'Mum never loved me.' How structural factors influence adolescent sexual and reproductive health through parent-child connectedness: a qualitative study in rural Tanzania

Parenting Styles and Suicidal Behaviors among College Students: Examining the Mediating Roles of Coping, Self-Esteem, and Depression

BACKGROUND

Suicide is influenced by multiple factors. However, the mechanisms through which these factors influence suicide remain understudied. This study aims to examine the relationship between parenting styles (warmth, control, indulgence, humiliation, and neglect), coping, self-esteem, depression, and suicidality (suicidal ideation and suicide attempts) among college students.

METHODS

Cross-sectional data were collected from 2369 undergraduates (mean age = 20.10 years) including 1201 women (50.7%) at four Chinese colleges.

RESULTS

Students reported high rates of suicidal behaviors (12.7% suicidal ideation, 6.4% suicidal attempts) and depression (37%). Structural equation modeling indicated that warmth (+) had associations with coping. Coping was linked to self-esteem and depression. Depression (+), self-esteem (-), warmth (-), and neglect (+) had direct correlations with suicidality. Self-esteem mediated the relationships between warmth and depression.

CONCLUSIONS

Future prevention intervention efforts aimed at reducing depression and suicidal behaviors should prioritize the promotion of positive parenting styles and the avoidance of negative ones. College mental health services should emphasize positive and optimistic coping strategies to enhance students' self-esteem.

The impact of the parenting for respectability programme on violent parenting and intimate partner relationships in Uganda: A pre-post study

BACKGROUND

There is a growing need for interventions that reduce both violence against children and intimate partner violence in low- and middle-income countries. However, few parenting interventions deliberately address this link. We tested the feasibility of a 16-session group-based parenting programme, Parenting for Respectability, in semi-rural Ugandan communities.

METHODS

This was a pre-post study with parents and their children (N = 484 parents; 212 children).

RESULTS

Pre-post comparisons found large effects for parent-reported reduced harsh parenting (Cohen's f2 = 0.41 overall; f2 = 0.47 (among session attendees); with an overall reduction of 26% for harsh parenting. Session attendees reported higher reductions than non-attendees (p = 0.014), and male caregivers reported higher reductions than female caregivers (p<0.001). Children also reported reduced harsh parenting by attending fathers (f2 = 0.64 overall; f2 = 0.60) and attending mothers (f2 = 0.56 overall; f2 = 0.51); with reduction in harsh parenting ranging between 27% to 29% in the various categories. Overall, spousal violence reduced by 27% (f2 = 0.19 overall; f2 = 0.26 (among session attendees). Both parents and children reported reduced dysfunctional parent relationships; parents: f2 = 0.19 overall; f2 = 0.26 (among session attendees); and children: f2 = 0.35 overall; f2 = 0.32 (for attending parents); with reductions ranging between 22% to 28%. Parents who attended more than 50% of the program reported greater effects on reduced dysfunctional relationships than those who attended less than half of the program (B = -0.74, p = 0.013). All secondary outcomes were improved with f2 ranging between 0.08 and 0.39; and improvements ranging between 6% and 28%.

CONCLUSION

Results suggest the importance of more rigorous testing to determine program effectiveness.

"You are a child and this is not your business": Decision-making on child marriage in Sindh, Pakistan

Young people in Pakistan face challenges such as child marriage, which have adverse consequences on their education, employment, health and overall well-being. We conducted interviews (26) and focus group discussions (12) with young people (15 to 24 years) and community stakeholders to understand how child marriage is perceived by them and to gain insight into the decision-making regarding marriage of youth in Sindh, Pakistan. Study findings show that many young people wish to marry later, but recognize that child marriage is used as a protective strategy to cope with poverty and prevent sexual activity prior to marriage. Young people are expected to obey elders and young women are relegated to domestic roles which limit their decision-making about marriage. Young people and parents who are educated seem to have more negotiating power in delaying marriage than those with little or no education. Our results suggest that interventions should focus on expanding education and livelihood opportunities for young women while changing social norms through parental engagement and youth empowerment.

