Sexual initiation: predictors and developmental trends

Opportunity and the sexual abuse of adolescents

OBJECTIVES

The risk of sexual abuse victimization was examined from a routine activity perspective. For comparison, predictors of sexual encounters with same-age peers were also examined.

METHODS

Analyses were based on a nationally representative sample of 24,823 Finnish youth who responded to questions about their sexual encounters with peers and with someone outside their family who was at least five years older.

RESULTS

Adolescents who had older friends and parents who did not monitor their social relationships were at greater risk of sexual abuse and peer encounters. In addition, delinquent youth had a higher risk of abuse than non-delinquents, controlling for exposure. Delinquent youth were also more likely to have favorable attitudes toward the abuse, to initiate the sexual encounter, and to experience repeat victimizations. Physical attractiveness, but not sexual maturity, was related to abuse.

CONCLUSIONS

Risk of sexual abuse is positively related to exposure to older people, susceptibility to deviant influence, and the target's value to the offender. A full understanding of risk factors requires a consideration of the victims' characteristics and their compliant behavior.

The Association between Substance Abuse and Sexual Misconduct among Macau Youths

This study investigates how peer influence, school attachment, and substance abuse are related to sexual behavior, with particular interest in exploring the relationship between substance abuse and sexual misconduct, while using a stratified random sample of adolescents in Macau. Mediation analyses were employed. The results show that substance abuse, apart from susceptibility to peer influence and school attachment/commitment, was significantly related to sexual misconduct. Substance abuse was the best predictor of sexual misconduct, and it significantly mediated the relationship between susceptibility to peer influence, as well as school attachment and sexual misconduct. This reflects that the use of substances, including drugs, alcohol, and cigarettes, can be viewed as a catalyst for triggering engagement in sexual misconduct. The implications of this study involve taking measures to reduce the rate of substance abuse as a way of decreasing sexual misconduct in adolescents. Future research directions in exploring the relationship between adolescent substance abuse and risky sexual behavior are discussed.

YSEX? A Replication Study in Different Age Groups

INTRODUCTION

10 years ago, Meston and Buss (Arch Sex Behav 2007;36:477-507) identified 237 reasons for having sex. Since then, only a few studies have built on the analyses of differences in sexual motivation.

AIM

To replicate the YSEX? in a broader sample of women and men of different ages.

METHODS

Women and men younger than 18 (n = 141), 18 to 22 (n = 1,039), 22 to 55 (n = 2,804), and at least 55 (n = 667) years old completed an online survey about their reasons for engaging in sex during the past year.

MAIN OUTCOME MEASURES

The YSEX? inventory was assessed to measure sexual motivation. The taxonomy consists of 4 main factors (physical, goal attainment, emotional, insecurity) and 13 subfactors.

RESULTS

4,655 participants took part in the survey. The top 5 primary reasons for engaging in sex were identical across age groups and sexes. However, results also showed that the pattern of motivations for sex significantly differed depending on the age and sex of the participant. Older participants reported significantly less physical and utilitarian reasons than younger participants. Young adult men (18-22 years) were particularly motivated to have sex for emotional reasons of love and commitment. Women in this age group engaged more often in sex to express their emotions than older women. Significant sex differences were found, with men preferring physical reasons and women more often expressing emotional and insecurity reasons, except for the group of adolescents.

CONCLUSIONS

Our study shows that most people are driven by the pleasure of sex. With aging, the physical driving force and sexual satisfaction significantly decrease, although sex remains important throughout life. The findings support a biopsychosocial approach to the understanding of people's sexual motivation. Evolutionary differences might explain some of our findings, as might shifting cultural norms. Wyverkens E, Dewitte M, Deschepper E, et al. YSEX? A Replication Study in Different Age Groups. J Sex Med 2018;15:492-501.

Teenage Pregnancies in Nepal - The Problem Status and Socio-Legal Concerns

INTRODUCTION

Teenage pregnancy is an issue that needs to be addressed for a better health of the women and the society. The present analysis is undertaken to find out the incidence of teenage mothers who have had hospital delivery and focuses upon the various reasons for teenage pregnancy with a brief discussion upon the associated medicolegal and social aspects.

METHODS

A cross sectional study was carried out in a tertiary hospital in western region of Nepal. The delivery case register were reviewed for teenage pregnancies and the relevant data was captured in a data sheet and analysed.

RESULTS

During the study period, a total of sixty-nine teenage pregnancies culminated into delivery/ childbirth. The mean age of teenage mother was 18.16±0.99 years. Majority of the teenage mothers had not completed their secondary education and were of low socioeconomic strata. Mode of delivery was caesarean section in thirty four cases, whereas vaginal delivery was conducted in thirty five cases. Live births accounted for 67 deliveries, a still birth case was of anencephalic foetus while the other one was a preterm which was spontaneously delivered at the 23rd weeks of gestation.

CONCLUSIONS

Education and awareness in the form of campaign, advertisements, road shows, television or radio programmes are suggested for a decline in the rate of teenage marriages and teenage pregnancies in Nepal in the days to come.

Anxiety's Relationship to Inconsistent Use of Oral Contraceptives

Five percent of typical oral contraceptive users experience an unintended pregnancy every year. Inconsistent use of oral contraception may be a leading contributor to the high rate of unintended pregnancy among oral contraceptive users. Previous medical research also suggests that anxiety may play a role in medication compliance, yet no known studies have examined the relationship between anxiety and oral contraceptive use. To test this relationship, the authors analyze data from the National Survey of Family Growth Cycle V (NSFG-V), restricting their sample to sexually activewomen currently taking oral contraceptives. They find thatwomenwho report multiple episodes of anxiety lasting at least 6 months have a greater probability of inconsistent use. The authors suggest goals for future research and discuss the role of health care professionals in addressing oral contraception compliance in light of their findings.

Transitions in body and behavior: a meta-analytic study on the relationship between pubertal development and adolescent sexual behavior

The present meta-analysis studies the relations of pubertal timing and status with sexual behavior and sexual risk behavior among youth aged 10.5-22.4 years. We included biological sex, age, and ethnicity as potential moderators. Four databases were searched for studies (published between 1980 and 2012) on the relation between pubertal timing or status and sexual behavior. The outcomes were (1) sexual intercourse; (2) combined sexual behavior; and (3) risky sexual behavior. Earlier pubertal timing or more advanced pubertal status was related to earlier and more sexual behavior, and earlier pubertal timing was related to more risky sexual behavior. Further, the links between (1) pubertal status and combined sexual behavior and (2) pubertal timing and sexual intercourse status, combined sexual behavior, and risky sexual behavior were stronger for girls than boys. Most links between pubertal status, timing, and sexual behavior and sexual risk behavior were stronger for younger adolescents. Moderation by ethnicity did not yield consistent results. There was significant variation in results among studies that was not fully explained by differences in biological sex, age, and ethnicity. Future research is needed to identify moderators that explain the variation in effects and to design sexual health interventions for young adolescents.

