Age at Time of Initial Sexual Intercourse and Health of Adolescent Girls

Comprehensive HIV knowledge, stigma and associated sexual risk behaviors among sexually active adolescent girls and young women in the Philippines

This study aims to investigate how comprehensive HIV knowledge, stigma and sociodemographic factors relate to sexual risk behaviors among sexually active young women in the Philippines. Using the 2022 Philippine National Demographic and Health Survey data, a cross-sectional quantitative approach analyzed 2494 sexually active young women aged 15-24 years. Logistic regression models examined associations, controlling for sociodemographic factors. Sexual risk behaviors included STI symptoms, multiple sexual partners and non-condom use. Findings revealed 26.6% reported sexual risk behaviors. Significant associations were found with secondary or lower educational attainment (AOR = 0.56, 95% CI 0.42-0.76) reducing the odds and daily internet access (AOR = 1.63, 95% CI 1.18-2.23) and recent alcohol consumption (AOR = 1.82, 95% CI 1.30-2.54) increasing the odds of sexual risk behavior. Knowing one's HIV test result was protective (AOR = 0.33, 95% CI 0.21-0.51), while comprehensive HIV/AIDS knowledge and stigma showed no significant associations. Overall, one in four sexually active young women in the Philippines is at risk of HIV infection. Thus, targeted interventions are crucial to address risk factors identified among young women. This study informs public health strategies, emphasizing proactive HIV testing to empower informed decision-making and reduce risky sexual behaviors.

Causal relationship between Women's reproductive traits and postpartum depression: a multivariate mendelian randomization analysis

Purpose

The relationship between women's reproductive traits and postpartum depression (PPD) has not been clarified. We reveal the association between genetically predicted modifiable women's reproductive traits and PPD using two-sample Mendelian randomization (MR).

Methods

We used genome-wide association studies (GWASs) to obtain instrumental variables (IVs) of 9 women's reproductive traits. Univariate and multivariate MR analyses were used to examine the association between traits and the risk of PPD (13,657 cases and 236,178 controls). The primary causal effect assessment employed the IVW method. Heterogeneity was assessed using Cochran's Q test. Multiple horizontal effects were assessed using the MR-PRESSO and MR-Egger intercept. Leave-one-out and LASSO regression analyses were used to check the robustness of the UVMR and MVMR results, respectively.

Results

In the UVMR result, genetic prediction showed that age at first sexual intercourse (AFS) (OR = 0.474, 95% CI 0.396-0.567; p = 4.6 × 10-16), age at first birth (AFB) (OR = 0.865, 95% CI 0.805-0.930; p = 8.02 × 10-5), and age at last live birth (ALLB) (OR = 0.296, 95% CI 0.138-0.636; p = 0.002) were significantly inversely associated with PPD, while a higher lifetime number of sexual partners (LNSP) (OR = 1.431, 95% CI 1.009-2.031; p = 0.045) and a greater number of spontaneous miscarriages (OR = 1.519, 95% CI 1.021-2.262; p = 0.039) are suggested to be associated with an increased risk of PPD. In the MVMR result, only AFB (OR = 0.804, 95% CI 0.661-0.978; p = 0.029) retained a direct causative relationship with PPD.

Conclusion

The study indicates that AFB is a significant risk factor for PPD. Furthermore, the likelihood of developing PPD appears to decrease with increasing gestational age at the time of the first childbirth.

An exploration of teacher and school-based nurse perceptions of current HPV education offered to students 15-16 years old in post-primary schools in Northern Ireland, UK

INTRODUCTION

Human papillomavirus virus (HPV) is highest among young adults 15-24 years old. High-risk strains are responsible for the development of cancers including cervical, vaginal, vulvar, anal, oropharyngeal and penile. Despite HPV school-based vaccination programmes in the UK, HPV vaccination uptake rates continue to fluctuate due to misinformation and vaccine hesitancy post COVID-19. The aim of this study is to explore perceptions of post-primary school teachers and nurses regarding the current HPV education provision and the need to provide HPV education to students 15-17 years old when they are most likely to be becoming sexually active.

METHODS

A qualitative study was conducted using online semi-structured interviews between February-August 2022 with post-primary teachers and nurses in Northern Ireland, UK. Stratified random sampling was used to contact schools to recruit participants. Recruitment continued until data saturation was reached. Braun & Clarke's six-phase framework for reflexive thematic analysis was used to analyse the data.

RESULTS

Twelve teachers and six nurses participated in the study. Four themes arose based on the analysis including 1) the importance of HPV education 2) self-consent to the HPV vaccine 3) design of the HPV education and 4) delivery of the HPV education. Identified barriers to implementation of HPV education included lack of parental education, religion and the conservative culture of Northern Ireland.

DISCUSSION

Participants perceived HPV education to be poor or non-existent in their schools but placed high importance on this education. They indicated that a non-judgemental health professional would be the ideal person to deliver interactive HPV education as part of a mandated spiral curriculum.

CONCLUSION

HPV education at 15-17 years old provides students with an opportunity to learn about their HPV risk, their HPV vaccination status and an opportunity to self-consent to the HPV vaccine. The Education Authority and Department of Health should support health professionals to deliver consistent robust HPV health information to students of this age.

Association of Hormonal Contraceptives with Depression among Women in Reproductive Age Groups: A Cross-Sectional Analytic Study

Introduction

Hormonal contraceptives (HCs) are used for birth control, menstrual disturbances, and premenopausal syndrome. Most women stop using hormonal contraceptives due to changes in their mood. The evidence regarding the association of hormonal contraception with depression shows mixed results. Therefore, we aim to establish the association between the use of hormonal contraception and depressive symptoms.

Methods

A cross-sectional study was conducted on 326 women of the reproductive age group (15-49 years) attending the family planning unit of the obstetrics and gynecology department of a medical college in Saudi Arabia. Their sociodemographic and medical details along with the current use of any contraceptives (hormonal, nonhormonal, or not using any) with duration were collected. Beck depression inventory-II (BDI-II) was applied to the women to assess for depression along with its severity, and a BDI score of >16 was taken to denote clinical depression. Women were stratified by type of contraceptive used, and its association with depression category was assessed.

Results

A total of 326 consenting eligible women in the age group of 15-49 years were enrolled in the study of which 165 (50.6%) were currently using a hormonal contraceptive and 49 (15.0%) were using a nonhormonal contraceptive and the rest 112 (34.4%) were not using any contraceptives. There was no significant difference in the mean BDI scores (p=0.79) and degrees of depression (p=0.06) between the HC users and HC nonusers. However, individual symptoms of depression such as sadness (p=0.01), reduced libido (p=0.0002), feelings of pessimism (p=0.02), and failure (p=0.003) were found to be significantly higher in the HC users than non-HC users.

Conclusion

We conclude that there was no significant difference in mean depression scores between groups. However, a few individual symptoms of depression were high in HC users suggesting depression as a potential side effect of hormonal contraceptive use.

A comprehensive genome-wide cross-trait analysis of sexual factors and uterine leiomyoma

Age at first sexual intercourse (AFS) and lifetime number of sexual partners (NSP) may influence the pathogenesis of uterine leiomyoma (UL) through their associations with hormonal concentrations and uterine infections. Leveraging summary statistics from large-scale genome-wide association studies conducted in European ancestry for each trait (NAFS = 214,547; NNSP = 370,711; NUL = 302,979), we observed a significant negative genomic correlation for UL with AFS (rg = -0.11, P = 7.83×10-4), but not with NSP (rg = 0.01, P = 0.62). Four specific genomic regions were identified as contributing significant local genetic correlations to AFS and UL, including one genomic region further identified for NSP and UL. Partitioning SNP-heritability with cell-type-specific annotations, a close clustering of UL with both AFS and NSP was identified in immune and blood-related components. Cross-trait meta-analysis revealed 15 loci shared between AFS/NSP and UL, including 7 novel SNPs. Univariable two-sample Mendelian randomization (MR) analysis suggested no evidence for a causal association between genetically predicted AFS/NSP and risk of UL, nor vice versa. Multivariable MR adjusting for age at menarche or/and age at natural menopause revealed a significant causal effect of genetically predicted higher AFS on a lower risk of UL. Such effect attenuated to null when age at first birth was further included. Utilizing participant-level data from the UK Biobank, one-sample MR based on genetic risk scores yielded consistent null findings among both pre-menopausal and post-menopausal females. From a genetic perspective, our study demonstrates an intrinsic link underlying sexual factors (AFS and NSP) and UL, highlighting shared biological mechanisms rather than direct causal effects. Future studies are needed to elucidate the specific mechanisms involved in the shared genetic influences and their potential impact on UL development.

Mendelian randomization analyses for the causal relationship between early age at first sexual intercourse, early age at first live birth, and postpartum depression in pregnant women

Introduction

There are insufficient epidemiological studies on the impact of age at first sexual intercourse (AFS) and age at first live birth (AFB) on postpartum depression (PPD) in pregnant women, and the conclusions of these studies are inconsistent.

