Correlates of first intercourse among women in Jamaica

Sexual and reproductive health and attitudes towards sex of young adults in China

BACKGROUND

The study aimed to discuss the importance of socioeconomic status (SES) and family sexual attitudes and investigate their association with sexual and reproductive health in a large sample of Chinese young adults.

METHODS

We analysed a large sample of 53 508 youth aged 15-24 years from an internet-based survey from November 2019 to February 2020. Multivariable logistic regression analyses were employed to examine the association between SES, family sexual attitudes, and sexual and reproductive health (SRH), stratified by sex and adjusting for potential confounders.

RESULTS

Individuals with the highest expenditure were more likely to engage in early sexual intercourse (female: OR 4.19, 95% CI 3.00 to 5.87; male: OR 3.82, 95% CI 2.84 to 5.12). For both sexes, the likelihood of young adult sexual risk-taking such as first intercourse without using a condom, acquiring sexually transmitted infections, and pregnancy was lower in those with higher maternal educational attainment, whereas it was higher in those with open family sexual attitudes.

CONCLUSIONS

Lower SES and open family attitudes toward sex had a significant association with a range of adverse young adulthood SRH outcomes. Public health policies should focus on more deprived populations and advocate suitable parental participation to reduce risky sexual behaviours in youth.

Early menarche: A systematic review of its effect on sexual and reproductive health in low- and middle-income countries

BACKGROUND

Adolescent girls aged 15-19 bear a disproportionate burden of negative sexual and reproductive health outcomes in low- and middle-income countries. Research from several high-income countries suggests that early age at menarche is an important determinant of sexual and reproductive health. We conducted this systematic review to better understand whether and how early menarche is associated with various negative sexual and reproductive health outcomes in low- and middle-income countries and the implications of such associations.

METHODS

We systematically searched eight health and social sciences databases for peer-reviewed literature on menarche and sexual and reproductive health in low- and middle-income countries. Two reviewers independently assessed all studies for inclusion, overall quality and risk of bias, and performed data extraction on all included studies.

RESULTS

Twenty-four articles met all inclusion criteria-nine of moderate quality and fifteen with several methodological weaknesses. Our review of the minimal existing literature showed that early menarche is associated with early sexual initiation, early pregnancy and some sexually transmitted infections in low- and middle-income countries, similar to what has been observed in high-income countries. Early menarche is also associated with early marriage-an association that may have particularly important implications for countries with high child marriage rates.

CONCLUSIONS

Early age at menarche may be an important factor affecting the sexual and reproductive health of adolescent girls and young women in low- and middle-income countries. More research is needed to confirm the existence of the identified associations across different settings and to better understand the process through which early menarche and other markers of early pubertal development may contribute to the increased vulnerability of girls to negative sexual and reproductive health outcomes in low- and middle-income countries. Given the association of early menarche with early marriage, ongoing efforts to reduce child marriage may benefit from targeting efforts to early maturing girls.

Age at menarche and age at first sexual intercourse: a prospective cohort study

OBJECTIVE

Younger age at menarche (AAM) may put girls at risk for earlier first sexual intercourse (FSI). Young age at FSI has far-reaching negative outcomes. We describe the longitudinal relationship between AAM and FSI in a large prospective birth cohort.

METHODS

AAM was collected from 554 girls from the Western Australia (Raine) Pregnancy Cohort Study, prospectively from age 10 or retrospectively at age 14. Age at FSI was collected at ages 17 and 20. Cox regression models describe likelihood of FSI by age and years since menarche for younger (<12 years) and older (≥14 years) AAM relative to average AAM (12-13 years).

RESULTS

Girls with younger AAM and average AAM were equally likely to have FSI by age 16 (adjusted hazard ratio [aHR]: 0.90 [95% confidence interval (CI): 0.60-1.35]). FSI by age 16 was less likely among girls with older AAM than those with average AAM (aHR: 0.35 [95% CI: 0.17-0.72]). Girls with younger AAM had a longer median interval between menarche and FSI than girls with average AAM (5.0 years [interquartile range: 4.4-8.5 years] vs 3.7 years [interquartile range: 2.4-5.3 years]). Those with younger AAM were less likely to report FSI within 4 years of menarche than those with average AAM (0-2 years aHR: 0.04 [95% CI: 0.01-0.31]; 2-4 years aHR: 0.36 [95% CI: 0.23-0.55]). By age 20, 429 girls (77.4%) reported FSI.

