Sexual initiation among adolescents (10 to 14 years old) and health behaviors

Risk Factors for Early Sexual Intercourse in Adolescence: A Systematic Review of Cohort Studies

This systematic review provides a comprehensive assessment of risk factors related to early sexual intercourse (ESI) among adolescents. We used PRISMA guidelines to identify eligible cohort studies published between January 1999 and December 2020. We searched on three databases: PubMed, Embase and LILACS. Studies were screened for quality and eligibility. Of 2787 identified studies, seven met our inclusion criteria. The studies examined a range of factors, which were organized into four dimensions - individual, family, social and environmental, and sociodemographic. Risk factors with strong associations for ESI were: adolescent and parental substance use, aggression and conduct disorders, family attachment, school achievement, family living situation, and maternal education. Three studies were birth cohorts. This review demonstrates the important roles of substance use, family attachment and academic factors in shaping adolescents' sexual behavior. A strength of this review is its focus on longitudinal studies, enabling exploration of exposures collected before initiation of sexual intercourse.

Social vulnerabilities and sexual initiation of 10- to 14-year-old pupils in the city of Rio de Janeiro, Brazil

This study aimed to estimate the prevalence of sexual initiation of pupils aged 10 to 14 who attended the second year of public and private high school in the IX Administrative Region of the city of Rio de Janeiro, Brazil and to identify the most vulnerable subgroups. The sample consisted of 694 pupils who were selected through cluster-based and stratified sampling by considering school type (public or private) and course type (daytime or evening). Information was collected by means of a structured self-administered questionnaire. The chi-square test (χ2) and 95% confidence intervals were used to assess the heterogeneity of proportions among subgroups. The prevalence of the event was 18.4%; it was higher in boys, in subgroups of greater social vulnerability, among those who hooked up/dated up to 14 years of age, in victims of sexual violence in affective-sexual relationships and in pupils showing health risk behaviors. The high rate of sexual initiation in early adolescence, especially in more vulnerable groups, shows that the situation must be understood and addressed by means of intersectoral public policies that take into account a social context of multiple needs rather than reproductive health alone.

Social vulnerabilities and sexual initiation of 10- to 14-year-old pupils in the city of Rio de Janeiro, Brazil

Abstract This study aimed to estimate the prevalence of sexual initiation of pupils aged 10 to 14 who attended the second year of public and private high school in the IX Administrative Region of the city of Rio de Janeiro, Brazil and to identify the most vulnerable subgroups. The sample consisted of 694 pupils who were selected through cluster-based and stratified sampling by considering school type (public or private) and course type (daytime or evening). Information was collected by means of a structured self-administered questionnaire. The chi-square test (χ2) and 95% confidence intervals were used to assess the heterogeneity of proportions among subgroups. The prevalence of the event was 18.4%; it was higher in boys, in subgroups of greater social vulnerability, among those who hooked up/dated up to 14 years of age, in victims of sexual violence in affective-sexual relationships and in pupils showing health risk behaviors. The high rate of sexual initiation in early adolescence, especially in more vulnerable groups, shows that the situation must be understood and addressed by means of intersectoral public policies that take into account a social context of multiple needs rather than reproductive health alone.

A Cost Effectiveness Model of Long-Acting Reversible Contraceptive Methods in the Brazilian National Health System

INTRODUCTION

The use of long-acting reversible contraceptives is low among adolescents owing to the high up-front cost. In this study, a 5-year cost-effectiveness model and budget impact analysis were used to compare the use of long-acting reversible contraceptives with the use of combined oral contraceptives among Brazilian adolescents.

METHODS

A Markov model was developed to mirror the clinical and economic effects of long-acting reversible contraceptives among sexually active Brazilian adolescents in the public health system for a 5-year duration, starting from 2018. The costs were expressed in U.S.$, and a 5% discount rate was applied for both costs and benefits. Model inputs included costs of the contraceptive methods, contraceptive discontinuation and adherence rates, abortion, and birth costs associated with unintended pregnancies. The model outcomes were avoided pregnancies, abortions, and births. Univariate and probabilistic sensitivity analyses were conducted.