"Girls Are the Ones Who Save the Family": Factors and Consequences of Engaging in Age-Disparate Transactional Sex Relationships

The 2019 Kenya Violence Against Children Survey highlighted the increased prevalence of sexual violence experienced by girls; 62.6% of girls who have experienced childhood sexual violence reported multiple incidents before age 18. Studies have shown that transactional sex (TS) relationships are a source of sexual violence, particularly age-disparate TS. TS is defined as sex that is a nonmarital, noncommercial relationship driven by the assumption that sex is exchanged for material support or other benefits. TS is common among adolescents and young women in sub-Saharan Africa, with the prevalence varying from as low as 5% to as high as 80%. This qualitative study explored the factors influencing age-disparate TS relationships in two rural districts, Mutomo and Ikutha Wards of Kitui South Sub County, Kenya. Four focus group discussions were conducted with primary (12-14 years of age) and secondary schoolgirls (15-18 years of age). The study results identified several main themes, which were grouped into two major themes: influencing factors and consequences. Influencing factors include material/basic needs, school-related influences, parental influence, peer pressure, and perpetrator access, while consequences include health and social consequences. Our study found that girls' sense of agency, social pressure, and economic vulnerability impacted their decision to engage in age-disparate TS. These relationships' power dynamics and exploitative nature increase girls' risk of experiencing gender-based sexual violence and adverse health and social outcomes. Our study suggests that explicitly addressing individual risk behaviors will not effectively reduce the incidence of TS relationships. Interventions should be focused on understanding the social-cultural beliefs of TS and shifting the narrative that has continued to fuel a patriarchal society in which women and girls have limited decision-making power in relationships.

Family structure and function in relation to adolescent reproductive health in developing countries: A scoping review

AIM

The study purpose was to explore the relationships between family structure and function and adolescent reproductive health in the context of family systems in developing countries.

BACKGROUND

The structures and functions of family are important elements for adolescent reproductive health. However, few studies discuss their relationships with the reproductive health of adolescents.

DESIGN

This study employed a scoping review design.

DATA SOURCES

The search was conducted for literature published from 2010 until 2020 using the electronic databases PubMed, CINAHL, Scopus, and Science Direct sourcing full-text papers in English. Original research papers that focused on family structures, family functions, and adolescent reproductive health were included.

REVIEW METHODS

Data extraction and analysis were completed on all retrieved studies. Content analysis was used for data analysis.

RESULTS

Fifteen articles were included. The nature of the relationship between the family structures and functions on adolescent reproductive health were explained in the categories of (i) family process and life cycle, (ii) family norms and values, (iii) family communication patterns and processes, (iv) family roles and connectedness, and (v) family coaching and guidance.

CONCLUSION

Findings of this study suggest that the relationships between family functions and structures and adolescent reproductive health were explained in multiple constructs. Further studies are needed to examine those constructs on reproductive health in adolescent in developing countries.

Qualitative Analysis Using Social Maps to Explore Young Women's Experiences With Social Support of their Oral PrEP Use in Kenya and South Africa

ABSTRACT

Daily oral pre-exposure prophylaxis (PrEP) adherence is challenging. We explored African adolescent girls and young women's (AGYW) perceptions of the social influencers of their PrEP use and the social influencers' PrEP knowledge and support (six focus group discussions; 33 South African and Kenyan AGYW) in the Prevention Options for Women Evaluation Research demonstration project. Participants completed a social mapping exercise indicating strength and direction of influence of members in their social networks. Mothers and counselors were identified as positive influencers and most influential by >50% of participants, sex partners were labeled negative influencers or both positive and negative, and best friends were mostly positive influencers. HIV- and PrEP-related stigma were the major reasons influencers were identified as negative. Participants wanted their social networks to be better educated about PrEP by someone other than the AGYW themselves (e.g., clinic staff) and to support their PrEP use. To improve PrEP adherence, community- and peer-based PrEP sensitization and delivery interventions should be evaluated.

Level and comfort of caregiver–young adolescent communication on sexual and reproductive health: a cross-sectional survey in south-western Uganda

Background

Communication on sexual and reproductive health (SRH) between caregivers and their young adolescent children plays a significant role in shaping attitudes and behaviours that are critical to laying the foundations for positive and safe SRH behaviours in later adolescence. Nevertheless, this communication is often limited, particularly in countries where adolescent sexuality is taboo. This study assessed the topics discussed (‘level’) and the comfort of caregivers with communicating with young adolescents on SRH, and their correlates. 