Social factors associated with readiness for sexual activity in adolescents: a population-based cohort study

Various factors are associated with sexual activity in adolescence and it is important to identify those that promote healthy and adaptive romantic and sexual development. The objectives of this study were to describe rates of early sexual intercourse (before 16 years) and sexual readiness in adolescence and to assess the extent to which these were social patterned. We prospectively studied nearly 5,000 15-year-olds from the Avon Longitudinal Study of Parents and Children, a UK birth cohort. Between 2006 and 2008, female and male participants answered a computer assisted interview about romantic and sexual behaviors in the last year. Predictors of sexual intercourse and readiness for sexual intercourse were examined across a range of sociodemographic measures. Overall, 17.7% (95% CI 16.7%, 18.9%) of participants reported having had sexual intercourse in the last year, with more girls than boys reporting sexual experience (risk ratio 1.30, 95% CI 1.15, 1.47). Of these, one-third of both male and female were classed as unready because they were unwilling, lacking in autonomy, felt regret or had not used contraception. There was strong evidence of social patterning for sexual activity with higher rates for young people from poorer homes, with lower social class, and with younger, less educated mothers. In contrast, among 860 young people who had had sexual intercourse, there was no clear evidence of associations between social factors and sexual readiness. The lack of social patterning in sexual readiness supports the provision of comprehensive education to develop life skills for adolescents across all social groups.

Male experiences of unintended pregnancy: characteristics and prevalence

STUDY QUESTION

What are the characteristics and circumstances of pregnancies men report as unintended in France?

SUMMARY ANSWER

Pregnancies reported as unintended were most prevalent among young men with insecure financial situations, less stable relationships and inconsistent use of contraception or false assumptions about their partner's use of contraception.

WHAT IS KNOWN ALREADY

Efforts to involve men in family planning have increased over the last decade; however, little is known about factors associated with men's pregnancy intentions and associated contraceptive behaviours.

STUDY DESIGN, SIZE, DURATION

The data presented in this study were drawn from the nationally representative FECOND study, a population-based survey conducted in France in 2010. The sample comprised 8675 individuals (3373 men), aged 15-49 years, who responded to a telephone interview about socio-demographics and topics related to sexual and reproductive health. The total refusal rate was 20%.

PARTICIPANTS/MATERIALS, SETTING, METHODS

This study included 2997 men, of whom 664 reported 893 recent pregnancies (in the 5 years preceding the survey). Multivariate Poisson's regression with population-averaged marginal effects was applied to assess the individual and contextual factors associated with men's intentions for recent pregnancies. The contraceptive circumstances leading to the unintended pregnancies were also assessed.

MAIN RESULTS AND THE ROLE OF CHANCE

Of all heterosexually active men, 5% reported they had experienced an unintended pregnancy with a partner in the last 5 years. A total of 20% of recent pregnancies reported by men were qualified to be unintended, of which 45% ended in induced abortion. Of pregnancies following a previous unintended pregnancy, 68% were themselves unintended. Among all heterosexually active men, recent experience of an unintended pregnancy was related to age, mother's education, age at first sex, parity, contraceptive method history, lifetime number of female partners and the relationship situation at the time of survey. Recent unintended pregnancies were also related to pregnancy order and to the financial and professional situation at the time of conception. The majority of unintended pregnancies occurred when men or their partners were using contraceptives; 58% of contraceptive users considered that the pregnancy was due to inconsistent use and 39% considered that it resulted from method failure. Half of the non-users who reported an unintended pregnancy thought that their partner was using a contraceptive method. The relative risk of non-use of a contraceptive method during the month of conception of a recent unintended pregnancy was higher among those without a high school degree (IRR = 2.9, CI 1.6, 5.2) and higher among men for whom the pregnancy interfered with education (IRR = 1.8, CI 1.0, 3.1) or work (IRR = 1.9, CI 1.1, 3.6).

LIMITATIONS, REASONS FOR CAUTION

From the perspective of men, the unintended pregnancy rates may be underestimated due to a combination of underreporting of abortion and post-rationalization of birth intentions. Our use of a dichotomous measure of unintended pregnancy is unlikely to fully capture the multidimensional construct of pregnancy intentions.

WIDER IMPLICATION OF THE FINDINGS

These results call for gender-inclusive family planning programmes, which fully engage men as active participants in their own rights.

STUDY FUNDING/COMPETING INTERESTS

The FECOND study was supported by a grant from the French Ministry of Health, a grant from the French National Agency of Research (#ANR-08-BLAN-0286-01; PIs N.B., C.M.), and funding from National Institute of Health and Medical Research (INSERM) and the National Institute for Demographic Research (INED). None of the authors have competing interests.

Experiencing sexuality in youth living in Greece: contraceptive practices, risk taking, and psychosocial status

STUDY OBJECTIVE

To assess initiation of sexual activity and contraception methods used among Greek adolescents. To determine the association of adolescents' emotional and behavioral status with their sexual activity.

DESIGN

A descriptive cross-sectional survey was conducted.

SETTING, PARTICIPANTS

The population (N = 1074, age 14-16) consisted of a random sample, stratified according to locality and population density, of 20 public junior high and high schools located in the urban district of Athens, Greece.

INTERVENTIONS

Anonymous self-reported questionnaires were used to assess sexual activity choices and contraception methods. The Youth Self-Report questionnaire was used to evaluate the psychosocial competencies and difficulties of Greek adolescents.

MEASURES

Analyses included frequencies with chi-square tests and multivariate logistic regression analysis.

MAIN OUTCOME

Factors that may influence sexual engagement of Greek adolescents were assessed.

RESULTS

Of the adolescents who completed the questionnaire 21.8% reported having experienced sexual intercourse. The male/female ratio was 3/1 (P < .001) and the mean age of sexual debut was 14.5 ± 0.9 years. Condoms were the most preferred contraceptive method (79.9%), followed by withdrawal (38.9%). Emergency contraception was used by 9.6% of participants. Adolescents with separated, divorced or with a deceased parent, and non-Greek nationality have higher possibility of being sexually active. Adolescents who reported sexual intercourse had significantly higher score of thought problems (β = 1.07, SE = 0.35, P = .002), attention difficulties (β = 0.67, SE = 0.29, P = .022), delinquent behavior problems (β = 2.37, SE = 0.34, P < .001), aggressive behavior (β = 1.97, SE = 0.48, P < .001), and externalizing problems (β = 4.18, SE = 0.78, P < .001).

CONCLUSIONS

Engagement in sexual activities was significantly associated with psychosocial difficulties among adolescents living in Greece.

Correlates of high school freshman girls' reported reasons for engaging in sexual intercourse

BACKGROUND

Intrapersonal and external factors, including social pressures and the desire for acceptance from peers, influence sexual activity among adolescents. This study examined how personal characteristics, risky behaviors, normative beliefs, household factors, and engagement in extracurricular activities were related to high school freshman girls' reported reasons for having sexual intercourse.

METHODS

Baseline data were analyzed from 158 girls enrolled in high school-based abstinence-only-until-marriage education programs during their freshman year. Binary logistic regression was performed to identify factors associated with Pressures and Reasons for Engaging in Sex Scale (PRESS) scores.

