Teenagers' use of sexual health services: perceived need, knowledge and ability to access

National trends and disparate access to formal and informal sex education among youth involved with the child welfare system in the USA

This study aimed to understand whether youth involved with the child welfare system in the USA are receiving formal and informal sex education. Data come from the Second National Survey of Child and Adolescent Wellbeing, a nationally representative sample of children and adolescents in contact with child protective services. Participants included young people (n=1093, aged 11-21) involved with the child welfare system. Participants reported whether they had received formal sex education about a) abstinence only; b) contraceptives/condoms only; c) abstinence and contraceptives/condoms; or d) none. They also reported whether they knew where to access family planning services. We examined the prevalence of sex education experiences and differences in sex education access and knowledge based on participants' pregnancy history and sociodemographic characteristics. Only half (49%) of participants had received any form of formal sex education. Pregnant youth were less likely to have received any sex education compared to non-pregnant youth (p=.045). 72% of adolescents who had received sex education about contraceptives/condoms reported knowing where to access family planning services compared to only 46% of adolescents who had not received sex education about contraceptives/condoms (p=.014). There is a pressing need for comprehensive sex education among young people involved with the child welfare system in the USA.

Needs assessment for gender sensitive reproductive health services for adolescents

Background A dimension of reproductive health services that should be gender sensitive is reproductive health services for adolescents. Objective This study aims to assess needs for gender sensitive reproductive health care services for adolescents. Methods This was a descriptive cross-sectional study on 341 of health care providers for adolescents in health centers and hospitals affiliated to Shiraz University of Medical Sciences in Iran in 2016. The subjects of the study were recruited using a convenience sampling method. The tools for data collection were: (1) a demographic information questionnaire and; (2) a valid and reliable questionnaire to Assess the Needs of Gender-Sensitive Adolescents Reproductive Health Care Services (ANQ-GSARHS) including three sections; process, structure and policy making for the services. Data were analyzed using SPSS 21. Results Three hundred and forty-one health providers with an average working experience of 8.77 ± 5.39 [mean ± standard deviation (SD)] years participated in the study. The results demonstrated the highest scores for educational needs (92.96% ± 11.49%), supportive policies (92.71% ± 11.70%) and then care needs (92.37% ± 14.34%) of the services. Conclusions Providing gender sensitive reproductive health care services for adolescents needs to be reformed as regards processes, structure and policies of the services. However, the gender appropriate educational and care needs as well as supportive policies are the priorities for reform of the services.

Reproductive health service utilization and associated factors: the case of north Shewa zone youth, Amhara region, Ethiopia

INTRODUCTION

Many youth are less informed, less experienced and less comfortable in utilizing reproductive health services. In the Sub-Saharan region the adolescents account for a higher proportion of new HIV infections and unmet need for reproductive health (RH) services. This study assessed reproductive health service utilization and associated factors among the youth in Amhara Region, Ethiopia.

METHODS

A community based cross-sectional study was conducted from June 15-July 30, 2014. Three hundred ninety one youth were selected by systematic random sampling technique and interviewed using structured questionnaire. Data were anlyzed using SPSS windows version 20. Multiple logistic regression was done to control potential confounding variables. P-values <0.05 were considered statistically significant.

RESULTS

Three hundred and nighty one in-school and out-of-school youth were interviewed; 256 (65.5%) participants were in school and 209 (53.5%) were males. Almost all respondents (93.9%) had heard about reproductive health services and a third 129 (33%) had ever practiced sexual intercourse and 54.7% of them had utilized at least one reproductive health services. Never had sexual intercourse (AOR=3.693, 95%CI: 1.266, 10.775), families that asked their children about friends (parental monitoring) (AOR=1.892, 95%CI: 1.026, 3.491), know where service provided (AOR=3.273, 95%CI: 1.158, 9.247), youths who reads newspaper readers (AOR=3.787, 95%CI: 1.849were independent predictors of youth reproductive service utilization at 95 % CI and p-value <0.05%.

CONCLUSION

Even though the youth have information about reproductive health services, youth reproductive health services utilization is very low. Therefore, building life skill, facilitating parent to child communication, establishing and strengthening of youth centres and increasing awareness for youth about those services are important steps to improve adolescents' reproductive health (RH) service utilization.