Methods

We performed a Mendelian randomization (MR) study to determine the causal relationship between AFS or AFB and the risk of PPD. The summary data were extracted from genome-wide association study (GWAS) summary datasets. We selected the instrumental variables according to the P value of exposure-related single nucleotide polymorphisms (P<5 ×10-9 for AFS and P<5 ×10-8 for AFB) and estimated the linkage disequilibrium using the clump parameter (10,000 kb, r2 < 0.001). Single nucleotide polymorphisms were considered instrumental variables that were significantly associated with exposure factors without linkage disequilibrium. The F-statistics of the instrumental variables should all be larger than 10. A random-effects model of IVW was constructed as the main method in our study.

Results and discussion

MR studies based on GWAS data revealed that both AFS (OR = 0.4, P <0.001) and AFB (OR = 0.38, P <0.001) were negatively correlated with the risk of PPD. Early AFS and early AFB should be studied as possible risk factors for PPD in the future. Public health departments should attach importance to sex education for young girls. The results of our TSMR should be verified by high-quality prospective epidemiological studies in the future.

Identifying causal associations between women's reproductive traits and risk of schizophrenia: a multivariate validated two-sample Mendelian randomization analysis

BACKGROUND

A significant association between women's reproductive traits and the risk of schizophrenia (SCZ) has been discovered, but the causalities remain unclear. We designed a two-sample univariate Mendelian randomization (MR) study using female-specific SNPs collected from a large-scale genome-wide association study as a genetic tool to explore the causal effect of female reproductive traits on the risk of SCZ, and conducted a multivariate MR study to re-validate the above findings.

METHODS

From extensive genome-wide association studies (GWAS) of people with European ancestry (n = 176,881 to 418,758 individuals), summary-level data on five female reproductive variables were extracted. Summary-level information on SCZ was taken from a GWAS meta-analysis involving 320,404 people with European ancestry. The inverse variance weighting estimations for both univariable MR (UVMR) and multivariable MR (MVMR) were presented as the primary results. MR-Egger, weighted median, simple mode, and weighted mode regression methods for UVMR, and MVMR-Egger, MVMR-Lasso, and MVMR-median methods for MVMR were used for sensitivity analyses.

RESULTS

The UVMR produced compelling proof for a connection between genetically predicted later age at first sexual intercourse (AFS) (OR, 0.632; 95% CI, 0.512-0.777; P < 0.01) and decreased SCZ risk. Pleiotropy analysis of the AFS-SCZ association confirmed the robustness of the MR results (P > 0.05). Consistent, substantial causal effects of AFS (OR, 0.592; 95%CI, 0.407-0.862; P < 0.01) on the risk of SCZ were demonstrated after adjusting for body mass index, years of schooling, and smoking initiation using MVMR.

CONCLUSIONS

Our findings provide convincing evidence that early AFS is a risk factor for SCZ. SCZ risk may be decreased by raising awareness of reproductive healthcare for women.

The Past, Present, and Future in the Diagnosis of a Neglected Sexually Transmitted Infection: Trichomoniasis

More than one million curable sexually transmitted infections occur every day. Trichomonas vaginalis is one of the main infections responsible for these epidemiological data; however, the diagnosis of this protozoan is still mainly based on microscopic and culture identification. The commercialization of immunological tests and the development of molecular techniques have improved the sensitivity of classical methods. Nevertheless, the fact that trichomoniasis is a neglected parasitic infection hinders the development of novel techniques and their implementation in routine diagnosis. This review article shows the different methods developed to identify T. vaginalis in population and the difficulties in diagnosing male and asymptomatic patients. The importance of including this parasite in routine gynecological screening, especially in pregnant women, and the importance of considering T. vaginalis as an indicator of high-risk sexual behavior are also discussed.

Causal effect of age first had sexual intercourse and lifetime number of sexual partners on cervical cancer

Objective

In this study, we aimed to investigate whether age first had sexual intercourse (AFSI) and lifetime number of sexual partners (LNSP) have a direct causal effect on cervical cancer by Mendelian randomization (MR) analysis.

Methods

Four approaches were used for MR Analysis, including MR-Egger, weighted method, weighted median, and inverse variance weighted (IVW). MR Pleiotropy RESidual Sum and Outlier (MR-PRESSO) as well as MR-Egger regression analysis were conducted to detect whether there was pleiotropy between IVs and outcome, and the outlier SNPs can be detected by MR-PRESSO. The presence or absence of heterogeneity among IVs was suggested according to Cochran's Q statistic. Leave-one-out sensitivity analysis was performed to identify and remove SNPs which could independently change the results. We corrected the results using Bonferroni correction.

Results

From the results of IVW, AFSI had a negative effect on cervical cancer (OR = 0.996, 95 % CI: 0.995, 0.998 P = 1.70E-07), which still persisted after Bonferroni correction. However, no causal effect of LNSP on cervical cancer was found according to the IVW results (OR = 1.003, 95 % CI: 1.000, 1.007, P = 0.071). From the results of MR-PRESSO and MR-Egger, no SNP with horizontal pleiotropy between cervical cancer was detected and no SNP was identified as an outlier SNP. Cochran's Q statistic suggested that no heterogeneity existed among IVs of AFSI and LNSP. According to Leave-one-out analysis, the results of MR did not change after excluding any single IV.

Conclusion

This MR study reveals that early AFSI has a causal effect on cervical cancer.

Causal associations between female reproductive behaviors and psychiatric disorders: a lifecourse Mendelian randomization study

BACKGROUND

The timings of reproductive life events have been examined to be associated with various psychiatric disorders. However, studies have not considered the causal pathways from reproductive behaviors to different psychiatric disorders. This study aimed to investigate the nature of the relationships between five reproductive behaviors and twelve psychiatric disorders.

METHODS

Firstly, we calculated genetic correlations between reproductive factors and psychiatric disorders. Then two-sample Mendelian randomization (MR) was conducted to estimate the causal associations among five reproductive behaviors, and these reproductive behaviors on twelve psychiatric disorders, using genome-wide association study (GWAS) summary data from genetic consortia. Multivariable MR was then applied to evaluate the direct effect of reproductive behaviors on these psychiatric disorders whilst accounting for other reproductive factors at different life periods.

RESULTS

Univariable MR analyses provide evidence that age at menarche, age at first sexual intercourse and age at first birth have effects on one (depression), seven (anxiety disorder, ADHD, bipolar disorder, bipolar disorder II, depression, PTSD and schizophrenia) and three psychiatric disorders (ADHD, depression and PTSD) (based on p<7.14×10-4), respectively. However, after performing multivariable MR, only age at first sexual intercourse has direct effects on five psychiatric disorders (Depression, Attention deficit or hyperactivity disorder, Bipolar disorder, Posttraumatic stress disorder and schizophrenia) when accounting for other reproductive behaviors with significant effects in univariable analyses.

CONCLUSION

Our findings suggest that reproductive behaviors predominantly exert their detrimental effects on psychiatric disorders and age at first sexual intercourse has direct effects on psychiatric disorders.

Levonorgestrel intrauterine device and depression: A Swedish register-based cohort study

BACKGROUND

The levonorgestrel intrauterine device (LNG-IUD) is traditionally viewed as a safe contraceptive with limited systemic effects. However, three recent studies have indicated an increased risk of depression subsequent to LNG-IUD use. This study aimed to examine the potential associated risk between LNG-IUDs and depression, and determine which women are at risk.

METHODS

This longitudinal cohort study was based on data from seven Swedish national population-based registers. All Nordic-born women aged 15-24 years residing in Sweden between 2010 and 2017 were included. Cox regression was implemented to estimate the adjusted hazard ratio (AHR) for developing depression, defined as first depression diagnosis or redeemed prescription for antidepressant treatment. We adjusted for age, education level, parental country of origin, parental psychiatric health, previous hormonal contraceptive use and medical indications for contraceptive use.

FINDINGS

703,157 women were included in the analysis. The LNG-IUD was associated with 57 % increased risk of depression [AHR 1.57 (95 % CI 1.51-1.64)]. The greatest risk increase was seen in adolescent women [AHR 2.57, (95 % CI 2.36-2.80)] and women who used the LNG-IUD as their first hormonal contraceptive method [AHR 1.63, (95 % CI 1.50-1.78)]. The risk of depression decreased at the end of study period [AHR 1.43, (95 % CI 1.36-1.51)], once the LNG-IUD became more widely accessible among nulliparous women.

CONCLUSIONS

Adolescent women who use the LNG-IUD as their first-ever hormonal contraceptive are at increased risk of developing depression. However, additional impact from confounding factors is likely as risk estimates decreased over the study period. Further research needs to determine if there is a causal relationship between LNG-IUDs and depression.