RESULTS

Results indicate that girls with high PRESS scores were significantly more likely to have had sex (OR = 4.29), consumed alcohol within the previous year (OR = 6.13), reported strict household rules (OR = 1.49), and thought more girls their age had sex (OR = 1.67).

CONCLUSION

School- and family-based interventions should be developed to encourage and strengthen parent-teen communication within the household and reinforce self-worth and positive self-perceptions among adolescent girls.

Age at Sexual Debut and Subsequent Sexual Partnering in Adulthood Among American Men

This study examined the association of sexual debut and sexual partnering among men in the United States aged 21 to 44 years who participated in the 2006-2010 National Survey of Family Growth. Age at debut was categorized as <15 years, 15 to 17 years, and ≥18 years to permit comparison with previous research. Sexual partnering was defined as being concurrent, serial monogamist, or monogamist in prior year. Eleven percent reported concurrent partnerships and 6% serial monogamy. Sexual debut <15 and 15 to 17 years was associated with concurrency (adjusted odds ratio [aOR] < 15 = 2.22; 95% confidence interval [CI] = 1.37-3.61; aOR 15-17 = 1.69; 95% CI = 1.05-2.74). Irrespective of age at sexual debut, interventions to reduce risky lifetime number of partners may prevent risky sexual behavior in early adulthood and later in life.

Age at menarche and age at first sexual intercourse: a prospective cohort study

OBJECTIVE

Younger age at menarche (AAM) may put girls at risk for earlier first sexual intercourse (FSI). Young age at FSI has far-reaching negative outcomes. We describe the longitudinal relationship between AAM and FSI in a large prospective birth cohort.

METHODS

AAM was collected from 554 girls from the Western Australia (Raine) Pregnancy Cohort Study, prospectively from age 10 or retrospectively at age 14. Age at FSI was collected at ages 17 and 20. Cox regression models describe likelihood of FSI by age and years since menarche for younger (<12 years) and older (≥14 years) AAM relative to average AAM (12-13 years).

RESULTS

Girls with younger AAM and average AAM were equally likely to have FSI by age 16 (adjusted hazard ratio [aHR]: 0.90 [95% confidence interval (CI): 0.60-1.35]). FSI by age 16 was less likely among girls with older AAM than those with average AAM (aHR: 0.35 [95% CI: 0.17-0.72]). Girls with younger AAM had a longer median interval between menarche and FSI than girls with average AAM (5.0 years [interquartile range: 4.4-8.5 years] vs 3.7 years [interquartile range: 2.4-5.3 years]). Those with younger AAM were less likely to report FSI within 4 years of menarche than those with average AAM (0-2 years aHR: 0.04 [95% CI: 0.01-0.31]; 2-4 years aHR: 0.36 [95% CI: 0.23-0.55]). By age 20, 429 girls (77.4%) reported FSI.

CONCLUSIONS

Younger AAM was not a risk factor for younger age at FSI in this cohort.

Protective and risk factors of early sexual initiation in youth subcultures

OBJECTIVES

To assess the association between subculture affiliation (Hip-hop, Techno-scene, Metal, Punk, Skinheads) and early sexual initiation, and whether gender, family affluence, peer influence, lack of parental bonding and lack of parental monitoring explain this association.

METHODS

We collected data on 15-year-old primary school pupils who participated in the Health Behaviour in School-aged Children 2009/2010 study. The association of subculture affiliation with early sexual initiation was adjusted for gender, family affluence, peer influence, lack of parental bonding and lack of parental monitoring in five consecutive models using logistic regression.

RESULTS

Nearly 50% of the adolescents had a subculture affiliation. These youths were significantly more likely than other adolescents to have had sexual intercourse. Peer influence explained 49% of this association. Adding lack of parental bonding and lack of parental monitoring into the model weakened the association of subculture affiliation with early sexual initiation (20%), but this association remained statistically significant.

CONCLUSION

Youth subculture affiliation is strongly correlated with early sexual initiation. This association is mediated for a large part by peer influence and defective parental monitoring and bonding. Health promotion regarding early sexual initiation should therefore in particular target adolescents under strong influence of peers and with weak parental relationships.

The Language of Love?-Verbal versus Implied Consent at First Heterosexual Intercourse: Implications for Contraceptive Use

BACKGROUND

Little is known about how young people communicate about initiating intercourse.

PURPOSE

This study was designed to gauge the prevalence of implied versus verbal consent at first intercourse in a U.S. college population, assess effects of consent type on contraceptive use, and explore the influences of gender, race and other factors.

METHODS

We conducted and analyzed a cross-sectional survey of non-Hispanic white and black students from four universities, exploring associations between verbal and nonverbal consent, contraceptive use and covariates.

RESULTS

Among those with consensual first intercourse experiences (N=1883), half (49%) provided nonverbal consent. Black men were the most likely to provide nonverbal consent (61%), followed by white men (55%), black women (51%), and white women (43%). Respondents who used condoms at first intercourse were more likely to provide verbal consent, suggesting that condoms may prompt sexual discussions (or vice versa). In contrast, even when controlling for covariates, those who provided nonverbal consent were less likely to have used contraception (significantly so for women).

DISCUSSION

These findings confirm the hypothesis that young people who do not discuss whether to engage in vaginal intercourse for the first time are less likely to use contraception. These results add an important layer to our current conceptual model of sexual development, in particular, how young people adopt, or fail to adopt, behaviors that will keep them healthy once they decide to become sexually active.

TRANSLATION TO HEALTH EDUCATION PRACTICE

Enhanced sexual communication skills are greatly needed. Public health practitioners should investigate type of consent in future research and programming, with sensitivity to gender and racial influences.

Subjective pubertal timing and health-compromising behaviours among Swiss adolescent girls reporting an on-time objective pubertal timing

AIM

The aim of this research is to assess the associations between subjective pubertal timing (SPT) and onset of health-compromising behaviours among girls reporting an on-time objective pubertal timing (OPT).

METHODS

Data were drawn from the Swiss SMASH 2002 survey, a self-administered questionnaire study conducted among a nationally representative sample of 7548 adolescents aged 16-20 years. From the 3658 girls in the initial sample, we selected only those (n = 1003) who provided information about SPT and who reported the average age at menarche, namely 13, considering this as an on-time OPT. Bivariate and logistic analyses were conducted to compare the early, on-time and late SPT groups in terms of onset of health-compromising behaviours.

RESULTS

A perception of pubertal precocity was associated with sexual intercourse before age 16 [adjusted odds ratio (AOR): 2.10 (1.30-3.37)] and early use of illegal drugs other than cannabis [AOR: 2.55 (1.30-5.02)]. Conversely, girls perceiving their puberty as late were less likely to report intercourse before age 16 [AOR: 0.30 (0.12-0.75)].

CONCLUSION

Faced with an adolescent girl perceiving her puberty as early, the practitioner should investigate the existence of health-compromising behaviours even if her puberty is or was objectively on-time.

