Sexual intercourse, age of initiation and contraception among adolescents in Ireland: findings from the Health Behaviour in School-aged Children (HBSC) Ireland study

Use of contraception during first sexual intercourse among Norwegian adolescents: a national cross-sectional study

BACKGROUND

Most Norwegian adolescents experience their first sexual intercourse during late adolescence. Use of contraception is important to avoid unwanted pregnancy, while condoms can also protect against sexually transmitted diseases. There are few studies on the use of contraception at first sexual intercourse, most with varying results, and some studies have only examined the use of contraception among girls. In our study, we aimed to determine the use of contraception at first sexual intercourse, and to investigate associations between use of contraceptives at first sexual intercourse, sociodemographic factors, and alcohol and other substance use.

METHODS

The study was based on data from the national electronic youth survey Ungdata, conducted in 2020-2022 among 113 049 upper secondary pupils (15-19 years) in Norway, which was around 65% of pupils attending upper secondary school during the study period. Descriptive analysis was used to estimate the prevalence of contraceptive use at first sexual intercourse, and multivariate logistic regression analyses to investigate the association between contraceptive use, sociodemographic factors, and alcohol intoxication and substance use.

RESULT

32% of Norwegian adolescents did not use contraception at first sexual intercourse. More girls (57.4%) than boys (42.6%) reported use of contraception. Factors associated with non-use of contraception during first sexual intercourse among boys were having parents with no college /university education (OR = 1.22: CI 1.13-1.32), perceived poor family finances (OR = 1.22: CI 1.06-1.40), alcohol intoxication, and use of cannabis or other narcotic substances during the past 12 months. The same factors were associated with non-use of contraception among girls. Additionally, being older than 16 years (OR = 1.13: CI 1.06-1.19) was also associated with non-use of contraception at first sexual intercourse.

CONCLUSION

Many adolescents did not use contraception at first sexual intercourse. Alcohol intoxication and use of cannabis or other narcotic substances were associated with a lower likelihood of using contraceptives. This highlights the importance of preventive efforts including earlier prevention education that focuses more on the consequences of not using contraception in order to prevent unwanted pregnancies and sexually transmitted infections.

Sexting in Young Adults: A Normative Sexual Behavior

With the advancement of technology, sexting has become more prominent in high school and university samples. The current study examined the rates and characteristics of sexting among an online sample of 2,828 young adults aged 18-30, primarily from the U.S. and Canada. We found that most participants sext (81%), sext often (most report ≥ 11 sexts), and start young (most by 16-17 years of age). Common reasons for sexting echoed reasons for participating in other normative sexual behaviors, including that it was sexually arousing, they were asked and wanted to reciprocate, or they wanted to flirt. Sexual coercion was a gendered phenomenon, with 1 in 10 cisgender women and 1 in 50 cisgender men reporting having sent a sext due to being threatened. The body parts captured in cisgender men's sexts were more diverse, whereas cisgender women focused on their chest, underwear/genitalia, and stomach. Sexual orientation was also found to be a relevant factor, with different patterns in sexting experiences emerging across identities. The current study adds to the mounting evidence that sexting is a normative sexual behavior. Sexual education programs should provide youth with information on consent and safe sexting practices rather than follow an abstinence approach.

Sexual well-being among young people in remote rural island communities in Scotland: a mixed methods study

BACKGROUND

It has been identified that rural young people face barriers to accessing support for their sexual well-being such as availability and transport, knowing healthcare staff personally, and fear of being judged negatively within their community. These factors may contribute to widening health inequalities and expose young people living in rural areas to increased risk of poor sexual well-being. Little is known about the current needs of adolescents residing in remote rural island communities (RRICs).

METHODS

A cross sectional mixed methods study was conducted with 473 adolescents aged 13-18 across the islands of the Outer Hebrides of Scotland. Analysis included descriptive, inferential statistics and thematic analysis.

RESULTS

59% (n=279) of participants held the perception there was no support, or did not know if there was support, about condoms and contraception in their local area. 48% (n=227) said that free condoms were not easily available for local young people. 60% (n=283) said they would not use youth services if they were locally available. 59% (n=279) said they did not receive enough relationships, sexual health and parenthood (RSHP) education. Opinion differed significantly by gender, school year group, and sexual orientation. Qualitative analysis identified three key themes: (1) alone yet visible, (2) silence and disapproval, and (3) safe spaces, with an underpinning theme of island cultures.

CONCLUSIONS

A need for further sexual well-being support that addresses the complexities and challenges for young people residing in RRICs is identified. The intersectionality of being LGBT+ and residing in this context may increase the experience of inequality in sexual well-being support.

Association between early sexual initiation and sexually transmitted infections among Peruvian reproductive-age women

Background

Sexually transmitted infections (STIs) are a serious public health problem worldwide, especially among reproductive-age women. The early sexual onset of sexual intercourse (EOSI) has been suggested as a risk factor, although there is no data at the national level.

Objective

To evaluate the association between EOSI and STIs in Peruvian women of childbearing age.

Methods

Analytical cross-sectional study with secondary data analyzes of the Peruvian Demographic and Family Health Survey 2018. The outcome was the presence of STIs in the last 12 months and the exposure variable was EOSI (age < 15 years at the time of their first sexual experience). To evaluate the association of interest, crude and adjusted prevalence ratios (aPRs) were calculated using generalized linear models with Poisson family and logarithmic link function.