Providing Contraception to Adolescents

Adolescents have high rates of unintended pregnancy and face unique reproductive health challenges. Providing confidential contraceptive services to adolescents is important in reducing the rate of unintended pregnancy. Long-acting contraception such as the intrauterine device and contraceptive implant are recommended as first-line contraceptives for adolescents because they are highly effective with few side effects. The use of barrier methods to prevent sexually transmitted infections should be encouraged. Adolescents have limited knowledge of reproductive health and contraceptive options, and their sources of information are often unreliable. Access to contraception is available through a variety of resources that continue to expand.

`No worries!'

`No Worries!' is a nurse-led drop-in sexual health service for young people in one Primary Care Trust in South West England. The service aims to provide sexual health promotion, contraception, STI testing and a range of health promotion advice. The service was evaluated from the young people's perspectives using quantitative and qualitative methodologies. Attendance data, questionnaires and interviews explored patterns of use, effectiveness and acceptability of three clinics, two in areas of social deprivation and a third with increasing teenage conception rates.

Questionnaire data were collected from 153 young people (232 clinic attendances) and 18 were interviewed (aged 14—18 years). The pattern of service use varied across the clinics, with those from the lowest socio-economic community using fewer condoms, having more pregnancy tests and STI swabs. Average age of first intercourse was 15 years, and most visited the clinic after having sex rather than before. Young people found the service accessible and they highlighted close proximity to home and school, the drop-in nature, and confidentiality, professionalism and friendliness of staff. After using the service, respondents reported that they would be more likely to practise safer sex and change their behaviour.

The clinics appeared to match up to young people's expectations of the service, but did not manage to attract many boys. Young people said the service made them feel more confident, more informed about sex, aware of sexually transmitted diseases and take fewer risks.

The challenges of female adolescents' health needs

Due to adolescents' future crucial roles, their health needs should be included in the national health system policy. In this cross-sectional study 2010 female adolescents were recruited from randomly selected schools in Iran. To obtain their health needs, the participants completed a self-administrated questionnaire. It was revealed that emotional needs were the most important health needs of adolescents. Furthermore, there was a meaningful relationship between health needs' score with the adolescents' age and their mothers' education level. Finally, the mean score of health needs was significantly higher in urban adolescents. Therefore, it is suggested that adolescents' emotional health needs to be paid attention; otherwise irrecoverable serious problems may occur in the next generation's health.

Reproductive health service utilization and associated factors among adolescents (15-19 years old) in Gondar town, Northwest Ethiopia

Background

The utilization of reproductive health services is an important component in preventing adolescents from different sexual and reproductive health problems. It plays a vital role in safeguarding youth in Sub-Saharan African countries including Ethiopia, which accounts for a high proportion of the region’s new HIV infections as well as maternal and infant mortality ratios. Due to this, assessing adolescent reproductive health service utilization and associated factors has its own contribution in achieving the national Millennium Development Goals (MDG), especially goals 4 to 6.

Methods

A community based cross-sectional study was conducted from April 5–19, 2012, in 4 randomly selected administrative areas of Gondar town. A total of 1290 adolescents aged 15–19 were interviewed using a pre-tested and structured questionnaire. Data were entered in to the EPI INFO version 3.5.3 statistical software and analyzed using an adapted SPSS version 20 software package. Logistic regression was done to identify possible factors associated with family planning (FP), and voluntary counseling and testing (VCT) service utilization.

Results

Out of the total participants, 79.5% and 72.2% utilized FP and VCT services, respectively. In addition, among sexually experienced adolescents, 68.1% and 88.4% utilized contraceptive methods and VCT service during their first sexual encounter, respectively. Educational status, discussion with family/relatives, peer groups, sexual partners and teachers were significantly associated with FP service utilization. Also, adolescents who had a romantic sexual relationship, and those whose last sexual relationship was long-term, were about 6.5 times (Adjusted Odds Ratio [AOR] = 6.5, 95% CI: 1.23, 34.59), and about 3 times (AOR = 3, 95% CI: 1.02, 8.24) more likely to utilize FP services than adolescents who had no romantic relationship or long-term sexual relationship, respectively. In addition, the variables significantly associated with VCT service utilization were: participants who had secondary education and above, schooling attendance, co- residence with both parents, parental communication, discussion of services with peer groups, health workers, and perception of a risk of HIV/AIDS.

Conclusions

The majority of the adolescents were utilizing FP and VCT service in Northwest Ethiopia. But among the sexually experienced adolescents, utilization of FP at first sexual intercourse and VCT service were found to be low. Educational status, schooling attendance, discussion of services, type of sexual relationship and perception of risk were important factors affecting the utilization of FP and VCT services. Building life skill, facilitating parent to child communication, establishing and strengthening of youth centers and school reproductive health clubs are important steps to improve adolescents’ reproductive health (RH) service utilization.