CONCLUSIONS

Younger AAM was not a risk factor for younger age at FSI in this cohort.

Genetic influences on adolescent sexual behavior: Why genes matter for environmentally oriented researchers

There are dramatic individual differences among adolescents in how and when they become sexually active adults, and early sexual activity is frequently cited as a cause of concern for scientists, policymakers, and the general public. Understanding the causes and developmental impact of adolescent sexual activity can be furthered by considering genes as a source of individual differences. Quantitative behavioral genetics (i.e., twin and family studies) and candidate gene association studies now provide clear evidence for the genetic underpinnings of individual differences in adolescent sexual behavior and related phenotypes. Genetic influences on sexual behavior may operate through a variety of direct and indirect mechanisms, including pubertal development, testosterone levels, and dopaminergic systems. Genetic differences may be systematically associated with exposure to environments that are commonly treated as causes of sexual behavior (gene-environment correlation). Possible gene-environment correlations pose a serious challenge for interpreting the results of much behavioral research. Multivariate, genetically informed research on adolescent sexual behavior compares twins and family members as a form of quasi experiment: How do twins who differ in their sexual experiences differ in their later development? The small but growing body of genetically informed research has already challenged dominant assumptions regarding the etiology and sequelae of adolescent sexual behavior, with some studies indicating possible positive effects of teenage sexuality. Studies of Gene × Environment interaction may further elucidate the mechanisms by which genes and environments combine to shape the development of sexual behavior and its psychosocial consequences. Overall, the existence of heritable variation in adolescent sexual behavior has profound implications for environmentally oriented theory and research.

Why don't smart teens have sex? A behavioral genetic approach

Academic achievement and cognitive ability have been shown to predict later age at first sexual intercourse. Using a sample of 536 same-sex twin pairs who were followed longitudinally from adolescence to early adulthood, this study tested whether relations between intelligence, academic achievement, and age at first sex were due to unmeasured genetic and environmental differences between families. Twins who differed in their intelligence or their academic achievement did not differ in their age at first sex. Rather, the association between intelligence and age at first sex could be attributed entirely to unmeasured environmental differences between families, whereas the association between academic achievement and age at first sex could be attributed entirely to genetic factors.

Age at menarche in Canada: results from the National Longitudinal Survey of Children & Youth

BACKGROUND

Given the downward trend in age at menarche and its implications for the reproductive health and wellbeing of women, little is known about menarcheal age in Canada. Most Canadian studies are only representative of specific populations. The present study, therefore, aims to assess the distribution of age at menarche for Canadian girls and explore its variation across socio-economic and demographic factors.

METHODS

The analysis of the study was based on all female respondents aged 14 to 17 years during Cycle 4 (2000/2001) of the National Longitudinal Survey of Children & Youth (NLSCY). The main outcome was age at menarche assessed as the month and year of the occurrence of the first menstrual cycle. Kaplan Meier was used to estimate the mean and median of age at menarche. Chi-square test was used to assess the differences in early, average and later maturers across the different levels of socio-economic and demographic variables. Bootstrapping was performed to account for the complex sampling design.

RESULTS

The total number of girls analyzed in this study was 1,403 weighted to represent 601,911 Canadian girls. The estimated mean and median of age at menarche was 12.72 years (standard deviation = 1.05) and 12.67 years, respectively. The proportions of early (< 11.53 years), average (≥ 11.53 years and ≤ 13.91 years) and late maturers (> 13.91 years) were 14.6% (95% confidence interval (CI): 11.92-17.35), 68.0% (95% CI: 63.82-72.17) and 17.4% (95% CI: 14.10-20.63), respectively. Variations across the menarcheal groups were statistically significant for the province of residence, household income and family type.

CONCLUSION

The findings of the study pave the way for future Canadian research. More studies are warranted to understand menarcheal age in terms of its variation across the provinces, the secular trend over time and its potential predictors.

