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Bae SH, Jeong J, Yang Y. Socially Disadvantaged Community Structures and Conditions Negatively Influence Risky Sexual Behavior in Adolescents and Young Adults: A Systematic Review. Int J Public Health 2022; 67:1604488. [DOI: 10.3389/ijph.2022.1604488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 10/19/2022] [Indexed: 11/09/2022] Open
Abstract
Objectives: This review aims to examine the association between community-level factors, namely, community structure and condition, and risky sexual behavior (RSB) including early sexual debut, having multiple sex partners, and unprotected sex, in adolescents and young adults.Methods: In total, 17 observational studies were identified for review using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Among the 11,216 identified articles, excluded articles comprised 8,361 duplicates, 2,855 articles by title screening, 893 by abstract screening, and 667 by full-text screening. Finally, eight additional articles were added by manual search.Results: The community structural factors included social disadvantage, economic, employment, education status, racial or ethnic composition, residential stability, and physical environment. The current review found that social disadvantage (six studies) and economic status (10 studies) were most frequently examined. Particularly, higher levels of social disadvantage were associated with higher rates of early sexual initiation, inconsistent condom use, and multiple sexual partners.Conclusion: This study highlights that community structure and conditions in terms of social disadvantages should be addressed to prevent RSB in the young population.
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Hong J, Park SJ, Lee JK, Jeong HJ, Oh J, Choi S, Jeong S, Kim KH, Son JS, Park SM. Association between community-level social trust and the risk of dementia: A retrospective cohort study in the Republic of Korea. Front Public Health 2022; 10:913319. [PMID: 36276340 PMCID: PMC9582360 DOI: 10.3389/fpubh.2022.913319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 09/12/2022] [Indexed: 01/22/2023] Open
Abstract
Introduction It is known that biological risk factors and lifestyle behaviors are important determinants of dementia. However, there has been yet to be sufficient evidence to prove that community-level social capital is one of the determinants of dementia. This retrospective cohort study is a large, long-term, population-based study that investigated the association between community-level social trust and the risk of dementia in the Republic of Korea. Methods Data came from the Korean National Health Insurance Service database. The community-level social trust values were determined by the Korean Community Health Survey. The study population consisted of 1,974,944 participants over 50 years of age and was followed up from 1 January 2012 to 31 December 2019 with a latent period of 5 years from 1 January 2012 to 31 December 2016. Cox proportional hazards regression was utilized to obtain the adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for the risk of dementia according to social trust quintiles. Results Participants within the highest quintile of community-level social trust had a lower risk for overall dementia (aHR, 0.90; 95% CI, 0.86-0.94) and Alzheimer's disease (aHR, 0.90; 95% CI, 0.85-0.94) compared to those within the lowest quintile of community-level social trust. The alleviating trend association of high community-level social trust on dementia risk was maintained regardless of whether the participants had health examinations. Conclusions Our findings suggest that higher community-level social trust is associated with a reduced risk of dementia. Community-level social trust is a crucial indicator of dementia and improving community-level social trust may lead to a lower risk of dementia.