Sexual and reproductive health communication between mothers and their adolescent daughters in northern Nigeria

We employed structured interviews and focus groups to investigate reproductive health (RH) communication practices among 184 mother-daughter pairs in Ungogo, northern Nigeria. Transcripts were analyzed using the grounded theory approach. A total of 136 mothers reported discussing RH issues with their daughters. The majority of daughters acquired RH education from their mothers. Parents were more likely to discuss marriage, menstruation, courtship, premarital sex, and sexually transmitted infections (STIs) than other sex education topics. Mothers in northern Nigeria need to be empowered with knowledge and skills to improve the scope and quality of home-based RH education.

Young women's adolescent experiences of oral sex: relation of age of initiation to sexual motivation, sexual coercion, and psychological functioning

Research examining oral sex during adolescence tends to investigate only potential negative consequences without considering its place in sexual development or distinctions between cunnilingus and fellatio. Using retrospective reports from 418 undergraduate women, we examined the relations among young women's ages of initiation of both cunnilingus and fellatio and sexual motives, experiences of sexual coercion, and indicators of psychological functioning. Age at cunnilingus initiation was unrelated to sexual coercion or psychological functioning; however it was related to engaging in sex for personal stimulation and gratification (personal drive motive) and to feel agentic, assertive, and skillful (power motive). Age at fellatio initiation was related to feelings of inferiority compared to others and a devaluing of the self (interpersonal sensitivity). Findings challenge the unilateral assumption that all adolescent sexual activity is negative and indicate the need for future research distinguishing between cunnilingus and fellatio.

Obstetrician-gynecologists' beliefs about safe-sex and abstinence counseling

OBJECTIVE

To examine obstetrician-gynecologists' beliefs about safe-sex and abstinence counseling.

METHODS

Between October 2008 and January 2009, a survey was mailed to a national randomized sample of 1800 practicing US obstetrician-gynecologists. Study variables were agreement with 2 statements. (1) "If physicians counsel patients about safe-sex practices, the patients will be less likely to engage in risky sexual behaviors". (2) "If physicians counsel patients about abstinence, the patients will be much less likely to engage in sexual activity". Covariates included demographic, clinical, and religious characteristics of the physician.

RESULTS

The response rate was 66% (1154/1760 eligible physicians). Most respondents somewhat (62%) or strongly (25%) agreed that counseling patients about safe-sex practices makes patients less likely to engage in risky sexual behaviors. Fewer agreed strongly (3%) or somewhat (28%) that counseling patients about abstinence makes patients less likely to engage in sexual activity. The belief that safe-sex counseling reduces risky behaviors was less common among males (odds ratio [OR] 0.6) and more common among immigrants (OR 2.0). Religious physicians were more likely to believe that abstinence counseling reduces sexual activity (OR 2.2-5.3).

CONCLUSIONS

Most obstetrician-gynecologists believed that counseling about safe sex is effective, and a significant minority endorsed abstinence counseling.

Why don't smart teens have sex? A behavioral genetic approach

Academic achievement and cognitive ability have been shown to predict later age at first sexual intercourse. Using a sample of 536 same-sex twin pairs who were followed longitudinally from adolescence to early adulthood, this study tested whether relations between intelligence, academic achievement, and age at first sex were due to unmeasured genetic and environmental differences between families. Twins who differed in their intelligence or their academic achievement did not differ in their age at first sex. Rather, the association between intelligence and age at first sex could be attributed entirely to unmeasured environmental differences between families, whereas the association between academic achievement and age at first sex could be attributed entirely to genetic factors.

Virginity lost, satisfaction gained? Physiological and psychological sexual satisfaction at heterosexual debut

Despite the literature's focus on (hetero)sexual initiation, little is known about the degree to which young people are satisfied by their first vaginal intercourse experience, let alone the factors that predict satisfaction. This study analyzed data from a cross-sectional survey of 1,986 non-Hispanic White and Black 18- to 25-year-old respondents from four university campuses. Respondents were asked to rate the degree to which their first vaginal intercourse was physiologically and psychologically satisfying. Both Black and White women were significantly less likely than Black and White men to experience considerable or extreme satisfaction at first vaginal intercourse, particularly physiological satisfaction. Among all four gender-race groups, being in a committed relationship with one's sexual partner greatly increased psychological satisfaction, particularly among women. Experiencing less guilt at first sexual intercourse was also strongly associated with psychological satisfaction for women. Developing sexual relationships with partners they care for and trust will foster satisfaction among young people at first vaginal intercourse. These findings highlight strong gender asymmetry in affective sexual experience.

Predictors of sexual debut at age 16 or younger

The present study examined the extent to which variables within the self system (i.e., symptoms of alcohol dependence and conduct disorder, gender, race, and metropolitan status) and the familial system (i.e., having an alcohol dependent biological parent or second-degree relative, religious background, educational background of parents, and being born to a teenage mother) were associated with sexual debut at 16 years old or earlier. Participants were 1,054 biological relatives, aged 18-25 years, of alcohol dependent probands who participated in the Collaborative Study on the Genetics of Alcoholism project. Comparison participants (N = 234) without alcohol dependent biological parents were also evaluated. Clinical and sociodemographic variables were assessed by structured, personal interviews. Parental history of alcohol dependence was evaluated by direct interview of parents in most cases and family history in uninterviewed parents. In a multivariate survival analysis, increased risk of becoming sexually active at 16 years of age or earlier was significantly associated with 6 of the 10 predictor variables, including race, one or more alcohol dependence symptoms, and/or one or more conduct disorder symptoms. Having an alcohol dependent biological parent or second-degree relative (e.g., aunt, uncle, or grandparent), educational background of mother, and being born to a teenage mother were also significantly associated with increased risk. These results provide evidence that specific variables in the self and familial systems of influence are important in predicting sexual debut at 16 years old or earlier.

African-American adolescent girls' initiation of sexual activity: survival analysis

PURPOSE

African-American adolescent females tend to initiate participation in sexual activity at an earlier age than Caucasian adolescent females. Early initial participation in sexual activity is associated with increased risk of HIV infection. However, limited prospective data are available on the rate at which African-American adolescent females delay their initial participation in sexual activity. The purpose is to determine low-income, inner-city, African-American adolescent females' survival or continued nonparticipation in sexual activity over a 20-month period and to determine predictors associated with survival.

METHODS

A longitudinal, quasi-experimental research design with multiple data collection points was used. The convenience sample consisted of 396 African-American females with a mean age of 12.4 years (SD = 1.1 years) and their mothers. The adolescents completed questionnaires assessing perceptions of maternal monitoring, HIV transmission knowledge, self-efficacy to refuse sex, intention to refuse sex, and age. Their mothers completed questionnaires assessing perception of maternal monitoring, safer sex self-efficacy, marital status, and educational level. At baseline, the adolescents reported nonparticipation in sexual activity. Survival analysis was conducted to determine the timing and predictors of sexual activity initiation for these adolescents.

FINDINGS

Of the 396 adolescents, 28.5% did not survive; they participated in sexual activity within the 20-month period. Predictors of non-survival were the adolescents' age, perception of maternal monitoring, and intention to refuse sex.

CONCLUSION

Findings suggest interventions that increase maternal monitoring and adolescents' intentions to refuse sex could be beneficial in delaying sexual activity.