Accessibility of sexual health services in teenage sexual health service users: local area geospatial analysis

BACKGROUND

Teenage pregnancy rates in the UK are the highest in Western Europe. Causes of teenage pregnancies are multifaceted with complex interplay of social, lifestyle and wider determinants influencing risk. Improving access to sexual health services through community services is an important factor in attempting to tackle this issue, but few studies have examined factors that influence this.

METHODS

Geospatial analysis was conducted on community sexual health service users and teenage conceptions from local sexual health services were recorded. Univariate and multinomial regression was performed to test associations between service type and socio-economic status.

RESULTS

No significant differences in accessibility of services between teenage girls who have conceived and those seeking sexual health services were found. Females aged 17 and under were more likely to use a young people's sexual health service than mainstream services (P < 0.001). However, a young person living in the most deprived quintiles was more likely to use a mainstream service if it was closer to their home address (adjusted odds ratios: 2.154, 95% confidence intervals: 1.533-3.027).

CONCLUSIONS

Service type and socio-economic status impact upon the choices young people make when accessing community sexual health services. The study supports policy for locating young person services within the most deprived areas of a community.

Swedish adolescents' experiences of educational sessions at Youth Clinics

Planning sex and relationship health education suitable for adolescents is a pedagogical challenge.

OBJECTIVE

To describe how secondary school pupils in Sweden experience health educational sessions at Youth Clinics.

METHODS

Data were collected from six focus groups within 2 weeks of an educational session. The groups consisted of pupils aged 14-16 years from three cities. The participants were 29 adolescents divided into groups of girls (n=15) and boys (n=14) and the interviews were audio taped. Data were analysed using qualitative content analysis.

FINDINGS

Five categories were identified: Impact of the educational session, The desirable educator, Didactic setup, Gender inequalities and Suitable age for the educational session. The adolescents were satisfied with the content of the education and the session was evaluated as a complement to school education. The educators were seen as competent with an ability to create a comfortable atmosphere which made it easier for participants to discuss the subject and ask questions. The session was experienced as secure which was appropriate for the intimate and personal subject and gender aspects were seen as influencing the conversation.

CONCLUSION

This study can give an understanding of the needs and demands of adolescents which can be useful when planning and conducting sex and relationship health education.

The contextual effect of school satisfaction on health-risk behaviors in Japanese high school students

BACKGROUND

The importance of school contextual effects on health and well-being among young people is currently recognized. This study examines the contextual effects of school satisfaction as well as the effects of individual-level school satisfaction on health-risk behaviors in Japanese high school students.

METHODS

Self-administered questionnaires were distributed to 3248 students in grades 10 through 12 at 29 public high schools throughout Okinawa, Japan. Using multilevel logistic regression models, the effects of individual- and contextual-level school satisfactions on health-risk behaviors were analyzed. The contextual-level school satisfaction was defined as satisfaction at the school level and was measured using aggregated individual scores. Behaviors studied included current smoking, current drinking, and sexual activity.

RESULTS

Approximately 15%, 6%, and 5% of the total individual differences in smoking, drinking, and sexual behaviors, respectively, occurred at the school level. Students with lower school satisfaction were more likely to engage in health-risk behaviors compared with those with higher school satisfaction. After adjustment for individual-level school satisfaction and other covariates, the odds of smoking and drinking increased with decreasing contextual-level school satisfaction. However, the association of contextual school satisfaction with sexual activity did not reach statistical significance.

CONCLUSIONS

This study showed that individual- and contextual-level school satisfactions affected smoking and drinking behaviors in Japanese high school students. However, no significant association between contextual-level school satisfaction and sexual activity was observed.

Contraception among girls who have had more than one partner by age 16 years: method use and pregnancy risk-taking behaviour

BACKGROUND

Attempts to address the 'problem' of teenage pregnancy need to further explore contraceptive use among young people at potentially greatest risk. We examine contraceptive use among a particularly vulnerable subgroup: girls who reported having had sex with more than one partner by age 16 years.

METHODS

Females (n = 435) completed questionnaires as part of the Scottish SHARE school-based sex education trial, reporting on contraceptive use at three episodes of sexual intercourse: first, first with most recent partner, and most recent.