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Affiliation(s)
- Jaeyi Hong
- Department of Biomedical Sciences, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea,Department of Statistics, University of Illinois at Urbana-Champaign, Champaign, IL, United States
| | - Sun Jae Park
- Department of Biomedical Sciences, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Jong-Koo Lee
- National Academy of Medicine of Korea, Seoul, South Korea
| | - Hye Jin Jeong
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea,Comprehensive Care Clinic, Public Healthcare Center, Seoul National University Hospital, Seoul, South Korea
| | - Juhwan Oh
- Department of Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Seulggie Choi
- Department of Biomedical Sciences, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea,Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Seogsong Jeong
- Department of Biomedical Informatics, CHA University School of Medicine, Seongnam, South Korea
| | - Kyae Hyung Kim
- Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea,Comprehensive Care Clinic, Public Healthcare Center, Seoul National University Hospital, Seoul, South Korea
| | - Joung Sik Son
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, South Korea
| | - Sang Min Park
- Department of Biomedical Sciences, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea,Department of Family Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, South Korea,*Correspondence: Sang Min Park
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Chabata ST, Makandwa R, Hensen B, Mushati P, Chiyaka T, Musemburi S, Busza J, Floyd S, Birdthistle I, Hargreaves JR, Cowan FM. Strategies to Identify and Reach Young Women Who Sell Sex With HIV Prevention and Care Services: Lessons Learnt From the Implementation of DREAMS Services in Two Cities in Zimbabwe. JMIR Public Health Surveill 2022; 8:e32286. [PMID: 35896024 PMCID: PMC9377473 DOI: 10.2196/32286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 03/31/2022] [Accepted: 05/11/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Young women who sell sex (YWSS), are underserved by available HIV prevention and care services. The Determined, Resilient, Empowered, AIDS-free, Mentored and Safe (DREAMS) Partnership aimed to reduce the risk of HIV acquisition among vulnerable populations of adolescent girls and young women, including YWSS, in 10 sub-Saharan African countries. We describe 2 methods, respondent-driven sampling (RDS) and peer outreach, used to refer YWSS for DREAMS services in Zimbabwe, and compare the characteristics and engagement of YWSS referred to these services by each method. We hypothesized that RDS would identify YWSS at higher risk of HIV and those who were less engaged with HIV prevention and care services than peer outreach. OBJECTIVE We aimed to compare respondent-driven sampling and peer outreach in recruiting and referring high-risk populations for HIV prevention and care services. METHODS We used RDS, a sampling method designed to reach a representative sample of the network of key populations, and peer outreach, a programmatic approach to identify, reach, and refer YWSS for DREAMS between April and July 2017, and January 2017 and July 2018, respectively, in 2 cities in Zimbabwe. For RDS, we conducted detailed mapping to understand sex work typology and geography, and then purposively selected 10 "seed" participants in each city to initiate RDS. For peer outreach, we initiated recruitment through 18 trained and age-matched peer educators using youth-tailored community mobilization. We described the characteristics and service engagement of YWSS who accessed DREAMS services by each referral approach and assessed the association of these characteristics with referral approach using the chi-square test. Analysis was performed with and without restricting the period when RDS took place. We estimated the relative incremental costs of recruiting YWSS using each strategy for referral to DREAMS services. RESULTS Overall, 5386 and 1204 YWSS were referred for DREAMS services through peer outreach and RDS, respectively. YWSS referred through RDS were more likely to access DREAMS services compared to YWSS referred through peer outreach (501/1204, 41.6% vs 930/5386, 17.3%; P<.001). Regardless of referral approach, YWSS who accessed DREAMS had similar education levels, and a similar proportion tested HIV negative and reported not using a condom at the last sex act. A higher proportion of YWSS accessing DREAMS through RDS were aged 18-19 years (167/501, 33.3% vs 243/930, 26.1%; P=.004) and more likely to be aware of their HIV status (395/501, 78.8% vs 396/930, 42.6%; P<.001) compared to those accessing DREAMS services through peer outreach. The incremental cost per young woman who sells sex recruited was US $7.46 for peer outreach and US $52.81 for RDS. CONCLUSIONS Peer outreach and RDS approaches can reach and refer high-risk but different groups of YWSS for HIV services, and using both approaches will likely improve reach. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-DOI 10.1186/s12889-018-5085-6.
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Affiliation(s)
- Sungai T Chabata
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe.,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Rumbidzo Makandwa
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe
| | - Bernadette Hensen
- Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Phillis Mushati
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe
| | - Tarisai Chiyaka
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe
| | | | - Joanna Busza
- Centre for Evaluation, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Sian Floyd
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Isolde Birdthistle
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - James R Hargreaves
- Centre for Evaluation, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Frances M Cowan
- Centre for Sexual Health and HIV/AIDS Research (CeSHHAR), Harare, Zimbabwe.,Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Wang X, Jin Y, Tian M, Zhuo Q, Lin CL, Hu P, Wang T. Safe-Sex Behavioral Intention of Chinese College Students: Examining the Effect of Sexual Knowledge Using the Theory of Planned Behavior. Front Psychol 2022; 13:805371. [PMID: 35656495 PMCID: PMC9152212 DOI: 10.3389/fpsyg.2022.805371] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 03/21/2022] [Indexed: 11/23/2022] Open
Abstract
Numerous contemporary studies have examined safe sexual behavior among college students. In China, families are reluctant to discuss sexual behavior, thus understanding and exploring the sexual knowledge of college students and the promotion of safe sexual behavior is essential. On the basis of the theory of planned behavior (TPB), a cognitive behavioral theory that is widely used to predict human social behavior, we conducted an in-depth investigation of the factors influencing the sexual behavioral intentions of Chinese college students. We referenced the relevant literature to develop a TPB-based model for analyzing differences in sexual knowledge. Our statistical analysis revealed the following: (1) subjective norms and behavior control are key variables that influence the safe sexual behavior of college students; (2) attitudes and safe-sex behavioral intentions are influential in groups with extensive sexual knowledge; (3) behavioral control and subjective norms influence the differences in the comparative sexual knowledge of students. On the basis of the present results, we propose research recommendations and directions for the development of sex education in China.