Results

We analyzed data from 31,028 women of childbearing age. The 11.3% reported having STIs in the last 12 months and 20.2% of the participants had an EOSI. After adjusting for potential confounders, we found that EOSI was associated with STIs (aPR: 1.27; 95% CI: 1.08-1.50; p = 0.005). When conducting stratified analysis by area of residence and number of sexual partners, this association was maintained in women living in urban areas (aPR: 1.36; 95% CI: 1.11-1.66; p = 0.003) those who did not report having a history of multiple sexual partners (aPR: 1.27; 95% CI: 1.08-1.51; p = 0.005), and those in the middle (aPR: 1.42; 95% CI: 1.03-1.97; p = 0.034) and highest (aPR: 2.12; 95% CI: 1.33-3.39; p = 0.002) wealth quintiles.

Conclusion

Among reproductive-age women from Peru, EOSI was associated with STIs, especially in women living in urban areas, with no history of multiple sexual partners, and belonging to the middle to higher wealth index. The implementation of measures to prevent EOSI and fostering appropriate sexual health counseling for women with EOSI is advised.

Parenting and Courage: Exploring the Mediating Role of Self-esteem and Emotion Regulation among Adolescents

With adolescence being a period for potential challenges but also positive growth, courage can aid adolescents in rising to some of these challenges. Yet few studies have investigated predictors and mechanisms of courage. The present study examined how three parenting constructs (attachment, autonomy support, and helicopter parenting) predict courage and if self-esteem or emotion regulation serve as mediators. The present study assessed predictors at Time 1 and courage at one-year follow-up. The sample included 203 American adolescents (51.7% girls, 14-15 year olds). Results suggested that relations between several parental variables (anxious attachment to parents, avoidant attachment to fathers, autonomy support of parents) and adolescent courage were mediated by self-esteem. In addition, cognitive reappraisal mediated associations between two mother-related variables (avoidant attachment, helicopter parenting) and courage. Findings contribute to the limited empirical research on adolescents' development of courage.

Exposure to Pornography and Adolescent Sexual Behavior: Systematic Review

BACKGROUND

Formative experiences in adolescence lay the foundation for healthy and pleasurable romantic and sexual relationships. Exposure to pornography may affect these experiences.

OBJECTIVE

We aimed to synthesize evidence published in the past decade on the relationship between exposure to pornography and sexual behavior (earlier age of first sex [<16 years], condomless sex, past-year multiple partners [>1], lifetime multiple partners [>1], group sex, sexual aggression including forced sex, paid sex, teenage pregnancy, and history of sexually transmitted infection) in adolescents aged between 10 and 19 years.

METHODS

We identified 19 eligible studies by searching MEDLINE, PsycINFO, Cochrane, CINAHL, Embase, and Web of Science databases from January 2010 to November 2022.

RESULTS

Out of 8 studies that assessed earlier age of first sex, 5 studies, including 1 longitudinal study, found a statistically significant association with exposure to pornography. Given that most studies were cross-sectional or had substantial limitations, causal inference could not be made. Also, exposure to pornography was not measured consistently. The evidence was conflicting or insufficient to draw any conclusions regarding other outcomes.

CONCLUSIONS

More quantitative research is needed to elucidate the association between pornography exposure and sexual behavior, and sex education should adopt evidence-based approaches to minimize the potential harms from pornography.

TRIAL REGISTRATION

PROSPERO International Prospective Register of Systematic Reviews CRD42021227390; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=227390.

Investigating the relationship between high-risk behaviors and mental health in adolescents in Rabor city, Iran

OBJECTIVES

High-risk behaviors (HRBs) represent significant health threats for adolescents and significantly affect adolescents' mental health. Adolescents often engage in risky behaviors. The present study was conducted to investigate the relationship between high-risk behaviors (HRBs) and mental health in adolescents in Rabor.

CONTENT

The present study was a cross-sectional analytical study that was performed on 334 girl and boy students aged 12-18 years in Rabor city in 2021. In this study, adolescents answered high risk behaviors and mental health questionnaires. Data were analyzed using SPSS-26 software and the spearman correlation coefficient and linear regression analysis (univariate and multivariate analysis) were used to analyze the data.

SUMMARY AND OUTLOOK

In this study, the mean age was 15.25 ± 1.78. The findings indicate that smoking and hookah use were higher in boys than girls. Among the demographic variables, age and level of education had a positive and significant relationship with HRBs and mental health (p<0.05). The mean score of total mental health for all subjects was 12.83 ± 10.82. The variables of age, sex, marital status of parents, the number of children in the family, educational level, smoking, hookah, and alcohol have been determined as influential and facilitating factors in HRBs of adolescents. Father's literacy was considered as a facilitator and age variables, alcohol consumption and parents' marital status were considered as deterrents to mental health. The present study showed that the male gender is one of the risk factors for alcohol, smoking and other substances, the tendency to high-risk sexual behaviors, depression, and suicide in adolescents. Among the determinants of the tendency to HRBs in adolescents, psychological variables are of particular importance at the individual, social, and family levels. Good mental health can improve quality of life, while poor mental health can make it worse.