RESULTS

Most used some form of contraception at each episode but a quarter reported withdrawal, putting on a condom before ejaculation or non-use. Some 57% of the girls reported using methods that suggested lower levels of pregnancy risk-taking behaviour at all three episodes, but 20% reported method use suggestive of greater risk-taking behaviour at one episode, 12% at two, and 11% at all three. In multivariate analysis, the factors associated with greater pregnancy risk-taking behaviour were living in social or rented accommodation, not knowing where to get prescription contraceptives, having pressurised or unexpected or spur of the moment sex, and not having talked to their partner about protection prior to sex.

CONCLUSIONS

Most girls used an effective method of contraception at each episode of intercourse but a sizeable minority reported use of no contraception, or an ineffective method, which suggested greater pregnancy risk-taking behaviour; one in ten at all three episodes. Particular efforts are required to further understand and better target those girls who are putting themselves at repeated risk of pregnancy.

[Perception of the risk to adquire a sexually transmitted disease in a young population]

OBJECTIVE

To find out the perception of the risk of adquire a sexually transmitted disease (STD) in young people (15-21 years), and their attitudes and behaviour to adopt protective measures in sexual relationships.

DESIGN

Socioconstructive qualitative study performed between the years 2006 and 2008

SETTING

Two Primary Care Centres in the city of Girona.

PARTICIPANTS

A total of 34 young people selected from lists provided by doctors and key informers.

METHODS

Theoretical sample from different designed profiles. The data was obtained and saturated by performing 5 group interviews. A thematic content analysis of the narrative data was made of the categorical subject.

RESULTS

They had partial knowledge on AIDS and very little on other STD. The risk of pregnancy has the most influence on adopting protective measures. Despite easy access and knowledge of condoms, in some cases they are not used either in stable relationships or in sporadic ones, with different reasons for having this risk behaviour. They have limited contact with the health services, and when they do it is mainly to ask for emergency contraception.

CONCLUSIONS

Health strategies should be directed towards adolescents, taking into account what they need from the health services as regards sexual health, in a different context from the health centre. Information should be focused on combating erroneous beliefs, such as AIDS is a disease of "others" and not "ours", and address these actions, not only to improve knowledge and attitudes but also changes in behaviour.

Adolescent reproductive health in Uganda: issues related to access and quality of care

Adolescent health in Kabarole district, Uganda, is seriously jeopardized by both high teenage pregnancy rates and high rates of sexually transmitted diseases, including HIV infection.

OBJECTIVES

To elucidate views, perceptions and attitudes of key informants who are involved in the delivery of reproductive health services to adolescents.

STUDY GROUP

Four managers of youth-related nongovernmental organizations, two government nurses, and four youth leaders.

METHODS

Qualitative study with content analysis using in-depth interviews.

RESULTS

Participants agreed that reproductive health services in Kabarole district are not adolescent friendly. Most often, lack of privacy and confidentiality for the adolescents attending a health unit was cited as one important reason. Other factors contributing to a less adolescent friendly service environment were inconvenience of services including the fragmentation of different service components and lack of specific traIning for health workers on how to relate appropriately to adolescents. Also noted was that several participants had a negative attitude toward the sexual activity of adolescents. Suggestions for service improvement were limited to training of health workers and increased support for the infrastructure.

CONCLUSIONS

Reproductive health services for adolescents in Kabarole district could be strengthened by improving the privacy and confidentiality of services. Health workers must also be trained in counseling and in treating adolescents in a youth-appropriate and high quality fashion. Staff attitudes must also be addressed.

What explains between-school differences in rates of sexual experience?

BACKGROUND

Schools have the potential to influence their pupils' behaviour through the school's social organisation and culture, as well as through the formal curriculum. This paper provides the first attempt to explain the differences between schools in rates of reported heterosexual sexual experience amongst 15 and 16 year olds. It first examined whether variations in rates of sexual experience remained after controlling for the known predictors of sexual activity. It then examined whether these residuals, or 'school effects', were attributable to processes within the school, or were more likely to reflect characteristics of the neighbourhood.

METHODS

Longitudinal survey data from 4,926 pupils in 24 Scottish schools were linked to qualitative and quantitative data on school processes including quality of relationships (staff-pupil, etc), classroom discipline, organisation of Personal and Social Education, school appearance and pupil morale. Multi-level modelling was used to test a range of models and the resulting 'school effects' were then interpreted using the process data.

RESULTS

Overall, 42% of girls and 33% of boys reported experience of sexual intercourse, with rates by school ranging from 23% to 61%. When individual socio-economic and socio-cultural factors were taken into account the school variation dropped sharply, though pupils' attitudes and aspirations had little effect. There was very little correlation between boys' and girls' rates of sexual experience by school, after controlling for known predictors of sexual activity. Girls were more influenced by individual socio-economic factors than boys. School-level socio-economic factors were predictive even after taking account of individual socio-cultural factors, suggesting that the wider socio-economic environment further influenced young people's sexual experience.