RESULTS

Copper intrauterine device use was dominant 100% of the time for all outcomes, and a budget impact analysis revealed a cost savings of $422,431,269.10 in the 5-year period. Levonorgestrel intrauterine system and subdermal implant use were cost effective for all outcomes. The budget impact analyses revealed costs of $65,645,417.54 for levonorgestrel intrauterine system and $302,852,972.12 for subdermal implant use during the 5-year study period.

CONCLUSIONS

According to this Brazilian model, copper intrauterine device use is dominant, and levonorgestrel intrauterine systems and subdermal implants are more cost effective than combined oral contraceptives.

The invisible magnitude of the rape of girls in Brazil

OBJECTIVE

Compare official data on notifications of sexual violence against girls aged 10 to 13 years with data on pregnancy for the same age group between 2012 and 2018.

METHODS

This is an epidemiological, descriptive, cross-sectional study with data from the Department of Informatics of the Unified Health System (DATASUS) on violence against and pregnancy of girls aged 10 to 13 years from 2012 to 2018. Data on sexual violence were accessed in the Health Information System (SINAN); on pregnancy, in the Live Births Information System (SINASC), on fetal deaths, in the Mortality Information System (SIM), and on abortions, in the Hospital Admission System (SIH).

RESULTS

Between 2012 and 2018, out of 136,387 pregnancies, there were 120,185 live births and 15,402 interrupted pregnancies by abortions or fetal deaths of mothers who became pregnant aged 13 years or younger. In the same period, SINAN received 46,548 notifications of sexual abuse against girls aged 10 to 13 years. The number of girls who became pregnant before the age of 14, victims of statutory rape, was 2.9 times higher than the number of cases notified to SINAN.

CONCLUSION

The lack of adequate notification of statutory rapes in Brazilian official statistics leads to the underestimation of its magnitude.

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.

School-based HPV Vaccination: The Challenges in a Brazilian Initiative

OBJECTIVE

 The present study assesses the implementation and the impact after 2 years of a school-based human papillomavirus (HPV) vaccination program in a Brazilian city.

METHODS

 A prospective study assessing the implementation of the program, offering quadrivalent HPV vaccine in two annual doses to girls and boys aged from 9 to 10 years old. The program was started in the city of Indaiatuba, state of São Paulo, Brazil, in 2018, and had authorization from the National Immunization Program. The number of HPV vaccine first doses applied and the coverage in 2018 was calculated and compared to the year 2017. There were described events that have influenced the results.

RESULTS

 The program invited 4,878 children through schools (87.1% of the target population), and 7.5% refused vaccination. Several concurrent events required or competed for health professionals of the vaccination teams. The coverage of the first dose (between 9 and 10 years old) was 16.1% in 2017 and increased to 50.5% in 2018 (p < 0.0001). The first dose in all ages increased 78% in 2018 compared with 2017 (6,636/3,733). Competing demands over the program continued in 2019, and the first dose coverage dropped (26.9%). For 2020, a municipal law instituted school-based vaccination and the creation of dedicated teams for vaccination, and these strategies are waiting to be tested.

CONCLUSION

 School-based annual HPV vaccination in children between 9 and 10 years old was feasible and increased vaccination coverage, regardless of gender, although the program was vulnerable to competing events.

Effectiveness of school-based interventions in delaying sexual debut among adolescents in sub-Saharan Africa: a protocol for a systematic review and meta-analysis

INTRODUCTION

Early sexual debut is associated with poor sexual and reproductive health outcomes across the life course. A majority of interventions aimed at delaying sexual debut among adolescents in sub-Saharan Africa (SSA) have been implemented in schools with mixed findings on the effectiveness of such interventions. This systematic review will summarise and synthesise existing evidence on the effectiveness of school-based interventions in delaying sexual debut among adolescents aged 10-19 years.