Connectedness as a predictor of sexual and reproductive health outcomes for youth

To review research examining the influence of "connectedness" on adolescent sexual and reproductive health (ASRH). Connectedness, or bonding, refers to the emotional attachment and commitment a child makes to social relationships in the family, peer group, school, community, or culture. A systematic review of behavioral research (1985-2007) was conducted. Inclusion criteria included examination of the association between a connectedness sub-construct and an ASRH outcome, use of multivariate analyses, sample size of >or=100, and publication in a peer-reviewed journal. Results were coded as protective, risk, or no association, and as longitudinal, or cross sectional. Findings from at least two longitudinal studies for a given outcome with consistent associations were considered sufficient evidence for a protective or risk association. Eight connectedness sub-constructs were reviewed: family connectedness (90 studies), parent-adolescent general communication (16 studies), parent-adolescent sexuality communication (58 studies), parental monitoring (61 studies), peer connectedness (nine studies), partner connectedness (12 studies), school connectedness (18 studies), and community connectedness (four studies). There was sufficient evidence to support a protective association with ASRH outcomes for family connectedness, general and sexuality-specific parent-adolescent communication, parental monitoring, partner connectedness, and school connectedness. Sufficient evidence of a risk association was identified for the parent overcontrol sub-construct of parental monitoring. Connectedness can be a protective factor for ASRH outcomes, and efforts to strengthen young people's pro-social relationships are a promising target for approaches to promote ASRH. Further study regarding specific sub-constructs as well as their combined influence is needed.

Sexual motivation in women as a function of age

INTRODUCTION

Women's motivations to engage in sex are likely influenced by their past sexual experiences, the type of relationship in which they are involved in, and numerous lifestyle factors such as career and family demands. The influences of these factors undoubtedly change as women age.

AIM

This study aimed to examine potential differences in sexual motivation between three distinct age groups of premenopausal women.

METHODS

Women aged 18-22 years (N = 137), 23-30 years (N = 103), and 31-45 years (N = 87) completed an online survey that assessed the proportion with which they had engaged in sexual intercourse for each of 140 distinct reasons.

MAIN OUTCOME MEASURES

The YSEX? Questionnaire by Meston and Buss [1] was used to measure sexual motivation. The items of this questionnaire were composed of four primary sexual motivation factors (physical, goal attainment, emotional, insecurity), and 13 subfactors.

RESULTS

Women aged 31-45 years reported a higher proportion of engaging in sex compared with one or both of the younger age groups of women for nine of the 13 YSEX? subfactors: stress reduction, physical desirability, experience seeking, resources, social status, revenge, expression, self-esteem boost, and mate guarding. At an item level, the top 25 reasons for having sex were virtually identical across age groups.

CONCLUSION

Women aged 31-45 have more motives for engaging in sex than do women aged 18-30, but the primary reasons for engaging in sex do not differ within this age range. Women aged 18-45 have sex primarily for pleasure, and love and commitment. The implications for diagnosis and treatment of women with sexual dysfunctions were discussed.

Dating, sex, and substance use predict increases in adolescents' subjective age across two years

This study examined the nature of the relationship between adolescents' subjective age (how old they feel) and chronological age, and explored whether dating, sex, and substance use predicted increases in adolescents' subjective age across a two-year period. The participants were 570 adolescents who were interviewed when they were first ages 12—19 and again two years later (ages 14—21). Results were that a quadratic function characterized the relationship between chronological and subjective age: subjective age increased from age 14 to 18.25 years, and then declined. Adolescents who dated, reported having sex, used alcohol, and used drugs at time 1 experienced an increased subjective age, that is, they felt older than less experienced adolescents by time 2. An older subjective age at time 1 did not predict increases in dating, sex, and substance use behaviors, with one exception: smoking. The results are consistent with theories assuming that self-perceptions of maturity may arise from engaging in “adult-like” behaviors.

Perceptions and experiences of first sexual intercourse in Australian adolescent females

PURPOSE

To better understand the factors that influence the initiation of first intercourse among adolescent females and to explore the context in which this occurs.

METHODS

A purposive sample of sexually active female teenagers aged between 14 and 19 years were recruited from sexual and reproductive health clinics across the Perth metropolitan area. Sixty-eight in-depth, semistructured interviews were conducted. Thematic analysis was employed to analyze the narrative data. Meanings and interpretations that emerged were constantly verified through subsequent inquiry.

RESULTS

The degree of personal control over the factors that led to their first experience of intercourse determined how teenagers reflected upon the experience. Those who were "ready" were more likely to have delayed intercourse until they were comfortable with both when and with whom this occurred. In contrast, conforming to peer norms, coercion from sexual partners and being intoxicated were common reasons for premature and unwanted first experience of sexual intercourse.

CONCLUSIONS

The explorative approach used in this study deepens current understanding of the factors influencing and associated with intercourse initiation, and how these reflect different aspects of adolescent development. In particular, the role of young peoples' sociocultural environment, including peer interaction and alcohol intoxication, alongside pressure from sexual partners in premature and unwanted sexual activity may assist in informing educational interventions of greater personal relevance and impact.

The effects of family structure, parent-child relationship and parental monitoring on early sexual behaviour among adolescents in nine European countries

AIMS

To identify the influence of family structure, parent-child relationship and parental monitoring on adolescents' involvement in early sexual behaviour.

METHODS

The study was undertaken in the context of the World Health Organization collaborative Health Behaviour in School-Aged Children study. The representative samples were drawn from 10 European countries. A group of 14,287 (6716 boys and 7571 girls) 15-year-olds was surveyed. The data were collected by standardized questionnaires. Adolescents were asked about sexual behaviour, family structure, parent-child communication, and parental control. A logistic regression analysis was applied to assess the impact of determinants.

RESULTS

Greenlandic adolescents were predominantly engaged in early sexual behaviour. Intact family was a key protective factor for adolescents' early sexual behaviour. It significantly decreased both boys' and girls' involvement in early sexual behaviour. Close parent-adolescent relationships and a high level of parental monitoring were found to be less protective factors than family structure. Easy communication with parents, especially with the mother, was more significant for girls' than for boys' early sexual behaviour. A low level of maternal monitoring had a higher impact on boys' early sexual behaviour, while a low level of paternal monitoring had a higher impact on girls. For both maternal and paternal monitoring, the strongest relationship was observed among Hungarian adolescents, but among Greenlanders it was not statistically significant.

CONCLUSIONS

Many 15-year-olds in European countries are engaged in early sexual behaviour. A close parent- child relationship and a high level of parental monitoring are not as important for adolescents' early sexual behaviour as an intact family.

Uptake of HPV vaccine: demographics, sexual history and values, parenting style, and vaccine attitudes

PURPOSE

To examine the relationships of demographics, parenting, and vaccine attitudes with the acceptance of the human papillomavirus (HPV) vaccine or to the intent to vaccinate in the next 12 months.

METHODS

Mothers (n = 153) with daughters ages 11 to 17 years were recruited through the pediatric clinic waiting room/announcements to complete a questionnaire.