Adolescent sexual activity and the development of delinquent behavior: the role of relationship context

Despite the well-established association between adolescent sexual activity and delinquent behavior, little research has examined the potential importance of relationship contexts in moderating this association. The current study used longitudinal, behavioral genetic data on 519 same-sex twin pairs (48.6% female) divided into two age cohorts (13-15 and 16-18 years olds) drawn from the National Longitudinal Study of Adolescent Health. Analyses tested whether adolescent sexual activity that occurred in romantic versus non-romantic relationships was associated with delinquency from adolescence to early adulthood, after controlling for genetic influences. Results indicated that, for both younger and older adolescents, common underlying genes influence both sexual behavior and delinquency. After controlling for these genetic influences, there was no within-twin pair association between sexual activity and delinquency in younger adolescents. In older adolescents, sexual activity that occurred in romantic relationships predicted lower levels of delinquency, both cross-sectionally and longitudinally, whereas sexual activity in non-romantic relationships predicted higher levels of delinquency. These results are consistent with emerging research that suggests that the psychological correlates of adolescent sexual activity may be moderated by the social context in which this activity occurs.

Adolescents can know best: using concept mapping to identify factors and pathways driving adolescent sexuality in Lima, Peru

The primary objective of this study was to identify and describe individual- and environmental-level factors that Peruvian adolescents perceive to be related to adolescent sexuality. A series of concept mapping sessions were carried out from January-March 2006 with 63 15-17 year olds from a low-income community near Lima in order for adolescents to: (1) brainstorm items that they thought were related to sexuality, (2) sort, group and rate items to score their importance for sexuality-related outcomes, and (3) create pathways from the groups of items to engaging in sex. Brainstorming resulted in 61 items, which participants grouped into 11 clusters. The highest rated clusters were personal values, respect and confidence in partner relationships, future achievements and parent-child communication. The pathway of decision-making about having sex primarily contained items rated as only moderately important. This study identified important understudied factors, new perspectives on previously-recognized factors, and possible pathways to sexual behavior. These interesting and provocative findings underscore the importance of directly integrating adolescent voices into future sexual and reproductive health research, policies and programs that target this population.

Premarital sex and condom use among never married youth in Vietnam

Premarital sex and unprotected sexual intercourse are issues of growing concern in Vietnam. The present study aims to explore the factors associated with the onset and delay of premarital sex among youth in Vietnam.

METHODS

A cross-sectional in-home survey was undertaken in a suburb of Hanoi, Vietnam among a sample of 2,394 never married youth ages 15 to 24 years in the end of 2003.

RESULTS

Cox regression analyses showed that youth who had ever experienced sexual abuse were 35 times more likely to report having had premarital sex. Connectedness to mother likewise was associated with a decreased likelihood of having sex before marriage. A medium level of school connectedness was also a factor associated with the delay of premarital sex (OR = 0.27). Peer social deviance, on the other hand, increased the likelihood by at least 2.6 times. Separate models for each sex confirmed: the protective effect of mother connectedness among females; the negative effect of peer social deviance among males; and the predominant risk of past sexual abuse in both sexes for premarital sex. When factors associated with condom use among sexually active never married youth were explored, males were found more likely to use condom at first sexual intercourse.

CONCLUSIONS

These results reaffirm a growing body of literature from around the world that has shown connectedness to a parent to be associated with delay of premarital sex, while peer social deviance and exposure of previous sexual abuse have been both associated with early sexual debut.

Individual, familial and extra-familial factors associated with premarital sex among Bangladeshi male adolescents

Background: A national survey found that more than one-tenth of unmarried Bangladeshi adolescents were sexually experienced and much of this experience involves high-risk behaviours such as unprotected sexual intercourse with commercial sex workers. However, very few studies have explored the factors that contribute to premarital sex among Bangladeshi adolescents. Methods: Data are from the 2004 Adolescent Reproductive Health Communication Midline Survey, a national survey in Bangladesh. Multivariate statistical methods were applied to identify risk and protective factors for premarital sex among Bangladeshi male adolescents. Results: Among 1048 unmarried males between ages of 15 and 19 years, 12.8% reported ever having had sex. Multivariate analyses demonstrated that, in terms of the self system, having plans to study in the future were associated with a lower risk of engaging in premarital sex (odds ratio (OR) = 0.38; 95% confidence interval (CI) = 0.25–0.59) while knowledge of reproductive health and life skills did not have a strong influence. Strong influences of both familial and extra-familial system were observed. Respect for parents’ values and beliefs about sex was associated with decreased odds of premarital sex (OR = 0.39; 95% CI = 0.26–0.59). ‘Ever talked with friends about sex-related issues’ was associated with threefold increased odds and an increase in peer influence score was associated with increased odds of premarital sex. Conclusions: These results demonstrate that premarital sex among Bangladeshi male adolescents was influenced by numerous factors, and they should be taken into account in programs aiming to delay the age of sexual debut.