Relationship Between Alcohol Consumption and Risky Sexual Behaviors Among Adolescents and Young Adults: A Meta-Analysis

Objectives: Adolescents exposed to alcohol have increased risky sexual behaviors (RSBs); however, the association between alcohol consumption and RSBs has to be systematically and quantitatively reviewed. We conducted a meta-analysis of the literature to systematically and quantitatively review the association between alcohol consumption and RSBs in adolescents and young adults. Methods: We searched for qualified articles published from 2000 to 2020 and calculated pooled odds ratios (ORs) using the random-effect model. We also conducted meta-regression and sensitivity analyses to identify potential heterogeneity moderators. Results: The meta-analysis of 50 studies involving 465,595 adolescents and young adults indicated that alcohol consumption was significantly associated with early sexual initiation (OR = 1.958, 95% confidence interval (CI) = 1.635-2.346), inconsistent condom use (OR = 1.228, 95% CI = 1.114-1.354), and having multiple sexual partners (OR = 1.722, 95% CI = 1.525-1.945). Conclusion: Alcohol consumption is strongly associated with RSBs, including early sexual initiation, inconsistent condom use, and multiple sexual partners among adolescents and young adults. To prevent the adverse consequences of alcohol consumption, drinking prevention programs should be initiated at an early age and supported by homes, schools, and communities.

Factors Associated with Early Sexual Activity in Adolescents Residing in an Urban Area of Northeastern Mexico Who Use WhatsApp or Facebook

Early sexual activity has been associated with unplanned pregnancy and sexually transmitted infections. In recent decades, the prevalence of early sexual activity and social media use has increased. However, the relationship between these variables has been little studied. Consequently, we examined the relationships of some factors present in the family and personal environment with early sexual activity in adolescents who use and do not use the WhatsApp and Facebook platforms. Through a cross-sectional study, data from 1328 adolescents aged 13 to 19 years were analyzed. Data collection was carried out using a self-administered questionnaire. Of the total participants, 35.7% reported early sexual activity, and 37.7% reported using social networks such as WhatsApp and Facebook. The mean age of onset of sexual activity was 15.59 ± 1.56 years. Multivariate logistic regression analysis showed significant associations of not studying (adjusted OR 4.70; CI 95% 1.31-16.78), consuming alcohol (adjusted OR 3.71; CI 95% 2.44-5.65) and having parents who consumed alcoholic beverages in the home (adjusted OR 1.48; 95% CI 1.03-2.12) with ESA. In the family and personal environment, some factors favored early sexual activity in young people who used the WhatsApp and Facebook applications. This information should be used by authorities in the health and education sectors to strengthen preventive programs targeting health risk habits and behaviors in adolescents.

Young People Awareness of Sexually Transmitted Diseases and Contraception: A Portuguese Population-Based Cross-Sectional Study

Adolescents and young adults are an important target concerning reducing health-risk behavior adoption, including sexual health. Studying their knowledge concerning sexuality and their main counsellors, can be an important step in targeting an updated health promotion approach. This study characterized adolescents and young adults' knowledge and attitudes about sexually transmitted diseases (STDs), and contraception, prospecting for their main trusted counseling sources. We conducted a cross-sectional, population-based, self-report survey of 746 individuals aged between 14 and 24 years from Paredes, Portugal. The questionnaire included many dimensions, as demographic characteristics, youth behavior, currently sexually active status, main counselors concerning health topics, awareness, and knowledge about STDs and contraception. Mean age of the participants was 18.3 years, 50.5% of them had started their sexual activity. Males present themselves as more sexually active, starting earlier, and have more sexual partners than females. Participants reported an adequate knowledge perception about STDs and contraception methods, however we found different patterns on specific STDs and contraceptive methods, according to gender, age, and sexually active status. Our results help design specific interventions to reach youth, community, and healthcare providers, pointing out the value of bringing people to the center of health policies.

Time to First Sexual Experience and Its Determinants among Female Youths in Ethiopia: Survival Analysis Based on EDHS 2016

Background. The first sexual experience is the most significant event in a woman’s life. Early sexual experience has short- and long-term health and behavioral risks. Studying the estimated time for a female to have her first sexual debut is important to reduce its health, demographic, and socioeconomic consequences. Thus, this study is aimed at assessing the time to first sexual experience and its determinants in Ethiopia. Methods. A survival analysis of time to first sexual experience was conducted among 6143 weighted study subjects. The data were extracted from EDHS 2016 using STATA version 16 software. A Kaplan-Meier survival curve was computed to estimate the time of first sexual experience. A log-rank test was used to compare the difference in survival curves. The Cox proportional hazard regression model was used to identify significant predictors. On multivariable analysis, variables having a $p$ value of ≤ 0.05 are considered statically significant. Results. The overall median survival time was 16 years. The significant determinants of time to first sexual experience are educational level (no education ( $\text{AHR}=2.72$ , 95% CI: 2.16, 3.39), primary education ( $\text{AHR}=2.17$ , 95% CI: 1.79, 2.63), and secondary education ( $\text{AHR}=1.47$ , 95% CI: 1.21, 1.77)) and wealth index (poor ( $\text{AHR}=1.15$ , 95% CI: 1.00, 1.32)). Conclusion. About 50% of female youths have a sexual experience for the first time before their 16th birthday. The timing of the first sexual experience in Ethiopia was mainly influenced by educational level and wealth index. Universal access to education and poverty reduction should be the area of concern.

Youth Assets and Initiation of Sexual Intercourse by Family Structure: A Longitudinal Cohort Study

BACKGROUND

The purpose of this study was to assess the protective influence of individual, family, and community assets from the initiation of sexual intercourse (ISI) for adolescents living in one-parent households compared with adolescents living in two-parent households.

METHODS

Five waves of data were collected annually over a 4-year period (N = 591, 52.5% female, mean age = 14.0 years) from a racially/ethnically diverse sample of adolescents. Extended Cox models were used to assess the relationship between assets and time of ISI while controlling for demographic variables. Potential interactions between adolescent's household structure and assets were examined.