Methods

A cross-sectional survey was conducted among 218 caregivers of young adolescents (10–14 years) in Mbarara district of south-western Uganda in January and February 2020. Participants were selected through consecutive sampling. A structured, pre-tested questionnaire administered by interviewers was used for data collection. The surveys were computer-assisted using Kobo Collect software. Data was exported to STATA 14 for analysis. Level of SRH communication was measured based on 10 SRH communication topics, while comfort was based on 9 SRH discussion topics. Bivariate and multivariate linear regression analyses were conducted to determine correlates of level of, and comfort with, SRH communication P-value < 0.05 was considered for statistical significance.

Results

The mean number of topics that caregivers discussed was 3.9 (SD = 2.7) out of the 10 SRH topics explored. None of the respondents discussed all the topics; 2% reported ever discussing nine topics with their young adolescent, while 3.5% reported never discussing any of the topics. General health and bodily hygiene (89.9%) and HIV/AIDS and other sexually transmitted infections (STIs) (77.5%) were the most commonly discussed, while night emissions in boys (4.3%) and condoms (8.3%) were least discussed. The majority of caregivers (62%) reported a high level of comfort with discussing SRH. The mean comfort score was 21.9 (SD = 3.8). In general, the level of SRH communication increased with an increase in comfort with SRH communication β = 0.22 (0.04); 95% CI = (0.15, 0.30). The level of comfort with SRH communication decreased with an increase in the number of YAs in a household β = -0.92 (0.38); 95%CI = (-1.66,-0.18).

Conclusion

Overall, the level of SRH communication is low and varies according to the number of SRH topics. Caregivers’ comfort with SRH communication with YAs was a significant correlate of SRH communication. This justifies the need for interventions that aim to improve caregivers’ comfort with communicating with young adolescents about SRH.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14561-3.

Communication between parents and children about sexual and reproductive health (SRH) during the early adolescence stage (10–14 years) plays a significant role in creating positive reproductive health outcomes in later adolescence and adulthood. We conducted surveys in rural areas of Mbarara district among 218 pairs of caregivers and their children aged 10–14 years between January and February 2020. The purpose of the study was to understand whether there is communication between the two, and how comfortable they felt having discussions about SRH. We also asked caregivers and their children about their knowledge of SRH, and how they generally felt about SRH for young people. This study, however, reports only results from caregivers.

We found that, on average, caregivers discussed 4 of the 10 SRH topics explored in this survey with their child, and that the majority of the caregivers reported being very comfortable discussing SRH—especially general health and bodily hygiene—with their children. On the whole, we found that caregivers’ SRH communication was largely influenced by their comfort with discussing SRH with their adolescent child. The level of comfort was influenced by the number of young adolescents living in a household. However, there is no clear justification for this finding from existing literature.

In conclusion, there is a need for interventions that facilitate improvement of communication on SRH between parents/caregivers and young adolescents. These should focus on improving comfort levels by promoting communication skills for caregivers and emphasizing value clarification.

'You don't have to sleep with a man to get how to survive': Girl's perceptions of an intervention study aimed at improving sexual and reproductive health and schooling outcomes

In sub-Saharan Africa, girls suffer from high rates of morbidity and mortality, enduring high exposure to sexual and reproductive health harms. Staying in school helps protect girls from such harms. Focus group discussions were conducted in a rural, impoverished area of Kenya with adolescent girls participating in a 4-arm cluster randomised controlled trial, evaluating menstrual cups, cash transfer, or combined cups plus cash transfer against controls. To explore girls' perceptions of how trial interventions affected their SRH risks and schooling, semi-structured discussions were held at baseline, midline, and study end. Data was explored using thematic analysis. At baseline there were no discernible differences between the 4 intervention groups regarding their perceptions of relationships with boys/men, and difficulties attending or remaining in school. Midline and endline discussions found that narratives from those receiving cash transfer only, or alongside a cup were similar; girls noted fewer pregnancies and less school dropout, attributed to the cash transfer reducing the need for transactional sex. Lower absenteeism was reported by the cup only group, with perceived minimal effect on pregnancy and dropout. Girls in control and cup only groups described feeling valued through inclusion, benefitting from puberty and hygiene education. Although seemingly having little effect on reducing pregnancy or dropout, these inputs reportedly empowered girls, whilst cash transfer girls were emboldened to refuse male sexual advances. Girls noticed benefits from trial interventions, with a reduction in transactional sex and resulting pregnancy impacting on school dropout, or reduced menstrual related absenteeism. Education and study inclusion were perceived as important. Future programmes should consider alleviating material deprivation which prevents girls from attending or performing at school through schemes such as cash transfer, alongside hygiene and education packages. This will empower girls to refuse unwanted sex and understand risks, in addition to motivating academic achievement and school completion. Trial registration: ClinicalTrials.gov NCT03051789.

