Parent-adolescent communication about sex in rural India: U.S.-India collaboration to prevent adolescent HIV

Adolescent Girls and Their Family Members' Attitudes Around Gendered Power Inequity and Associations with Future Aspirations in Karnataka, India

Intergenerational differences in inequitable gender attitudes may influence developmental outcomes, including education. In rural Karnataka, India, we examined the extent of intergenerational (adolescent girls [AGs] vs. older generation family members) dis/agreement to attitudes around gendered power inequities, including gender roles and violence against women (VAW). Unadjusted and adjusted logistic regression examined associations between intergenerational dis/agreement to attitude statements and AGs' future educational and career aspirations. Of 2,457 AGs, 90.9% had a matched family member (55% mothers). While traditional gender roles were promoted intergenerationally, more AGs supported VAW than family members. In adjusted models, discordant promotion of traditional gender roles and concordant disapproval of VAW were associated with greater aspirations. Results highlight the need for family-level programming promoting positive modeling of gender-equitable attitudes.

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

AIM

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

BACKGROUND

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

DESIGN

This study employed a scoping review design.

DATA SOURCES

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

REVIEW METHODS

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

RESULTS

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

CONCLUSION

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

Perceptions and Experiences of Pakistani-Descent Female Adolescents Living in Canada, on Developing Sexuality and Self-Identity

Immigrant adolescents make up a substantial proportion of newcomers to Canada. Most newcomer youth from South Asia aged 15 to 24 are from racialized “visible minority” backgrounds. The sexual health needs of female immigrant adolescents in Canada have been largely unmet and have increased in magnitude over the last few years. For immigrant female adolescents, the silence around issues of sexuality needs can affect their physical, emotional, sexual health, and overall well-being as well as their ability to reach their full potential. Evidence suggests that immigrant adolescents lack sexual and reproductive health knowledge and use fewer sexual health-related services and sex education resources than non-immigrant youth. In Pakistani immigrant adolescents, this difference appears to be associated with socio-cultural and religious practices. The purpose of this study was to qualitatively explore the experience of developing sexuality and its relationship to well-being in middle- to late-female adolescents of Pakistani-descent, living in a large urban area in Canada. The study aimed to establish space for dialogue and to bridge the perceived cultural divide on issues of sexuality using the postmodern feminist lens, which often arises between individuals from different cultural backgrounds. Using the interpretive descriptive methodology, a purposive sample of 21 female adolescents who were of first- or second-generation Pakistan-descent was obtained. Participants included female adolescents aged from 14 to 19 years. Data were collected using a semi-structured interview guide and a timeline. A total of 21 first interviews and seven follow up interviews were conducted. The narratives and timelines presented in this study tell the story of female Pakistani adolescents, their narratives, and the timelines reflect the complexities of the sexuality of female adolescents and how they perceive and attribute meanings to their experiences. The study found that living in a bicultural world can cause significant stress and anxiety among female adolescents, especially when making personal life decisions related to sexuality. Moreover, silence around all aspects of female sexuality negatively affects the capacity for desire and pleasure. In addition, the intersection of gender and patriarchy have created layers of power and oppression in adolescent lives that tightly control their sexuality. The participants’ stories reveal the complex interaction of factors that influence the behavior of female adolescents related to sexuality and sexual health. These findings establish the need for cultural awareness while viewing each girl’s experience in relation to the intersectionality of social spheres such as race, ethnicity, culture, and religion. Finally, this study provides implications to policymakers to revise the existing policies and create youth-friendly policies for immigrant youth to draw attention to the hidden voices of female adolescents and increase the awareness of ways to address issues arising in evolving sexuality.

Shifting Social Norms and Adolescent Girls' Access to Sexual and Reproductive Health Services and Information in a South African Township

Despite policy on adolescent sexual and reproductive health (SRH) services and education, teen pregnancies remain common in South Africa. Social norms and cultural resistance are a well-documented challenge for SRH program implementation in South Africa, and beyond. To gain insight on the complex picture of adolescents' access to SRH information and services in a peri-urban township, we explored this topic from a diversity of perspectives, carrying out 86 interviews to capture perceptions of adolescents, their parents, community members, and health professionals. Our research shows that despite the taboo nature of the issue of adolescent SRH, individual positions on adolescent access to SRH services and information are shifting and diverse, and are influenced by factors other than cultural norms. This research serves as a reminder to avoid simplistic reference to "culture" as a way of explaining health-related behaviors and people's responses to health challenges.