RESULTS

Eighteen percent of the daughters had not received the vaccine, although it had been offered; 34% had not been offered the vaccine and did not intend to get it in the next 12 months; 22% had not been offered the vaccine but intended to get it in the next 12 months; 26% had started vaccination or completed the series. In a multinomial, multivariable logistic regression model, those mothers who had less than a high school degree, had a history of a sexually transmitted infection, supervised their daughter more when she was with peers, and whose daughter would not mind three shots were more likely to be favorable about their daughter being vaccinated. The following variables were not related to their attitudes about getting the vaccine: mothers' and daughters' ages, race/ethnicity, mothers' self-reported history of HPV disease and age of sexual initiation, daughters' dating status and anticipated age of sexual initiation, the number of sexual topics discussed and level of comfort, mother's sexual values, and the family environment.

CONCLUSIONS

Mothers' decisions about the HPV vaccine were not related to their sexual values or their daughters' sexual behavior, but rather their parenting, sense of vulnerability, and vaccine attitudes. Mothers who were not planning to vaccinate did not appear to not feel an urgency given the newness of the vaccine, and many planned to vaccinate eventually.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Reasons why adolescents and young adults have sex: associations with psychological characteristics and sexual behavior

This study examined associations of psychological characteristics and sexual behavior with types of reasons for episodes of sexual intercourse among youth. After completing a baseline assessment, 62 adolescents (47 female) used a handheld computer to report when they had sex as soon as possible after the event as well as in response to random signals. Youth indicated for each sex event the main reason, categorized as intimacy/desire, external, affect management, and other; analyses were restricted to sex with a main partner (234 events). Baseline sexual behavior was not related to reasons for sex. Higher anxiety was associated with external reasons for sex; younger age and lower self-esteem were associated with affect management reasons. Female youth with higher impulsiveness reported more external reasons and fewer intimacy/desire reasons. Among male youth, lower self-esteem was associated with intimacy/desire reasons, but lower depression was associated with affect management reasons. These findings may aid health care providers and researchers in understanding the differences in young people's motivations for sex.

Recent and past intimate partner abuse and HIV risk among young women

OBJECTIVE

To examine the associations between past intimate partner abuse experienced during adolescence (verbal and physical), recent intimate partner abuse (verbal, physical, and sexual), and HIV risk (as indicated by lack of condom use) for sexually active young adult women in relationships with male partners.

DESIGN

Secondary data analysis of waves II and III of the National Longitudinal Study of Adolescent Health (Add Health).

SETTING

The Add Health Study is a longitudinal, in-home survey of a nationally representative sample of adolescents.

SAMPLE

Analyses involved 2,058 sexually active young adult women.

MAIN OUTCOME MEASURES

HIV risk was measured by consistent condom use over the past 12 months.

RESULTS

Physical and verbal abuse experienced in adolescence were associated with physical/verbal abuse experienced in young adulthood. Young, sexually active women experiencing no abuse in their relationships were more likely to consistently use condoms in the past 12 months than were their abused counterparts.

CONCLUSION

A causal pathway may exist between prior abuse, current abuse, and HIV risk.

Adolescent girls' communication with partners about microbicide use

BACKGROUND

Topical microbicides could be a female-controlled method of preventing sexually transmissible infections. Despite the possibility of surreptitious use, most women report that they would tell partners, and microbicides may be detectable. The purpose of the present study was to examine communication between adolescent girls and their partners regarding microbicides.

METHODS

Girls (aged 14-21 years) participated in a 6-month study in which they were given vaginal moisturisers to use when they had intercourse. Data was collected about their demographics, sexual histories and conversations with mothers and partners. Both quantitative and qualitative analyses were conducted.

RESULTS

Girls (n = 171) were asked about conversations with their partners. Talking with mothers and using the product were significantly related to talking with partners. Reasons for not talking were intrapersonal or interpersonal variables, the context of the relationship did not warrant an explanation and the lack of a decision to communicate. There seemed to be no difference in conversations for those who used or did not use. Girls had conversations with their partners when deciding to be in the study, when they were engaged in study activities or when deciding to use the product. Conversations about using the product focused on needing to use the product because of study demands, the lubricating properties or wanting to experience product use.

CONCLUSIONS

Most of the girls talked to their partners and had positive conversations. Girls may need help initiating conversations and managing reluctant partners.

Interpersonal and personal factors influencing sexual debut among Mexican-American young women in the United States

PURPOSE

The purpose of this study is to better understand factors influencing the age of sexual initiation among Latina youth.

METHODS

Prior qualitative research with young women from the target population and the existing literature determined the theoretical framework for this study. A quantitative instrument was then developed and pre-tested. We enrolled a convenience sample of predominantly Mexican-American adolescent and young adult women from the west side of Chicago. A total of 271 participants were included in the analysis. Bi-variate and multivariable analyses were conducted to determine factors associated with age of first sexual intercourse.

RESULTS

We found that personal, family, and peer/partner related factors influence the sexual decision making of these young women. Strong family expectations regarding educational attainment, negative parental messages about premarital sex and pregnancy, resistance to the influence of peers and partners, greater sense of personal control over sexual behaviors, preference for speaking Spanish, and small age difference between the young woman and her first sexual partner were all positively associated with age of sexual initiation. Among these, greater sense of personal control over behaviors was the strongest factor influencing age of sexual initiation.

CONCLUSIONS

This study provides a model that can be used to better understand Latina sexual decision making. Our findings might also inform future programs for Latinas, as they suggest that increasing girls' feelings of personal control over decisions regarding sexual debut and helping Latino parents to communicate strong messages about educational achievement, pregnancy, and sexuality may lead to positive health behaviors.

More than just vaginal intercourse: anal intercourse and condom use patterns in the context of "main" and "casual" sexual relationships among urban minority adolescent females

PURPOSE

Receptive anal intercourse has long been recognized as a risk factor for the transmission of HIV and STIs. Most HIV/STI prevention messages continue to emphasize penile-vaginal transmission, so many teens do not recognize anal intercourse as risky sexual behavior. This purpose of this study was to determine the prevalence of anal intercourse, and to describe the relationship between types of sexual relationships (main vs. casual), types of sexual behaviors (vaginal vs. anal sex), and types of contraception used among inner-city sexually experienced adolescents.

METHODS

Reproductive health histories were obtained from 350 sexually experienced adolescent females aged 12-18 years participating in a 5-year STI acquisition study at an urban health center. Baseline sexual behavior data was analyzed and described using frequencies, percentages and chi-square tests.

RESULTS

41% of teens and 86.5% of teens reported engaging in sexual activity with casual and main partners respectively. Sixteen percent of teens with main partners and 12% of those with casual partners engaged in receptive anal intercourse (P = 0.31). Condom use is more prevalent for both vaginal (61% vs. 32.4%, P < or = 0.0001) and anal (47.1% vs. 21.3%, P = 0.0428) intercourse in the context of casual as compared to main sexual relationships. Teens involved in a casual relationship were more likely to use anal intercourse as a form of contraception (41.2% vs. 8.5%, P = 0.0022).

