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Jahanfar S, Zendehdel M. Contraceptive knowledge, prevalence of contraception use, and the association between sex education and contraception knowledge among university students in Michigan, USA. J Family Med Prim Care 2024; 13:1676-1682. [PMID: 38948568 PMCID: PMC11213420 DOI: 10.4103/jfmpc.jfmpc_1212_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/01/2023] [Accepted: 10/25/2023] [Indexed: 07/02/2024] Open
Abstract
Background The danger of sexual activities among adolescents is worrisome worldwide. This study aimed to delineate total contraception knowledge of university students and the prevalence of contraceptive use, in addition to the association between sex education in school and the students' contraception knowledge. Materials and Methods A school-based cross-sectional study was carried out. Results The mean total level of contraceptive knowledge was 16.53 ± 2.38, which ranged from 5 to 18. In response to which method was the most suitable for the youngsters, 36.3% responded pills, 49.2% condoms, 6.3% injection, 0.7% withdrawal, 0.5% periodic abstinence, and 5.9% other. Adjusted to sociodemographic characteristics and other confounders, students with a history of sex education in school tended to have a higher level of contraceptive knowledge than those without [AOR: 1.06; 95% CI: 0.15, 2.64]. Moreover, adjusted to the characteristics of one-night stands, students with a high level of contraceptive knowledge agreed that one-night stands were OK compared with those without the knowledge [AOR: 0.65; 95% CI: 0.16, 1.13]. Conclusion Although the total contraceptive knowledge was satisfactory, more attention should be paid to male students' education. Modern and long-term effective contraceptive methods had better be included in the training program.
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Affiliation(s)
- Shayesteh Jahanfar
- MPH Program, School of Public Health and Community Science, School of Medicine, Tufts University, Boston, MA, USA
| | - Mozhgan Zendehdel
- Reproductive and Sexual Health Research Centre, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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C. Millanzi W. Adolescents’ World: Know One Tell One against Unsafe Sexual Behaviours, Teenage Pregnancies and Sexually Transmitted Infections Including Chlamydia. Infect Dis (Lond) 2022. [DOI: 10.5772/intechopen.109048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Addressing adolescents’ sexual and reproductive health (SRH) matters using multidisciplinary pedagogical innovations may assure the proper development and well-being of adolescents so that they reach the adulthood stage healthy and strong enough to produce for their future investment. This is in response to sustainable development goal number 3, target 3.7, and SDG4, target 4.7 in particular emphasizes the universal availability and accessibility of sexual information and education among people and knowledge and skills for gender equality, human rights and sustainable lifestyles by 2030, respectively. Yet, the innovative strategies may respond to a call stated by SGD5 (gender equality), target 5.3 which advocates the elimination of child, early, and forced marriages, and target 5.6 which focuses on ensuring universal access to SRH and rights to all by 2030.
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Burchett HED, Griffin S, de Melo M, Picardo JJ, Kneale D, French RS. Structural Interventions to Enable Adolescent Contraceptive Use in LMICs: A Mid-Range Theory to Support Intervention Development and Evaluation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14414. [PMID: 36361287 PMCID: PMC9658296 DOI: 10.3390/ijerph192114414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 09/29/2022] [Accepted: 10/03/2022] [Indexed: 06/16/2023]
Abstract
Enabling contraceptive use is critical for addressing high adolescent pregnancy rates in low- and middle-income countries (LMICs). Broader or 'upstream' determinants, such as poverty, education, and social norms, can affect the knowledge, attitudes, motivation, and ability to access and use contraception. Structural interventions aim to address these broader determinants, e.g., through poverty alleviation from livelihood training or cash transfers, increasing school participation, or changing social norms. We conducted an evidence synthesis using intervention component analysis, a case-based approach, following a systematic mapping of the evidence base. We identified 17 studies with 29 structural intervention arms, which reported adolescent contraceptive use outcomes compared to a control group or baseline. It was not possible to identify with certainty which interventions were 'likely effective' or 'likely ineffective' due to the high heterogeneity of the methods. We built on an existing framework of family planning use to propose three steps to designing interventions: (1) tailor interventions to adolescents' life stages; (2) assess the baseline situation; and (3) select appropriate activities to match the gaps. These steps will aid developers and evaluators of structural adolescent contraceptive interventions to develop an evidence base that is of use across a wide range of settings and use scenarios.