RESULTS

Five of 17 assets were prospectively and significantly associated with a reduced risk of ISI among adolescents living in one-parent households compared with 11 of 17 assets for adolescents living in two-parent households. Adolescents living in one-parent households who possessed any one of five assets (e.g., general aspirations for the future, relationship with mother, positive peer role models) had between a 27% and 57% lower risk of ISI, whereas adolescents living in two-parent households who possessed any of one of 11 assets (e.g., responsible choices, family communication, community involvement) had between a 20% and 42% lower risk of ISI.

CONCLUSION

The results suggest that strengthening specific youth assets across multiple dimensions of behavioral influence may decrease the risk of ISI for adolescents living in both one-parent and two-parent households. Public health efforts focused on developing programs to promote asset building tailored to adolescent's family structure are warranted.

Results of the National Contraception Survey Conducted by Sociedad Española de Contracepción (2020)

Background: The National Contraception Survey conducted by Sociedad Española de Contracepción intends to know the sexual and contraceptive habits of Spanish women of reproductive age. Methods: A descriptive and cross-sectional study with random sample selection was conducted with women aged from 14 to 49 years old in July and August 2020. Results: A total of 1801 women participated in the study, of which 78.7% used some contraception method during their sexual relationships. The most frequently used methods were condoms (31.3%) and combined oral contraceptives (18.5%) at their last sexual encounter. A total of 25.7% used both condoms and pills, especially younger women and those who had no steady partners (p < 0.001). Use of Long-acting Reversible Contraceptives continues to be low, although a slight increase in their use is observed, and they are recommended for 50% of the users who need contraception. Counselling on contraception was provided to 64.3% of the women, mainly by their gynaecologists. Regarding the decision to use a contraceptive method, the one suggested by health professionals was more influential, although this was not the case for women aged less than 20 years old (p < 0.001). A total of 38.4% of the women have used emergency oral contraception at least once and 66.8% of those who do not make continuous use of contraception methods do so out of personal choice. Conclusions: It is necessary to deepen work on counselling and awareness among the population towards the use of efficient contraceptive methods that prevent unplanned pregnancies.

Using Co-Design to Develop a Health Literacy Intervention with Socially Disadvantaged Adolescents

The aim of this study was to initiate a co-design process with adolescents to inform the development of a targeted health literacy intervention for implementation in designated socioeconomically disadvantaged post-primary schools in Ireland. Purposely developed vignettes were explored in a series of eight workshops that were conducted separately with staff (n = 26) and students (n = 33) across four schools. Data was analysed using content analysis. A number of key health topics were identified as important and influential for the participants in this context: food choices, mental health and wellbeing, physical activity and sedentary behaviour, sleep and substance misuse. Participants also suggested many health-related capacity building actions. Participants recognized that many of these health topics and capacity building actions were intertwined and also highlighted that some of these actions may be more feasible and/or impactful than others. For example, students and school staff both indicated the need to use relevant, applied and engaging approaches to improve health literacy and subsequent health behaviour. The co-design process adopted empowered stakeholders to actively engage in the design and development of future intervention strategies, which may increase the likelihood of acceptability, effectiveness and sustainability of the resulting intervention.

Understanding Sexual Health Indicators During Adolescence: A Study to Consider Time Since Sexual Debut When Exploring Multiple Sexual Partners

Understanding risky sexual behaviors among adolescents is key in efforts devoted to reducing the health burden related to sexually transmitted infections and unintended or unplanned pregnancies. The aims of this study were to understand the association between number of lifetime sexual partners and time since sexual debut (TSSD) among adolescents and to determine whether sex modified this association. Data were drawn from the 2018-2019 COMPASS-Quebec study, a cohort study conducted in secondary schools in the province of Quebec, Canada. Of 18,467 respondents aged 14 years and older, 6991 (37.9%; mean age 15.3) reported consensual sexual intercourse and answered questions on their age at sexual initiation and number of lifetime sexual partners. Multilevel Poisson regressions with robust standard errors were estimated to adjust for covariates and produce adjusted group mean differences. The adjusted mean number of lifetime sexual partners ranged from 1.5 for those who had recently begun sexual activity (< 12 months) to 4.0 for those who had been active for > 35 months, an average rise of about 0.6 per year. Females-to-males adjusted mean differences showed that males reported more sexual partners than females at all time points, but the differences were only significant at the shorter (< 12 months) and longer (> 35 months) time spans. This study highlights the importance of taking into account TSSD when using and interpreting the number of lifetime sexual partners as risky sexual behavior among adolescents. Sex did not have a significant modifying effect on the relationship between number of lifetime sexual partners and TSSD.

Knowledge of pelvic floor disorders in young women: a cross-sectional study

Abstract Introduction: Young women’s knowledge about pelvic floor function and dysfunction are poor. Objective: To identify the level of knowledge of young women about pelvic floor muscles (PFM) anatomy and function, pelvic floor muscle dysfunction (PFMD), pelvic organ prolapse (POP), and sexual dysfunction (SD). Methods: This is a cross-sectional study. Two hundred forty-two (242) young women from first to the third year of high school from ten public schools, in geographically disparate areas of a Brazilian county serving economic minority student populations, participated in the study. Data analysis was performed using SPSS 20.0 (SPSS Inc., Chicago, IL). The categorical data were expressed as absolute and relative frequency. Results: Only 28% of the young women knew PFM, and 26% answered to be able to contract these muscles. The prevalence of urinary incontinence was 16%, while 5% reported fecal incontinence. The previous knowledge about POP was similar between bladder and uterus prolapse, 34% and 40%, respectively. SD was known by 48% of the young women. Seventy-seven young women (31.8%) declared to have had sexual intercourse. Ten percent declared difficulties to allow vaginal penetration, and 48% of those who were able to have penetration declared that they experienced pain and discomfort. Conclusion: Young women have little knowledge about the PFM anatomy and function, PFMD, POP, and SD. In addition, they have complaints related to sexual practice, such as difficulty during vaginal penetration and pain.

