Characteristics of youth sexual and reproductive health and risky behaviors in two rural provinces of Cambodia

Exploring Cambodian adolescents' perceptions on sex: a qualitative investigation

Introduction

Involvement in sexual activities increases during adolescence in many countries, including Cambodia. The objective of this study is to explore the perspectives and interpretations of sex held by Cambodian adolescents within the context of their social norms and culture.

Methods

A qualitative research design was used to conduct in-depth interviews with a purposive sample of 91 Cambodian adolescents aged between 15 and 19 years. Participants were recruited from rural areas, and data was collected through face-to-face interviews using semi-structured interview guides. Thematic analysis was used to analyze the data.

Results

Four themes as perspectives of sex were identified: (1) Desire: Releasing sexual desire and stress; (2) relationship: an emotional connection and demonstration of love; (3) roles: responsibilities within a woman's marital duties; and (4) values: the value of virginity and future engagement. Cambodian adolescents' perspectives and interpretations of sex were deeply influenced by their social norms and cultural values. Men typically perceived sex through the lens of instinct and pleasure, while women often emphasized a deep sense of familial duty and held premarital sex to be morally unacceptable.

Discussion

The findings suggest that interventions aimed at improving the sexual health of Cambodian adolescents should be designed with an understanding of the social norms and cultural values that shape their perspectives and interpretations of sex. Such interventions should focus on promoting safe sex practices and providing accurate and comprehensive sexual education.

Stakeholders' perspectives of comprehensive sexuality education in Iranian male adolescences

Background

A coherent sexuality education program for adolescents is part of their sexual and reproductive rights and can help them have a healthier future. Therefore, the aim of this study was to explore the perspectives and intervention preferences of Iranian stakeholders regarding comprehensive sexuality education (CSE) in male adolescents based on the IMB model (information, motivation, behavioral skills).

Methods

This study was a qualitative study that was analyzed through a directed content analysis approach. Individual interviews and focused group discussions (FGDs) were used for data collection. The data were collected through in-depth semi-structured interviews with stakeholders in two schools and the Education Department in Sari and the Ministry of Health and Ministry of Education in Tehran from March 2019 to August 2019. Data saturation was achieved after 28 interviews and 1 FGDs with 9 participants. Finally, two sets of data were coded and analyzed using directed content analysis.

Results

In this study, five themes emerged as (1) role of institutions; (2) role of organizations; (3) need for stakeholder’s partnership; (4) need for adolescent sexuality socialization management; and (5) need for enhancing the teachers’ professional competence, which seemed to influence the implementation of CSE in male adolescents. Participants also expressed a number of intervention preferences for CSE. The most important of these was the change in macro policies, helping to create a culture against all forms of violence and breaking the taboo of sexuality education for children and adolescents.

Conclusions

The results of this study revealed the need for a CSE program for adolescents' sexuality socialization. The finding showed that teachers required training to enhance their professional competence about sexuality issues. Therefore, it is necessary to design and implement culture-appropriate skill based programs to enhance the teachers’ professional competence regarding the adolescents’ sexual health.

Barriers and facilitators for the sexual and reproductive health and rights of young people in refugee contexts globally: A scoping review

BACKGROUND

The need to address sexual and reproductive health and rights (SRHR) in humanitarian settings is more urgent than ever, especially among young refugees. We conducted a scoping review to identify and synthesise the literature on perceived barriers and facilitators to SRHR among young refugees and interventions created to address their needs.

METHODS

We searched three databases (PubMed, Global Health and POPLINE) for peer-reviewed and grey literature published in English between January 2008 and June 2018 that reported on SRHR barriers, facilitators and interventions for young refugees aged 10 to 24 years. We extracted data using standardised templates and assessed the quality of studies according to study design. Data were charted using qualitative content analysis and organised in line with a socio-ecological framework (individual, social and community, institutional and health system, and structural).

FINDINGS

We screened 1,169 records and included 30 publications (qualitative, quantitative, and mixed methods) across 22 countries; 15 were peer-reviewed articles and 15 were from the grey literature. Twenty-two publications reported on young people in refugee camps or alternatives to camps (e.g. sustainable settlements), and eight referred to young refugees who had been resettled to a third country. We identified 19 sub-categories for barriers and 14 for facilitators at the individual, social and community, institutional and health system, and structural levels. No publications discussed the SRHR challenges faced by young homosexual, bisexual, transgender or queer refugees, or those living with HIV. Nine publications described interventions, which tended to focus on the provision of SRHR services and information, and the training of peers, parents, religious leaders and/or service providers.

CONCLUSIONS

Findings highlight that while young refugees experience similar barriers to SRHR as other young people, many of these barriers are exacerbated by the refugee context. The limited number of publications and evidence on interventions underlines the immediate need to invest in and evaluate SRHR interventions in refugee contexts.