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Affiliation(s)
- Helen Elizabeth Denise Burchett
- Department of Public Health, Environments & Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
| | - Sally Griffin
- International Center for Reproductive Health, Maputo 1100, Mozambique
| | - Málica de Melo
- International Center for Reproductive Health, Maputo 1100, Mozambique
| | | | - Dylan Kneale
- EPPI-Centre, UCL Social Research Institute, University College London, London WC1H 0NR, UK
| | - Rebecca S. French
- Department of Public Health, Environments & Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London WC1H 9SH, UK
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Burchett HED, Kneale D, Griffin S, de Melo M, Picardo JJ, French RS. Which Structural Interventions for Adolescent Contraceptive Use Have Been Evaluated in Low- and Middle-Income Countries? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11715. [PMID: 36141987 PMCID: PMC9517431 DOI: 10.3390/ijerph191811715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/08/2022] [Accepted: 09/09/2022] [Indexed: 06/16/2023]
Abstract
Reducing adolescent childbearing is a global priority, and enabling contraceptive use is one means of achieving this. Upstream factors, e.g., gender inequalities, fertility norms, poverty, empowerment and schooling, can be major factors affecting contraceptive use. We conducted a systematic map to understand which structural adolescent contraception interventions targeting these upstream factors have been evaluated in LMICs. We searched eight academic databases plus relevant websites and a 2016 evidence gap map and screened references based on set inclusion criteria. We screened 6993 references and included 40 unique intervention evaluations, reported in 138 papers. Seventeen evaluations were reported only in grey literature. Poverty reduction/economic empowerment interventions were the most common structural intervention, followed by interventions to increase schooling (e.g., through legislation or cash transfers) and those aiming to change social norms. Half of the evaluations were RCTs. There was variation in the timing of endline outcome data collection and the outcome measures used. A range of structural interventions have been evaluated for their effect on adolescent contraceptive use/pregnancy. These interventions, and their evaluations, are heterogenous in numerous ways. Improved understandings of how structural interventions work, as well as addressing evaluation challenges, are needed to facilitate progress in enabling adolescent contraceptive use in LMICs.
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Affiliation(s)
- Helen Elizabeth Denise Burchett
- Department of Public Health, Environments & Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
| | - Dylan Kneale
- EPPI-Centre, UCL Social Research Institute, University College London, London WC1H 0NR, UK
| | - Sally Griffin
- International Center for Reproductive Health: Mozambique, Maputo, Mozambique
| | - Málica de Melo
- International Center for Reproductive Health: Mozambique, Maputo, Mozambique
| | | | - Rebecca S. French
- Department of Public Health, Environments & Society, Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
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Jahanfar S, Pashaei Z. Sexual attitudes and associated factors of risky sexual behaviors among university students. Brain Behav 2022; 12:e2698. [PMID: 35801345 PMCID: PMC9392532 DOI: 10.1002/brb3.2698] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Revised: 05/17/2022] [Accepted: 06/23/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Risky sexual behaviors. Adequate awareness of reproductive health in young people is important because they are in the early years of fertility, and engaging in risky sexual behaviors is more probable. This study aimed to evaluate the sexual attitude and associated factors of risky sexual behaviors among girls and boys and the difference in sexual norms by gender among university students. METHODS A university-based study with a cross-sectional survey was conducted for 9 months in 2019. A total of 800 university students were studied by a random sampling technique using a self-administered structured questionnaire derived from the World Health Organization illustrative questionnaire to assess sexual attitudes among adolescents and young adults. RESULTS Most of the respondents were female and single. Girls were more religious, more frequently visited the cinemas and were more likely to discuss sex matters with family members than boys. There was no significant difference in the total score of sexual attitudes in girls and boys, and both genders had negative attitudes toward risky sexual behavior (42/72). Those who go to parties, bars, or movies are more likely to have risky sexual behavior. Being a religious person is an essential predictor of having less risky behavior (RR = 2.02, 95% CI = [0.96, 3.41]). CONCLUSION Being religious was a protective factor for engaging in risky sexual behavior. More interventions in schools and universities need to educate students to enhance awareness about the consequences of risky sexual behavior and reduce its rate.