Health risk behaviours among adolescents in the English-speaking Caribbean: a review

BACKGROUND

The aim of this paper was to review and summarize research on prevalence of health risk behaviours, their outcomes as well as risk and protective factors among adolescents in the English-speaking Caribbean.

METHODS

Searching of online databases and the World Wide Web as well as hand searching of the West Indian Medical Journal were conducted. Papers on research done on adolescents aged 10 - 19 years old and published during the period 1980 - 2005 were included.

RESULTS

Ninety-five relevant papers were located. Five papers were published in the 1980s, 47 in the 1990s, and from 2000-2005, 43 papers. Health risk behaviours and outcomes were divided into seven themes. Prevalence data obtained for these, included lifetime prevalence of substance use: cigarettes-24% and marijuana-17%; high risk sexual behaviour: initiation of sexual activity

CONCLUSION

There is a substantial body of literature on Caribbean adolescents documenting prevalence and correlates of health risk behaviours. Future research should emphasize the designing and testing of interventions to alleviate this burden.

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Affiliation(s)

Rohan G Maharaj Unit of Public Health and Primary Care, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
Paula Nunes Unit of Public Health and Primary Care, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago
Shamin Renwick Medical Sciences Library, Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago

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Detrimental Psychological Outcomes Associated with Early Pubertal Timing in Adolescent Girls

Though often discussed as though it were a discrete event, puberty comprises one segment of a larger developmental continuum and is notable for rapid transformation across a multitude of domains. Research suggests that an earlier rate of pubertal maturation in girls correlates with a number of detrimental outcomes compared with on-time or later maturation. The present review synthesizes the research on negative psychological sequelae of early pubertal timing in adolescent girls. Emphasis is on three theoretical perspectives by which precocious development is believed to affect the emergence of adverse outcomes: biological, psychosocial, and selection effects.

Predictors of early initiation of vaginal and oral sex among urban young adults in Baltimore, Maryland

Over the past three decades, most research on adolescent sexual behavior has focused on vaginal intercourse and related behaviors, including contraception and unintended pregnancy. In this study, we describe the prevalence and correlates of vaginal, oral, and anal sex in an epidemiologically defined population in Baltimore, Maryland. Young adults (ages 18-24), who had been enrolled in a behavioral intervention trial during elementary school, were interviewed by telephone between 1998 and 2002 to assess their sexual behavior. Of 1679 respondents interviewed, 70.8% were Black and 55% were women. Overall, 93% of the young adults reported vaginal intercourse, 78% reported receiving oral sex, 57% reported performing oral sex, and 10% reported receptive anal intercourse. Among men, 27% reported insertive anal intercourse. Blacks initiated vaginal intercourse at an earlier age than Whites; White women performed oral sex earlier than Black women. Significant interactions were observed between age of first vaginal partner and both gender and race/ethnicity. Blacks with older partners initiated sex at an earlier age than both Blacks with a partner the same age or younger and Whites. We also observed a relationship between older female sex partners and earlier vaginal sex initiation among men. We conclude that older sex partners play an important role in sexual initiation among young adults. In light of the rates of oral and anal sex, sexual education and intervention programs should address the risk for unintended consequences of these behaviors.

Sociocultural contexts of adolescent sexual behavior in rural Hanover, Jamaica

PURPOSE

To investigate sexual behavior of adolescents in rural Hanover, Jamaica, and to elucidate the cultural contexts of this behavior.

METHODS

Focus group discussion (FGD) sessions with 73 out-of-school young adolescents aged 15 to 18 years, recruited from health centers, as well as community-based organizations through the Social Development Commission (SDC) in Hanover, a local youth and community development organization, within the Ministry of Local Government, Youth and Community Development. The discussions focused on the adolescents' knowledge of sex and sexual risks, perceived vulnerability to sexual risks, use of protection, self-efficacy, and societal expectations. Data were analyzed, using the content analysis technique.