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Affiliation(s)
| | - Yuanqing Jin
- College of Science and Technology, Ningbo University, Ningbo, China
| | | | | | - Chien-Liang Lin
- College of Science and Technology, Ningbo University, Ningbo, China
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Understanding the association between exposure to family planning messages and consistent condom use among never married men in Ghana. PLoS One 2021; 16:e0255325. [PMID: 34428211 PMCID: PMC8384178 DOI: 10.1371/journal.pone.0255325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 07/14/2021] [Indexed: 11/20/2022] Open
Abstract
Background Despite considerable efforts to promote condom use, sexually active people in sub-Sahara Africa still engage in risky sexual behaviours, with condom use relatively low. With this high vulnerability of these persons to HIV and sexually transmitted infections, research related to exposure to family planning messages to help curb this trend remains sparse. This study examined how exposure to family planning messages in the midst of some socio-demographic factors is associated with consistent condom use among sexually active never married men in Ghana. Methods Data were obtained from the 2014 Demographic and Health Survey (DHS) of Ghana. Only never married men (15–64 years) who have had sexual experience in the last 12 months were included in the analysis (N = 971). Frequencies, percentages, chi-square tests and binary logistic regression analyses were carried out. Results of the binary logistic regression analysis were presented using crude odds ratios (cOR) and adjusted odds ratios (aOR). Results The results showed that only 26.15% of sexually active never married men in Ghana consistently used condom during sex. Men who were exposed to family planning messages were 51% more likely use condom consistently compared to those who are not exposed [aOR = 1.51, CI = 1.04–2.18]. In terms of the covariates, the likelihood of consistent condom use among men in Ghana was lower among those aged 35 years and above compared to those aged 15–24 [aOR = 0.46 CI = 0.21–0.99]. The odds of consistent condom use among men increased with level of education, with men with higher level of education having the highest odds of consistent condom use compared to those with no formal education [aOR = 9.98, CI = 2.05–48.46]. Men of the richest wealth quintile were more likely to use condom consistently compared to those of the poorest wealth quintile [aOR = 2.62, CI = 1.30–5.27]. Higher odds of consistent condom use was found among men who dwelled in the Central, Northern, and Upper East regions compared to those of the Western region. Conclusion Our findings have established a strong association between exposure to family planning messages alongside age, educational level, wealth, and region of residence and consistent condom use. Men exposed to family planning messages were more likely to use condoms consistently. Designed programs should use intervention strategies that focus on interactive and participatory educational activities to improve sexually active men’s interpersonal communication on family planning messages, especially on consistent condom use with their sexual partners.