Using Social Ecological Theory to Identify Factors Associated With Risky Sexual Behavior in Cambodian Adolescent Girls and Young Women Aged 10 to 24 Years: A Systematic Review

There is an increase in risky sexual behavior (RSB) in Cambodian female youth aged 10 to 24 years, which can contribute to detrimental sexual and reproductive health due to the increased risk of acquiring sexually transmitted infections, unintended pregnancies, or abortions. Bronfenbrenner’s social ecological model was used to identify factors at personal, microenvironment, and macroenvironment levels potentially associated with RSB. A systematic literature review employing PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines was conducted to search 8 databases for articles published between 1994 and 2019. A risk of bias tool was applied for methodological quality of the 4 included studies. RSB is associated with multiple factors including sexual debut at young age, alcohol and substance abuse, multiple partners, living away from parents or orphan status, peer delinquency, non-use of condoms by partners, transactional sex, low education and socioeconomic status, and no access to sexual and reproductive health services. Multipronged preventive strategies operating at different levels are recommended in terms of including sex education and increasing reproductive health literacy programs at the schools and community programs for safe sex, condom use and sexual negotiation skills, and access to modern contraceptive methods.

Creation of Sexually Transmitted Diseases Education Program for Young Adults in Rural Cambodia

Introduction: Globally, adolescents and young adults aged from 15 to 24 years accounted for 25% of the sexually active population. They also took up almost 50% of all newly acquired sexually transmitted diseases (STDs) worldwide. In developing countries/ regions, there have been more unreported cases due to the limited resources and availability of data. This project aimed to enhance sexual health knowledge and encourage behavioral change in sexual practice in rural Cambodia by educational interventions. Methods: A multi-prong project used the Theory of Planned Behavior (TPB) as framework to guide the implementation, which involved carrying out educational talks, group discussion sessions. The educational health talks described the signs and symptoms of STDs and preventive measures including the Abstinence-Be faithful- Condom (ABC) strategy. Pre- and post-intervention assessments were conducted on 111 villagers aged between 18 and 30 years who lived in Peaksneng Thyme Village, Cambodia. Special materials were prepared that highlighted such information were also given to all participants. This was followed by discussion sessions that aimed to strengthen an appropriate attitude toward STDs. A pilot trial was done to prepare and build a constructive, realistic atmosphere and facilitated in-depth spread of main messages. A 20-item assessment of STD knowledge was used as pre- and post-intervention evaluation tool. Individual participant scores were compared to determine the effectiveness of interventions. Conclusion: This comprehensive program was effective in enhancing sexual knowledge in high-risk groups of both sexes as well as general public in rural Cambodia. With experiences gained, this could be replicated in nearby communities, possibly motivating community behavioral change in future. Alternatively, this approach could be further developed, or using other behavioral theories, and applied to other health issues in this country.

Prevalence of factors related to active reproductive health behavior: a cross-sectional study Indonesian adolescent

OBJECTIVES

Complex and diverse factors are related to reproductive health (RH) behavior among adolescents according to the social and cultural context of each countries. This study examined the prevalence of active RH and factors related to active RH behavior among Indonesian adolescents.

METHODS

A cross-sectional study was conducted among 1,040 of students who were selected through a multi-stage random sampling technique. A self-administered questionnaire was developed, including the World Health Organization Illustrative Questionnaire for Interview-Surveys with Young People, pubertal development scale, and sexual activity scale, modified in accordance to the Indonesian context. The data were analyzed using descriptive and comparative statistics, as well as logistic regression analyses.

RESULTS

The prevalence of active RH behavior were more higher in boys (56.6%; 95% confidence interval [CI], 50.6% to 62.6%) than in girls (43.7%; 95% CI, 37.6% to 49.8%). Negative attitudes towards RH were a factor related to active RH behavior in both boys and girls. Smoking and kind relationship envisioned before marriage (pacaran [courtship] and nikah siri [non-registered marriage]) were factors related to active RH behavior in boys; whereas the absence of access to information on substance abuse was an additional factor in girls. Moreover, an interaction was found between access to information on development and smoking (boys) and attitudes on RH (girls) as independent variables associated with active RH behavior.

CONCLUSIONS

Sex education for adolescents in Indonesia, particularly in the context of a health promotion program, should be developed based on prevalent social, cultural, and religious values to prevent active RH behavior. Such programs should focus on the kind of relationship envisioned before marriage and smoking for boys and access to information on subtance abuse for girls.

Adolescents and Pornography: A Review of 20 Years of Research

The goal of this review was to systematize empirical research that was published in peer-reviewed English-language journals between 1995 and 2015 on the prevalence, predictors, and implications of adolescents' use of pornography. This research showed that adolescents use pornography, but prevalence rates varied greatly. Adolescents who used pornography more frequently were male, at a more advanced pubertal stage, sensation seekers, and had weak or troubled family relations. Pornography use was associated with more permissive sexual attitudes and tended to be linked with stronger gender-stereotypical sexual beliefs. It also seemed to be related to the occurrence of sexual intercourse, greater experience with casual sex behavior, and more sexual aggression, both in terms of perpetration and victimization. The findings of this review need to be seen against the background of various methodological and theoretical shortcomings, as well as several biases in the literature, which currently precludes internally valid causal conclusions about effects of pornography on adolescents.