Parenting and youth sexual risk in context: The role of community factors

Sexual health knowledge acquisition processes among very young adolescent girls in rural Malawi: Implications for sexual and reproductive health programs

Early adolescence is a period characterized by enormous biological, cognitive, sexual, emotional, and social changes. Sexual curiosity and the desire to acquire sexual health (SH) information are part of these developments. Understanding the SH knowledge acquisition process is critical for designing interventions that can best support very young adolescents (VYAs). This study explored the SH knowledge acquisition processes among VYA girls aged 10 to 14 years who attended the DREAMs Girl Only Clubs (GOCs) and those who did not. The GOCs were a part of a larger comprehensive HIV prevention project called DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) which provided an evidence-based core package of interventions to VYAs to prevent HIV. In-depth interviews were conducted with 43 VYA girls aged 10-14 years in two rural southern districts of Zomba and Machinga in Malawi. Twenty-three VYA girls were GOC participants and 20 VYAs were not. Guided by the Social Ecological Model, a thematic analysis approach was used to analyze the data with the assistance of Nvivo 12 software. The SH knowledge acquisition processes were the interaction of various factors at the microsystem (self-efficacy, attitudes, trust and the beginning of menstruation), mesosystem (communication of SH issues between VYAs and their immediate family and peers), and exosystem levels (availability of life skills programs and mother-groups in schools and availability of GOCs). Compared to Non-GOC participants, GOC participants demonstrated an in-depth knowledge of SH issues and positive sexual behaviors such as HIV testing. Limitations to SH knowledge acquisition were adult messages' focus on sexual relationship avoidance and on girls who have started menstruation; the perception of adults not being knowledgeable about SH and school teachers hiding some SH information. VYAs' SH interventions that provide VYAs with accurate, consistent, and age-appropriate SH information such as the GOCs have the potential to address the limitations that other sources have in reaching VYAs. Integrating such interventions with programs that empower parents, other adults, and teachers with comprehensive SH information and with skills on how to deliver SH information to VYAs can enhance VYAs' SH knowledge acquisition and influence positive behavior change.

Associations of Social Support with Sexual Practices, Health Behaviours, and Health Outcomes Among Adolescent Girls and Young Women: Evidence From a Longitudinal Study in KwaZulu-Natal, South Africa

BACKGROUND

Several studies have reported on the benefits of social support for health behaviour, including risky sex. Social support may thus be an important resource for promoting individual health and well-being, particularly in regions where HIV rates are high and healthcare resources are scarce. However, prior research on the implications of social support for the health behaviour of young women has yielded mixed and inconclusive findings. Using prospective data from young women in South Africa, this study examines the associations of social support with subsequent sexual practices, health behaviour, and health outcomes.

METHOD

We used two rounds of longitudinal data from a sample of n = 1446 HIV-negative emerging adult women, aged 18 to 29 years, who participated in a population-based HIV study in KwaZulu-Natal, South Africa. Applying the analytic template for outcome-wide longitudinal designs, we estimated the associations between combinations of social support (i.e. tangible, educational, emotional) and ten HIV risk-related outcomes.

RESULTS

Combinations of tangible, educational, and emotional support, as well as tangible support by itself, were associated with lower risk for several outcomes, whereas educational and emotional support, by themselves or together, showed little evidence of association with the outcomes.

CONCLUSION

This study highlights the protective role of tangible support in an environment of widespread poverty, and the additional effect of combining tangible support with non-tangible support. The findings strengthen recent evidence on the benefits of combining support in the form of cash and food with psychosocial care in mitigating risk behaviours associated with HIV and negative health outcomes among young women.