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Affiliation(s)
- Shayesteh Jahanfar
- MPH Program, Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts, USA
| | - Zahra Pashaei
- Iranian Research Centre for HIV/AIDS (IRCHA), Tehran University of Medical Sciences, Tehran, Iran
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Millanzi WC, Kibusi SM, Osaki KM. Effect of integrated reproductive health lesson materials in a problem-based pedagogy on soft skills for safe sexual behaviour among adolescents: A school-based randomized controlled trial in Tanzania. PLoS One 2022; 17:e0263431. [PMID: 35192640 PMCID: PMC8863272 DOI: 10.1371/journal.pone.0263431] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 01/19/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Adolescents are currently becoming sexually active before their 18th birthday during which they have to battle with unsafe sexual behaviours, teenage pregnancies, sexually transmitted infections (STIs), and school dropouts. The trend is linked with low soft skills (self-esteem and assertiveness skills) for them to make informed, reasoned, and responsible decisions over sexual activities. This study designed and tested the effect of integrated reproductive health (RH) lesson materials in a problem-based pedagogy (PBP) to enhance soft skills for safe sexual behaviour among adolescents in Tanzania. METHODS A double-blinded clustered randomized controlled trial was conducted between September 2019 and September 2020 among 660 randomly selected adolescents. A Sexual-risk Behaviour Beliefs and Self-esteem Scale adopted from previous studies measured soft skills for safe sexual behaviour. A descriptive statistical analysis was performed by using the statistical analysis software programme version 9.4. The effect of the intervention was determined using Linear Mixed Model set at α error probability = 5% significance level (95% confidence interval) and a β error probability = 0.80. FINDINGS Adolescents' mean age was 15±1.869 with 57.5% females. The end-line findings indicated that the coefficient of soft skills was significantly higher among adolescents in the hybrid PBP (β=9.0986, p<0.01; 95%CI: 4.7772, 14.2311) and pure PBP (β =8.7114, p<0.01; 95%CI: 3.9990, 10.1208) than in the control group. The retention rate of soft skills was still significantly higher at 3-months follow-up (β=2.0044; p<0.01; 95%CI: 1.0234, 4.1182) and at 6-months follow-up (β=1.9803; p<0.01; 95%CI: 0.8399, 3.1099) compared to the baseline and immediate post-intervention assessments. CONCLUSION The intervention substantially enhanced soft skills for safe sexual behaviour among adolescents of both sex. Despite the fact that scores for soft skills varied across the study timelines, adolescents demonstrated significant intentions to abstain from sexual intercourse, delay sexual relationships, negotiate condom use, and withstand sexual coercions. The PBP may need to be incorporated in ordinary level secondary school curricula as a formal guide to teachers and or health workers to optimally prepare adolescents for their healthy adulthood.
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Affiliation(s)
- Walter C. Millanzi
- Department of Nursing Management and Education, School of Nursing and Public Health, The University of Dodoma, Dodoma, Tanzania
| | - Stephen M. Kibusi
- Department of Public Health, School of Nursing and Public Health, The University of Dodoma, Dodoma, Tanzania
| | - Kalafunja M. Osaki
- Centre for Pedagogy, Education, Development, Writing and Editing Documents, St. Augustine University of Tanzania, Mwanza, Tanzania
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Larsson FM, Bowers-Sword R, Narvaez G, Ugarte WJ. Exploring sexual awareness and Decision-making among adolescent girls and boys in rural Nicaragua: A socio-ecological approach. SEXUAL & REPRODUCTIVE HEALTHCARE 2021; 31:100676. [PMID: 34775356 DOI: 10.1016/j.srhc.2021.100676] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 10/04/2021] [Accepted: 11/01/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To explore how individual, relational, and social contexts influence adolescents' sexual awareness and decision-making in rural Nicaragua. METHODS Eighteen semi-structured interviews were conducted with adolescent boys and girls aged 15 to 19 years. Thematic analysis identified patterns of meaning applying a socio-ecological approach. A thematic map illustrates how the themes are organized according to the socio-ecological model and suggests their interactions. RESULTS Six main themes emerged as (1) Adolescence - a period of life changes, (2) Fears as a pathway to awareness and decision-making, (3) Awareness about protective measures, (4) Relational influences on adolescents' sexual health, (5) Service provision and institutional influences on awareness and decision-making and (6) Sociocultural determinants on adolescent sexual health. Informants of both genders expressed concern in several issues of their sexuality. They identified fear of pregnancy, STIs, and their impact on future goals, family communication, and school-based sexual education as protective factors for their sexual decision-making. Adolescents of both genders are challenging social and cultural norms by developing sexual agency. CONCLUSION These findings imply that personal and societal factors in rural Nicaragua produce a multi-dimensional effect on adolescent sexual self-efficacy. Our study is relevant for a wider discussion about sexual awareness to promote positive development and health outcomes particularly among adolescents' girls and boys living in rural settings.
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Affiliation(s)
- Frida M Larsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Gabriela Narvaez
- Faculty of Medicine, Nicaraguan National Autonomous University, León, Nicaragua
| | - William J Ugarte
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Faculty of Medicine, Nicaraguan National Autonomous University, León, Nicaragua.