How perceived Australian sexual norms shape sexual practices of East Asian and sub-Saharan African international students in Sydney

INTRODUCTION

Sexual norms, real or perceived, shape young people's sexual behaviour and may constitute one of the greatest challenges in HIV/STIs prevention among this population. This study used sexual script theory to explore how international students in Sydney, Australia - from traditional cultures of East Asian and sub-Saharan African countries - construct home backgrounds and Australian sexual norms and how this may shape their sexual practices during their studies in Australia.

METHODS

The study involved face-to-face and telephone semi-structured in-depth interviews. Data were provided by 20 international students who are enrolled in various universities in Sydney. Interviews were audio-recorded, transcribed, coded into NVivo and analysed using reflexive thematic analysis.

RESULTS

Identified patterns in the data showed three themes through which participants perceive sexual norms in Australia as distinctly different from their home country norms. First, participants stated that unlike their home country norms, sexual norms in Australia are permissive. Second, participants hold the view that compared to their home country norms, sex in Australia is largely casual as it is not always attached to love. Some participants revealed that this could shape their own sexual practices during their studies in Australia. Finally, participants noted that compared to their home countries' norm of sex talk taboo, Australia has an open sexual communication norm; which they believe, enables young people in western societies to easily acquire sexual health information.

CONCLUSIONS

Findings provide evidence to support a need for contextualized and effective sexual health services for international students that take account of perceptions around sexual norms and how they can be modified to ensure that sexual practices which these students may engage in, will be managed in a safe and responsible manner.

Addressing the Adherence-Adaptation Debate: Lessons from the Replication of an Evidence-Based Sexual Health Program in School Settings

Whether high adherence to programs is necessary to achieve program outcomes is an area of great debate. The objectives of this study were to determine the frequency, type, and rationale of adaptations made in the implementation of an evidence-based program and to determine program outcomes for intervention program participants, as compared to comparison participants, by the level of adaptations. A total of 1608 participants in 45 classrooms participated. Percent adaptations was calculated by classroom. Thematic qualitative analysis was used to categorize types and rationales for adaptations. Program outcomes by level of adaptations were determined using logistic regression analyses and mean differences. Propensity score matching methods were used to create comparability between adaptation subgroup participants and comparison participants. Adaptations ranged from 2 to 97% across classrooms, with mean adaptations of 63%. Thematic analysis revealed that the adaptations made were related to delivery of content, rather than to the content itself and in response to participant needs and setting constraints. Program outcomes did not appear to be reduced for the high-adaptation subgroup. Understanding both rationale (intent) and type of adaptation made is crucial to understanding the complexity of adaptations. These finding support the argument for allowing facilitators some flexibility and autonomy to adapt the delivery of prescribed content to participant needs and setting constraints.

Parent - adolescent communication on sexual and reproductive health: the qualitative evidences from parents and students of Addis Ababa, Ethiopia

BACKGROUND

Repeatedly adolescents in Africa have been experiencing early pregnancy by more than 50%, early parenthood by 30% and new HIV infections by more than 80%. Parent - Adolescent communication as an effective strategy on sexual and reproductive health has not been taken up in most of African countries including Ethiopia. The aim of the study was to assess the challenges of Parent - Adolescent communication on sexual and reproductive health practices in Addis Ababa, Ethiopia.

METHODS

A qualitative cross-sectional study exploring Parent - Adolescent communication practices was conducted in two high schools Yeka sub-city, Addis Ababa, Ethiopia. Students aged 15-19 years were recruited for in-depth interviews and focused group discussions (FGD) as well as respective parents for in-depth interviews and parents' FGD.