CONCLUSION

It is imperative that health care providers recognize that adolescents engage in anal sex, specifically inquire about their types of sexual behavior and types of sexual relationships so that anticipatory guidance regarding HIV/STI transmission risk reduction education can be tailored to meet their needs.

Advancing biocultural models by working with communities: a partnership approach

Culture and human behavior are recognized today as major forces acting on human biological variation around the world. Studies of the relationships between biology and processes, such as modernization, urbanization, and social stratification, are prominent in our journals and meetings. An ongoing study of the interrelationships between toxicant exposure (organochlorines, lead, and mercury), health, and culture among youth of the Mohawk Nation at Akwesasne is located within this context and is used to analyze the strengths and challenges of a partnership approach to biocultural research. To assist in modeling the complex relationships between health, behavior, and culture, we have employed concepts from contemporary social theory, integrated qualitative and quantitative research, and implemented community-based research principles to develop a partnership approach to research in human biology. The community is directly involved in identifying research goals, developing research protocols appropriate for local cultural sensitivities and complexities, implementing the protocols in the field, and collaborating in the analysis and publication of results. We show the utility of this approach for understanding the relationships of toxicants to behavior and biological outcomes (adolescent growth, sexual maturation, and endocrine system alteration); as well as how it facilitates the agency of participants and communities involved in research, and brings greater social engagement to the development of the new human biology.

Predictors of adolescent sexual behavior and intention: a theory-guided systematic review

PURPOSE

To better understand why adolescents initiate sexual activity at early ages, we conducted a systematic literature review guided by eight key elements outlined in an integrative theoretical framework.

METHODS

Using the matrix method for literature reviews, we extracted-from 69 published studies-statistically significant and nonsignificant findings (related to the attempted prediction/explanation of adolescents' sexual behavior and intention) and organized them using the various integrative model elements. We also assessed these publications' methodological quality including each study's deployment of theory, appropriate design, and data analytic/reporting techniques.

RESULTS

Three integrative theoretical framework elements-intention, perceived norms, and an environmental constraint variable, time home alone-emerged as stable predictors of sexual behavior outcomes in this body of literature. This analysis revealed, however, a literature that has remained rather stagnant regarding its methodological quality, over time.

CONCLUSIONS

Implications for adolescent sexual health promotion practice and research are discussed.

Adolescent girls' communication with "mothers" about topical microbicides

STUDY OBJECTIVE

Topical microbicides, a female-initiated method to protect against sexually transmitted infections (STI) and pregnancy, will only be effective if found acceptable. Mothers may have an influence on acceptability and use among adolescent girls. The current study examined the communication between girls and mothers to understand the potential predictors and nature of conversations regarding surrogate microbicide products.

DESIGN

Sexually experienced girls, 14 to 21 years, were recruited for a 6-month study examining microbicide acceptability. During face-to-face interviews, qualitative data were collected regarding communication between girls and mothers. Two independent raters coded the responses, which were organized into themes. Themes were interpreted according to the conceptual understanding of mother-daughter communication.

RESULTS

Fifty percent of the 171 girls with codable responses had a conversation with their mother. Higher levels of indirect parental monitoring were related to being more likely to have a conversation. Concrete events related to the study (i.e. receiving phone call from the researcher, having an appointment, or seeing the product) or inquiries by mothers appeared to promote conversation. Barriers to conversation included the private nature of the information and relationship issues between the mother and daughter. Conversations often addressed issues related to girls' participation in the study, although some conversations included global issues related to sexuality.

CONCLUSIONS

Girls may talk to their mothers about new products for STI prevention, and such conversations may provide opportunities to promote use.

Stages of sexual readiness and six-month stage progression among African American pre-teens

We examined the range of sexual intentions and behaviors preceding sexual initiation among 211 African-American pre-teens assigned to the control arm of a longitudinal community-based intervention trial. Stage of sexual readiness was assessed using the stage of change construct from the Transtheoretical Model, and patterns of stage movement during a 6-month period were examined. Overall, 90% of participants were in precontemplation at baseline, with the proportion of participants in this stage declining with each year of age. There was substantial stability in stage of sexual readiness during the 6-month period (87% stable). While definitive conclusions regarding exact patterns of movement are not yet possible, stage movement does not appear to be linear for all pre-teens, and there is evidence of both stage progression and regression. We present emerging patterns of stage movement, which suggest potential variation by age, gender, and baseline stage, and discuss potential implications.

Risk factors for unintended versus intended rapid repeat pregnancies among adolescents

PURPOSE

Whereas previous research has elucidated a number of risk factors for rapid repeat pregnancies among adolescents, we sought to assess both established and hypothetical risk factors in the context of the intendedness of the repeat pregnancy.

METHODS

The study population, drawn from the 2002 National Survey of Family Growth (NSFG), consisting of women who experienced at least one pregnancy as an adolescent, were interviewed at least 24 months since that pregnancy's resolution and were aged 30 years and younger at the time of the NSFG interview. To evaluate the effect of various predictor variables on the intendedness of a rapid repeat pregnancy, we constructed a polytomous multiple logistic regression model. Outcomes are reported as ratios of odds ratios (ROR) and were calculated using women experiencing an adolescent pregnancy, but not a rapid repeat pregnancy, as the reference group.

RESULTS

In the 2002 NSFG, 34% of the adolescents experiencing a rapid repeat pregnancy reported such pregnancies to be intended. Although young age (< or = 15 years) at first conception was associated with a decreased likelihood of an unintended rapid repeat pregnancy, racial/ethnic characteristics as well as characteristics of the teen's mother (educational status and young age of the teen's mother at first birth) were not associated with either intended or unintended rapid repeat pregnancies. Factors found to be associated with an increased likelihood of having an intended repeat pregnancy included an intended first pregnancy, prior poor obstetrical outcome, and having the repeat pregnancy intended by the teen's partner. Being married at the time of second conception was associated with a decreased likelihood of an unintended rapid repeat pregnancy.

CONCLUSIONS

Consideration of the intendedness of repeat pregnancies among teenagers could help create more appropriate and effective family planning interventions.

Increased condom use at sexual debut in the general population of Slovenia and association with subsequent condom use

OBJECTIVES

To describe the extent of condom use at first heterosexual intercourse (FHI) in the general population of Slovenia, identify associated factors and assess the association with subsequent use.

DESIGN

Cross-sectional survey comprising the first Slovenian National Survey of Sexual Lifestyles, Attitudes and Health.

METHODS

Data were collected during 1999-2001 from a probability sample of the general population aged 18-49 years. Statistical methods for complex survey data were used to carry out weighted analyses.

RESULTS

Condom use at FHI was reported by 23.6% of men and 21.3% of women. The more recently they experienced FHI, the more likely respondents were to report condom use (71.7% of men; 63.8% of women with FHI during 1995-1999). Men with FHI at age 18 or older and those with higher levels of education were more likely to use a condom and those who lost control (because drunk or carried away by feelings) less likely. Men seem to have more control over condom use at FHI than women. Sexually active men and women who used condom at FHI were 11 and 2.5 times more likely to consistently use condoms during the month preceding the interview.