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Lassi ZS, Kedzior SGE, Tariq W, Jadoon Y, Das JK, Bhutta ZA. Effects of preconception care and periconception interventions on maternal nutritional status and birth outcomes in low- and middle-income countries: A systematic review. CAMPBELL SYSTEMATIC REVIEWS 2021; 17:e1156. [PMID: 37131925 PMCID: PMC8356350 DOI: 10.1002/cl2.1156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Background The preconception period is an ideal time to introduce interventions relating to nutrition and other lifestyle factors to ensure good pregnancy preparedness, and to promote health of mothers and babies. In adolescents, malnutrition and early pregnancy are the common challenges, particularly among those who live in low- and middle-income countries (LMIC) where 99% of all maternal and newborn deaths occur. These girls receive little or no attention until their first pregnancy and often the interventions after pregnancy are too late to revert any detrimental health risks that may have occurred due to malnutrition and early pregnancy. Objectives To synthesise the evidence of the effectiveness of preconception care interventions relating to delayed age at first pregnancy, optimising inter-pregnancy intervals, periconception folic acid, and periconception iron-folic acid supplementation on maternal, pregnancy, birth and child outcomes. Search Methods Numerous electronic databases (e.g., CINAHL, ERIC) and databases of selected development agencies or research firms were systematically searched for all available years up to July 2019. In addition, we searched the reference lists of relevant articles and reviews, and asked experts in the area about ongoing and unpublished studies. Selection Criteria Primary studies, including large-scale programme evaluations that assessed the effectiveness of interventions using randomised controlled trials (RCTs) or quasi-experimental designs (natural experiments, controlled before-after studies, regression discontinuity designs, interrupted time series [ITS]), that targeted women of reproductive age (i.e., 10-49 years) during the pre- and periconceptional period in LMICs were included. Interventions were compared against no intervention, standard of care or placebo. Data Collection and Analysis Two or more review authors independently reviewed searches, selected studies for inclusion or exclusion, extracted data and assessed risk of bias. We used random-effects model to conduct meta-analyses, given the diverse contexts, participants, and interventions, and separate meta-analyses for the same outcome was performed with different study designs (ITS, RCTs and controlled before after studies). For each comparison, the findings were descriptively summarised in text which included detailing the contextual factors (e.g., setting) to assess their impact on the implementation and effectiveness of each intervention. Main Results We included a total of 43 studies; two of these were included in both delaying pregnancy and optimising interpregnancy intervals resulting in 26 studies for delaying the age at first pregnancy (14 RCTs, 12 quasi-experimental), four for optimising interpregnancy intervals (one RCT, three quasi-experimental), five on periconceptional folic acid supplementation (two RCTs, three quasi-experimental), and 10 on periconceptional iron-folic acid supplementation (nine RCTs, one quasi-experimental). Geographically, studies were predominantly conducted across Africa and Asia, with few studies from North and Central America and took place in a combination of settings including community, schools and clinical. The education on sexual health and contraception interventions to delay the age at first pregnancy may make little or no difference on risk of unintended pregnancy (risk ratio [RR], 0.42; 95% confidence internal [CI], 0.07-3.26; two studies, =490; random-effect; χ 2 p .009; I 2 = 85%; low certainty of evidence using GRADE assessment), however, it significantly improved the use of condom (ever) (RR, 1.54; 95% CI, 1.08-2.20; six studies, n = 1604; random-effect, heterogeneity: χ 2 p .004; I 2 = 71%). Education on sexual health and and provision of contraceptive along with involvement of male partneron optimising interpregnancy intervals probably makes little or no difference on the risk of unintended pregnancies when compared to education on sexual health only (RR, 0.32; 95% CI, 0.01-7.45; one study, n = 45; moderate certainty of evidence using GRADE assessments). However, education on sexual health and contraception intervention alone or with provision of contraceptive showed a significant improvement in the uptake of contraceptive method. We are uncertain whether periconceptional folic acid supplementation reduces the incidence of neural tube defects (NTDs) (RR, 0.53; 95% CI, 0.41-0.77; two studies, n = 248,056; random-effect; heterogeneity: χ 2 p .36; I 2 = 0%; very low certainty of evidence using GRADE assessment). We are uncertain whether preconception iron-folic acid supplementation reduces anaemia (RR, 0.66; 95% CI, 0.53-0.81; six studies; n = 3430, random-effect; heterogeneity: χ 2 p < .001; I 2 = 88%; very low certainty of evidence using GRADE assessment) even when supplemented weekly (RR, 0.70; 95% CI, 0.55-0.88; six studies; n = 2661; random-effect; heterogeneity: χ 2 p < .001; I 2 = 88%; very low certainty of evidence using GRADE assessments),and in school set-ups (RR, 0.66; 95% CI, 0.51-0.86; four studies; n = 3005; random-effect; heterogeneity: χ 2 p < .0001; I 2 = 87%; very low certainty of evidence using GRADE assessment). Data on adverse effects were reported on in five studies for iron-folic acid, with the main