Prevalence and correlates of early sexual initiation among Brazilian adolescents

Background

Early adolescence is a critical stage in adolescents. This is the phase at which many young people start their sexual life early, increasing the risk of sexually transmitted infections and unintended pregnancy. Few studies have analyzed the factors associated with early sexual initiation in very young adolescents in low- and middle-income countries. Therefore, this study assessed the early sexual initiation stratified by sex and its correlates in a sample of Brazilian adolescents.

Methods

The study sample included Brazilian adolescents aged 12–14 who participated in The Study of Cardiovascular Risk in Adolescents (ERICA), a multicenter, school-based, country-wide, cross-sectional study. Early sexual initiation was defined as the first sexual intercourse at or before 14 years old. Multivariate logistic regression was used to identify independent factors associated with early sexual initiation.

Results

The prevalence of early sexual initiation was 7% among girls and 18% in boys. In a multivariate analysis, the adolescent’s age, mother’s schooling, smoking, alcohol consumption, and Tanner Stages were associated with early sexual initiation for both boys and girls. For girls, living with both parents, common mental disorders, and age at menarche were predictors of early sexual initiation, while race and type of school were correlated to early sexual initiation only for boys.

Conclusions

The early sexual initiation was associated with sociodemographic, lifestyle risk factors and secondary sexual characteristics in both sexes, while there were differences between the predictors of early sexual initiation among girls and boys. It emphasizes the importance of sex education and promotes healthy lifestyles in environments through families and schools in early adolescence.

Changes in sexual behavior among high-school students over a 40-year period

The aim of this study was to investigate sexual behavior, contraceptive use, risk factors as well as sources of sex information among first-year high-school students in Sweden. Secondly, to assess differences between genders and study programs as well as changes over a 40-year period. A repeated cross-sectional survey was conducted in two cities. A questionnaire comprising 77 items was used. The study population consisted of 415 students (63.4% females). The median age of sexual intercourse was 15 years. In total, 37% had had sexual intercourse, compared to 56.3% in 2009 and 45% in 1999 (p < 0.001), and the proportion of students who had their first sexual intercourse was not influenced by gender. More students in vocational programs (46.3%), compared to theoretical (33.3%), had experience of at least one sexual intercourse (p = 0.019). The same extend of contraception use at first and latest intercourse was reported, compared to previous studies. Forty-nine percent were mostly informed about sex from the internet, while in previous years, magazines, family and youth clinics were the main information sources. Comparing over time, students were in general less sexually experienced and less engaged in non-penetrative sex and physical intimacy. These findings call for a new approach, when designing sex and relationship education and health-care counseling in adolescents.

Alcohol use, cigarette smoking, vaping and number of sexual partners: A cross-sectional study of sexually active, ethnically diverse, inner city adolescents

Context

There are few UK data on the prevalence and clustering of risky behaviours in ethnically diverse adolescents.

Objectives

To investigate the prevalence of reported alcohol use, smoking and vaping, and explore whether these behaviours are associated with increased numbers of sexual partners.

Design

Questionnaire survey of ‘Test n Treat’ chlamydia screening trial participants.

Setting and participants

Sexually active students attending six London technical colleges completed confidential questionnaires and provided genitourinary samples.

Results

The median age of the 509 participants was 17 years (IQR: 16‐18), 47% were male, 50% were of black ethnicity, 55% reported ≥2 sexual partners in the past year (67% of males and 45% of females) and 6.2% had chlamydia infection and 0.6% gonorrhoea. Almost half (48%) reported getting drunk in the past month, 33% smoked cigarettes and 7% had ever vaped.

A larger percentage of students with ≥2 sexual partners than 0‐1 partners reported getting drunk in the past month (53.7%, 144/268% versus 42.2% 94/223, adjusted prevalence ratio: 1.33, 95% confidence interval: 1.11‐1.61) and smoking cigarettes (36.6%, 100/273% versus 30.2%, 67/222, 1.34 (1.05‐1.70)). By contrast, multiple sexual partners were not associated with vaping or chlamydia infection, but numbers were small.

Conclusions

We found high prevalences of risky behaviour and an association between multiple sexual partners and smoking and/or getting drunk. Findings support the introduction of compulsory sex and relationship education in UK secondary schools, including information about the adverse effects of alcohol and smoking.

Public contribution

Participants helped with study design, conduct and interpretation.

Does parenting style moderate the relationship between parent-youth sexual risk communication and premarital sexual debut among in-school youth in Eswatini?

BACKGROUND

Based on propositions of the contextual model of parenting style, we examined whether there is a relationship between parent-youth sexual risk communication (PYSRC) and premarital sexual debut, and whether this relationship is moderated by the parenting style.

METHODS

A cross-sectional study design was employed, and data were collected using a self-reported questionnaire from 462 youth (211 boys and 251 girls) aged 15-24 years in senior grades of three public high schools (two rural and one urban) in Eswatini (formerly Swaziland). A hierarchical binary regression analysis was conducted to examine the association between PYSRC and premarital sexual debut, and to test whether parenting style moderates this relationship.