METHODS AND ANALYSIS

We will conduct a comprehensive database search of peer-reviewed studies published in PubMed, Scopus, Science Direct, Web of Science, HINARI and EBSCO (PsycINFO, Global Health, CINAHL) and in Cochrane library, National Institute of Health and Turning Research into Practice databases for ongoing studies yet to be published. All studies conducted in SSA between January 2009 and December 2020, regardless of the study design, will be included. Two authors will independently screen all retrieved records and relevant data on sexual debut extracted.Data will be pooled using the random effects model. Dichotomous outcomes will be reported as risk ratios and continuous data as mean difference at 95% CI. Heterogeneity will be assessed using the I² statistic. Findings will be presented in tables and charts, while providing a description of all included studies, themes and concepts drawn from literature.

ETHICS AND DISSEMINATION

Ethical approval is not required. The findings will be disseminated through peer-reviewed publications, presentations at relevant conferences and other convening focusing on adolescent sexual and reproductive health.

Características dos adolescentes ofensores sexuais e de suas vítimas: um estudo de processos judiciais

Resumo A violência sexual praticada por adolescentes ainda é pouco estudada no Brasil. Conhecer esses sujeitos é fundamental para a compreensão do fenômeno e execução de ações preventivas. Este artigo apresenta características dos adolescentes ofensores sexuais, bem como de suas vítimas e do contexto da violência. Para isso, foram analisados 254 processos judiciais, entre 2013 e 2016, no Distrito Federal, envolvendo 285 ofensores e 291 vítimas. A partir das informações coletadas, elaborou-se um quadro descritivo, cuja análise foi realizada de forma contextualizada e tendo como referência outros importantes estudos na área. Os resultados apontaram a diversidade dos adolescentes ofensores sexuais, porém as informações sobre as famílias foram bastante escassas nos processos. Quanto à idade e à escolaridade, a maior parte cometeu a ofensa com 16/17 anos (41,4%) e cursava o ensino fundamental II (29,5%). Um número significativo de adolescentes tinha envolvimento anterior com a justiça (24,2%). Os abusos foram prioritariamente extrafamiliares (48,5%), com vítimas do sexo feminino (67,7%), entre 10 e 14 anos (40,5%) e conhecidas do ofensor (92,2%). Ressalta-se a complexidade dos casos, impossibilitando intervenções padronizadas e descontextualizadas, assim como a importância de conhecer o contexto social e as relações familiares desses sujeitos com vistas a intervenções mais assertivas.

Início da atividade sexual e sexo protegido em adolescentes

Resumo Objetivos Identificar a prevalência do início da atividade sexual em adolescentes e a prática de sexo seguro entre os mesmos. Método Estudo transversal realizado com 499 adolescentes, em Pouso Alegre, Minas Gerais, de fevereiro a abril de 2017, por meio de um questionário autoaplicado e semiestruturado, contemplando iniciação, práticas sexuais, conhecimento sobre contracepção, prevenção de infecções sexualmente transmissíveis e participação em atividades educativas sobre o tema. Os dados foram analisados por estatística descritiva, as diferenças estatísticas avaliadas pelo teste X2 de Pearson. Resultados A prevalência da atividade sexual foi 47,3%, com idade média da sexarca de 14,1 anos, e tendência de iniciação sexual precoce no sexo masculino. Um terço das primeiras relações sexuais foram desprotegidas (33,9%). As participantes do sexo feminino apresentavam maior conhecimento a respeito de contracepção e prevenção de doenças, menor adesão ao uso de preservativos e maior utilização de contraceptivos orais e de emergência. Conclusão e implicações para a prática O estudo mostrou início precoce de vida sexual entre adolescentes, e um terço das relações sexuais sem proteção. Há necessidade de ações de saúde e educação que garantam a aquisição de conhecimento e acesso a métodos contraceptivos.