complaint relating to gastrointestinal side effects. The quality of evidence across the interventions of interest was variable (ranging from very low to moderate) which may be attributed to the different study designs included in this review. Concerning risk of bias, the most common concerns were related to blinding of participants and personnel (performance bias) and whether there were similar baseline characteristic across intervention and comparison groups. Authors' Conclusions There is evidence that education on sexual health and contraception interventions can improve contraceptive use and knowledge related to sexual health, this review also provides further support for the use of folic acid in pregnancy to reduce NTDs, and notes that weekly regimes of IFA are most effective in reducing anaemia. However the certainty of the evidence was very low and therefore more robust trials and research is required, including ensuring consistency for reporting unplanned pregnancies, and further studies to determine which intervention settings (school, community, clinic) are most effective. Although this review demonstrates promising findings, more robust evidence from RCTs are required from LMICs to further support the evidence.
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Affiliation(s)
- Zohra S. Lassi
- Robinson Research InstituteUniversity of AdelaideAdelaideAustralia
| | - Sophie G. E. Kedzior
- Faculty of Health and Medical Sciences, Robinson Research InstituteUniversity of AdelaideAdelaideAustralia
| | | | - Yamna Jadoon
- Department of PaediatricsAga Khan University HospitalKarachiPakistan
| | - Jai K. Das
- Division of Women and Child HealthAga Khan University HospitalKarachiPakistan
| | - Zulfiqar A. Bhutta
- Centre for Global Child HealthThe Hospital for Sick ChildrenTorontoCanada
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10
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Apter D. International Perspectives: IUDs and Adolescents. J Pediatr Adolesc Gynecol 2019; 32:S36-S42. [PMID: 31585617 DOI: 10.1016/j.jpag.2019.04.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 04/06/2019] [Accepted: 04/17/2019] [Indexed: 11/19/2022]
Abstract
Unplanned or unwanted pregnancy among adolescents is a worldwide public health issue. In many countries unmarried young women are denied contraceptive services. Long-acting reversible contraceptive methods such as the intrauterine devices (IUDs) have been shown to be more effective than short-acting such as the pill, and safe also for adolescents. The popularity has varied a lot with time and between populations. Health care providers, health system, and user factors all influence IUD use. A good sexuality education through school provides a foundation, and health care providers give specific individual counseling. International and country-specific guidelines have been published during the past decade indicating the advantage of IUDs. New smaller size devices make placement easier for nulliparous adolescents. Still the uptake has remained rather low in most regions, cost being one barrier. Several municipalities have started to provide long-acting reversible contraceptive methods for adolescents free of charge, and this has led to a significant increase in IUD use, accompanied by a reduction in abortion rates. Adolescent-friendly services should offer low-cost or free contraception, including male and female condoms, emergency contraception, and a full range of modern methods, including long-acting reversible methods, according to adolescents' preferences and needs.
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Affiliation(s)
- Dan Apter
- VL-Medi Clinical Research Center, Helsinki, Finland.
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Parker JJ, Veldhuis CB, Hughes TL, Haider S. Barriers to contraceptive use among adolescents in two semi-rural Nicaraguan communities. Int J Adolesc Med Health 2019; 32:ijamh-2017-0228. [PMID: 30939115 DOI: 10.1515/ijamh-2017-0228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 04/01/2018] [Indexed: 06/09/2023]
Abstract
Objective To identify barriers to contraceptive use among adolescents in two neighboring semi-rural communities in Nicaragua. Methods We recruited and surveyed a convenience sample of 287 adolescents, ages 15-19 years old, in July and August, 2013 about barriers to contraceptive use. We compared adolescents by gender, sexually active status (sexual intercourse in the previous year) and frequency of contraceptive use. Results More than 40% (43.5%) of the adolescents surveyed reported that they had ever had sexual intercourse. The likelihood of ever having had sexual intercourse differed based on gender, relationship status, sexual activity of peers, and the presence of a father in the home. Contraceptive use was low and female adolescents were more likely than their male counterparts to report never or rarely using contraceptives (46.5% vs. 21.4%, p < 0.007). Contraceptive use for females was positively associated with discussing contraception with a healthcare professional (HCP) [adjusted odds ratio (AOR) 13.32; 95% confidence interval (CI) 1.35-139.98] and a family member (AOR 4.64; 95% CI 1.09-19.72). Reasons for non-use also varied significantly by gender. Low rates of contraceptive use in these two semi-rural Nicaraguan communities appear to be primarily related to gender norms, social stigma, and poor communication about family planning. Conclusions Interventions that focus on promoting gender equality and encouraging adolescent communication with HCPs, schools, families, and partners are imperative to combating adolescent pregnancy in Nicaragua and countries worldwide.