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Seidu AA, Ahinkorah BO, Ameyaw EK, Darteh EKM, Budu E, Iddrisu H, Nartey EB. Risky sexual behaviours among school-aged adolescents in Namibia: secondary data analyses of the 2013 Global school-based health survey. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-019-01140-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Casmir E, Daniel AK, Ongolly F, Thuo N, Oluoch L, Kiptinness C, Wald A, Mugo NR, Roxby AC, Ngure K. Protection at First Sexual Intercourse Among Adolescent Girls and Young Women in Kenya. ARCHIVES OF SEXUAL BEHAVIOR 2021; 50:219-227. [PMID: 32720186 PMCID: PMC8024200 DOI: 10.1007/s10508-020-01785-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 06/19/2020] [Accepted: 06/25/2020] [Indexed: 06/11/2023]
Abstract
Adolescent girls and young women (AGYW) are at high risk of HIV and other sexually transmitted infections (STIs), including at first sexual intercourse. The literature is scarce on factors influencing use of protective strategies at this critical time. We conducted 20 in-depth interviews and five focus group discussions with purposively sampled AGYW aged 16-20 years who reported first sex while enrolled in a larger cohort study and willing to participate. All AGYW were counseled on HIV prevention and had access to reproductive health information and services. Data collected were transcribed, translated and analyzed thematically. We identified two approaches to first sex. In one approach, the AGYW facilitated protection use, and those AGYW reported intention and preparation to initiate sexual activity and ability to request condom use, as well as their male partner's willingness to use and provide condoms. In another approach, AGYW experienced first sexual intercourse without agency (the feeling of control over actions and their consequences [Moore, 2016]) and described lack of prior intentions and planning, discomfort with discussions about sex and condom use, and desire to experience sexual pleasure as reported by peers. No AGYW mentioned parents/adults as playing any role as facilitators of protection use at first sex, highlighting the need for further research on the missing gap. The AGYW were trusting of verbal reports by male partners describing themselves as having never engaged in sex, HIV negative, and free of STIs. We found that some AGYW were empowered to plan, discuss, and request protection at first sex, and others did not take agency. First sex is a time of vulnerability where innovative strategies are needed to strengthen AGYW's agency and promote condom use and other HIV/STI prevention methods.
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Affiliation(s)
- Edinah Casmir
- Center for Clinical Research, Kenya Medical Research Institute, KNH, Nairobi, 19865-0020, Kenya.
| | | | - Fernandos Ongolly
- Center for Clinical Research, Kenya Medical Research Institute, KNH, Nairobi, 19865-0020, Kenya
| | - Nicholas Thuo
- Center for Clinical Research, Kenya Medical Research Institute, KNH, Nairobi, 19865-0020, Kenya
| | - Lynda Oluoch
- Center for Clinical Research, Kenya Medical Research Institute, KNH, Nairobi, 19865-0020, Kenya
| | - Catherine Kiptinness
- Center for Clinical Research, Kenya Medical Research Institute, KNH, Nairobi, 19865-0020, Kenya
| | - Anna Wald
- Department of Medicine, University of Washington, Seattle, WA, USA
- Department of Epidemiology, University of Washington, Seattle, WA, USA
- Department of Laboratory Medicine, University of Washington, Seattle, WA, USA
- Vaccines and Infectious Diseases Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Nelly Rwamba Mugo
- Center for Clinical Research, Kenya Medical Research Institute, KNH, Nairobi, 19865-0020, Kenya
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Alison C Roxby
- Department of Global Health, University of Washington, Seattle, WA, USA
- Department of Medicine, University of Washington, Seattle, WA, USA
| | - Kenneth Ngure
- Department of Community Health, Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
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Social Capital and Age at Sexual Debut: Race Differences in South Africa. SOCIAL SCIENCES-BASEL 2020. [DOI: 10.3390/socsci9110197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Literature on social capital has long considered whether and how social capital is protective against various risk behaviors, including age at sexual debut. However, much of this literature uses data from wealthy countries in the Global North and is often cross-sectional, dampening generalizability. In this paper, we employ longitudinal South African data from adolescents in the Cape Area Panel Study to examine the longitudinal link between social capital and age at sexual debut. We first examine the overall relationship between age at sexual debut and social capital and then examine how the relationship differs by race. Results suggest that, on average, each additional activity is associated with an approximate 2 month delay in age at sexual debut. However, we observed steep racial differences. For Africans, the link between social capital and age at sexual debut was not significant, while the results for Coloureds and Whites were. For Coloureds, each additional activity translated into a 3 month delay in sexual debut, while for Whites we found a 4 month delay. We found no evidence of sex differences. Taken together, these results suggest that social capital is not equally efficacious for all South African adolescents. For Africans, social capital does not appear to be linked to age at sexual debut. In contrast, more social capital activities appear to be linked to delayed sexual debut, most particularly for Whites.