Early Sexual Debut and Its Associated Factors Among Young Women Aged 15-24 in Mali: A Multilevel Analysis

Early sexual debut is associated with increased risk of several sexual and reproductive health problems, including unwanted pregnancies and sexually transmitted infections. Hence, determining factors that promote early sexual initiation is significant to guide policy and inform interventions aimed to promote the health of young people through to adulthood. This study examined the prevalence of early sexual debut and its associated factors among young women in Mali. Using cross-sectional nationally representative data from the 2018 Mali Demographic and Health Survey, a total of 4063 young women aged 15-24 were included in the study. Multilevel binary logistic regression analysis was done to determine the factors associated with early sexual debut. The results were presented using adjusted odds ratios (aOR) and 95% confidence intervals (CIs). The prevalence of early sexual debut in Mali was 17.8% (95% CI; 16-19.7%). Young women who attended higher school had lower odds of early sexual debut (aOR = 0.10, 95% CI; 0.01-0.82) compared to young women who had no formal education. Young women from richest households had lower odds of early sexual debut compared to those from the poorest households (aOR = 0.48, 95% CI; 0.27-0.82). Young women from households with large family size also had lower odds of experiencing early sexual debut compared to those in small family size (aOR = 0.81, 95% CI; 0.66-0.99). Furthermore, the odds of early sexual debut were lower among young women in Koulikoro (aOR = 0.59, 95% CI; 0.39-0.90), Sikasso (aOR = 0.35, 95% CI; 0.21-0.56), Segou (aOR = 0.40, 95% CI; 0.25-0.64), and Mopti (aOR = 0.44, 95% CI; 0.23-0.82) regions compared to young women in Kayes region. Higher odds of early sexual debut were found among currently employed compared to not currently employed young women (aOR = 1.74, 95% CI; 1.42-2.12) and currently married compared to not currently married young women (aOR = 4.64, 95% CI; 3.64-5.92). Young women from the Peulh ethnic groups compared to those from the Bambara ethnic groups were at a higher odds of early sexual debut (aOR = 1.43, 95% CI; 1.03-1.99). The findings suggest the need for interventions aimed at addressing early sexual debut among young women. These can include emphasizing the promotion and importance of female education, addressing the cultural practices that promote negative sexual norms/practices such as child marriages, and ensuring social change through efforts such as creating employment or economic opportunities for families.

Women's health, hormonal balance, and personal autonomy

Hormone-based contraception disrupts hormonal balance, creating artificial states of anovulation and threatening women's health. We reviewed its main adverse effects and mechanisms on accelerated ovarian aging, mental health (emotional disruptions, depression, and suicide), sexuality (reduced libido), cardiovascular (brain stroke, myocardial infarction, hypertension, and thrombosis), and oncological (breast, cervical, and endometrial cancers). Other "collateral damage" includes negative effects on communication, scientific mistrust, poor physician-patient relationships, increased patient burden, economic drain on the healthcare system, and environmental pollution. Hormone-sensitive tumors present a dilemma owing to their potential dual effects: preventing some cancers vs. higher risk for others remains controversial, with denial or dismissal as non-relevant adverse effects, information avoidance, and modification of scientific criteria. This lack of clinical assessment poses challenges to women's health and their right to autonomy. Overcoming these challenges requires an anthropological integration of sexuality, as the focus on genital bodily union alone fails to encompass the intimate relational expression of individuals, complete sexual satisfaction, and the intertwined feelings of trust, safety, tenderness, and endorsement of women's femininity.

Prevalence of sexually transmissible infections in adolescents treated in a family planning outpatient clinic for adolescents in the western Amazon

Sexually transmitted infections (STIs) are among the most common public health problems worldwide, especially among adolescents and young adults, who account for almost 50% of all STI patients. Studies on the subject in the western Amazon are limited. This study aimed to evaluate the prevalence of STIs (chlamydia, gonorrhea, trichomoniasis, herpes simplex virus, syphilis, human immunodeficiency virus [HIV], hepatitis B, and hepatitis C) in adolescents treated at a family planning outpatient clinic in the western Amazon: Porto Velho, Rondônia, Brazil. A total of 196 adolescents were enrolled. During the gynecological examination, endocervical samples were collected to test for four STIs (chlamydia, gonorrhea, trichomoniasis, and herpes simplex virus), and blood samples were collected for the detection of HIV, syphilis, and hepatitis B and C. The mean age was 17.3 ± 1.5 years, the age at sexarche was 14.4 ± 1.6 years, and 54.6% of participants had their first sexual intercourse at 14 years or younger. Only 1.0% of the adolescents used condoms in all sexual relations, and 19.9% had casual partner(s) in the last year. In the evaluation of prevalence, we found that 32% of the adolescents had at least one STI, with the most prevalent being chlamydia (23%), followed by trichomoniasis (5.6%), herpes simplex (4.6%), and gonorrhea (3.1%). No positive cases of hepatitis B, hepatitis C, or HIV were detected, but 1% of the adolescents tested positive for syphilis. These indicators will support more effective health care strategies aimed at improving the quality of life of populations in this region of the western Amazon. In conclusion, our findings demonstrated high rates of STIs in the studied patients, reinforcing the need to expand epidemiological studies to implement more appropriate public policies and intervention strategies to prevent STIs in adolescents and other vulnerable populations in the western Amazon.

Influence of Selected Sociodemographic and Cultural Factors on the Age of Sexual Initiation of Students from Polish Universities

Sexuality is the one of the most important parts of human life. The aim of our study was to identify the factors influencing the onset and age of sexual initiation in students and drawing attention to the need to improve access to sexual education in Polish schools at a sufficiently high level. An original questionnaire with 31 questions was used for the study. Data were collected using the Google Forms tool. A total of 7528 students participated in the study and 5824 underwent sexual initiation. The mean age at sexual initiation was 18.1 years. Logistic regression analysis was performed to show factors influencing the onset of sexual activity, while linear regression analysis was used for factors influencing the age of sexual initiation. Religion, drug use, smoking, alcohol consumption, type of housing, and conversations with parents about contraception or sex affect the onset of sexual activity. The age of sexual initiation is affected by religion, the age of the first viewing of pornography, quality of life, the size of the city of residence, smoking and drug use.

Examining Associations Between Resilience and Sexual Health Among South African Girls and Young Women Living With and Without HIV

Resilience, or multilevel processes related to thriving, offers a strengths-based approach to reducing HIV and sexual risk behaviors among girls and young women. Processes of resilience may change based on the experience of living with HIV. However, little is known about how resilience and serologically verified HIV status influence sexual health. Using weighted cross-sectional data collected during 2017-2018 from South African girls and young women aged 15-24 (N = 7237), this article examines associations between resilience and three sexual risk behaviors among those living with and without HIV. Logistic regression models indicated greater resilience scores were associated with reduced odds of engaging in transactional sex and early sexual debut. Results also identified differing associations between resilience and sexual risk behaviors by HIV status. Findings provide implications for programming to prevent HIV and improve sexual health while underscoring the need for tailored resilience-promoting interventions for South African girls and young women living with HIV.

Association between childhood sexual abuse and early sexual debut among Chinese adolescents: The role of sexual and reproductive health education

Background

Despite accumulating evidence of the long-term impacts of childhood sexual abuse (CSA), few studies have investigated the association between CSA and early sexual debut among adolescents. In this study, we examine the relationship between CSA and early initiation of sexual intercourse among Chinese youth, and the role of school-based sex education in this association, based on a nationally representative survey.

Methods

Data were collected from the Survey of Youth Access to Reproductive Health in China (YARHC) conducted in 2009. Multivariable logistic regression models were used to investigate the association between CSA experience and early sexual debut, and the interaction terms between sexual and reproductive health education and CSA were included to examine the role of education in the association between CSA and early sexual debut.

Results

Among 4,907 sexually experienced youth, 1,062 (21.6%) made their early sexual debut. After adjusting for sociodemographic characteristics, it was found that CSA experience was significantly associated with early sexual debut, with an adjusted odds ratio of 3.13 (95% CI: 1.67-5.87). Receiving any type of sexuality education (reproductive health, sexually transmitted disease (STD) and HIV prevention, or contraception use) was not associated with a decreased risk of early sexual debut.

Conclusion

Our results indicate a greater risk of early sexual debut among Chinese adolescents with a history of CSA, and only 46.7% sexually experienced youth had received prior sex education, which suggested an inadequacy of school-based sexuality education. To reduce this risk, targeted intervention with timely and adequate sexuality education for both early starters of sexual intercourse and CSA victims is warranted in China.

EFFECT OF HORMONAL CONTRACEPTION ON DEPRESSION IN WOMEN

Oral contraceptives are the most frequently chosen method of preventing pregnancy in Poland. Mood changes are one of the most common reasons why young women quit therapy. Depression is a severe disorder that affects millions of people around the world. Some long-term studies suggest an increased relative risk of antidepressant use during contraceptive use compared to non-users. Scientists note an increased risk of suicide as well. Other researchers suggest that there is insufficient evidence to support these findings. Some indicate strong correlation between most hormonal contraceptives and following usage of antidepressant drugs in female adolescents. There is still no consensus in the scientific community. Analyzes of many studies provide ambiguous information. Large-scale studies with properly selected test groups and particular therapies taken into consideration are required in order to accurately assess the risk of depression and mood disorders. In this article, we try to present different approaches to the subject of effects of various types of hormonal contraception methods on depression in women.