RESULTS

The mean age of participants was 18.9 (±1.85) years, and a slight majority were females (54.3%). About 35.9% of participants reported having had sex (i.e., premarital sexual debut). After adjusting for age, gender, living arrangement, school location, and peer sexual activity, neither PYSRC (adjusted odds ratio [AOR] = 1.01, 95% confidence interval [CI]: 1.00, 1.03) nor parenting style (AOR = 0.81, 95% CI: 0.64, 1.04) significantly predicted premarital sexual debut in the sample. Likewise, parenting style did not significantly moderate the relationship between PYSRC and premarital sexual debut (AOR = 1.01, 95% CI: 1.00, 1.02).

CONCLUSION

Contrary to propositions of the contextual model of parenting style, in this study, parenting style (authoritativeness) did not moderate the studied relationship, indicating the need for more studies to test the applicability of the contextual model of parenting style in African settings.

Contraceptive and reproductive health practices of unmarried women globally, 1999 to 2018: Systematic review and meta-analysis

BACKGROUND

Premarital sex practices and contraceptive prevalence rate (CPR) among unmarried women worldwide remain unclear, even though unmarried women tend to have multiple sex partners over time, which makes their sexual behaviors particularly important to the sexual and reproductive health of society more broadly.

METHODS

We searched the MEDLINE, PubMed, and Google Scholar databases for relevant articles published between January 1, 1999 and December 31, 2018. Data on prevalence of premarital sexual intercourse, use of highly prevalent contraceptive methods, as well as CPR overall and at first sexual intercourse were extracted and estimated using a DerSimonian- Laird random effects model.

RESULTS

Of the 3918 articles identified, 37 covering 19 countries were included. The estimated overall prevalence of premarital sexual intercourse was 41.9% (95%CI 34.2-49.6%). Pooled CPR was 57.0% (95%CI 44.3-69.8%) overall and 57.6% (95% CI 39.5- 75.6%) at first intercourse. The overall prevalence of condom use was 51.2% (95%CI 42.7-59.7%), followed by oral contraceptives (20.5%, 95%CI 13.7-27.3%), withdrawal (12.7%, 95%CI 9.4-15.9%), and rhythm (12.1%, 95%CI 6.7-17.4%).

CONCLUSION

The findings of this global study indicate worrying trends in unprotected intercourse and contraceptive practices, suggesting the need for greater attention and resources aimed at educating unmarried adolescent women about sexual and reproductive health.

SYSTEMATIC REVIEW REGISTRATION NUMBER

CRD42019132736.

ADOLESCENT STUDENTS' ATTITUDES TOWARDS SEXUALITY: THE CONSTRUCTION AND VALIDATION OF A SCALE

Objective:

To construct a scale of adolescents' attitudes towards sexuality and to determine their psychometric characteristics.

Methods:

Methodological study conducted with 394 students from the 8th to 12th grades of a school in central Portugal. They answered a questionnaire consisting of the Adolescent Students' Attitude Scale for Sexuality (E3AS) and socio-demographic and academic data. The project received a favorable opinion from the National Data Protection Commission (authorization No. 10421/2017). Construct validity analysis was performed through exploratory factor analysis and internal consistency was performed through Cronbach's alpha. A maximum error probability of 5% was considered.

Results:

The mean age of the sample was 14.9±1.4 years, with 53.3% being female. The instrument consisted of 34 items distributed into five factors: F1. Family planning and sex education (α=0.826); F2. First sexual relationship (α=0.819); F3. Violation of sexual rights and who to turn to in the event of unplanned pregnancies (α=0.695); F4. Gender expression and identity (α=0.542), and F5. Unplanned pregnancy and parenting (α= 0.761), with a total alpha value of 0.766, accounting for 45.3% of total variance.

Conclusions:

The psychometric adequacy of the E3AS for the Portuguese population allows us to affirm that it is a valid and reliable instrument that can be used in future studies to assess the attitudes of adolescent students towards sexuality.

Pornography Use in Adolescents and Its Clinical Implications

(1) Background: The Differential Susceptibility to Media Effects Model (DSMM) suggests that pornography use effects are conditional and they depend on dispositional, developmental, and social differential susceptibility variables. This framework also highlights that the differential susceptibility variables act as predictors of pornography use and as moderators of the effect of pornography on criterion variables. (2) Methods: By administering a survey to n = 1500 adolescents, we tested whether these assumptions were met. (3) Results: Pornography use was related to being male and older, having a bisexual or undefined sexual orientation, higher substance use, being non-Muslim, and reporting sexual interest and the use of the media to obtain sexual information. Structural Equation Modeling (SEM) showed that higher levels in the criterion variables were directly related to pornography use, older age, substance use, and being women. Some mediational links also emerged. Pornography use mediated between the age and criterion variables. Moreover, substance use mediated the association between age and gender with the criterion variables. (4) Conclusions: Our findings support the clinical applicability of the theoretical DSMM framework. Knowing adolescent pornography consumers’ profiles and the impact of pornography on this population would allow for the designing of more effective prevention and regulation proposals.