Sexual health communication between sex worker mothers and their children in India

In India, relatively little is known about sex worker mothers' beliefs regarding sexual health communication with their children. Using qualitative data collected in Kolkata, India, this study used the Parent Expansion of the Theory of Planned Behaviour to examine sex worker mothers' beliefs about sexual health communication and factors shaping these beliefs. Sex worker mothers' beliefs about sexual health communication were shaped by societal norms and collectivising processes often driven by Durbar Mahila Samanwaya Committee (DMSC), a sex workers' collective in Kolkata, India. Specifically, we found that challenging stigma, assuming ownership over one's body and health, and making relevant material resources and knowledge accessible and meaningful were key in supporting mothers to overcome barriers around sexual health communication. These collectivising processes shaped mothers' beliefs about sexual health communication and facilitated their ability to engage in it. Future research, policies and programmes should consider the far-reaching impact of community-led structural interventions on sex worker mothers and their children.

Parent-adolescent communication on sexual and reproductive health among school adolescents of Woldia town, Ethiopia by the year 2019

Purpose

The purpose of this paper is to assess the magnitude of parent-adolescent communication on sexual and reproductive health (SRH) issues and its association with gender and premarital sexual practice among school adolescents of Woldia town.

Design/methodology/approach

School-based cross-sectional study was conducted on 368 unmarried secondary and preparatory school adolescents (15–19 years) in Woldia town. Simple random sampling was employed to select study participants. Self-administered questionnaire was used. Data were entered by EPI-Data version 3.0.2 and analyzed by using SPSS version 20.

Findings

In this study, 56.3% of school adolescents had parental communication on sexual and reproductive health issues. The result of this study showed that adolescents who had history of sexual intercourse where 64% less likely to communicate with parents on sexual and reproductive health issues (AOR: 0.36 95% CI: 0.20, 0.65), but there was no association between gender and sexual and reproductive health communication between adolescent and parent (AOR: 1.06, 95% CI: 0.64, 1.75).

Originality/value

Parent-adolescent communication about sexual matters is one of the means that encourages adolescents to adopt responsible sexual behavior. Many children in Africa are uncomfortable to have a communication about sexual and reproductive health issues with their parents because the subject is a taboo topic in most homes.

Curious eyes and awkward smiles: Menstruation and adolescent boys in India

INTRODUCTION

Most Indian studies on menstruation include only girls/women as participants, making it a 'women's' topic. This exclusion of adolescent boys fails to understand menstruation as a social epidemiological entity with existing gender inequalities. For engaging boys to play a meaningful role in improving women's health, studying their knowledge, beliefs regarding topics such as menstruation and socioeconomic characteristics influencing their menstruation-related experiences need attention. Addressing this is an essential step for reducing gender disparities in adolescent health. Thus, we explore boys' knowledge, beliefs and attitudes regarding menstruation and the impact of social determinants on their menstruation-related experiences.

METHODS

A sequential mixed-methods study comprising 21 semi-structured interviews, 5 Focus Group Discussions and 12 key respondent interviews; followed by a cross-sectional survey of 744 boys from Nashik district, India was conducted. We employed thematic analysis for qualitative data and multivariable regression to model risk ratios for outcomes.

RESULTS

An amalgam of curiosity and awkwardness regarding menstruation was observed. Many lacked accurate knowledge and possessed misinformation. Social and individual-level determinants influenced boys' menstruation related experiences. Fully adjusted models revealed that being admitted in private unaided schools; having mothers with at least a college education; and comfort with teacher positively influenced boys'knowledge, attitudes and beliefs (incidence rate ratios at 95% CI: 2.67 [1.02, 6.95], p < 0 0.05; 3.16 [1.35, 7.38], p < .05 and 1.92 [1.24, 2.99],p < .01, respectively).

CONCLUSION

Our study highlights the need of improving Indian boys' understanding and beliefs about menstruation by addressing the social determinants that influence their menstruation-related experiences.