Shared genetic basis between reproductive behaviors and anxiety-related disorders

Reproductive behaviors are associated with risks for psychiatric disorders. Reproductive phenotypes are moderately heritable and have genetic overlaps with risks for psychiatric disorders. However, the genetic and causal relationships between anxiety-related disorders or specific anxiety disorders and reproductive phenotypes remain unknown. We utilized large-scale genome-wide association study (GWAS) results (n = 9537-542,901) for five reproductive phenotypes [age at menarche, age at first sexual intercourse (AFS), age at first birth (AFB), number of children ever born (NEB), and age at menopause] and five anxiety-related disorders [panic disorder, anxiety disorders from the ANGST and the UK biobank (UKBB), posttraumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD)]. To assess genetic correlations and causal associations, linkage disequilibrium score regression and Mendelian randomization analyses, respectively, were performed. We found that AFS and AFB were negatively correlated with anxiety disorders ANGST (AFS: r_g ± SE = -0.28 ± 0.08, p = 6.00 × 10^-4; AFB: -0.45 ± 0.11, p = 3.26 × 10^-5), anxiety disorders UKBB (AFS: -0.18 ± 0.03, p = 9.64 × 10^-9; AFB; -0.25 ± 0.03, p = 2.90 × 10^-13) and PTSD (AFS: -0.42 ± 0.12, p = 4.00 × 10^-4; AFB: -0.44 ± 0.12, p = 2.00 × 10^-4) and positively correlated with OCD (AFS: 0.25 ± 0.05, p = 2.46 × 10^-6; AFB: 0.25 ± 0.05, p = 3.92 × 10^-7). Conversely, NEB was negatively correlated with OCD (-0.28 ± 0.08, p = 6.00 × 10^-4). We revealed bidirectional effects between earlier AFS and AFB and anxiety disorders (odds ratios: OR_{earlier AFS→Anxiety} = 1.64, p = 2.27 × 10^-8; OR_{earlier AFB→Anxiety} = 1.15, p = 2.28 × 10^-3; OR_{Anxiety→earlier AFS} = 1.02, p = 6.62 × 10^-8; OR_{Anxiety→earlier AFB} = 1.08, p = 1.60 × 10^-4). In contrast, we observed unidirectional effects of later AFS and AFB on OCD (OR_{later AFS→OCD} = 2.18, p = 2.16 × 10^-6; OR_{later AFB→OCD} = 1.22, p = 0.016). We suggest that those who have earlier sexual debut and childbirth are prone to risk for anxiety disorders and vice versa, while those who have later sexual debut and childbirth are genetically prone to risk for OCD. Our findings further support revising the diagnostic criteria (DSM-5) such that OCD is independent from anxiety disorders.

Time to First Sexual Experience and Its Determinants among Female Youths in Ethiopia: Survival Analysis Based on EDHS 2016

Background

The first sexual experience is the most significant event in a woman's life. Early sexual experience has short- and long-term health and behavioral risks. Studying the estimated time for a female to have her first sexual debut is important to reduce its health, demographic, and socioeconomic consequences. Thus, this study is aimed at assessing the time to first sexual experience and its determinants in Ethiopia.

Methods

A survival analysis of time to first sexual experience was conducted among 6143 weighted study subjects. The data were extracted from EDHS 2016 using STATA version 16 software. A Kaplan-Meier survival curve was computed to estimate the time of first sexual experience. A log-rank test was used to compare the difference in survival curves. The Cox proportional hazard regression model was used to identify significant predictors. On multivariable analysis, variables having a p value of ≤ 0.05 are considered statically significant.

Results

The overall median survival time was 16 years. The significant determinants of time to first sexual experience are educational level (no education (AHR = 2.72, 95% CI: 2.16, 3.39), primary education (AHR = 2.17, 95% CI: 1.79, 2.63), and secondary education (AHR = 1.47, 95% CI: 1.21, 1.77)) and wealth index (poor (AHR = 1.15, 95% CI: 1.00, 1.32)).

Conclusion

About 50% of female youths have a sexual experience for the first time before their 16th birthday. The timing of the first sexual experience in Ethiopia was mainly influenced by educational level and wealth index. Universal access to education and poverty reduction should be the area of concern.

Community structure and timing of sexual activity among adolescent girls in Nigeria

Studies have linked the timing of sexual debut to unplanned pregnancies and sexually transmissible infections, including HIV. Current understandings of sexual debut among Nigerian adolescents focused on the roles of individual and familial characteristics. We leveraged the 2018 Nigeria Demographic and Health Survey data to examine how community features like affluence, ethnic diversity, and women empowerment may be associated with the timing of sexual debut among adolescent girls. The sample comprised 7449 adolescent girls who were usual residents in 6,505 households and 1,352 clusters or communities. Statistical associations between community characteristics and the onset of sexual debut were assessed using a two-level mixed-effects parametric survival model with Weibull distribution. We found that community affluence [aHR:0.43, 95%CI: 0.30-0.62] and community ethnic diversity [aHR: 0.63, 95%CI: 0.42-0.94] are associated with a lower hazard of sexual debut among adolescent girls. We also observed that women that married within the observation period had an earlier sexual initiation than those who were unmarried. The results disaggregated by marital status further shows that higher community level of women's employment [aHR: 2.45, 95%CI: 1.38-4.38] and women's education [aHR:1.85, 95%CI: 1.03-3.33] were associated with a higher hazard of sexual debut among unmarried adolescent girls but not married adolescent girls. Higher community affluence [aHR:0.40, 95%CI: 0.27-0.60] was also associated with a lower hazard of sexual debut among unmarried adolescent girls but not married adolescent girls. Our results illuminate the associated factors of the timing of sexual debut among adolescent girls that moves beyond individual characteristics to community characteristics.

Analysis of Unmarried Adolescents and Modern Contraceptives Initiation in Nigeria: Evidence from 2018 NDHS

Nigeria is one of Africa’s most populous countries. Nigeria’s population is expected to exceed 400 million by 2050, putting it among the top five most populous countries in the world. High birth rates, limited contraception use, and early marriage are the main causes of this rapid increase. In Nigeria, adolescents play a substantial role in these issues, with 117 births per 1000 girls aged 15–19 years. Data for this article comes from the 2018 Nigerian Demographic and Health Survey (NDHS). Our sample consisted of 1014 sexually active unmarried adolescents aged 15–19 years. Kaplan Meier’s curve, Log Rank Test, and Cox proportional hazards model were modeled to estimate the parameters at p > 0.05. Findings show that the average time to the first use of modern contraceptives after sexual initiation is two years. Initiating sex at age 15 or later, belonging to the richest household wealth quintile, and use of the internet is associated with the early initiation of modern contraceptive methods, while residing in the northwest region and being older are associated with a low incidence of modern contraceptive use. Results indicate a deferred initiation of modern contraceptives after first sexual encounter. It has become imperative for tailored interventions to improve the time of initiation of contraceptives, so as to reduce the associated burdens and consequences.

Perhaps It Was Too Soon: College Students' Reflections on the Timing of Their Sexual Debut

Early sexual debut has been a focus of social scientific research due to its association with adverse circumstances and negative outcomes. However, there has been a recent shift to considering not only chronological age, but also the degree to which the event is viewed to be optimally timed (i.e., the perception that it occurred at the "right time" versus too soon). The purpose of this study was to assess how individual/family background variables and contextual aspects of the experience (including partner and relationship aspects) are associated with both the actual age at sexual debut and the perceived acceptability of the timing of the event. Using data collected from students at a U.S. university between 1990 and 2019 (N = 6,430), several factors (in addition to chronological age) were associated with the perceived acceptability of the timing of sexual debut. Strong gender differences were found - women perceived their timing to be less acceptable, even though they did not differ from men in actual age at sexual debut. Other robust predictors of perceived acceptability included (lower) religious involvement and recalling desire (for the experience), pleasure, and lower guilt at the time. Only slight changes occurred over the 30-year period in age at sexual debut and perceived acceptability of the timing. Suggestions for future research are provided and implications for sex education/sexual health interventions are discussed.

Identification of 371 genetic variants for age at first sex and birth linked to externalising behaviour

Age at first sexual intercourse and age at first birth have implications for health and evolutionary fitness. In this genome-wide association study (age at first sexual intercourse, N = 387,338; age at first birth, N = 542,901), we identify 371 single-nucleotide polymorphisms, 11 sex-specific, with a 5-6% polygenic score prediction. Heritability of age at first birth shifted from 9% [CI = 4-14%] for women born in 1940 to 22% [CI = 19-25%] for those born in 1965. Signals are driven by the genetics of reproductive biology and externalising behaviour, with key genes related to follicle stimulating hormone (FSHB), implantation (ESR1), infertility and spermatid differentiation. Our findings suggest that polycystic ovarian syndrome may lead to later age at first birth, linking with infertility. Late age at first birth is associated with parental longevity and reduced incidence of type 2 diabetes and cardiovascular disease. Higher childhood socioeconomic circumstances and those in the highest polygenic score decile (90%+) experience markedly later reproductive onset. Results are relevant for improving teenage and late-life health, understanding longevity and guiding experimentation into mechanisms of infertility.