Contradições acerca da violência sexual na percepção de adolescentes e sua desconexão da lei que tipifica o “estupro de vulnerável”

Resumo: O Art. 217-A da Lei nº 12.015/2009 definiu como crime de estupro de vulnerável a conjunção carnal ou outro ato libidinoso praticados com menor de 14 anos. Diante da baixa idade de início da atividade sexual observada na atualidade, objetivamos neste estudo compreender a concepção de adolescentes acerca da iniciação sexual, da violência sexual e da lei que a tipifica como “estupro de vulnerável”. Utilizamos método qualitativo por meio de 13 grupos focais com 132 estudantes do Ensino Médio de escolas públicas e privadas do Município do Rio de Janeiro, Brasil. A análise dos dados foi realizada com apoio do software webQDA, em uma abordagem hermenêutico-dialética que deu origem a três categorias: sentir-se apto a iniciar o sexo, (in)vulnerabilidade à violência sexual e mecanismos de proteção. A iniciação sexual para as moças está relacionada a uma visão romântica, a se sentirem seguras e terem confiança no parceiro, ao passo que, para os rapazes, está associada a oportunidade, livre de outros fatores. Para a maioria dos estudantes, quando o consentimento para a prática sexual é mútuo, independente da idade, não há violência. Ao mesmo tempo, questionam-se quanto à capacidade de discernimento das mais jovens para permitir o sexo. A maior parte discorda das medidas protetivas previstas na lei, por entender que é dever da família prover esse cuidado. As contradições na percepção dos adolescentes sobre a vulnerabilidade à violência sexual e o estupro de vulnerável previsto em lei nos levam a concluir que é necessário ampliar e qualificar a educação sexual de forma abrangente para adolescentes, assim como criar espaços de discussão que possam proporcionar aperfeiçoamento desse dispositivo legal.

Temporal trend of adolescent pregnancy in Brasil

SUMMARY OBJECTIVE: To analyze the temporal trend and factors associated with adolescent pregnancy during ten years in Brasil. METHODS: Data were extracted from the Live Births Information System, of the Brazilian Health System and included information regarding live births from adolescent mothers from 2006 to 2015. The overall proportion of gestation in adolescence and the specific proportions according to the characteristics analyzed were calculated using the standardized reporting coefficients and the simple linear regression method. The study was approved by the ethics committee of the University of Southern Santa Catarina (UNISUL). RESULTS: The general proportion of Live Births from adolescent mothers varied from 21.4% in 2006 to 18.1% in 2015. This reduction occurred because of the negative variation observed among mothers aged 15 to 19 years. The indigenous group was the only that did not present a reduction. There was an increase in the proportion of adolescents with between four and seven years of formal education and in the proportion of adolescents living with partners. There was a reduction in all Brazilian Regions and in large part of the Federation Units. CONCLUSION: The analysis of the temporal trend identifies a reduction in the proportion of live births among adolescent mothers in Brasil. However, there is a growing trend among some specific groups.

Factors associated with family, school and behavioral characteristics on sexual initiation: A gender analysis for Brazilian adolescents

Adolescence is a period of transition between childhood and adulthood. The article aims to study the individual, family and school characteristics of adolescents beginning their sexual lives. The database we used was the 2015 PeNSE (National Adolescent School-based Health Survey) and the methodology was the survival analysis. The results show that boys initiate sexual activity before girls and risky behaviors associated with the use of licit and illicit drugs increase the chance of having early sex. In addition, this work highlights the importance of parental practices in reducing the chances of beginning sexual activity, as well as the presence of school workshops on the risks of pregnancy. It should be noted that intervention strategies need to be differentiated according to gender in order to increase effectiveness.