RESULTS

Twenty students were available for in-depth interviews and all of them for FDG. Sixteen parents were available for in-depth interviews and nine of them for parent's FGD. Parent - Adolescent communication on sexual and reproductive was reported to be important by both adolescents and parents. The parental initiation is rare. The initial sexual activity by the adolescents triggers initiation by parents. The communications are gender dependent, not planned and not continuous and inhibited by intergenerational cultural taboo. A gap exists in parental knowledge on such communications. Parents deny responsibilities to communicate with adolescent as they fear it will perpetuate early sex practices, adolescents are too young it's an embarrassment, often being busy for household income retards their wills to communicate.

CONCLUSIONS

Parent-Adolescent communications on sexual and reproductive health is not a common practice in Addis Ababa, Ethiopia due to taboo, cultural structures, gender domains and parental knowledge. These findings alarm the risk of adolescent exposure towards unwanted pregnancies, transmissions of HIV/AIDS and Sexually Transmitted Infections in Addis Ababa.

Obstacles to intergenerational communication in caregivers' narratives regarding young people's sexual and reproductive health and lifestyle in rural South Africa

BACKGROUND

Statistics from South Africa show the world's highest HIV prevalence with an estimated seven million people living with the virus. Several studies have pointed to communication about sexuality between parents/caregivers and children as a protective factor. However, communication between generations has been described as problematic, especially due to discomfort in discussing sexual matters. The aim of this study was to explore how caregivers in a poor, rural part of South Africa talked about young people in general, their sexuality, and their lifestyle practices. A particular interest was directed towards central discourses in the caregivers' narratives and how these discourses were of importance for the caregivers to function as conversation partners for young people.

METHODS

In this qualitative study convenience sampling was used to select and invite participants. Information was collected from nine one-on-one interviews conducted with caregivers from rural areas within South Africa. The interview guide included nine main questions and optional probing questions. Each interview took place in an uninterrupted setting of choice associated with the caregivers' home environment. The interviews were transcribed and analyzed using discourse analysis.

RESULTS

Interview narratives were characterized by three central discourses - demoralized youths in a changing society, prevailing risks and modernity and a generation gap. The youths were discursively constructed as a problematic group relating to specific prevailing risks such as early pregnancies, modern technologies, STI/HIV and contraceptives. The interview narratives illustrated that caregivers tried to impose their views of a respectable lifestyle in young people. At the same time caregivers expressed a morality of despair mirroring a generation gap which counteracted their ability to communicate with their children and grandchildren.

CONCLUSIONS

The findings add to the body of earlier research illustrating that rural South African caregivers and their children/grandchildren hold different moral standards. The interview material reflected a 'clash' between generations relating to their differing perceptions of a desirable lifestyle. To overcome the generational gap, we recommend further research about how a well-founded national and community collaboration linked to school-based programs can support family participation in order to empower adults in their communication with young people.

Effects of Parent-Child Relationships on Child Marriage of Girls in Ethiopia, India, Peru, and Vietnam: Evidence From a Prospective Cohort

PURPOSE

Parental influence over early marriage of girls is well-documented in qualitative research, but little quantitative work in this area has been conducted. This study assesses the effects of the parent-child relationship in early adolescence (aged 12 years) on early marriage of girls.

METHODS

We analyzed survey data from a multicountry prospective cohort of girls (n = 1,648) followed over four rounds from age 8 to 19 years (2002-2013), as part of the Young Lives study in India, Ethiopia, Vietnam, and Peru. Multinomial logistic regression models assessed the effects of parent-child communication and parent-child relationship quality, as reported when girls were aged 12 years on child and early marriage (married <16 years, married 16-17 years, married 18-19 years, unmarried). Covariates were wealth, rural/urban residence, maternal education, parents' value of education, early menarche, and country.

RESULTS

One in five girls (18.04%) reported marriage before 18 years of age, and 8.1% reported marrying before 16 years (8.3% and 13.7% in India and Ethiopia). Multinomial regression found that girls reporting good parent-child communication and high parent-child relationship quality at age 12 years were significantly less likely to marry before age 16 years (moderate relationship quality, adjusted relative risk ratio: .23, 95% confidence interval: .07-.72; high relationship quality, adjusted relative risk ratio: .34, 95% confidence interval: .11-.99).