There is no association between combined oral hormonal contraceptives and depression: a Swedish register-based cohort study

OBJECTIVE

To investigate whether users of hormonal contraceptives (HCs) are at increased risk of depression compared with non-users.

DESIGN

Register-based cohort study.

SETTING

Sweden.

SAMPLE

Women aged 15-25 years between 2010 and 2017 with no prior antidepressant treatment, psychiatric diagnose or contraindication for HCs (n = 739 585).

METHODS

Women with a prescription of HC were identified via the Swedish Prescribed Drug Register (SPDR). Relative risks (RRs) for first depression diagnosis in current HC-users compared with non-users were modelled by Poisson regression. Adjustments included age, medical indication for HC-use and parental history of mental disorders, among others.

MAIN OUTCOME MEASURES

Depression, captured by a redeemed prescription of antidepressant treatment, or a first depression diagnosis in the SPDR and the National Patient Register.

RESULTS

Compared with non-users, women on combined oral contraceptives (COCs) and oral progestogen-only products had lower or no increased risk of depression, relative risk (RR) 0.89 (95% CI 0.87-0.91) and 1.03 (95% CI 0.99-1.06) after adjustments, respectively. Age-stratified analyses demonstrated that COC use in adolescents conferred no increase in risk (RR 0.96, 95% CI 0.93-0.98), whereas use of progestogen-only pills (RR 1.13, 95% CI 1.07-1.19), contraceptive patch/vaginal ring (RR 1.43, 95% CI 1.30-1.58), implant (RR 1.38, 95% CI 1.30-1.45) or a levonorgestrel intrauterine device (RR 1.59, 95% CI 1.46-1.73) were associated with increased risks.

CONCLUSIONS

This study did not find any association between use of COCs, which is the dominating HC in first time users, and depression. Non-oral products were associated with increased risks. Residual confounding must be addressed in the interpretation of the results.

TWEETABLE ABSTRACT

There is no association between combined hormonal contraceptives and depression.

The Positive Choices trial: study protocol for a Phase-III RCT trial of a whole-school social marketing intervention to promote sexual health and reduce health inequalities

Background

Positive Choices is a whole-school social marketing intervention to promote sexual health among secondary school students. Intervention comprises school health promotion council involving staff and students coordinating delivery; student survey to inform local tailoring; teacher-delivered classroom curriculum; student-run campaigns; parent information; and review of sexual/reproductive health services to inform improvements. This trial builds on an optimisation/pilot RCT study which met progression criteria, plus findings from another pilot RCT of the Project Respect school-based intervention to prevent dating and relationship violence which concluded such work should be integrated within Positive Choices. Young people carry a disproportionate burden of adverse sexual health; most do not report competence at first sex. Relationships and sex education in schools can contribute to promoting sexual health but effects are small, inconsistent and not sustained. Such work needs to be supplemented by ‘whole-school’ (e.g. student campaigns, sexual health services) and ‘social marketing’ (harnessing commercial marketing to social ends) approaches for which there is good review-level evidence but not from the UK.

Methods

We will conduct a cluster RCT across 50 schools (minimum 6440, maximum 8500 students) allocated 1:1 to intervention/control assessing outcomes at 33 months. Our primary outcome is non-competent first sex. Secondary outcomes are non-competent last sex, age at sexual debut, non-use of contraception at first and last sex among those reporting heterosexual intercourse, number of sexual partners, dating and relationship violence, sexually transmitted infections, and pregnancy and unintended pregnancy for girls and initiation of pregnancy for boys. We will recruit 50 school and undertake baseline surveys by March 2022; implement the intervention over the 2022–2024 school years and conduct the economic and process evaluations by July 2024; undertake follow-up surveys by December 2024; complete analyses, all patient and policy involvement and draft the study report by March 2025; and engage in knowledge exchange from December 2024.

Discussion

This trial is one of a growing number focused on whole-school approaches to public health in schools. The key scientific output will be evidence about the effectiveness, costs and potential scalability and transferability of Positive Choices.

Trial registration

ISRCTN No: ISRCTN16723909. Trial registration summary: Date:. Funded by: National Institute for Health Research Public Health Research Programme (NIHR131487). Sponsor: LSHTM. Public/scientific contact: Chris Bonell. Public title: Positive Choices trial. Scientific title: Phase-III RCT of Positive Choices: a whole-school social marketing intervention to promote sexual health and reduce health inequalities. Countries of recruitment: UK. Intervention: Positive Choices. Inclusion criteria: Students in year 8 (age 12–13 years) at baseline deemed competent by schools to participate in secondary schools excluding pupil referral units, schools for those with special educational needs and disabilities, and schools with ‘inadequate’ Ofsted inspections. Study type: interventional study with superiority phase III cluster RCT design. Enrollment: 1/9/21-31/3/22. Sample size: 50 schools and 6440–8500 students. Recruitment status: pending. Primary outcome: binary measure of non-competent first sex. Secondary outcomes: non-competent last sex; age at sexual debut; non-use of contraception at first and last sex; number of sexual partners; dating and relationship violence (DRV) victimisation; sexually transmitted infections; pregnancy and unintended pregnancy for girls and initiation of pregnancy for boys using adapted versions of the RIPPLE measures. Ethics review: LSHTM research ethics committee (reference 26411). Completion data: 1/3/25. Sharing statement: Data will be made available after the main trial analyses have been completed on reasonable request from researchers with ethics approval and a clear protocol. Amendments to the protocol will be communicated to the investigators, sponsor, funder, research ethics committee, trial registration and the journal publishing the protocol. Amendments affecting participants’ experience of the intervention or important amendments affecting the overall design and conduct of the trial will be communicated to participants.

Determinants Factors of High-risk Sexual Behavior Pregnancy among Adolescent in Indonesia

BACKGROUND: The vulnerability of adolescent lifestyles, especially sexual behavior among adolescents, which causes an increase in pregnancy and early marriage. AIM: This study aimed to analyze the determinants of high-risk sexual behavior among adolescents in Indonesia. METHODS: A correlational analytic research design was used with a cross-sectional approach using secondary data for the 2017 Indonesian demographic and health survey data (IDHS). The data collection was carried out through filling in the instruments developed by the 2017 IDHS. The data were analyzed using percentages, Chi-square test, and logistic regression. The study population was all adolescents, totaling 9,971 women and 12,612 single men aged 15–24 and living in Indonesia in the 2017 IDHS. The sampling technique used total sampling. Time of research: August-November 2020. Place: research locations in 34 provinces in Indonesia. RESULTS: In male respondents, it was shown that the factors most influencing high-risk sexual behavior in adolescents were age (p = 0.000), knowledge (p = 0.003), place of residence (p = 0.000), discussion before wet dreams (p = 0.000), age at first wet dream (p = 0.000), age at first dating (p = 0.019), and internet usage (p = 0.000). Meanwhile, female respondents indicated that the most influential factors were age (p = 0.000) and place of residence (p = 0.032). CONCLUSION: Boys have many factors that influence high-risk sexual behavior than girls. Information on determinant factors of high-risk adolescent sexual behavior can be used as a basis for developing policies for developing interventions in solving problems of premarital pregnancy due to high-risk sexual behavior among adolescents.

Trends and Factors Associated with Oral Contraceptive Use among Korean Women

Although oral contraceptives (OC) are widely used, few national-level epidemiologic studies have evaluated the prevalence of OC use and factors related to their use in Korea. We performed a population-based cross-sectional study on OC use by premenopausal women aged 20–59 years residing in Korea. We used secondary data from the 2010–2019 National Health and Nutrition Examination Survey to examine trends in the annual prevalence of OC use between 2010 and 2019, and factors influencing OC use. Based on data from 14,386 premenopausal women, the average annual prevalence of OC use was 8.2–10.7% between 2010 and 2014; it increased to 12.6–14.4% during 2015–2019. The prevalence of OC use was significantly higher in women with higher (≥5) than lower gravidity (<5). In addition, among sociodemographic factors, education level, household income, cigarette smoking, and alcohol drinking were significantly associated with OC use in Korean women. As OC use is affected by sociodemographic factors, a contraceptive plan that considers sociodemographic factors is needed to establish an effective family planning policy.

Sexual Health Experiences Among High School Students With Disabilities

PURPOSE

The purpose of this study was to investigate the sexual experiences of adolescents with and without disabilities.

METHODS

Data were from the 2015 and 2017 Oregon Healthy Teens survey, a state-wide representative sample of 11th grade students. We compared teens with and without disabilities on whether or not they had ever had sexual intercourse (N = 20,812). Among those who had ever had intercourse (N = 8,311), we used multivariable Poisson regression to measure the association between disability status and the prevalence of five sexual experiences.