[Sexual initiation and contraceptive practices among adolescents in the tri-border area between Brazil, Argentina, and ParaguayIniciación sexual y prácticas anticonceptivas de adolescentes en la triple frontera entre Brasil, Argentina y Paraguay]

OBJECTIVE

To determine the prevalence of sexual initiation and the contraceptive practices of adolescents in the tri-border area between the cities of Foz do Iguaçu (Brazil), Ciudad del Este (Paraguay), and Puerto Iguazú (Argentina).

METHOD

A cross-sectional study was conducted with 2 788 adolescents from public schools (age 12 to 18 years). Information was obtained through questionnaires administered in the schools between 2012 and 2013. The prevalence of sexual initiation, contraceptive practices, and sociodemographic variables was analyzed. To verify the association between the studied variables, the chi-square test was used with a significance level of 5%.

RESULTS

The overall prevalence of sexual initiation among adolescents was 34.6% (Puerto Iguazú: 45.3%; Foz do Iguaçu: 35.2%; Ciudad del Este: 23.3%). The prevalence of sexual initiation was higher in males and in the 15-16 year age range. Sexual initiation was associated with sex, age, schooling, and school shift (morning, afternoon, or evening). Having received information on contraceptives was associated with sex, age, schooling, and contraceptive use in all three cities/countries. Adolescents of both sexes had received information about contraceptives, especially from the family and the school.

CONCLUSIONS

It is suggested that municipalities/countries seek to structure a tri-national border policy with intersectoral programs and projects in order to promote educational practices regarding sexual and reproductive health for adolescents.

Young women's contraceptive practices: a household survey in the city of São Paulo, Brazil

The last decade has witnessed initiatives to expand access to contraceptives in Brazil. However, the last population-based study on contraception was undertaken in 2006. A household survey in 2015 investigated contraceptive practices in women 15 to 44 years of age living in the city of São Paulo. The current study selected data on young women 15 to 19 years of age. The objectives were to identify the prevalence of contraception, the contraceptives used, sources, and differences in contraceptive practices. The young women are part of a probabilistic study sample. Differences in contraception use were compared by multiple logistic regression analysis. A total of 633 young women were interviewed, of whom 310 (48.5%) were sexually initiated. Of these, 60% reported emergency contraception use at least once in their lives. Emergency contraception use was directly proportional to age and lifetime number of partners. Prevalence of contraception was 81%. The odds of current contraception use were higher among young women residing in the health district of the city with the better social conditions, Catholics, those who reported sexual relations in the previous 30 days, and those with history of an obstetrics and gynaecology visit in the previous year, and inversely proportional to the lifetime number of sex partners. Male condoms and the pill were the most common methods (28.2% and 23%). Most of the women purchased their contraceptives in retail pharmacies (75.2%), and the Brazilian Unified National Health System (SUS) was only a significant source for injectable hormonal contraceptives. Government support for women's sexual and reproductive rights is still insufficient.

Age of sexual initiation and depression in adolescents: Data from the 1993 Pelotas (Brazil) Birth Cohort

BACKGROUND

Studies have shown that sexual initiation at earlier ages increases the risk of depressive symptoms in adolescents. However, little is known about its association with major depressive episode (MDE).

METHODS

The association between age of sexual initiation and MDE at 18 years was assessed in the 1993 Pelotas Birth Cohort using multiple logistic regression. Sexual initiation characteristics (age and type of partner) were assessed at the 15- and 18-years follow-up. The age of sexual initiation was evaluated in categories (11-14, 15-16, 17+ years). The type of partner was categorized into: boyfriend/ girlfriend, casual partner and other. MDE was assessed using the Mini International Neuropsychiatric Interview (MINI).

RESULTS

From the 4027 adolescents assessed, the prevalence of MDE was higher in females (10.1%) than in males (3.4%), and 66.7% of the males and 58.6% of the females reported sexual initiation up to 16 years (p < 0.001). Female adolescents who had sexual initiation <17 years had higher odds of MDE (15-16 years: OR 2.29; 11-14 years: OR 2.23), however no association was found for males. The type of partner in the first sexual intercourse was not associated to depression.

