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

`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.

Dual use of long-acting reversible contraceptives and condoms among adolescents

Unintended pregnancy and sexually transmitted infections (STI) continue to be significant public health problems, and adolescents are disproportionately affected by both. With national attention and funding directed toward adolescent pregnancy prevention, promotion of long-acting reversible contraceptive (LARC) use among adolescents is both timely and relevant. However, LARCs provide no protection against STIs, requiring dual-method use of both LARC and barrier methods, most commonly the male latex condom, to address these issues simultaneously. Rates of both LARC and dual-method contraception are low in the United States, but have increased in recent years. Dual-method contraception is highest among younger women and adolescents with multiple or new sex partners. Consistent condom use remains a major barrier to dual-method use, as it necessitates admission of STI risk by both partners, and use is dependent upon two decision-makers rather than a single contraceptive user. Promoting the initiation and maintenance of LARC and condom use across multiple partnered sexual encounters requires understanding of individual, dyadic, and social influences. Successful maintenance of contraceptive and STI prevention behaviors requires individualized, longitudinal reinforcement, and social supports, but can ultimately reduce the burden of unintended pregnancy and STI among adolescents.

Adaptive Persuasive Systems

This article describes the use of personalized short text messages (SMS) to reduce snacking. First, we describe the development and validation ( N  = 215) of a questionnaire to measure individual susceptibility to different social influence strategies. To evaluate the external validity of this Susceptibility to Persuasion Scale (STPS) we set up a two week text-messaging intervention that used text messages implementing social influence strategies as prompts to reduce snacking behavior. In this experiment ( N  = 73) we show that messages that are personalized (tailored) to the individual based on their scores on the STPS, lead to a higher decrease in snacking consumption than randomized messages or messages that are not tailored (contra-tailored) to the individual. We discuss the importance of this finding for the design of persuasive systems and detail how designers can use tailoring at the level of social influence strategies to increase the effects of their persuasive technologies.

Retaining young people in a longitudinal sexual health survey: a trial of strategies to maintain participation

Background

There is an increasing trend towards lower participation in questionnaire surveys. This reduces representativeness, increases costs and introduces particular challenges to longitudinal surveys, as researchers have to use complex statistical techniques which attempt to address attrition. This paper describes a trial of incentives to retain longitudinal survey cohorts from ages 16 to 20, to question them on the sensitive topic of sexual health.

Methods

A longitudinal survey was conducted with 8,430 eligible pupils from two sequential year groups from 25 Scottish schools. Wave 1 (14 years) and Wave 2 (16 years) were conducted largely within schools. For Wave 3 (18 years), when everyone had left school, the sample was split into 4 groups that were balanced across predictors of survey participation: 1) no incentive; 2) chance of winning one of twenty-five vouchers worth £20; 3) chance of winning one £500 voucher; 4) a definite reward of a £10 voucher sent on receipt of their completed questionnaire. Outcomes were participation at Wave 3 and two years later at Wave 4. Analysis used logistic regression and adjusted for clustering at school level.

Results

The only condition that had a significant and beneficial impact for pupils was to offer a definite reward for participation (Group 4). Forty-one percent of Group 4 participated in Wave 3 versus 27% or less for Groups 1 to 3. At Wave 4, 35% of Group 4 took part versus 25% or less for the other groups. Similarly, 22% of Group 4 participated in all four Waves of the longitudinal study, whereas for the other three groups it was 16% or less that participated in full.

Conclusions

The best strategy for retaining all groups of pupils and one that improved retention at both age 18 and age 20 was to offer a definite reward for participation. This is expensive, however, given the many benefits of retaining a longitudinal sample, we recommend inclusion of this as a research cost for cohort and other repeat-contact studies.

Sexual behaviour and contraception in people under the age of 20 in Alicante, Spain

OBJECTIVE

To describe and to analyse the relationship between patterns of sexually-risky behaviour and emergency contraception among young females attending a Family Planning Centre (FPC).