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Affiliation(s)
- J J Parker
- Center for Global Health, University of Illinois at Chicago, 1940 W Taylor Street, Room 214, Chicago, IL 60612, USA, Phone: +847.525.9882
| | - Cindy B Veldhuis
- Center for Research on Women and Gender, University of Illinois at Chicago, Chicago, IL, USA
- School of Nursing, Columbia University, New York, NY, USA
| | - Tonda L Hughes
- School of Nursing, Columbia University, New York, NY, USA
| | - Sadia Haider
- Department of Obstetrics and Gynecology, University of Chicago, Chicago, IL, USA
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Cordova-Pozo K, Hoopes AJ, Cordova F, Vega B, Segura Z, Hagens A. Applying the results based management framework to the CERCA multi-component project in adolescent sexual and reproductive health: a retrospective analysis. Reprod Health 2018; 15:24. [PMID: 29422099 PMCID: PMC5806234 DOI: 10.1186/s12978-018-0461-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 01/22/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescent sexual and reproductive health (SRH), problems such as unplanned pregnancies are complex and multifactorial, thus requiring multifaceted prevention interventions. Evaluating the impact of such interventions is important to ensure efficiency, effectiveness and accountability for project funders and community members. In this study, we propose Results Based Management (RBM) as a framework for project management, using the Community Embedded Reproductive Health Care for Adolescents (CERCA) as a case study for RBM. The CERCA Project (2010-2014) tested interventions to reduce adolescent pregnancy in three Latin American countries, Bolivia, Ecuador and Nicaragua. Activities were designed to increase adolescent SRH behaviors in four domains: communication with parents, partners and peers; access to SRH information; access to SRH services; and use of contraception. When the project ended, the outcome evaluation showed limited impact with concerns about accuracy of monitoring and attrition of participants. METHODS We reviewed and analyzed a series of CERCA documents and related data sources. Key findings from these documents were organized within an RBM framework (planning, monitoring, and impact evaluation) to understand how CERCA methodology and performance might have reaped improved results. RESULTS Strengths and weaknesses were identified in all three elements of the RBM framework. In Planning, the proposed Theory of Change (ToC) differed from that which was carried out in the intervention package. Each country implemented a different intervention package without articulated assumptions on how the activities of intervention would bring about change. In Monitoring, the project oversight was mainly based on administrative and financial requirements rather than monitoring fidelity and quality of intervention activities. In Impact Evaluation, the original CERCA evaluation assessed intervention effects among adolescents, without identifying success and failure factors related to the outcomes, the nature of the outcomes, or cost-effectiveness of interventions. CONCLUSIONS This analysis showed that multi-country projects are complex, entail risks in execution and require robust project management. RBM can be a useful tool to ensure a systematic approach at different phases within a multi-country setting.
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Affiliation(s)
| | - Andrea J. Hoopes
- Kaiser Permanente Washington, 13451 SE 36th, Bellevue, WA 98006 USA
| | - Freddy Cordova
- South Group, C. Ecuador O-138, Edificio Holanda, A-3A, Cochabamba, Bolivia
| | - Bernardo Vega
- University of Cuenca- Facultad de Ciencias Médicas, Avenida 12 de abril S/N sector El Paraíso, Cuenca, Ecuador
| | - Zoyla Segura
- Instituto Centroamericano de la Salud, Reparto Los Robles, Restaurante La Marsellaise 1 c. al norte 1 c. al este, casa #, 77 Managua, Nicaragua
| | - Arnold Hagens
- South Group, C. Ecuador O-138, Edificio Holanda, A-3A, Cochabamba, Bolivia
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Hong E, Kang Y. Gender Differences in Sexual Behaviors in Korean Adolescents. J Pediatr Nurs 2017; 37:e16-e22. [PMID: 28802592 DOI: 10.1016/j.pedn.2017.08.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 07/06/2017] [Accepted: 08/06/2017] [Indexed: 11/30/2022]
Abstract
PURPOSE The purposes of this study were to identify whether there are gender differences in sexual behaviors among Korean adolescents and to explore the factors that influence safe sex practices across both sexes. METHODS A secondary analysis was conducted using nationally representative data obtained from the 2014 Youth Risk Behavior Web-based Survey. Sample consisted of 3,210 adolescents who had experience of sexual intercourse. The dependent variable in this study was practicing safe sex. The independent variables included a range of individual, family, and school factors. RESULTS Female adolescents were less likely to practice safe sex (i.e., always using a condom). Individual (smoking, no drinking before sexual intercourse), family (living with parents, higher allowance per week) and school factors (non-coeducational school students, had received school-based sex education) were significant predictors of practicing safe sex in males. In contrast, family (lower economic status) and school factors (middle school students) predicted practicing safe sex among female adolescents. CONCLUSION We demonstrated that gender plays an important role in the sexual behavior of adolescents. The findings of this study indicate a need to design and implement gender-specific interventions.