Social Correlates of HIV-Risky Behaviours among African Canadian Adolescents Living in British Columbia, Canada: A Secondary Data Analysis

Studies have linked HIV-risky behaviours among young people to several socio-contextual factors. However, the social factors that might increase African Canadian adolescents' exposure to HIV-risky behaviours, including unprotected sex and forced or multiple-sexual partnerships, have received little or no attention in the literature. Using data from the British Columbia Adolescent Health Surveys (2003-2018) and guided by intersectionality and socio-ecological frameworks, we examined the social determinants of HIV-risky behaviours (HRB) among African Canadian adolescents in British Columbia. We observed a general decline in HRB from 2008 to 2018. However, more than half (54.5%) of the 1042 who were sexually experienced in 2018 reported having 2 or more sexual partners, and nearly half reported condom-less sex. Our results demonstrate an important need to evaluate the impacts of several social factors on health outcomes for a unique, marginalized population.

Factors associated with adolescents' sexual experience based on the biopsychosocial model: a cross-sectional study using the Korea Youth Risk Behavior Web-based Survey (KYRBS)

OBJECTIVES

Sexual activity is an important integrative behaviour that interacts with biological, psychological and social factors among various changes in adolescence. However, starting sex at an early age is associated with adverse outcomes. Thus, this study aimed to investigate the factors associated with adolescents' sexual experience based on the biopsychosocial model.

DESIGN

A cross-sectional study.

SETTING

The participants were selceted through a complex sample design at high schools and middle schools nationwide in Korea.

PARTICIPANTS

We employed 4-year data (2017-2020) of the cross-sectional Korea Youth Risk Behavior Web-based Survey. In total, 234567 participants attending middle school and high school were analysed. Sexual experience was defined as having had sexual intercourse (oral, anal or vaginal) in their lifetime. To identify variables associated with adolescents' sexual experiences, we used a biopsychosocial model. Logistic regression analysis was performed to identify the variables associated with sexual experience.

RESULTS

3.4% of boys and 1.6% of girls attending middle school had sexual experiences, showing a significant difference. A total of 10.4% of boys and 5.1% of girls attending high school had sexual experiences (p<0.001). Among the biological factors of the biopsychosocial model, age and gender were significantly associated with sexual experiences in adolescents. Regarding the psychological factors, suicidal thoughts were a significant risk factor associated with sexual experience. Furthermore, social factors including drinking, smoking and family structure were associated with sexual experience in adolescents. Particularly, a significantly higher sexual experience was found in the three groups living with a single parent, step-parents and no parents compared with the group living with both parents in family structure.

CONCLUSIONS

This study demonstrated the factors associated with adolescents' sexual experience based on the biopsychosocial model. Further research and policy strategies that consider supporting family communication and mental health and preventing substance use are required to prevent adolescents' sexual health.

Parenting stress predicts longitudinal change in parental involvement among mothers living with HIV

Mothers living with HIV (MLH) face unique challenges that may compound parenting stress and impede effective parenting practices. Among the general population, research has demonstrated bidirectional longitudinal relations between parenting stress and parenting practices; yet, despite the additional stressors faced by MLH, these processes have not been examined longitudinally in this population. Utilizing the process model of parenting, the present study examined the longitudinal relations between parenting stress and parental involvement among a sample of MLH with children aged 6-14 years (N = 174). MLH completed self-report measures on their parenting stress and parental involvement at four timepoints spanning 15 months. Latent change score modeling was employed to examine how changes in parenting stress and changes in parental involvement were related across time. Results revealed that increases in parenting stress-specifically distress within the parental role-predicted subsequent decreases in parental involvement. The effects were unidirectional; parental involvement did not predict subsequent changes in parenting stress. Other aspects of parenting stress (perceptions of dysfunctional parent-child interactions and perceptions of the child's temperament as difficult) did not have significant longitudinal associations with changes in parental involvement. Results highlight the central role of parenting stress for MLH as a potential driving factor of parenting quality. Beyond supporting the use of effective parenting skills, clinical prevention and intervention efforts with families affected by HIV should also incorporate stress reduction techniques to increase MLH's capacity for active parental involvement and thereby support positive outcomes for their children. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Effect of Quality of Caregiver-Adolescent Relationship on Sexual Debut, Transactional Sex, and on Age-Disparate Relationships Among Young Women in Rural South Africa Enrolled in HPTN 068

BACKGROUND

Adolescent girls and young women (AGYW) remain burdened by the HIV epidemic. Positive caregiver-child relationships are associated with safe sexual behaviors in young people; yet, this literature often highlights the role of parent-child communication and parental monitoring, neglecting the importance of emotional relationships between a caregiver and adolescent.