CONCLUSION

Parent-child relationship quality and communication in early adolescence are protective against very early marriage of girls cross-nationally, although communication may facilitate marriage soon on completion of school. Primary prevention interventions targeting child marriage may benefit from components focused on improving the parent-child relationship.

Adolescent-parent communication about sexual and reproductive health among junior high school students in five areas with the highest prevalence of HIV in Indonesia: A qualitative study

OBJECTIVE

To explore female adolescents' perceptions of their communication with their mothers on the topics of sexuality and reproductive health.

METHOD

A qualitative methodology was used for this study. Data were obtained via focus-group discussions involving 78 female junior high school students, aged 11-15 years. The data were analyzed using content analysis. This study was conducted in Papua, Bali, Jakarta, Riau, and Pontianak.

RESULT

Several themes: (1) knowledge of sexuality and reproductive health, (2) mothers as primary sources of information about reproductive health, (3) factors facilitating communication between adolescents girls and their mothers with mothers, and (4) problems faced by adolescent girls when discussing SRH.

CONCLUSION

Although mothers and daughters communicate freely about many topics; however, discussions of SRH occur infrequently. Parent-based approaches could be effective strategies, especially in terms of improving communication with daughters.

Determinants of risky sexual behaviours among adolescents in Central African Republic, Eswatini and Ghana: evidence from multi-indicator cluster surveys

Despite the declining HIV/AIDS prevalence globally, nearly half of all new HIV infections still occur among youth, especially in sub-Saharan Africa. While determinants of risky sexual behaviour have received copious attention in the literature, we still lack multi-country studies that track regional changes in sexual risk among youth in sub-Saharan Africa. This study seeks to fill part of this gap by identifying the determinants of risky sexual behaviours among adolescents in Ghana, Central African Republic (CAR) and Eswatini (formerly Swaziland). We used nationally representative sample data from the Multi Indicator Cluster survey, round four (MICS4). Results of the descriptive analysis show that overall consistent condom use is still extremely low in sub-Saharan Africa. In Ghana, only 8.5% of male youth and 7% of female youth consistently use condoms. In CAR this figure is 8% and 4% in male youth and female youth respectively. In Eswatini, with one of highest HIV prevalence in the world, the prevalence of consistent condom use is at 29% in males and 20% in females, higher than both in Ghana and CAR. Results of hierarchical models show that age at first sex does not predict risky sexual behaviour in Ghana, but it does predict risky sexual behaviour in CAR although only among young males. In Swaziland, age at first sex predicts risky sexual behaviour in both male and female youth but the relationship is not in the expected direction. Low socio-economic status predicts inconsistent condom use in all the three countries, but only among young females. This paper provides relevant policy lessons and recommendations.

Characteristics of the Family Support Network of Pregnant Adolescents and Its Association with Gestational Weight Gain and Birth Weight of Newborns

It has been proposed that, in the Mexican culture, family support can be a factor that contributes to protect the maternal and child health of pregnant adolescents. There may be complex associations between family support and the circumstances of a pregnancy during adolescence. The aim of the study was to analyze the association between the family support network (FSN) characteristic and the maternal and neonatal outcomes in Mexican adolescents. A cross-sectional study was conducted, and 352 pregnant adolescents participated; their FSN during pregnancy was assessed. The gestational weight gain and birth weight/length of newborns were registered. The size of the FSN was described and divided into quartiles; the main members for each quartile were identified. Then, sociodemographic and clinical variables were compared by FSN quartiles. Logistic regression models were performed to assess the association of FSN size and pregnancy and neonatal outcomes. Our results indicate that the mean age was 15 ± 1 year old. The primary support member in the FSN was the mother of the adolescent in each quartile, except for quartile 3, where the primary support was the mother-in-law. In quartile 3 there was a significantly lower gestational weight gain compared to quartile 4 (11.8 ± 5 vs. 13 ± 5 kg, p = 0.054). According to the regression model, a higher risk of small for gestational age (OR 2.99, CI 95% 1.25⁻7.15) newborns was found in quartile 3. We conclude that the maternal and neonatal outcomes did not differ between quartiles of FSN size, except for quartile 3. Small for gestational age newborns were observed when a non-blood relative was present in the FSN. The quality rather than the network size might be more important for improving pregnancy outcomes.