Performance of family health teams for tackling chronic diseases in a state of the Amazon

The most common cause of death worldwide is noncommunicable diseases. A cross-sectional study was conducted to evaluate the adequacy of the work process among family health teams and compare differences in regional adequacy in the state of Tocantins, in the Amazonian Region, Brazil. Categorical principal components analysis was used, and scores of each principal component extracted in the analysis were compared among health regions in Tocantins. A post hoc analysis was performed to compare the heath region pairs. The adequacy of family health teams’ work process was evaluated with respect to the Strategic Action Plan to Tackle NCDs. The results showed that the family health teams performed actions according to the Strategic Action Plan to Tackle NCDs. However, overall, the adequacy percentages of these actions according to the axes of the Plan are very uneven in Tocantins, with large variations among health regions. The family health teams in the Bico do Papagaio (Region 1), Médio Norte Araguaia (Region 2), Cantão (Region 4) and Capim Dourado (Region 5) regions have adequacy percentages ≥ 50% with the Strategic Action Plan to Tackle NCDs, whereas all other regions have percentages <50%. Health teams perform surveillance actions, health promotion, and comprehensive care for NCDs in accordance with the guidelines of the Strategic Action Plan to Tackle NCDs. The challenge of NCDs in primary care requires a care model that is tailored to users’ needs and has the power to reduce premature mortality and its determinants.

Associated factors and sex differences in condom non-use among adolescents: Brazilian National School Health Survey (PeNSE)

Background

Condom non-use among sexually active adolescents is a major cause of unintended pregnancy and sexually transmitted infections. In order to promote condom use, it is essential to understand factors associated with condom non-use.

Aim

Our aim was to evaluate sex differences and associated factors of condom non-use based on the nationally representative Brazilian National School Health Survey.

Methods

The study participants were 100,962 adolescents 13–18 years old, 9th graders from both public and private schools throughout Brazil. The following factors were considered as explanatory group variables for the outcome of condom non-use among adolescents: school and health service, sexual behavior, substance use, and self-reported body and health perception. Poisson regression model was performed.

Results

Of the total students, 28% (n = 28,157) had had sexual intercourse at least once. (boys, 37.1%; girls, 19.5%). Of these, 69.2% had used condoms the last time they had intercourse (girls: 68%; boys: 69.9%). The variables associated with condom non-use for both sexes were not having accessed a health service or approached a health professional for health-related care; not having received pregnancy prevention counseling or guidance on AIDS or STI prevention at school; early sexual initiation; no additional contraception method; substance use; feeling alone; not being satisfied with their own body; feeling fat or thin; and poor self-reported health. The number of sexual partners was also associated with condom non-use; however, contrasting behavior was indicated between sexes. A higher number of sexual partners indicated less use of condoms among girls, while for boys, a higher number of sexual partners indicated higher condom use.

Conclusion

High condom non-use appears to be associated with lack of health care access and sexual health education, poor sexual practices, substance use, and poor self-perception, indicating areas for health promotion programs.

Individual and social determinants of early sexual activity: A study of gender-based differences using the 2018 Canadian Health Behaviour in School-aged Children Study (HBSC)

Introduction

Early sexual activity, often defined as initiation before the age of 16, is a risk behaviour associated with negative health outcomes in adulthood. The objective of this study was to explore links between early sexual activity and individual and contextual characteristics in Canadian youth, and whether these differ for girls and boys.

Methods

Data were from the 2018 Canadian Health Behaviour in School-aged Children (HBSC) survey administered in classrooms across Canada to students in grades 6 to 10 (ages 11 to 16). The sample includes the 7882 students in grades 9 and 10 who were asked about sexual activity. Individual and contextual measures used included emotional well-being, socioeconomic status, participation in team sports, body image, social media use, family structure, and family support. Descriptive data overall and separately for girls and boys are presented, followed by Poisson regression models to estimate relative risks and associated 95% confidence intervals for strength of associations between characteristics and early sexual activity. Models were adjusted for clustering by school using generalised estimating equations.

Results

Overall, contextual factors i.e. disrupted family structure or low family support were the characteristics most strongly associated with early sexual activity. Among boys there was an incremental and strong relationship between hours spent in organised sport and early sexual activity. Among girls, poorer body image, lower socioeconomic status, and higher social media use aligned most strongly with early sexual activity.

Conclusion

Persistent gender stereotypes appear to underlie differences in individual and contextual factors associated with adolescents’ sexual behaviour. Findings from this exploratory analysis may be of benefit to subsequent researchers, policy makers and those who care for youth.

Individual and contextual factors associated with sexual initiation among adolescents

Adolescent sexual practices have been widely investigated as experiences that pose potential risks for health. The present study, therefore, aimed to investigate individual and contextual factors associated with sexual initiation, sexual activity before the age of 15 years, and inconsistent condom use. A total of 253 adolescents aged 11 to 18 years, from public schools in the capital and metropolitan region of Rio Grande do Sul, were interviewed. They answered a questionnaire covering sociodemographic data and sexual behaviors and completed the Perception of Family Support Inventory. The data were analyzed through descriptive and inferential statistics and it was verified that both individual (higher level of education, school repetition, and use of licit and illicit substances) and contextual factors (perception of less affective-consistent support and greater autonomy from the family) were related to sexual initiation among adolescents. The associations found for the groups with sexual initiation before and after 15 years of age were similar, indicating that age did not increase the exposure to risks. Inconsistent condom use was related to the use of tobacco and other drugs. Taken together, the results indicated the co-occurrence of risk behaviors, such as sexual risks and substance abuse, as well as highlighting some family characteristics as protective factors.

Evaluation of the primary care for chronic diseases in the high coverage context of the Family Health Strategy

BACKGROUND

This cross-sectional study evaluated the adequacy of the Family Health Strategy for the primary care model for chronic noncommunicable diseases and the changes that occurred between the two cycles of external evaluations of the National Program for Improving Access and Quality of Primary Care, which took place in 2012 and 2014, in the higher coverage context of the Family Health Strategy of Brazil, in the state of Tocantins, Brazil.