SETTING

We used longitudinal data from HIV Prevention Trial Network 068-conducted among 2533 AGYW (13-20 years) over a period of 5 years in Agincourt, South Africa.

METHOD

Kaplan-Meier and Cox models were used to estimate the effect of quality of caregiver-adolescent relationships (caring and closeness) on sexual debut, and log-binomial models with generalized estimating equations were used to examine the relationship between our exposures and transactional sex and age-disparate relationships.

RESULTS

Sexual debut was delayed among those who reported high levels of caregiver caring [hazard ratio: 0.80, 95% confidence interval (CI): 0.69 to 0.93] and caregiver closeness (hazard ratio: 0.80, 95% CI: 0.68 to 0.95). AGYW who reported high quality caregiver-adolescent relationships had a lower risk of transactional sex [caring: risk ratio (RR): 0.67, 95% CI: 0.58 to 0.78; closeness: RR: 0.58; 95% CI: 0.50 to 0.67]. Similarly, those with high-quality caregiver-adolescent relationships were less likely to be in an age-disparate relationship (caring: RR: 0.68, 95% CI: 0.58 to 0.79; closeness: RR: 0.77, 95% CI: 0.66 to 0.90).

CONCLUSIONS

Findings indicate high-quality caregiver-adolescent relationships are associated with delayed sexual debut, a lower risk of transactional sex, and having an older partner. Family-centered interventions are needed to improve relationships between AGYW and caregivers.

"Youth Photovoice": Promoting Youth-Driven Community Changes for HIV Prevention in Rural Malawi

ABSTRACT

To meet the Joint United Nations Programme on HIV/AIDS global goal of no new HIV infections by 2030, it is imperative to reduce new infections among youth. Youth Photovoice was a 10-month, participatory, community-action research project developed to engage rural Malawi youth in an HIV prevention project focused on community-level outcomes. In this study, we describe how participants in Youth Photovoice engaged adults and community leaders to implement action plans, as well as the community and individual changes that occurred as a result of these collaborative efforts. Youth Photovoice participants, their parents, and local leaders in the community participated in focus groups and individual interviews. Community-level changes, such as moving initiation ceremonies to churches and changes to local business practices, were observed, along with increased community and parental involvement in youth monitoring for local events and activities. This youth-led project led to changes in the community environment that reduced exposure to situations supporting unsafe sex, uncovered ways that youth can lead collaborations with adults, and informed the implementation of plans for community action.

Longitudinal Relations among Adolescent Risk Behavior, Family Cohesion, Violence Exposure, and Mental Health in a National Sample

Violence is a public health concern linked with mental health problems among adolescents, and risk behavior increases the likelihood of violence exposure. Family cohesion may attenuate the negative effects of risk behavior. The purpose of this study was to examine family cohesion as a moderator in the relation between risk behavior (substance use and delinquency) and violence exposure, and to explore longitudinal associations among cohesion, violence exposure, and subsequent mental health outcomes (PTSD and depression). Data were drawn from the National Survey of Adolescents-Replication, a nationally representative sample of 3604 adolescents, with data collected via structured phone interviews at three waves spanning a two-year period. Hypotheses were tested using longitudinal structural equation modeling. Findings revealed that high family cohesion attenuated the relation between risk behavior and subsequent violence exposure. Wave 2 violence exposure was associated with more Wave 3 mental health problems, but high family cohesion was related to fewer subsequent symptoms. Follow-up analyses revealed that family cohesion moderated the relation between risk behavior and experiencing, but not witnessing, violence. Several demographic associations were observed. Although risk behavior increases exposure to violence, and in turn, mental health problems, family cohesion may serve as a protective factor, attenuating the link between risk behavior and subsequent negative consequences. This effect emerged even when accounting for demographic and socioeconomic covariates. Interventions with adolescents should target family relationships as a protective factor to reduce risk of violence exposure and mental health problems, particularly for adolescents who are engaging in high-risk behaviors.