Development and Testing of the Family Structure and Family Functions Scale for Parents Providing Adolescent Reproductive Health Based on the Friedman Family Assessment Model

Background and Purpose:

To describe the development and testing of a psychometric of Family Structure and Functions (FSF) that measures parents’ ability to provide adolescent reproductive health (ARH).

Methods:

A cross-sectional study of Indonesian parents (n = 525). Multifactors FSF-ARH were examined using construct validity (exploratory factor analysis [EFA] and confirmatory factor analysis [CFA]) and content validity (Content Validity Index [CVI]). Internal consistency was explored using Cronbach’s α coefficient.

Results:

EFA revealed nine factors with 26 items accounting for 61.64% of explained variance and CFA validity testing fit for the construct validity of FSF-ARH. The CVI indicated adequate content validity (0.80–0.10) and acceptable internal consistency (0.70).

Conclusions:

FSF-ARH contains valid, reliable, and robust measures although some subscales performed moderate reliability, establishing the purpose for further research.

"My mother told me that I should not": a qualitative study exploring the restrictions placed on adolescent girls living with HIV in Zambia

Introduction

Adolescent girls in sub‐Saharan Africa are disproportionately affected by HIV due to a range of social and structural factors. As they transition to adulthood, they are recipients of increasing blame for HIV infection and ‘improper’ sex, as well as increasing scrutiny, restrictions and surveillance. This study used a qualitative and participatory approach to explore the messaging and restrictions imposed on adolescent girls living with HIV in Zambia.

Methods

Thirty‐four in‐depth interviews and four participatory workshops were carried out with 24 adolescent girls aged 15 to 19 years old living with HIV in Lusaka, Zambia. Key themes explored included experiences living with HIV, finding out about HIV status, disclosure, experiences with antiretroviral treatment, and support needs. Data were organized, coded and analysed using a grounded theory approach to thematic analysis. This analysis uses data on participants’ experiences of living with HIV and their interactions with their parents, guardians and healthcare providers.

Results

Family and healthcare providers, partly in a quest to protect both the health of adolescent girls living with HIV and also to protect them from blaming discourse, imposed restrictions on their behaviour around three main topics: don't disclose your HIV status, don't have sex, and don't miss your medicines. These restrictions were often delivered using tactics of fear, and usually disconnected from other options. Participants responded to these messages in several ways, including internalizing the messages, changing their behaviour either to comply with or resist the restrictions, by remaining silent and anxious when restrictions were broken, and developing concerns around their own health and sexual and reproductive aspirations. Participants also sometimes experiencing stigma when restrictions could not be maintained.

Conclusions

Restrictive messages were delivered to adolescent girls living with HIV through the broader social discourses of stigma, religion, and global and local narratives about HIV. Programmes aiming to support adolescent girls living with HIV need to work together with parents and healthcare providers to reflect on the impact of sanctioning messages, and to encourage more enabling and empowering messaging for adolescent girls living with HIV.

Structural and Behavioral Correlates of HIV Infection among Pregnant Women in a Country with a Highly Generalized HIV Epidemic: A Cross-Sectional Study with a Probability Sample of Antenatal Care Facilities in Swaziland

INTRODUCTION

HIV disproportionately affects women in Sub-Saharan Africa. Swaziland bears the highest HIV prevalence of 41% among pregnant women in this region. This heightened HIV-epidemic reflects the importance of context-specific interventions. Apart from routine HIV surveillance, studies that examine structural and behavioral factors associated with HIV infection among women may facilitate the revitalization of existing programs and provide insights to inform context-specific HIV prevention interventions.