Relationships Between Adolescents' Knowledge, Attitudes, and Fears Related to HIV/AIDS

AIMS

To explore adolescents' knowledge, attitudes, and fears of HIV/AIDS and to examine relationships between these variables and demographic variables among female adolescents.

BACKGROUND

HIV/AIDS is one of the major public health concerns all around the world, including India. Although the prevalence of HIV infection is low, it is still considered a high risk among Indian youth because of low and inaccurate HIV/AIDs knowledge, low condom usage and unsafe sexual practice, and lack of access to information.

METHODS

A descriptive correlational design was used in this study. A convenience sample of 150 adolescents attending one of the girls' high schools completed demographic and HIV/AIDS knowledge and attitude questions in June 2018. The data was analyzed using descriptive statistics and Pearson-product-moment correlation coefficients.

RESULTS

The majority of adolescents had a moderate degree of HIV/AIDS knowledge, however; many of them still had misconceptions about modes of HIV/AIDS transmission and prevention of HIV infection. Most of the adolescents had fairly positive attitudes and beliefs toward people with HIV/AIDS. About three-fourths of the participants were afraid of getting HIV/AIDS. The total HIV/AIDS knowledge was positively correlated with age (r = 0.288, p < .000), fathers' education (r = 0.235, p < .003), fear of getting HIV infection (r = 0.222, p < .005), and discussion about sexually transmitted diseases with parents (r = 0.195, p < .01).

CONCLUSION

The findings indicate a need for educating students on HIV/AIDS, which can be accomplished by incorporating information regarding HIV transmission and prevention into their school curriculum. School-based educational program could be beneficial.

Being an other-sex crush during early adolescence in India: Investigating socio-behavioral and psychological concomitants

INTRODUCTION

After years of neglect, there is now strong empirical interest in adolescents' romantic experiences. Most studies, however, focus on adolescents' romantic relationships in Western societies and fail to consider other-types of romantic experiences and adolescents who reside in non-Western societies.

METHODS

The present study begins to address these research gaps by examining the social-behavioral and psychological concomitants of being viewed by many other-sex peers as a crush, or having high crush status, in a large (N = 445; 56% male; M_age = 13.77 years, SD = 0.43) longitudinal sample of young adolescents in urban India.

RESULTS

Utilizing self- and peer-report data, results provide the first evidence that being viewed by many peers as an other-sex crush in India is related to some of the same (i.e., physical attractiveness), but also different (i.e., shyness) social-behavioral characteristics relative to what has been found in studies of young adolescents from the United States. Further analysis revealed new evidence regarding the unique social-behavioral (i.e., decreased physical aggression) and psychological (i.e., decreased social anxiety) outcomes associated with high crush status in urban India.

CONCLUSIONS

Taken as a whole, results underscore the importance of considering the larger cultural context in studies of young adolescents' crush experiences.

Menstrual health communication among Indian adolescents: A mixed-methods study

Background

Research in health communication frequently views it as an information dissemination strategy, thus neglecting the intricacies involved in communicating a sensitive topic such as menstruation. The social patterning in menstrual communication, a taboo in India, and its consequent health-effects on adolescents are under-studied.

Methods

We studied the social determinants of menstrual communication influencing menstrual- health through semi-structured interviews of 21 boys and girls each, 12 key-respondent interviews, followed by a cross-sectional survey of 1421 adolescents from Nashik district, India. We thematically analysed the qualitative data and fit multivariable logistic regression to model risk ratios.

Findings

We found social disparities in adolescents’ experiences of communication taboo regarding menstruation. While boys curbed their curiosity about the topic, girls too faced resistance to their experience-sharing and treatment-seeking for menstrual illnesses. The inequality in menstruation-related communication was evident as more boys than girls faced avoidance to their questions [IRR at 95%CI: 2.75 (2.04, 3.71)]], and fewer tribal than rural girls were communicated severe taboos (OR at 95% CI: 0.18 (0.09, 0.36))]. Girls who had been communicated severe (versus no/mild) taboos reported greater stress about menstrual staining (IRR at 95% CI: 1.31 (1.10, 1.57)], emphasizing the health consequences of such communication inequalities.