Longitudinal Bidirectional Relations among Parenting Quality, Parenting Stress, and Child Functioning in HIV-affected Families

Mothers living with HIV (MLH) face unique stressors impacting parenting, parenting stress, and child psychosocial functioning, but longitudinal, bidirectional relations among family processes have not been examined in this population. This study examined relations among parenting quality, parenting stress, and child functioning in 174 MLH-child dyads (aged 6-14, M_age = 9.65, SD = 2.49; 51% female; 57% Black/African American; 35% Latinx). Families completed self-report questionnaires over four waves spanning 15 months. Cross-lagged panel analysis revealed unidirectional and bidirectional relations between parenting stress and child functioning; parenting quality and child functioning; and parenting quality and parenting stress. The findings suggest that prevention and intervention efforts with HIV-affected families should target both parent factors (e.g., communication skills) and child factors (e.g., emotion regulation), emphasizing parenting stress reduction in order to bolster family outcomes.

Girl-only clubs' influence on SRH knowledge, HIV risk reduction, and negative SRH outcomes among very young adolescent girls in rural Malawi

BACKGROUND

Early adolescence is an important period to lay the foundation for positive sexual health development that can overcome sexual and reproductive health (SRH) challenges faced by very young adolescents (VYAs) as they reach puberty and sexual debut. In this study, we explored the following questions: first, what are the experiences of VYA girls on DREAMS' Go Girl club participation? Second, how does club participation influence the VYAs SRH knowledge to reduce their risk for HIV and negative sexual health outcomes?

METHODS

This was a qualitative study in which twenty-three in-depth interviews were conducted with VYA girls aged 12-14 years. These girls were enrolled in girl-only clubs in two rural southern districts in Malawi. The clubs were a part of larger comprehensive HIV prevention project called DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe) which provided an evidence-based core package of interventions to VYAs to prevent HIV. Interventions included improved access to key health services, education support, social skills, asset building, and economic strengthening. Narrative inquiry was used to generate first-hand accounts of the girls' experiences with club participation. Thematic analysis was used to generate themes from the transcribed stories.

RESULTS

Six main themes were generated: 1) reasons for joining the clubs with desire to learn about SRH as a motivation for joining the clubs.; 2) influence on gender norms and roles whereby participants described a change of gender roles and norms at home; 3) influence on child abuse practices whereby participants reported a decline in child abusive practices at home;4) influence on life skills and social networks whereby participants described learning about networking; 5) support to go back to school whereby out-of-school girls described how economic empowerment of their guardians facilitated their return to school; and 6) influence of clubs on SRH knowledge acquisition and behaviours whereby participants described acquiring knowledge on sexual health issues.

CONCLUSION

Girls-only HIV and SRH programs coupled with economic empowerment for their families can be effective in keeping VYA girls in school and improving SRH knowledge and health seeking behavior.

A Mixed-Methods Longitudinal Investigation of Mothers' Disclosure of HIV to Their Children

Mothers living with HIV (MLH) must navigate disclosing their serostatus to their children, but the longitudinal impact on families remains unknown. This study examined HIV disclosure, parenting, parenting stress, and child adjustment among 174 MLH-child dyads (aged 6-14; 35% Latinx; 57% Black/African American). Quantitative data were collected over four waves spanning 15 months. Qualitative data were collected with 14 families in which disclosure had occurred. Latent change score modeling revealed that disclosure led to improvements in parenting stress, communication, and relationship quality. Disclosure did not predict child adjustment. Qualitative themes contextualized these findings, revealing stability and improvements in family functioning. MLH should be supported in disclosing their serostatus to their children to minimize parenting stress and bolster parenting skills.