RESULTS

Analyses of transcripts revealed the existence of different sexual scripts for males and females. Whereas females are culturally restrained, abstinence is less desirable for males. Both male and female adolescents expressed the view that the family was an important part of an adolescent's life, and has a strong influence on adolescent sexual behavior. Perception of vulnerability to HIV/AIDS and other sexually transmitted infections, and knowledge of sexual risks among the adolescents was low, and often erroneous.

CONCLUSIONS

The results show that sexual attitudes and behavior of adolescents in the study setting are shaped by cultural and gender norms that impose different standards on males and females.

Sexual initiation: predictors and developmental trends

BACKGROUND

Early initiation of sexual intercourse is associated with increased risk for acquiring sexually transmitted diseases.

GOAL

To examine variables related to sexual initiation and developmental changes in the reasons why adolescent girls have sexual intercourse.

STUDY DESIGN

A longitudinal study of girls recruited from an adolescent medicine clinic was performed.

RESULTS

Logistic regression showed that girls who described their families as being expressive, having a moral-religious emphasis, providing supervision, and having greater maternal education, and who experienced menarche at an older age were older at sexual initiation. On the basis of contingency analyses, younger girls were less likely to report attraction or love, and more likely to report peers having sex as a reason for sexual intercourse at initiation. A generalized estimating equation analysis indicated that girls at younger ages are more likely to report curiosity, a grown-up feeling, partner pressure, and friends having sexual intercourse as reasons for intercourse. Girls at older ages are more likely to report a feeling of being in love, physical attraction, too excited to stop, drunk or high partner, and feeling romantic as reasons for having sexual intercourse.

CONCLUSIONS

Prevention programs should include a focus on familial characteristics and susceptibility to peer norms. They should be conducted with sensitivity to the developmental changes in intimate relationships that occur during adolescence.

Size at birth predicts age at menarche

OBJECTIVE

This study examines the relationship of intrauterine growth, measured by size and maturity at birth, to age at menarche, while also considering a wide range of other factors that may affect maturation. The research is motivated by the current debate about the importance of the prenatal environment as a determinant of later disease risk.

METHODS

Data were collected during the Cebu Longitudinal Health and Nutrition Survey. This community-based study has followed a cohort of several thousand Filipino infants since their birth in 1983 to 1984. Participants live in urban and rural communities of Metro Cebu, the second largest metropolitan area of the Philippines. The analysis sample includes 997 girls 14 to 15 years of age. The main outcome measure is age at menarche, determined from girls' self-report of the month and year of first menses. Factors that influenced age at menarche were identified using Weibull parametric survival time models. The main exposure variables of interest included weight and length (measured by trained field staff) and gestational age (assessed from mother's reported date of last menstrual period, augmented by clinical assessments at birth). The analysis also takes into account a wide range of other factors that are likely to affect age at menarche. These include the girls' early postnatal growth rates, premenarcheal body composition (body mass index and skinfold thicknesses measured at 8 years), current diet (measured by two 24-hour dietary recalls), and socioeconomic conditions of the household in which they live. We also assessed the contribution of maternal characteristics, including age at menarche, height, and nutritional status while pregnant with the study child.

RESULTS

The median age at menarche calculated from the hazard model is 13.1 years, with 50% of girls attaining menarche between 12.4 and 13.9 years. Earlier menarche is characteristic of girls who live in urban, higher socioeconomic status households, as indicated by higher maternal education, better housing quality, and possession of assets, such as a TV or refrigerator. Age at menarche is significantly associated with birth characteristics. Although birth weight alone was not significantly related to age at menarche, girls who were relatively long and thin at birth (>49 cm, <3 kg) attained menarche ~6 months earlier than did girls who were short and light (<49 cm, <3 kg). This effect of thinness at birth is most pronounced among girls with greater than average growth increments in 6 months of life. The effects of birth size are not modified when body mass index and skinfold thicknesses at 8 years are taken into account. Effects of birth size on age at menarche also remain significant when maternal nutritional status during pregnancy and the girl's current diet and socioeconomic indicators are taken into account.

CONCLUSIONS

The study provides additional evidence of fetal programming of later health outcomes by showing that future growth and maturation trajectories are established in utero. Furthermore, rapid postnatal growth potentiates the effects of size at birth and is related independently to earlier pubertal maturation.