METHODS AND FINDINGS

This cross-sectional study employed a two-stage random cluster sampling in ten antenatal health care facilities in the Hhohho region of Swaziland in August and September 2015. Participants were eligible for the study if they were 18 years or older and had tested for HIV. Self-administered tablet-based questionnaires were used to assess HIV risk factors. Of all eligible pregnant women, 827 (92.4%) participated, out of which 297 (35.9%) were self-reportedly HIV positive. Among structural factors, family function was not significantly associated with self-reported HIV positive status, while lower than high school educational attainment (AOR, 1.65; CI, 1.14-3.38; P = 0.008), and income below minimum wage (AOR, 1.81; CI, 1.09-3.01; P = 0.021) were significantly associated with self-reported HIV positive status. Behavioral factors significantly associated with reporting a positive HIV status included; ≥2 lifetime sexual partners (AOR, 3.16; CI, 2.00-5.00; P<0.001), and ever cohabited (AOR, 2.39; CI, 1.66-3.43; P = 0.00). The most cited reason for having multiple sexual partners was financial gain. HIV/AIDS-related knowledge level was high but not associated to self-reported HIV status (P = 0.319).

CONCLUSIONS

Structural and behavioral factors showed significant association with self-reported HIV infection among pregnant women in Swaziland while HIV/AIDS-related knowledge and family function did not. This suggests that HIV interventions should be reinforced taking into consideration these findings. The findings also suggest the importance of future research sensitive to the Swazi and African sociocultural contexts, especially research for family function.

Who's that girl? A qualitative analysis of adolescent girls' views on factors associated with teenage pregnancies in Bolgatanga, Ghana

Background

Adolescent pregnancy remains a public health concern, with diverse serious consequences, including increased health risk for mother and child, lost opportunities for personal development, social exclusion, and low socioeconomic attainments. Especially in Africa, teenage pregnancy rates are high. It is important to find out how girls without pregnancy experience differ in their contraceptive decision-making processes as compared with their previously studied peers with pregnancy experience to address the high rate of teenage pregnancies.

Methods

We conducted semi-structured in-depth interviews with never been pregnant girls (N = 20) in Bolgatanga, Ghana, to explore the psychosocial and environmental factors influencing the sexual decision making of adolescents. Themes such as relationships, sex, pregnancy, family planning and psychosocial determinants (knowledge, attitudes, self-efficacy, norms, risk perceptions) derived from empirical studies and theories related to sexuality behavior guided the development of the interview protocol.

Results

Results showed that the girls did talk about sexuality with their mothers at home and did receive some form of sexual and reproductive health education, including the use of condoms discussions in school. Participants reported high awareness of pregnancy risk related to unprotected sex, were positive about using condoms and indicated strong self-efficacy beliefs towards negotiating condom use. The girls also formulated clear future goals, including coping plans such as ways to prevent unwanted pregnancies to reach these targets. On the other hand, their attitudes towards family planning (i.e., contraceptives other than condoms) were negative, and they hold boys responsible for buying condoms.

Conclusion

An open parental communication on sexuality issues at home, comprehensive sex education in school and attitude, self-efficacy, risk perception towards contraception, alongside with goal-setting, seem to be protective factors in adolescent girls’ pregnancy prevention efforts. These factors should be targets in future intervention programs at the individual, interpersonal, and school and community levels.

Adolescents' sexual and reproductive health: an ecological perspective

BACKGROUND

Adolescence is the key time in the formation of sexual confidence and fertility in people and many risky sexual behaviors in this sensitive era are the roots of many adulthood diseases. STD and early pregnancy are among the most important issues of adolescence.

OBJECTIVE

This study deals with reviewing ecological factors related to the sexual and reproductive health of adolescents.

METHODS

As this study was a narrative review the researchers conducted their computer search in public bases such as Google Scholar and then in more specialized ones such as MEDLINE, EMBASE, Science Direct, Up-to-date, SPRINGER, SID, Magi ran, Iranmedex and Irandoc with the key words adolescents, sexual health, reproductive health and ecological from 1991 to 2015. Initially 152 articles were elicited and after a review study of the title and abstract, 80 articles entered the study. After reading the full text, 39 articles were chosen for writing the current review article.

RESULTS

Reviewing the articles led to organizing the contents in three main classes according to Bronfenbrenner's suggestion namely ecological factors at microsystem, mesosystem and macrosystem levels which include individual predisposing factors, environmental enabling factors and social reinforcing factors.

CONCLUSION

Adolescents are at a high risk of STD and early pregnancy. Many factors are considered as effective at this critical era, based on which comprehensive intervention based on ecological factors is needed to step forward toward preventing adolescence risks.