LIMITATIONS

Possibility of recall bias on the age of sexual initiation, and low statistical power for some analyses.

CONCLUSIONS

A positive association between age of sexual initiation and MDE was observed only in females. More investigation is needed to understand the mechanisms through which age of sexual initiation can affect the risk of depression and whether the association persists in adulthood.

ERICA: sexual initiation and contraception in Brazilian adolescents

OBJECTIVE To estimate the prevalence of sexual initiation and contraceptive use at the last sexual intercourse of Brazilian adolescents, according to sociodemographic features. METHODS The data were obtained from the Study of Cardiovascular Risks in Adolescents (ERICA), a national school-based cross-sectional study. We included 74,589 adolescents from 32 geographic strata (27 capitals and five sets of municipalities with more than 100,000 inhabitants of each of the five macro-regions of the Country). Information on sexual initiation and contraceptive use at the last sexual intercourse (male condom and oral contraceptive pill) has been used. We have estimated prevalence and confidence intervals (95%CI) considering sample weights according to sex, age, type of school, residence status, macro-region and capitals. RESULTS We observed that 28.1% (95%CI 27.0-29.2) of the adolescents had already initiated sexual life, with higher prevalence among those aged 17 years (56.4%, 95%CI 53.9-58.9), males (33.5%, 95%CI 31.8-35.2), studying at public schools (29.9%, 95%CI 28.5-31.4), and from the Northern region (33.9%, 95%CI 32.3-35.4), mainly from Macapa, Manaus, and Rio Branco. Among those who had started their sexual life, 82.3% (95%CI 81.1-83.4) reported the use of contraceptive methods at the last intercourse, and the prevalence of use was higher among adolescents aged 17 years (85.3%, 95%CI 82.7-87.6), females (85.2%, 95%CI 83.8-86.5) and those living in the Southern region (85.9%, 95%CI 82.9-88.5). Male condom was used by 68.8% (95%CI 66.9-70.7), with no difference by type of school or macro-regions; the contraceptive pill was used by 13.4% (CI95% 12.2-14.6), and more frequently used among women (24.7%, 95%CI 22.5-27,0) and 17-year-old adolescents (20.8%, 95%CI 18.2-23.6) from urban settings(13.7%, 95%CI 12.5-14.9) and from the Southern region (22.6%, 95%CI 19.0-26.8), and less often in the Northern region. CONCLUSIONS ERICA's data analysis on sexuality and contraception shows heterogeneities in the prevalence of sexual initiation and use of contraceptive methods among Brazilian adolescents, depending on their age, where they live, and the type of school they study at. Younger adolescents and those living in the Northern region seem to be more vulnerable to the consequences of unprotected sexual intercourses.

Factors Associated with Suicidal Ideation and Suicide Attempt among School-Going Urban Adolescents in Peru

The study examines the prevalence of suicidal ideation and suicide attempt, and associated factors among school-going urban adolescents in Peru. A cross-sectional survey was conducted in a sample of 916 secondary school adolescents in 2014. A structured questionnaire adapted from Global School-based Student Health Survey was used to obtain information. Data were analyzed using logistic regression models at 5% level of significance. Overall, 26.3% reported having suicidal ideation, and 17.5% reported having attempted suicide during the past 12 months. Multivariate logistic regression analysis showed that female sex, being in a fight, being insulted, being attacked, perceived unhappiness, smoking and sexual intercourse initiation were significantly associated with increased risk of suicidal ideation, while female sex, being in a fight, being insulted, being attacked, perceived unhappiness, alcohol and illicit drug use were related to suicide attempt. The prevalence of suicidal ideation and suicide attempts observed in the survey area is relatively high. Female adolescents are particularly vulnerable to report suicidal ideation and suicide attempt. Interventions that address the issue of violence against adolescents, fighting with peers, health risk behaviors particularly initiation of smoking, alcohol and illicit drug use and encourage supportive role of parents may reduce the risk of suicidal behaviors.