METHODS

The data source contained information on the infrastructure of the 233 Primary Health Units and on the work process of 266 health teams. The Principal Component Analysis for Categorical Data technique and the McNemar chi-squared statistical test for comparing paired samples were used, and a significance level of 5% with a 95% Confidence Interval was used.

RESULTS

The analysis identified a low proportion of dispensing of medications for the treatment of chronic disease in both cycles. There was a significant increase in seasonal influenza vaccination, in the number of sterilization, procedure, dressings and inhalation rooms. There was a small but significant reduction in the materials for cervical cancer screening, although they are available in almost 90.0% of the PHUs. More than 70.0% of the health teams carried out additional health education activities, encouraged physical activity, registered schoolchildren with health needs for monitoring, evaluated user satisfaction and user referral.

CONCLUSIONS

The findings of this study highlighted the improvement of the structure of the Primary Health Units, but identified a low provision of medicines to treat chronic diseases. The health promotion was performed as the main work process tool of family health teams, but it was little focused on intersectoral actions and on actions with the population in the area or on the empowerment of users through self-management support for chronic diseases. Furthermore, it is critical that the Family Health Strategy in Tocantins be organized and focused on the care of chronic diseases to improve and adapt itself to a primary chronic care model.

Partnered Intimate Activities in Early Adolescence-Findings From the UK Millennium Cohort Study

PURPOSE

Little is known about potential influences on emerging partnered intimate behaviors in early adolescence. We investigate (1) the prevalence of partnered intimate activities and (2) associations with social relationships, parental monitoring and supervision, health behaviors, and psychosocial well-being.

METHODS

We used population-based data from the UK's Millennium Cohort Study on 11,079 participants aged 14 years. Partnered intimate activities were grouped into three categories: "light" (handholding, kissing, and cuddling); "moderate" (touching and fondling under clothes); and "heavy" (oral sex and sexual intercourse). Multinomial logistic regression models were used.

RESULTS

Thirty percent of study participants reported not engaging in partnered intimate activity. Fifty-eight percent reported "light," 7.5 percent "moderate," and 3.2 percent "heavy" activity. Associated with increased likelihood (adjusted relative risk ratios [RRRs]) of intimate activities were confiding worries in a friend (light RRR = 2.13, moderate RRR = 3.42, heavy RRR=5.32), low parental monitoring-staying out late or overnight (late: light RRR = 1.62, moderate RRR = 2.44, heavy RRR = 2.32; overnight: light RRR = 1.57, moderate RRR = 1.94, heavy RRR = 3.38), health-damaging behaviors (per unit increase: light RRR = 1.91, moderate RRR = 3.15, heavy RRR = 5.03), and depressive symptoms (per scale point increase light RRR = 1.03, moderate RRR = 1.09, heavy RRR = 1.11). Confiding in a parent was associated with lower likelihood of intimate activity (light RRR = .82, moderate RRR = .65, heavy RRR = .65).

CONCLUSIONS

Partnered intimate activity of some form is commonplace among 14-year-olds in the United Kingdom. Given the short- and long-term implications of adolescent sexual development and well-being, improving our understanding of influences could help identify opportunities for interventions with benefits across the lifecourse.

Socio-Demographic, Health and Lifestyle Factors Influencing Age of Sexual Initiation among Adolescents

Behavioural and developmental factors mean that adolescents who initiate sexual intercourse early may be at an increased risk of adverse sexual health outcomes at the time of first sex and later in life. In an Irish context, there is insufficient knowledge about the specific correlates of early sexual initiation. This research explores relationships between contextual socio-demographic, health and lifestyle factors and the timing of first sexual intercourse among 15–17-year-olds in Ireland. Multiple regression analysis was carried out in conjunction with Multiple Imputation using data collected through the 2014 Health Behaviour in School-Aged Children Ireland study on a sample of 879 sexually active adolescents. The socio-demographic and lifestyle factors measured were a stronger predictor of age of sexual initiation among girls than boys. Risk behaviour initiation was significantly related to age of sexual initiation for adolescents, while alcohol use/drunkenness and unhealthy food consumption was significant among girls only. Family support and number of male friends were significant predictors for boys only. The study highlights the need for holistic approaches to sexual health promotion and provides a foundation for the development of alternative strategies and policies aimed at reducing negative health, well-being, educational and economic outcomes.

Sexual activity and sexual health among young adults with and without mild/moderate intellectual disability

Background

There is widespread concern about the sexual ‘vulnerability’ of young people with intellectual disabilities, but little evidence relating to sexual activity and sexual health.

Method

This paper describes a secondary analysis of the nationally representative longitudinal Next Steps study (formerly the Longitudinal Survey of Young People in England), investigating sexual activity and sexual health amongst young people with mild/moderate intellectual disabilities. This analysis investigated family socio-economic position, young person socio-economic position, household composition, area deprivation, peer victimisation, friendships, sexual activity, unsafe sex, STIs, pregnancy outcomes and parenting.

Results

Most young people with mild/moderate intellectual disabilities have had sexual intercourse by age 19/20, although young women were less likely to have sex prior to 16 than their peers and both men and women with intellectual disabilities were more likely to have unsafe sex 50% or more of the time than their peers. Women with intellectual disabilities were likely to have been pregnant and more likely to be a mother.

Conclusion

Most young people with mild/moderate intellectual disabilities have sex and are more likely to have unsafe sex than their peers. Education and health services need to operate on the assumption that most young people with mild/moderate intellectual disabilities will have sex.