CONCLUSION

Importantly, school processes did not explain the variation between schools in sexual experience. Rather, the variation may have been due to neighbourhood culture.

Meeting the sexual health care needs of young people: a model that works?

INTRODUCTION

In the UK, young people have been identified as a specific group who experience poor sexual health and there is scope for improving this if sexual health services are sensitive and relevant to their needs. This paper reports on the work of two services which were set up specifically for young people, exploring whether the model of service provision adopted was successful in engaging this group.

METHODS

Routine monitoring data (anonymous) in relation to all contacts with the services were collected. After the services had become established, short questionnaires were administered to young people using them.

RESULTS

For service one, 425 contacts were recorded over 34 service sessions. Of these, 149 were new clients: 52% young men (78) and 48% young women (71), with a mean age of 14 years. There were 259 repeat contacts: 74% with young men (191) and 26% with young women (68). For service two, 399 contacts were recorded over 61 service sessions. Of these, 118 were new clients: 32% young men (38) and 68% young women (80), with a mean age of 16.8 years. There were 274 repeat contacts: 40% with young men (108) and 60% (166) with young women. All of the young people were generally very satisfied with the services they received. The youngest young people were less likely to indicate that they would have accessed other sexual health services.

DISCUSSION AND CONCLUSIONS

This study indicates that young people of both sexes, between the ages of 11 and 19 years, can be engaged by sexual health services, if provision is modelled on 'best practice' and what is known about the sexual health service needs of young people. Engagement with such services is a prerequisite for addressing the diversity of sexual health needs young people are likely to have in contemporary society and the findings of this study in relation to gender and age are particularly pertinent.

Inequalities in the provision of sexual health information for young people

BACKGROUND

Sexual health has been emphasised in national and regional strategies as a target for health and social well-being. In Northern Ireland (NI), the Sexual Health Promotion Strategy concentrates on reducing the incidence of sexually transmitted infections (STIs), reducing the number of unplanned births to teenage mothers, providing appropriate, effective and equitable sexual health information, and facilitating access to sexual health services. This article reports on a study carried out within NI and explores young people's knowledge and sources of sexual health information.

METHODS

School pupils aged 14-18 years (n = 414) participated in the study and a self-administered questionnaire was used to collect the data.

RESULTS

Whilst approximately half of the respondents reported being sexually active, only 68.2% always used some form of contraception. In fact, 40.8% of sexually active females had used the 'morning-after pill', with 37.5% of these respondents using this method more than once. The results also indicated that students receive varying amounts of sexual health information from schools resulting in inequalities with regard to sources of information. Students from a Roman Catholic religious background were more likely to receive information on sexual health from informal sources such as friends, books/magazines or television/radio than from within the school environment compared with their Protestant counterparts.

CONCLUSIONS

The provision of standard and accurate information appropriate to the target population is necessary in order to reduce the increasing rates of STIs and help the Government reach their target of halving the teenage pregnancy rate by the year 2010.

Do sexual health services encourage teenagers to use condoms? A longitudinal study

OBJECTIVE

Sexual health services have the potential to encourage teenagers' condom use through both the free supply of condoms and counselling. This study investigated whether 15/16-year-olds who attended sexual health services used condoms more and had different beliefs about condoms compared to those who did not use these services.

METHODS

First, a cross-sectional multivariate model investigated the association between service visits and condom consistency (a ratio of the number of times a condom was used to the number of times a teenager had sexual intercourse in the past year) in teenagers at age 15/16 years (n = 1013). Second, a longitudinal multivariate model examined links between service use and changes in condom-related cognitions measured at age 13/14 and age 15/16 years (n = 3432).

RESULTS

Visiting a service for free condoms was linked with greater condom consistency, after controlling for attitudes towards condoms, condom purchase and other factors. Visiting a service for other purposes was associated with lower consistency. Obtaining free condoms from services predicted greater condom self-efficacy and personal responsibility, and lower negative feelings relating to sexual pleasure when condoms were used. However, visiting a service for other purposes predicted less positive attitudes towards dual protection.

CONCLUSIONS

Obtaining free condoms from services was associated with greater condom use and positive changes in attitudes towards condoms, although the role of service counselling remains unclear. Services could do more to stress the need for continued dual protection against sexually transmitted infections (STIs) when prescribing the pill.