positive school experiences, more involvement in injuries and physical violence, were less (girls) and more (boys) physically active, and perceived a poorer health than teenagers without intercourse experience.

CONCLUSION

Sexual intercourse at the age of 15 or younger is an indicator for a hazardous lifestyle and problematic life situation.

Risk factors among men who have repeated experience of being the partner of a woman who requests an induced abortion

BACKGROUND

Prevention of unintended pregnancies is a public health objective; however, the profiles of male partners of women who choose to abort are relatively unexplored.

OBJECTIVE

To investigate risk factors among men who have repeated experience of being the partner of a woman electing an induced abortion.

METHODS

A questionnaire was used to collect information from 590 men recruited through their pregnant partner who applied for an abortion in Sweden during 2009. A binary logistic regression model assessed risk factors associated with repeated experience of abortion.

RESULTS

One-third of the men had previous experience of a pregnant partner electing an induced abortion. Univariate analysis indicated these men were older, had a lower educational level and less emotional support, and were more often tobacco users than men for whom it was the first experience of a partner choosing to abort. Independent risk factors were being a victim of physical, psychological, or sexual violence or abuse over the past year (OR 2.62, 95% CI 1.36-5.08), unemployment or sick leave (OR 2.58, 95% CI 1.57-4.25), and having children (OR 2.00, 95% CI 1.22-3.28). The men suggested improved sex and relationship education in school and lower unemployment rates could prevent unintended pregnancies and abortions.

CONCLUSIONS

Men with experience of repeat abortions present a picture of vulnerability that should be recognised in the prevention of unintended pregnancies. Increased work opportunities might be one important intervention to reduce the number of abortions.

Promoting STI testing among senior vocational students in Rotterdam, the Netherlands: effects of a cluster randomized study

BACKGROUND

Adolescents are a risk group for acquiring sexually transmitted infections (STIs). In the Netherlands, senior vocational school students are particular at risk. However, STI test rates among adolescents are low and interventions that promote testing are scarce. To enhance voluntary STI testing, an intervention was designed and evaluated in senior vocational schools. The intervention combined classroom health education with sexual health services at the school site. The purpose of this study was to assess the combined and single effects on STI testing of health education and school-based sexual health services.

METHODS

In a cluster-randomized study the intervention was evaluated in 24 schools, using three experimental conditions: 1) health education, 2) sexual health services; 3) both components; and a control group. STI testing was assessed by self reported behavior and registrations at regional sexual health services. Follow-up measurements were performed at 1, 3, and 6-9 months. Of 1302 students present at baseline, 739 (57%) completed at least 1 follow-up measurement, of these students 472 (64%) were sexually experienced, and considered to be susceptible for the intervention. Multi-level analyses were conducted. To perform analyses according to the principle of intention-to-treat, missing observations at follow-up on the outcome measure were imputed with multiple imputation techniques. Results were compared with the complete cases analysis.

RESULTS

Sexually experienced students that received the combined intervention of health education and sexual health services reported more STI testing (29%) than students in the control group (4%) (OR = 4.3, p < 0.05). Test rates in the group that received education or sexual health services only were 5.7% and 19.9%, not reaching statistical significance in multilevel analyses. Female students were more often tested then male students: 21.5% versus 5.4%. The STI-prevalence in the study group was low with 1.4%.

CONCLUSIONS

Despite a low dose of intervention that was received by the students and a high attrition, we were able to show an intervention effect among sexually experienced students on STI testing. This study confirmed our hypothesis that offering health education to vocational students in combination with sexual health services at school sites is more effective in enhancing STI testing than offering services or education only.

Contraceptive use during the reproductive lifecycle as reported by 46-year-old women in Sweden

OBJECTIVES

The aim of this study was to investigate the contraceptive methods 46-year-old women in Sweden had chosen during different phases of their reproductive lifecycle and, the factors affecting their choice.

STUDY DESIGN

The design was a retrospective cross-sectional study and targeted 46-year-old women. Five hundred Swedish women were randomly selected from a national population-based register and sent a questionnaire with 18 multiple response questions: the response rate was 47%.