Conclusions

Our study highlights the need to address gender and setting-specific communication experiences of adolescents in India, a patriarchal society. The inequality in communication needs attention as it creates unequal patterns in Indian adolescents’ menstrual health and experiences, which may manifest as inequities in reproductive health-related outcomes even in their adult-lives.

Good girls and boys: findings from a cross-sectional survey on adolescent rights, relationships, and sexuality in an urban informal settlement in India

Around 20% of India’s population are adolescents aged 10–19 years. Our objective was to strengthen program interventions on gender equity, health, and participation by gauging adolescents’ levels of understanding and opinions. In a cross-sectional survey, we interviewed 2005 adolescents on their opinions on rights, friendship and sex, sexual refusal and coercion, and communication with family, using a two-stage probability proportional to size sample. Opinions on gender allocations were generally equitable, although females supported clothing proscriptions. Premarital sex, multiple partners, masturbation and non-heterosexual partnerships were frowned upon. Few respondents said that they felt pressure to be sexually active, 79% said that sexual coercion was a form of violence, but 14% of older adolescents said that it would be unreasonable to refuse sex. Our interviews described young people negotiating the terrain between perceived normative expectations and contemporary aspirations, showing limited manoeuvring within assumed gender roles in which family control was prominent.

Culturally Grounded Prevention for Minority Youth Populations: A Systematic Review of the Literature

Contemporary prevention science has focused on the application of cultural adaptations of evidence-based prevention programs for minority youth populations. Far less is known about culturally grounded methods that are intended to organically develop prevention programs within specific populations and communities. This article systematically reviews recent literature on culturally grounded interventions used to prevent health disparities in ethnic minority youth populations. In this review, we assessed 31 peer-reviewed articles published in 2003 or later that fit inclusionary criteria pertaining to the development and evaluation of culturally grounded prevention programs. The evaluated studies indicated different approaches toward cultural grounding, as well as specific populations, geographic regions, and health issues that have been targeted. Specifically, the findings indicated that most of the studies focused on the development and evaluation of culturally grounded HIV/STI and substance abuse prevention programs for Mexican-American, African American, and American Indian/Alaska Native youth residing in the South or Southwestern US. These studies largely relied on community-based participatory or qualitative research methods to develop programs from the "ground up." This review has implications for the development of future culturally grounded and culturally adapted prevention programs targeting underserved minority youth populations and geographic regions. Specifically, it identifies populations and regions where culturally grounded prevention efforts are underdeveloped or non-existent, providing some scientific direction for the future development of these types of programs.

Congruence in reported frequency of parent-adolescent sexual health communication: A study from Mexico

BACKGROUND

Most studies on parent-adolescent sexual health communication come from developed countries and are based on either parents' or children's reports. In developing countries, there is little evidence about the agreement among reports of all parties involved in parent-adolescent sexual health communication.

OBJECTIVE

The objective of this study is to explore the congruence (agreement) between adolescents and their parents about how frequently they discuss on selected sexual health topics.

SUBJECTS

A total of 1606 parent-adolescent dyads of adolescents attending the first year in public high schools and their parents, in Morelos, Mexico were sampled in this study.

METHODS

The participants completed a self-administered questionnaire that included the frequency of parent-adolescent communication about eight sexual health topics. An ordinal logistic threshold model was used to estimate intra-class correlation coefficients within parent-adolescent dyads (as a measure of congruence) and to test if thresholds were equal between parents and adolescents.

RESULTS

Congruence in reported frequency of parent-adolescent sexual health communication ranged from 0.205 (menstruation) to 0.307 (condoms) for mother-adolescent dyads, and from 0.103 (ejaculation) to 0.380 (condoms) for father-adolescent dyads. The thresholds (i.e., the cutoff points that define the categories in the observed ordinal variable) differed between parents and adolescents for each of the sexual health topics explored (p<0.05 for father-adolescent dyads and p<0.001 for mother-adolescent dyads).

CONCLUSION

Our findings suggest a low congruence between parents' and adolescents' reports on parent-adolescent sexual health communication. This might be due to interpretation of frequency and intensity of sexual health communication which differs between parents and adolescents.