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Affiliation(s)
- Eunyoung Hong
- Department of Nursing, Gyeongnam National University of Science and Technology, Republic of Korea
| | - Youngmi Kang
- East-West Nursing Research Institute, College of Nursing Science, Kyung Hee University, Republic of Korea.
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Gabster A, Mohammed DY, Arteaga GB, Castillero O, Mojica N, Dyamond J, Varela M, Pascale JM. Correlates of Sexually Transmitted Infections among Adolescents Attending Public High Schools, Panama, 2015. PLoS One 2016; 11:e0163391. [PMID: 27657700 PMCID: PMC5033244 DOI: 10.1371/journal.pone.0163391] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 09/06/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Sexually transmitted infections (STIs) are common in adolescents worldwide. Vulnerability to STIs increases with risky sexual practices. This study described the sexual practices, estimated the prevalence of STIs, and identified correlates associated with STIs among participants, enrolled in public high schools, in the District of Panama, Panama. METHODS A cross sectional study, using multistage cluster sampling, was conducted among participants, aged 14-18 years, enrolled in public high schools, in the District of Panama, Panama City, Panama, from August to November, 2015. Participants completed a self-administered questionnaire and provided biological samples. The samples of those reporting sexual activity (oral, vaginal, and/or anal intercourse) were tested for STIs. Odds ratios were used to identify correlates of STIs in this population. RESULTS A total of 592 participants were included, of whom, 60.8% reported a history of sexual activity, and 24.4% tested positive for least one STI. STIs were more common in female participants, (33.5%). Compared to those without STIs, higher proportions of those with at least one STI reported ≥3 sexual partners in their lifetime (60.0%) and current sexual activity (76.3%). In the multivariable model, correlates of STI included female participants (Adjusted Odds Ratio (AOR) = 5.8, 95% Confidence Interval (CI) 2.3-14.6) and those who engaged in sexual intercourse with casual partners (AOR = 3.0, 95% CI: 1.2-7.5). CONCLUSIONS We report a high STI prevalence among adolescents attending public high schools, in the District of Panama. Reported risky sexual practices were common and correlated with STIs. Female participants and those reporting sexual intercourse with casual partners were more likely test positive for at least one STI. Our study identified a need for effective interventions to curb future infections in this population.