RESULTS

The women used different contraceptive methods during different phases of their reproductive lifecycle. Women mainly used oral contraceptive pills and condoms before pregnancy, copper-IUD between pregnancies and, hormonal- and copper IUD after pregnancy. Condoms were used during all phases of women's fertile period. Women with early sexual debut were more likely to have used condom as their first contraceptive method than women with late sexual debut, and women who had children were more likely to use IUD as current contraception than women without children. High efficacy, accessibility and advice from a counselor were the most cited reasons for choosing a particular method. The most common reasons for discontinuing contraceptive use were a wish to be pregnant and concerns about side effects. The partner had little or no influence on choice of method, but advice from a gynecologist or midwife was influential.

CONCLUSIONS

46-year-old women in Sweden had chosen different contraceptive methods during different phases of their reproductive lifecycle. Partners appear to have limited influence over this choice. Individualized counseling by health care providers seems important.

Assessing perceived risk and STI prevention behavior: a national population-based study with special reference to HPV

INTRODUCTION

To better understand trends in sexually transmitted infection (STI) prevention, specifically low prevalence of condom use with temporary partners, the aim of this study was to examine factors associated with condom use and perceptions of STI risk amongst individuals at risk, with the underlying assumption that STI risk perceptions and STI prevention behaviors are correlated.

METHODS

A national population-based survey on human papillomavirus (HPV) and sexual habits of young adults aged 18-30 was conducted in Sweden in 2007, with 1712 men and 8855 women participating. Regression analyses stratified by gender were performed to measure condom use with temporary partners and STI risk perception.

RESULTS

Men's condom use was not associated with STI risk perception while women's was. Awareness of and disease severity perceptions were not associated with either condom use or risk perception though education level correlated with condom use. Women's young age at sexual debut was associated with a higher risk of non-condom use later in life (OR 1.95 95% CI: 1.46-2.60). Women with immigrant mothers were less likely to report seldom/never use of condoms with temporary partners compared to women with Swedish-born mothers (OR 0.53 95% CI: 0.37-0.77). Correlates to STI risk perception differ substantially between sexes. Number of reported temporary partners was the only factor associated for both men and women with condom use and STI risk perception.

CONCLUSIONS

Public health interventions advocating condom use with new partners could consider employing tactics besides those which primarily aim to increase knowledge or self-perceived risk if they are to be more effective in STI reduction. Gender-specific prevention strategies could be effective considering the differences found in this study.

Knowledge of human papillomavirus among high school students can be increased by an educational intervention

The aim of this study was to evaluate the effect of an educational intervention concerning human papillomavirus (HPV) directed at Swedish first year high school students. The intervention consisted of a class room lesson, a website and a folder. Outcome variables were knowledge of HPV and attitudes to preventive methods such as HPV vaccination, condom use and Pap smear testing. An intervention group (n = 92) was matched with two comparison groups (n = 184). At baseline, the median score for HPV knowledge was one out of 10 in both groups. At follow-up, the median knowledge score had increased to six in the intervention group, but was still one in the comparison group (P < 0.001). Attitudes to HPV vaccination, condom use and Pap smear testing remained the same (P > 0.05). In conclusion, a short school-based intervention can greatly increase the students' knowledge about HPV, but attitudes and behaviours are less easy to influence.

Sexual activity, knowledge and contraceptive usage by gender among university students in Turkey

OBJECTIVE

To assess sexual activity and contraceptive knowledge and practice by gender among university students.

METHODS

Descriptive and cross-sectional study conducted at Ege University, Turkey, with 1000 volunteering students. Data collection was stopped when 500 students of each gender had participated.

RESULTS

Of the surveyed students, 50.3% (27.4% female, 73.2% male) reported having had sexual intercourse; the mean age at first sexual intercourse was 18.4 years for girls and 16.9 years for boys. We found that 44.5% of female and 30.6% of male students failed to use contraception at their first coitus, whereas 2.2% of female and 13.7% of male students failed to do so at their most recent intercourse. The rate of condom usage for students' first sexual encounter was 50.1% (35.8% female, 55.5% male) and was 67.8% (70.1% female, 66.9% male) at their most recent intercourse. Abortion was mentioned by 43.9% of female and 39.2% of male students as a method of preventing pregnancy after unprotected coitus.

CONCLUSION

Male Turkish students had started sexual relations at a younger age but had less often unprotected first sex than female students.