RESULTS

After adjusting for sociodemographic characteristics, the prevalence of ever having had intercourse was 25% higher among teens with disabilities than among those without (adjusted prevalence ratio [aPR] 1.25, 95% confidence interval [CI]: 1.20-1.30). Among students who had had intercourse, the prevalence of having had intercourse before the age of 15 years (aPR 1.25, 95% CI: 1.14-1.47), having ≥ 2 lifetime sexual partners (aPR 1.13, 95% CI 1.07-1.19), having ≥ 2 sexual partners in the previous three months (aPR 1.23, 95% CI: 1.00-1.52), having used alcohol and/or drugs at the last intercourse (aPR 1.28, 95% CI: 1.10-1.48), and having condomless sex at the last intercourse (aPR 1.17, 95% CI: 1.08-1.27) was higher among students with disabilities than among students without disabilities. After accounting for sexual abuse, each of these associations was attenuated and most were no longer significant.

CONCLUSIONS

Youth with disabilities are sexually active. Findings highlight the need for increased attention to sexual abuse prevention, sexual health promotion, and risk reduction efforts for this population.

Association between First Sexual Intercourse and Sexual Violence Victimization, Symptoms of Depression, and Suicidal Behaviors among Adolescents in the United States: Findings from 2017 and 2019 National Youth Risk Behavior Survey

The objective of this study was to investigate the association between first sexual intercourse and sexual violence victimization, symptoms of depression, and suicidal ideation among sexually active adolescents in the United States. Data for this study came from the U.S. 2017 and 2019 iterations of the National Youth Risk Behavior Survey. An analytic sample of 6252 adolescents aged 14–18 years old (49.5% female) who reported ever having sexual intercourse was analyzed using Poisson regression. The outcome variables investigated in this study were sexual violence victimization, symptoms of depression, suicidal ideation, a suicide plan, and suicide attempts, and the main explanatory variables were age at first sexual intercourse and forced sexual intercourse. We also analyzed differences by gender and race. Of the 6252 adolescents who reported ever having sexual intercourse, 7.1% had their first sexual intercourse before age 13, and 14.8% experienced forced sexual intercourse. About 16% of adolescents experienced sexual violence during the past year, 42.6% reported symptoms of depression, 23.9% experienced suicidal ideation, 19.3% made a suicide plan, and 11.1% attempted suicide during the past year. In the regression analysis, early sexual intercourse was significantly and positively associated with suicidal ideation (relative risk (RR) = 1.15, 95% Confidence Interval (CI) = 1.02–1.30), suicide plan (RR = 1.18, 95% CI = 1.00–1.38), and suicide attempts (RR = 1.36, 95% CI = 1.15–1.61). Controlling for the effects of covariates, history of forced sexual intercourse was positively associated with the five outcomes examined with the relative risk ranging between 1.59 and 6.01. Findings of this study suggest that history of early or forced sexual intercourse is associated with poor mental health outcomes among adolescents and underscores the importance of developing interventions that offer psychological support in reducing the adverse impact of early sexual intercourse and forced sexual intercourse on adolescent health.

Towards individualised contraceptive counselling: clinical and reproductive factors associated with self-reported hormonal contraceptive-induced adverse mood symptoms

OBJECTIVE

The study aim was to establish which demographic, clinical, reproductive and psychiatric factors are associated with self-reported hormonal contraceptive (HC)-induced adverse mood symptoms.

STUDY DESIGN

We compiled baseline data from two Swedish studies: one cross-sectional study on combined oral contraceptive (COC)-induced adverse mood symptoms (n=118) and one randomised controlled trial on adverse mood symptoms on COC (n=184). Both included women eligible for COC use, aged over 18 years. All women answered a questionnaire on HC use and associated mood problems. The Mini-International Neuropsychiatric Interview (M.I.N.I.) was used to capture mood and anxiety disorders. Women who acknowledged HC-induced adverse mood symptoms, ongoing or previously (n=145), were compared with women without any such experience (n=157).

RESULTS

Compared with women without self-reported HC-induced adverse mood symptoms, women with these symptoms were younger at HC start (adjusted odds ratio (aOR) 0.83, 95% CI 0.72 to 0.95), had more often undergone induced abortion (OR 3.36, 95% CI 1.57 to 7.23), more often suffered from an ongoing minor depressive disorder (n=12 vs n=0) and had more often experienced any previous mental health problem (aOR 1.90, 95% CI 1.01 to 3.59).

CONCLUSIONS

In line with previous research, this study suggests that women with previous or ongoing mental health problems and women who are younger at HC start are more likely to experience HC-induced adverse mood symptoms. Former and current mental health should be addressed at contraceptive counselling, and ongoing mental health disorders should be adequately treated.

IMPLICATIONS

This study adds valuable knowledge for identification of women susceptible to HC-induced adverse mood symptoms. It should facilitate the assessment of whether or not a woman has an increased risk of such symptoms, and thus enable clinicians to adopt a more personalised approach to contraceptive counselling.

A national survey of HIV knowledge, sexual practices and attitude towards homosexuality for HIV elimination among young people in China

Background Elimination of HIV is a public health priority in China, but there has been reports of an upsurge in HIV among young people. A nationwide cross-sectional survey was conducted to assess the awareness of HIV knowledge, attitudes towards homosexuality and practice of sexual behaviours among Chinese aged 15-24 years.

METHODS

The face-to-face survey was conducted from June to August 2017, collecting data on sociodemographic characteristics, HIV-related knowledge, attitudes towards homosexuality and practice of sexual behaviours among Chinese senior high school and university students. A generalised linear model (GLM) was used to assess the different levels of HIV knowledge between groups, and identify the key contributors to HIV knowledge scores.

RESULTS

The survey was completed by 73.6% (1355/1840) of the students approached. The overall level of HIV-related knowledge was low (58.9%, 10.6/18); 48.0% (650/1355) supported same-sex marriage; and 6.9% (93/1355) self-identified as homosexual or bisexual. The major factors associated with higher scores [mean ± standard deviation (s.d.)] in HIV knowledge among students included: having received school-based HIV education (11.47 ± 3.51 vs 9.02 ± 4.14, P < 0.05); support for same-sex marriage (11.69 ± 3.33 vs 9.49 ± 4.29, P < 0.05) and older age (11.61 ± 2.78 vs 9.87 ± 4.17, P < 0.05). Compared with females, males were significantly more likely (all P < 0.05) to report masturbation (60.7% vs 7.6%), pornography experiences (77.4% vs 35.3%), sexual encounters (24.6% vs 12.3%), casual sex (37.0% vs 18.1%) and sex under the influence of alcohol (29.5% vs 12.8%).

CONCLUSIONS

There is is still much room for improvement in terms of HIV/AIDS prevention and health education for Chinese young people, and more comprehensive and diverse models of education for HIV prevention are urgently needed.

Narratives on Sex and Contraception From Pregnant Adolescent Women in a Northern Province in Thailand: A Phenomenological Study

Gaps in understanding, a lack of awareness of contraceptive use and a lack of control, related to gender dynamics, may influence the demand for contraception among adolescents and their decision-making around pregnancy prevention. This study explored the experiences of pregnant adolescents at the time of pregnancy and prior to becoming pregnant, examining attitudes toward sex and contraception. An interpretive phenomenological study guided by Heideggerian philosophy, analysed data from 30 in-depth interviews conducted with purposively selected consenting pregnant adolescents aged 15–19. Interviews were audio-recorded and transcribed verbatim and were analysed using a modified interpretative phenomenological approach. Participants exposed 5 key findings or experiences associated with sex and contraception: ‘Premarital cohabitation and sex’, ‘Staying in the relationship’, ‘Unforeseen future’, ‘Parental conformity’, and ‘Male command’. These findings can have far-reaching implications for the holistic understanding of the needs of adolescents in Thailand. They can be used to inform the development of appropriate and responsive interventions to support female and male adolescents, their families, and society. This includes interventions around reproductive health rights and sex education from health care providers, educators providing counselling to facilitate adolescents’ decision-making in order to reduce unintended adolescent pregnancy.

Sexual Practices During Adolescence

Adolescence is characterized by significant biological and psychological changes. During this time, the increased production of androgens leads to increased sexual behavior, and this may contribute to early initiation of sexual activity. The objectives of the present cross-sectional study of adolescents enrolled in state schools in the city of Ribeirão Preto, state of São Paulo, Brazil, were to determine the average age at the first sexual intercourse (sexarche), the average number of sexual partners, and the frequency of contraceptive and condom use. Information on the age at sexarche, number of sexual partners, use of different contraceptive methods, and use of condoms were obtained using a semistructured questionnaire. Quantitative variables are expressed as means and standard deviations (SDs), and qualitative variables as absolute and relative frequencies. The chi-squared test was used for comparisons of qualitative variables, and the Student t-test for comparisons of continuous variables. All statistical analyses were performed using SAS (version 9.4, North Carolina State University, USA). We evaluated 202 students who answered the questionnaire, 69 males (36.36%) and 133 females (63.64%). The age at sexarche for men ranged from 7 to 18 years old, and for women from 7 to 17 years old. Forty-eight girls (36.01%) and 21 boys (30.43%) were in the first year of high school, 66.94% of adolescents reported sexual intercourse, and 56.25% used a condom during the first sexual intercourse. A total of 36.72% of students said they had safe sex most of the time, and 83.59% said that the first sexual intercourse happened because they "had a crush on" the other person.