Violence Victimization and Parenting Among Black South African Mothers

PURPOSE

Black South African women and girls face high rates of violence victimization, including physical, sexual, and emotional abuse in childhood and intimate partner violence (IPV) in adulthood. U.S.-based research suggests that violence victimization predicts parenting difficulties, but this relation has not been examined in a South African context.

METHOD

Among a sample of 99 Black South African female caregivers, we examined rates of child abuse, IPV, and cumulative trauma, and we explored the associations between caregivers' victimization history and current parenting quality (i.e., parent-child relationship quality & parental involvement with child). Caregivers completed self-report questionnaires using ACASI software.

RESULTS

Hierarchical regression analyses revealed that caregivers reporting childhood physical or sexual abuse were less involved with their children. Caregivers with a history of emotional abuse reported significantly worse parent-child relationship quality. Cumulative trauma was associated with worse parental involvement and parent-child relationship quality.

CONCLUSIONS

Results reveal relatively high rates of interpersonal violence victimization among this convenience sample of Black South African women, as well as unique relations between forms of victimization and specific parenting practices. The findings highlight the importance of behavioral parent training interventions with a focus on specific assessment of parents' victimization experiences.

Social Support and Its Effects on Adolescent Sexual Risk Taking: A Look at Vulnerable Populations in Baltimore and Johannesburg

INTRODUCTION

We seek to understand whether and how much social support affects adolescent sexual risk-taking in disadvantaged urban environments.

METHODS

Secondary analyses were conducted on data from the global Wellbeing of Adolescents (15-19 years old) in Vulnerable Environments study. The outcomes of interest were sexual experience, age at sexual debut, number of lifetime sexual partners, and condom use at last sex. Social support scales measuring support at home, at school, and from peers were created, as well as a measure about who raised them. Logistic and linear regressions were used to examine associations between social support and sexual risk-taking after controlling for age, schooling, and family structure.

RESULTS

Higher social support was associated with adolescents taking less sexual risk but it was context- and gender-specific. Boys raised by males had lower odds of having sex (adjusted odds ratios (aORs) from .15 (CI = .05-.42) to .19 (.04-.88)). Baltimore girls raised by grandmothers had lower odds of having sex (aOR .34 (.16-.71)). Female support at home was positively associated with girls in Baltimore (aOR .08 (CI = .04-.17)) and Johannesburg (aOR .17 (CI = .03-.87)) having fewer partners. Baltimore girls raised by fathers (aOR 3.78 (CI = 2.33-6.12)) and Johannesburg boys raised by non-biological/step caregivers (aORs from 3.89 (CI = 1.12-13.44) to 8.85 (CI = 6.02-12.99)) were more likely to use condoms.

CONCLUSION

Young men without male support and young women lacking parental support are at particular risk of sexual risk-taking in disadvantaged communities. Parental support can be affected by other contextual factors. Violence in neighborhoods and at home should be considered.

South African Adolescents' Neighborhood Perceptions Predict Longitudinal Change in Youth and Family Functioning

This study examined South African early adolescent youth (aged 10 to 14) and their female caregivers (N = 99 dyads) participating in an HIV prevention intervention over a period of eight months. We examined youth perceptions of neighborhood cohesion, safety, and collective monitoring as they related to concurrent and longitudinal associations with youth (externalizing behavior and hope about the future) and family (parent-youth relationship quality, parental involvement, and parental responsiveness to sex communication) functioning while controlling for baseline characteristics. Neighborhood perceptions were significantly associated (p < .05) with short- and longer-term outcomes. Gender differences suggested a greater protective association of perceived neighborhood conditions with changes in functioning for boys versus girls. Unexpected associations were also observed, including short-term associations suggesting a link between better neighborhood quality and poorer family functioning. We account for the culture of this South African community when contextualizing our findings and conclude with recommendations for interventions targeting neighborhood contexts.