CONCLUSIONS

Currently, the majority of Slovenian men and women use protection against HIV, other sexually transmitted infections, and unplanned conception at FHI. The steep increase over time in condom use at FHI suggests that HIV-related condom use promotion has had an impact on preventive behaviours and should be sustained, especially since condom use at FHI predicts subsequent use.

Tailoring STI & HIV Prevention Programs for Teens

Successful HIV/sexually transmitted infection (STI) prevention programs are not "one size fits all." To effectively meet the HIV/STI prevention needs of all adolescents, programs should be developmentally and gender specific, should integrate an understanding of racial/ethnic culture, and should be open to variations in sexual expression. Nurse researchers have demonstrated the importance of these differences in programs, and this article offers concrete suggestions for ways to apply this knowledge in community programs.

Young adolescents' perceptions of peer sexual behaviours: the role of television viewing

OBJECTIVE

To investigate whether young adolescents' perceptions of peers' sexual activity is related to the amount of television viewing, and whether this relationship may be moderated by young adolescents' pubertal development.

METHODS

This study used a sample of 12- and a sample of 15-year-olds; 2127 respondents in a targeted sample of nine schools in Flanders (the Dutch-speaking part of Belgium), completed a questionnaire with questions about their television viewing behaviour, the estimated prevalence of given sexual activities in peers, and self-reports on pubertal development and sexual experience.

RESULTS

In the sample of 12-year-olds, results demonstrated that a quadratic regression equation provides the best description for the relationship between television viewing and perceptions of peer sexual behaviours, indicating that the 'effect' of television only starts off after a level of about 45 h of television viewing per week. Further exploration showed that this relationship remains significant when controlling for gender and sexual experience, and is stronger at more advanced levels of pubertal development. In the sample of 15-year-olds, linear and unmoderated relationships were found. Irrespective of their pubertal status, gender, or level of sexual experience, television viewing is related to higher expectations of peers' sexual activities.

CONCLUSION

Concerns about the impact of television viewing on sexual health should not be limited to older adolescents. This research has identified 12-year-olds who display a higher level of pubertal development and generally spend much time with television viewing as a category of viewers-at-risk.

Managing the sexually transmitted disease pandemic: a time for reevaluation

The serious implications of the sexually transmitted disease (STD) pandemic that currently challenges educators, medical practitioners and governments suggest that prevention strategies, which primarily focus on barrier protection and the management of infection, must be reevaluated and that initiatives focusing on primary prevention of behaviors predisposing individuals to STD risk must be adopted. Human immunodeficiency virus/acquired immunodeficiency syndrome, human papillomavirus, genital herpes, and Chlamydia are used to illustrate the pervasive presence of STDs and their serious consequences for individuals and national infrastructures. Long-term sequelae are discussed, including the emerging link between various sexually transmitted infections and cancer, and the psychosexual and psychosocial factors which impact infected individuals. Although risk reduction and treatment of existing infection is critical, the promotion of optimal life-long health can be achieved most effectively through delayed sexual debut, partner reduction, and the avoidance of risky sexual behaviors.

Family socioeconomic status and self-reported sexually transmitted diseases among black and white american adolescents

OBJECTIVE

The objective of this study was to assess associations between socioeconomic status (SES) and adolescent sexually transmitted diseases (STDs) stratified by race and gender.

STUDY

In cross-sectional analyses of the National Longitudinal Study of Adolescent Health Wave One (1995), unadjusted and adjusted associations between 4 family SES indicators and STD reports for black and white 7th through 12th graders were examined.

RESULTS

Lower maternal education and nonprofessional maternal occupations were associated with higher STD reports in all groups except white females. Generally, STD reports were higher for adolescents not living in 2-parent homes, and lower income was only associated for black males.

CONCLUSION

Overall, SES is only a weak to moderate marker for adolescent STD risks. The relationship of SES and STDs varies by the SES measure used and differs across race-gender groups. Other individual factors such as risk behaviors or community factors such as income inequality could play a more critical role for adolescent STDs than family SES.

Adolescent girls perceptions of the timing of their sexual initiation: "too young" or "just right"?

PURPOSE

To examine variables associated with adolescent girls' perceptions of the timing of their first consensual intercourse.

METHODS

One hundred seventy-four primarily African-American adolescent girls, aged 12 to 15 years participated in a 3-year longitudinal study of psychosexual development. Seventy-three percent reported being sexually experienced by the end of the study. They were asked whether they believed their age of initiation was "too young," "too old," or "just right." A generalized estimating equation (GEE) model was used to evaluate predictors of perception of timing of first consensual intercourse.

RESULTS

Ninety-nine (78%) said that they were "too young" and 28 (22%) said that their age had been "just right." The results of the final GEE model indicated that variables associated with perceiving age of first consensual intercourse as "just right" included younger chronological age, an older age of first consensual intercourse, endorsement of being "in love" as a reason for first consensual intercourse, greater indirect parental monitoring (vs. "none" or "direct parental monitoring"), and a higher level of education for mothers.

CONCLUSIONS

Most of these adolescents thought their age of initiation was too young. Factors associated with perceiving the timing of consensual intercourse as "just right" are similar to those reported in the literature to be associated with delaying the initiation of consensual intercourse.

Improving adolescent sexual and reproductive health. A view from Australia: learning from world's best practice

There is increasing awareness worldwide of the importance of sexual and reproductive health in adolescents. Australia's high rates of teenage pregnancy and increasing rates of sexually transmitted infections in young people reflect a failure to prioritise adolescent sexual and reproductive health on the public health agenda. This paper reviews adolescent sexual and reproductive health in Australia in comparison with international data, and examines the systemic, social and cultural factors that influence it. Based on comparisons with international best practice, recommendations are included for improvement in adolescent sexual and reproductive health within the Australian context.

Adolescent sexuality and sexual behavior

PURPOSE OF REVIEW

Adolescence is a time of self-discovery and physical, as well as cognitive, development. It is within this context that adolescent sexual development and sexual behavior occur. While curiosity and experimentation are normal, sexual behaviors, both coital and non-coital, place adolescents at risk for undesired consequences including sexually transmitted disease acquisition and pregnancy. Trends in adolescent sexual behavior are changing, and health care professionals must be aware of these trends to provide necessary medical care and education to this population.

RECENT FINDINGS

While the sexual activity of teenagers garners much attention, attention must also be directed at non-coital activities such as masturbation, mutual masturbation and oral sex, as the riskier of these behaviors appear to be increasing. The trends in sexual activity and contraceptive use are encouraging with a decrease in the proportion of adolescents reporting sexual activity, and an increase in the proportion reporting using contraception. These trends, however, are not shared equally among racial groups with the greatest decline reported in the in lowest risk groups. Sexual minority youth continue to report a higher prevalence of high-risk behaviors, both sexual and non-sexual, as compared to their heterosexual peers.

SUMMARY

These findings highlight the multiple roles health care professionals can play in caring for this unique population: firstly as health care providers, offering age appropriate, confidential health care; secondly, as reproductive health care educators providing factual, balanced, and realistic information to both teenagers and the community; and thirdly, as advocates lobbying for greater education and services for this at-risk population.