Perceptions of the community leaders on adolescents' HIV status: cross sectional study in Mulanje, Malawi

INTRODUCTION

the spread of HIV among adolescents requires effective interventions as new infections are high in this cohort globally. We explored perception of community leaders on the prevalence of adolescent´s HIV in Mulanje, Malawi.

METHODS

focus group discussion (n=11) and in-depth interviews (n=15) were conducted with community leaders in all Traditional Authorities in Mulanje district, Malawi. The interviews were audio recorded and transcribed. Data were analysed using thematic content approach.

RESULTS

the perceptions of community leaders on the HIV prevalence among adolescents fall into three groups: lack of access to health services in rural areas, cultural beliefs and social practices. Unavailability of condoms and youth centres were perceived to contribute to lack of access to health services. On harmful cultural beliefs, study participants observed that initiation ceremonies and prolonged wedding dances at night were contributing to HIV spread. Several issues were reported on social issues including poverty, illicit drug and substance abuse, long distances to school, modern technologies and peer pressure.

CONCLUSION

there are many factors perceived to contribute towards high HIV prevalence among adolescents. Our study suggests urgent need for the country to sustainably address key harmful cultural and social practices that potentially increase adolescents´ vulnerability to HIV.

Individual and social determinants of early sexual activity: A study of gender-based differences using the 2018 Canadian Health Behaviour in School-aged Children Study (HBSC)

Introduction

Early sexual activity, often defined as initiation before the age of 16, is a risk behaviour associated with negative health outcomes in adulthood. The objective of this study was to explore links between early sexual activity and individual and contextual characteristics in Canadian youth, and whether these differ for girls and boys.

Methods

Data were from the 2018 Canadian Health Behaviour in School-aged Children (HBSC) survey administered in classrooms across Canada to students in grades 6 to 10 (ages 11 to 16). The sample includes the 7882 students in grades 9 and 10 who were asked about sexual activity. Individual and contextual measures used included emotional well-being, socioeconomic status, participation in team sports, body image, social media use, family structure, and family support. Descriptive data overall and separately for girls and boys are presented, followed by Poisson regression models to estimate relative risks and associated 95% confidence intervals for strength of associations between characteristics and early sexual activity. Models were adjusted for clustering by school using generalised estimating equations.

Results

Overall, contextual factors i.e. disrupted family structure or low family support were the characteristics most strongly associated with early sexual activity. Among boys there was an incremental and strong relationship between hours spent in organised sport and early sexual activity. Among girls, poorer body image, lower socioeconomic status, and higher social media use aligned most strongly with early sexual activity.

Conclusion

Persistent gender stereotypes appear to underlie differences in individual and contextual factors associated with adolescents’ sexual behaviour. Findings from this exploratory analysis may be of benefit to subsequent researchers, policy makers and those who care for youth.

Early Anal Sex Experience Among Men Who Have Sex with Men in Dar Es Salaam Tanzania: Implications for HIV Prevention and Care

Early age at first sex experience has been attributed to medical and psychological consequences, including practice of risk behaviors and HIV infection later in life. Studies have examined early heterosexual experience, but little is known about early anal sexual experience among men who have sex with men (MSM) in Africa. We conducted a time to event analysis to examine the extent and role of early anal sexual experience and HIV risk and infection in the largest MSM survey in Africa. A total of 753 MSM with a mean age of 26.5 years and that at first anal sexual experience of 18.3 years participated. Of those who participated, 29.0% (219/753) had their first anal sexual experience at age below 15. MSM reporting early anal sexual experience were young, had men as first sexual partner (adjusted hazard ratio-AHR, 4.75; 95%CI: 3.51-6.43), assumed receptive position during last anal sex (AHR, 3.25; 95%CI: 2.42-4.35), had anal sex as first penetrative sexual experience (AHR, 5.05, 95%CI; 3.68-6.97), had unprotected first anal sex (AHR, 1.55, 95%CI: 1.03-2.33), not preferring women for sex (AHR, 2.78; 95%CI: 2.11-3.67), had non-consensual first sex (AHR, 1.53, 95%CI: 1.10-9.41), and HIV positive (AHR, 1.75; 95%CI: 1.21-2.50). A third of MSM engaged in anal sex at an early age and were more likely to report sexual abuse, practice HIV risk behaviors, and been HIV seropositive. Roll-out of the existing Comprehensive Guideline for HIV Treatment and Care for key population in Tanzania should be implemented alongside measures addressing sexual abuse among young people.

The relationship between early risk-taking behavior and mental health problems among a nationally representative sample of Australian youth

BACKGROUND

Earlier engagement in risk-taking behaviors has been associated with more severe mental health problems across development. However, sex differences in risk-outcome relationships remain underexplored and mental health outcomes spanning both ends of the internalizing and externalizing spectra are rarely considered within the same sample. The present study examined associations between age at initiation of alcohol use, illicit drug use, and sexual intercourse, and symptoms of internalizing, externalizing, depression and self-harm, for males and females.

METHODS

The present study analyzed self-report survey data from a nationally representative sample of Australian adolescents (N=2,950). Logistic regression models were conducted separately for males and females to test the association of early (age 15 or younger) and concurrent (age 16-17) initiation of alcohol use, illicit drug use and sexual behavior with symptoms of internalizing, externalizing, depression and self-harm at age 16-17.

RESULTS

Risk-taking behaviors were associated with all mental health outcomes. Generally, earlier initiation of risk-taking behaviors demonstrated stronger associations with mental health outcomes than concurrent initiation. Associations between risk-taking behaviors and mental health outcomes varied by participant sex and mental health outcome.

LIMITATIONS

Mechanisms underlying the relationship between risk-taking behaviors and mental health problems were not tested and the sample had not yet reached early adulthood.

CONCLUSIONS

Risk-taking behaviors, particularly when initiated early, share links with multiple mental health problems in adolescence. Public health strategies to delay the onset of risk-taking behaviors may therefore incur multiple benefits as might an integrated approach to mental health prevention programs for youth.

The role of community leaders on adolescent's HIV and sexual reproductive health and rights in Mulanje, Malawi

BACKGROUND

We conducted this study to understand roles of community leaders on adolescent's HIV and Sexual and Reproductive Health (SRH) rights in Mulanje-Malawi. We discussed how each role can influence health seeking behaviour and improve SRH rights among adolescents from the local perspective.

METHODS

A qualitative study approach was used. We conducted 17 Key Informant Interviews (KIIs) and 12 Focus Group Discussions (FGDs) with community leaders. Purposive sampling technique was used to select study participants for KIIs. We also used purposive sampling technique to identify two villages from each of the six Traditional Authorities (TAs) where FGDs were conducted. All participants in FGDs were purposively selected. Inductive thematic content analysis was done guided by the study objectives to generate emerging themes.

RESULTS

Community leaders have many roles on adolescents HIV and SRH. These roles include advisory, encouragement, regulating and restricting cultural practices, formulating bye-laws and handling sexual abuse complaints. However, community leaders with religious affiliation have shown to have different views with those representing other institutions not affiliated to religion. In addition, the majority of community leaders indicated low level of knowledge on adolescent's SRH rights.

CONCLUSION

We suggest that the roles of community leaders differ depending on the position held and institution represented. Those not affiliated with religious institutions can encourage certain behaviour in adolescents while those from religious background are discouraging it. Stakeholders involved in the fight against HIV, promotion of SRH and rights should invest more on capacity building among the community leaders.

Depression and Incident HIV in Adolescent Girls and Young Women in HIV Prevention Trials Network 068: Targets for Prevention and Mediating Factors

The human immunodeficiency virus (HIV) epidemic among adolescent girls and young women (AGYW) in sub-Saharan Africa is a critical public health problem. We assessed whether depressive symptoms in AGYW were longitudinally associated with incident HIV, and identified potential social and behavioral mediators. Data came from a randomized trial of a cash transfer conditional on school attendance among AGYW (ages 13-21 years) in rural Mpumalanga Province, South Africa, during 2011-2017. We estimated the relationship between depressive symptoms and cumulative HIV incidence using a linear probability model, and we assessed mediation using inverse odds ratio weighting. Inference was calculated using the nonparametric bootstrap. AGYW with depressive symptoms had higher cumulative incidence of HIV compared with those without (risk difference = 3.5, 95% confidence interval (CI): 0.1, 7.0). The strongest individual mediators of this association were parental monitoring and involvement (indirect effect = 1.6, 95% CI: 0.0, 3.3) and reporting a partner would hit her if she asked him to wear a condom (indirect effect = 1.5, 95% CI: -0.3, 3.3). All mediators jointly explained two-thirds (indirect effect = 2.4, 95% CI: 0.2, 4.5) of the association between depressive symptoms and HIV incidence. Interventions addressing mental health might reduce risk of acquiring HIV among AGYW.