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Affiliation(s)
- Amanda Gabster
- Departmento de Genómica y Proteómica, Instituto Conmemorativo Gorgas de Estudios de la Salud, Calle 35, Ave Justo Arosemena, Panamá, Panamá
- * E-mail:
| | - Debbie Y. Mohammed
- William Paterson University, 300 Pompton Rd, Wayne, New Jersey, 07470, United States of America
- St. Michael’s Medical Center, 111 Central Avenue, Newark, New Jersey, 07102, United States of America
| | | | - Omar Castillero
- Departmento de Genómica y Proteómica, Instituto Conmemorativo Gorgas de Estudios de la Salud, Calle 35, Ave Justo Arosemena, Panamá, Panamá
| | - Nataly Mojica
- Facultad de Medicina, Universidad de Panamá, Transístmica, Panamá, Panamá
| | - José Dyamond
- Departmento de Genómica y Proteómica, Instituto Conmemorativo Gorgas de Estudios de la Salud, Calle 35, Ave Justo Arosemena, Panamá, Panamá
| | - Maria Varela
- Hospital Santo Tomás, Calle 37 Este, Panamá, Panamá
| | - Juan Miguel Pascale
- Departmento de Genómica y Proteómica, Instituto Conmemorativo Gorgas de Estudios de la Salud, Calle 35, Ave Justo Arosemena, Panamá, Panamá
- Facultad de Medicina, Universidad de Panamá, Transístmica, Panamá, Panamá
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Córdova Pozo K, Chandra-Mouli V, Decat P, Nelson E, De Meyer S, Jaruseviciene L, Vega B, Segura Z, Auquilla N, Hagens A, Van Braeckel D, Michielsen K. Improving adolescent sexual and reproductive health in Latin America: reflections from an International Congress. Reprod Health 2015; 12:11. [PMID: 25616439 PMCID: PMC4320614 DOI: 10.1186/1742-4755-12-11] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 01/14/2015] [Indexed: 11/12/2022] Open
Abstract
In February 2014, an international congress on Promoting Adolescent Sexual and Reproductive Health (ASRH) took place in Cuenca, Ecuador. Its objective was to share evidence on effective ASRH intervention projects and programs in Latin America, and to link this evidence to ASRH policy and program development. Over 800 people participated in the three-day event and sixty-six presentations were presented.This paper summarizes the key points of the Congress and of the Community Embedded Reproductive Health Care for Adolescents (CERCA) project. It aims at guiding future ASRH research and policy in Latin America. 1. Context matters. Individual behaviors are strongly influenced by the social context in which they occur, through determinants at the individual, relational, family, community and societal levels. Gender norms/attitudes and ease of communication are two key determinants. 2. Innovative action. There is limited and patchy evidence of effective approaches to reach adolescents with the health interventions they need at scale. Yet, there exist several promising and innovative examples of providing comprehensive sexuality education through conventional approaches and using new media, improving access to health services, and reaching adolescents as well as families and community members using community-based interventions were presented at the Congress. 3. Better measurement. Evaluation designs and indicators chosen to measure the effect and impact of interventions are not always sensitive to subtle and incremental changes. This can create a gap between measured effectiveness and the impact perceived by the targeted populations. Thus, one conclusion is that we need more evidence to better determine the factors impeding progress in ASRH in Latin American, to innovate and respond flexibly to changing social dynamics and cultural practices, and to better measure the impact of existing intervention strategies. Yet, this Congress offered a starting point from which to build a multi-agency and multi-country effort to generate specific evidence on ASRH with the aim of guiding policy and program decision-making. In a region that contains substantial barriers of access to ASRH education and services, and some of the highest adolescent pregnancy rates in the world, the participants agreed that there is no time to lose.
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Affiliation(s)
- Kathya Córdova Pozo
- />South Group, C. Ecuador O-138, Edificio Holanda, A-3A, Cochabamba, Bolivia
| | - Venkatraman Chandra-Mouli
- />Reproductive Health and Research, World Health Organization, 20 Avenue Appia, CH - 1211 Geneva 27, Switzerland
| | - Peter Decat
- />International Centre for Reproductive Health (ICRH), Ghent University, De Pintelaan 185 6 K4, 9000 Gent, Belgium
| | - Erica Nelson
- />Center for Social Science and Global Health, University of Amsterdam, Nieuwe Achtergracht 166, 1018 WV Amsterdam, The Netherlands
| | - Sara De Meyer
- />International Centre for Reproductive Health (ICRH), Ghent University, De Pintelaan 185 6 K4, 9000 Gent, Belgium
| | - Lina Jaruseviciene
- />Department of Family Medicine, Lithuanian University of Health Sciences, Kaunas, 44307 Lithuania
| | - Bernardo Vega
- />University of Cuenca- Facultad de Ciencias Médicas, Avenida 12 de abril S/N sector El Paraíso, Cuenca, Ecuador
| | - Zoyla Segura
- />Instituto Centroamericano de la Salud, Reparto Los Robles, Restaurante La Marsellaise 1 c. al norte 1 c. al este, casa # 77, Managua, Nicaragua
| | - Nancy Auquilla
- />University of Cuenca- Facultad de Ciencias Médicas, Avenida 12 de abril S/N sector El Paraíso, Cuenca, Ecuador
| | - Arnold Hagens
- />South Group, C. Ecuador O-138, Edificio Holanda, A-3A, Cochabamba, Bolivia
| | - Dirk Van Braeckel
- />International Centre for Reproductive Health (ICRH), Ghent University, De Pintelaan 185 6 K4, 9000 Gent, Belgium
| | - Kristien Michielsen
- />International Centre for Reproductive Health (ICRH), Ghent University, De Pintelaan 185 6 K4, 9000 Gent, Belgium
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