METHODS

Data was obtained from a systematic analysis of 384 health records.

RESULTS

Mean age of the sample subjects was 18.24 years (SD 1.47, range 13-20). Of these, 92% were single, 60% students and 83% were with the same partner. Age at first intercourse was 16.5 years (SD 1.52, range 11-20). Those who used condoms systematically totalled 72%. Mean number of sexual partners was 1.85 (SD 2.91, range 1-50). A total of 9% had become pregnant and 2% had had an abortion. Emergency contraception was resorted to by 26% of the young women on at least one occasion. Emergency contraception was related to younger age at first sexual intercourse (p < 0.001) and to a great number of partners (p = 0.011). Of the total number of subjects, 48.4% demonstrated sexually-risky behaviour. This behaviour was related to alcohol consumption (p < 0.0001) and to the existence of dysfunction (p < 0.001).

CONCLUSIONS

Spanish youngsters have enough knowledge regarding contraception. Condoms are mostly used on the occasion of a first sexual intercourse. However, the frequency of sexually-risky behaviour is still high due to the limited use of condoms in successive sexual relations with the same partner. Sexually-risky behaviour is also related to a high number of partners and to alcohol consumption on weekends.

Contraceptive method at first sexual intercourse and subsequent pregnancy risk: findings from a secondary analysis of 16-year-old girls from the RIPPLE and SHARE studies

PURPOSE

Existing failure rate studies indicate that typical use of oral contraception (OC) results in fewer unplanned pregnancies than condom use, even among teenagers. However, comparative data on pregnancy risk associated with different contraceptive methods are lacking for younger teenagers starting their first sexual relationship. This study examined associations between contraceptive method at first intercourse and subsequent pregnancy in 16-year-old girls.

METHODS

Six thousand three hundred forty-eight female pupils from 51 secondary schools completed a questionnaire at mean age 16 years; 2,501 girls reported sexual intercourse. Logistic regression (N = 1952) was used to model the association of contraceptive method at first intercourse with pregnancy.

RESULTS

At first intercourse (median age 15 years) 54% reported using condoms only, 11% dual OC and condoms, 4% OC only, 4% emergency contraception, and 21% no effective method. Method used was associated with a similar method at a most recent intercourse. One in 10 girls reported a pregnancy. When compared to use of condoms only, greater pregnancy risk was found with no effective method (odds ratio [OR] 2.97, 95% confidence interval [CI] 2.12-4.15) or OC only (OR 2.44, 95% CI 1.29-4.60). Pregnancy risk for dual use and emergency contraception did not differ from that for condoms only. Both significant effects were partially attenuated by adjusting for user characteristics and sexual activity.

CONCLUSIONS

Young teenagers may use OC less efficiently than condoms for pregnancy prevention. The characteristics of those using OC-only confirm vulnerability to unintended pregnancy, and suggest that alternative contraceptive strategies should be considered for these young women.

The experience of having become sexually active for teen mothers

The purpose of this phenomenological study was to describe teen mothers' experience of having become sexually active. Most scholars who have studied teen sexual behavior have used quantitative methods and measured constructs such as self-esteem. Prior to data-gathering, literature about teen sexual behavior was reviewed and set aside to enable a more direct focus on data. Parental consent for participation was obtained for participants under 18. Of the 10 participants (aged 16 to 19 years), all had at least one living child. Each participant took part in 3 audiotaped interviews. Data about perceptions, actions, and intentions were compared across each participant's interviews and interviews of all participants. Four phenomena were discerned as ways in which participants had structured their experiences: (a) making a safe place, (b) redefining myself, (c) creating my own life story, and (c) engaging with the unknown. Compared to prior literature, the phenomena offer a richer and deeper perspective on teen sexual behavior. Findings suggest that efforts to increase perceptions of safety, to support personal identity, to bolster creativity, and to offer exploratory opportunities beyond sexual encounters could enhance effectiveness of programs designed to prevent early-onset sexual activity.