The Impact of Sexual Initiation Timing and Sexual Experience on Depressive Symptoms in South Korean Adolescents: Gender Differences in a Nationwide Cross-Sectional Study

PURPOSE

This study utilized data from the Korea Youth Risk Behavior Survey to examine gender differences in the impact of sexual initiation, and age at sexual initiation, on depressive symptoms among Korean adolescents.

DESIGN AND METHODS

This study performed a secondary analysis of cross-sectional data from the 14th Korea Youth Risk Behavior Survey (2018). Data from 60,040 adolescents aged 12-18 were included in this study. The relationship between sexual experience, age at initiation, and depressive symptoms was analyzed with complex sample multiple logistic regression.

RESULTS

Overall, 5.7% of participants declared having had sexual experience. Sexual initiation tended to occur from grade 7 and above. In addition, 33.6% of girls and 21.1% of boys reported having depressive symptoms. Depressive symptoms were associated with sexual initiation experience, but depression symptoms were not associated with the timing of sexual initiation.

CONCLUSIONS

This study provides preliminary evidence of a relationship between sexual experience and depressive symptoms among adolescents; however, this relationship appeared independent of the timing of sexual initiation. These findings suggest that sexually active adolescents should be screened for depressive symptoms, regardless of gender.

PRACTICE IMPLICATIONS

This is the first study to examine the impact of sexual initiation and its timing on depressive symptoms among Korean adolescents. Sexual behaviors of Korean adolescents should be accounted for during the development of mental health policies aimed at young people. In addition, sexually active adolescents should be screened and monitored for depressive symptoms.

Relationships between women's emotional reaction to first coital experience and subsequent sexual risk-taking behaviour

Objectives: The study aimed to consider the affective reactions of young French women to their experience of first sexual intercourse and examine the relationship with subsequent risky sexual behaviours, using cluster profiles.Methods: A descriptive cross-sectional study was conducted among women in France (n = 391) (mean age 22.36 years, standard deviation 3.08). Participants completed a questionnaire with self-reported measures of emotional responses to first sexual intercourse and risky sexual behaviours.Results: Cluster analyses revealed four emotional reaction profiles: Pleasure, Guilty-pleasure, Negative-emotional and Anxiety-unpleasant. The Pleasure group reported overall and higher satisfaction and positive emotions towards first sexual intercourse; this group reported lower condom use. The Guilty-pleasure group felt pleasure tinged with guilt and reported fewer same-sex partners. The Negative-emotional profile group tended to feel major negative emotions related to initial coital experience, reporting lower or no pleasure. The Anxiety-unpleasant group reported little pleasure and major anxiety associated with first sexual intercourse. The latter two groups, respectively, reported a higher number of male sexual partners and higher alcohol consumption prior to sexual intercourse compared with the two pleasure groups.Conclusion: These results suggest that women's emotional reactions to first sexual intercourse may be associated with subsequent healthy versus risky sexual behaviours in young adulthood.

Age at first intercourse, number of partners and sexually transmitted infection prevalence among Danish, Norwegian and Swedish women: estimates and trends from nationally representative cross-sectional surveys of more than 100 000 women

INTRODUCTION

Sexual behavior at the population level impacts on public health. Recent representative sexual behavior data are lacking.

MATERIAL AND METHODS

Cross-sectional surveys in 2005 and 2012 on women age 18-45 years randomly selected from the general population in Denmark (n = 40 804), Norway (n = 30 331) and Sweden (n = 32 114).

RESULTS

Median (interquartile range) age at first intercourse was 16 (15-18) years in Denmark, 17 (16-18) years in Norway, and 17 (15-18) years in Sweden. Women in the most recent birth cohort had sexual debut at the lowest age, and were most likely to have sexual debut before the legal age of consent. Proportions with debut age ≤14 years among women born 1989-1994 vs 1971-1976, odds ratio (95% confidence interval) were: 18.4% vs 10.9%, 1.95 (1.74-2.18) in Denmark, 12.9% vs 6.3%, 2.38 (2.01-2.82) in Norway, 17.8% vs 11.4%, 1.75 (1.55-1.98) in Sweden. Median (interquartile range) number of lifetime sexual partners was 6 (3-10) in Denmark, 5 (2-10) in Norway, and 6 (3-11) in Sweden. The proportion of women reporting >10 sexual partners was also highest in the most recent survey. The percentage with odds ratio (95% confidence interval) in 2012 vs 2005 surveys were: 24.9% vs 22.8%, 1.13 (1.07-1.18) for Denmark; 23.8% vs 19.8%, 1.27 (1.19-1.34) for Norway; and 28.3% vs 23.8%, 1.31 (1.24-1.38) for Sweden. Similarly, the proportion of women reporting ever having had a sexually transmitted infection among women age <30 years were: 29.4% vs 26.4%, 1.21 (1.13-1.31) in Denmark, 28.9% vs 25.0%, 1.20 (1.10-1.31) in Norway, and 29.4% vs 22.2%, 1.45 (1.33-1.58) in Sweden.

CONCLUSIONS

Scandinavian women reported lower age at first intercourse in younger birth cohorts. Moreover, they reported more lifetime sexual partners and a higher prevalence of ever having a sexually transmitted infection in 2012 than in 2005. Our findings may inform the interpretation of trends in outcomes associated with sexual health, and public health policies.

Adolescent sexual initiation and pregnancy: what more can be learned through further analysis of the demographic and health surveys in the Philippines?

Background

Adolescent pregnancy poses risks to the life of a young mother and her baby, and can affect their health, educational and future employment outcomes. In many low- and middle-income countries like the Philippines, the Demographic and Health Surveys (DHS) Program is among the most reliable and easily accessible sources of demographic and health data for researchers, development workers, and policymakers. Data on adolescent sexual and reproductive health (SRH) are often limited, but in the absence of other sources, there is room to make the most of the adolescent health data gathered by the DHS. The aim of this study is to explore what more can be learned about adolescent sexual initiation and pregnancy through the further analysis of demographic and health data, using DHS data from the Philippines as an example.

Methods

This study conducted trend analysis of DHS data over three survey rounds (2003, 2008 and 2013) to explore the context of adolescent sexual initiation and pregnancy over time. Bivariate and multivariate logistic regression were then used to study associations between adolescent pregnancy experience and selected demographic, socioeconomic and SRH variables using data from the 2013 DHS.

Results

This study found that between 2003 and 2013, proportions of Filipino young women experiencing adolescent sexual initiation and adolescent pregnancy have increased. Multivariate logistic regression affirmed the protective effect of education and belonging to higher wealth quintiles on the risk of adolescent pregnancy. Ever use of contraception was positively associated with adolescent pregnancy but is likely indicative of use after a prior pregnancy, and/or other factors relating to improper/inconsistent contraceptive use.

Conclusions

In the absence of reliable, easily accessible data on adolescent SRH, the DHS data can provide important insights about adolescent reproductive transitions such as sexual initiation and first pregnancy. However, there are limited variables in the datasets that could proxy for other important social determinants which prior studies have linked to adolescent SRH outcomes. There remains a need for timely and targeted collection of quantitative and qualitative data on adolescent SRH that can guide programming and policy intended to foster positive health outcomes during this crucial transition period to adulthood.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7451-4) contains supplementary material, which is available to authorized users.

The prevalence of religiosity and association between religiosity and alcohol use, other drug use, and risky sexual behaviours among grade 8-10 learners in Western Cape, South Africa

BACKGROUND

Alcohol and other drug use (AOD) and risky sexual behaviours remain high among adolescents in South Africa and globally. Religiosity influences, mitigates and provides resilience against engaging in risky behaviours among young people but few South African studies have explored potential associations between religiosity, AOD use and risky sex. We report the prevalence of religiosity and association between religiosity and AOD use and risky sexual behaviours among learners in the Western Cape Province, South Africa.

METHODS

Between May and August 2011, a cross sectional survey was conducted among 20 227 learners from 240 public schools randomly selected through a stratified multistage sampling design to determine the prevalence of AOD use and sexual risk behaviours. We performed univariate and multivariate logistic regression analyses to assess the association between religiosity, AOD use and risky sexual behaviours.

RESULTS

The learners were aged 10-23 years. Almost three quarters (74%) of learners reported high religiosity (defined as attending religious services or activities at least 1-2 times a month). More female than male learners had high religiosity. The prevalence of past 30 day reported alcohol, tobacco and cannabis use was 23%, 19% and 8% respectively. Compared to learners with low religiosity, those with high religiosity were less likely to engage in AOD use: specifically alcohol use, (AOR = 0.86, 95%CI: 0.76-0.97), tobacco use (AOR = 0.76, 95%CI: 0.67-0.87), cannabis use (AOR = 0.57, 95%CI: 0.48-0.68) in the last 30 days. They were also less likely to engage in risky sexual behaviours (AOR = 0.90, 95%CI: 0.81-0.99).

CONCLUSION

Religiosity was associated with lower odds of reported AOD use and risky sexual behaviours among learners in the Western Cape. This calls for further exploration on how to incorporate religiosity into AOD use and risky sexual behaviour interventions.