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Ohnishi M, Leshabari S, Tanaka J, Nishihara M. Factors associated with the awareness of contraceptive methods, understanding the prevention of HIV/AIDS and the perception of HIV/AIDS risk among secondary school students in Dar es Salaam, Tanzania. J Rural Med 2020; 15:155-163. [PMID: 33033535 PMCID: PMC7530594 DOI: 10.2185/jrm.2020-001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 04/30/2020] [Indexed: 11/27/2022] Open
Abstract
Objective: To assess the awareness of contraceptive methods, understanding
of HIV/AIDS prevention and the perception of HIV/AIDS risks among secondary school
students in Tanzania. Methods: An anonymous self-administered questionnaire survey was conducted
among secondary school students in Tanzania. The questionnaire included sociodemographic
characteristics, awareness of contraceptive methods, an understanding of HIV/AIDS
prevention, and the perception of HIV/AIDS risks. Three secondary schools were selected by
considering the gender balance and location, which included the urban and surrounding
areas. The research objectives, methods, and ethical considerations were explained, and
the students voluntarily completed the questionnaire. Results: A total of 233 responses were collected, and 204 responses were
considered valid for the analysis. The mean and standard deviation of age were 18.5 ± 1.0.
Regardless of the gender, age, religion, and major course of study, the maternal
educational status (adjusted odds ratio [AOR]: 3.129; 95% confidence interval [CI]: 1.324,
7.398; P=0.009) and the number of information sources (AOR: 7.023, 95%
CI: 3.166, 15.579, P<0.001) demonstrated associations with the
awareness of contraceptive methods. Respondents who lived outside a dormitory (AOR: 3.782;
95% CI: 1.650, 8.671; P=0.002) and who currently had a partner (AOR:
3.616; 95% CI: 1.486, 8.800; P=0.005) were associated with a high level
of understanding of HIV/AIDS prevention regardless of gender, age, religion, and major
course of study. Respondents with few information sources were associated with a high
level of perception of HIV/AIDS risks (AOR: 0.293; 95% CI: 0.115, 0.747;
P=0.010), regardless of gender, age, religion, and major course of
study. Conclusion: Factors associated with the awareness of contraceptive methods,
the understanding of HIV/AIDS prevention, and perception of HIV/AIDS risks were not
consistent. To ensure the improvement of these factors among secondary school students,
sexual health education should be integrated into educational programs and provided
holistically.
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Affiliation(s)
- Mayumi Ohnishi
- Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Sebalda Leshabari
- School of Nursing, Muhimbili University of Health and Allied Sciences, Tanzania
| | - Junichi Tanaka
- Nagasaki University Graduate School of Biomedical Sciences, Japan
| | - Mika Nishihara
- Nagasaki University Graduate School of Biomedical Sciences, Japan
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Koenig LR, Li M, Zimmerman LA, Kayembe P, Lou C, Mafuta E, Ortiz J, Moreau C. Associations Between Agency and Sexual and Reproductive Health Communication in Early Adolescence: A Cross-cultural, Cross-sectional Study. J Adolesc Health 2020; 67:416-424. [PMID: 32331930 PMCID: PMC7456790 DOI: 10.1016/j.jadohealth.2020.02.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/08/2020] [Accepted: 02/16/2020] [Indexed: 11/24/2022]
Abstract
PURPOSE To assess the extent to which adolescents aged 10-14 have communicated about sexual relationships, pregnancy, and contraception and how agency in the form of voice and decision-making along with an enabling socioecological environment are associated with sexual and reproductive health (SRH) communication. METHODS Using data from the Global Early Adolescent Study, we included 1,367, 697, and 1,424 adolescents in Kinshasa, Cuenca, and Shanghai, respectively. Patterns of SRH communication and agency levels were described by site and sex. Multivariable logistic regressions assessed odds of SRH communication first in relation to socioecological characteristics and second with levels of agency, after adjustment for social environmental factors. Interaction terms tested sex differences in associations. RESULTS Experiences of SRH communication ranged from one in ten in Kinshasa to about half in Cuenca. Pregnancy was the most discussed SRH topic. Socioecological factors consistently related to SRH communication included older age and pubertal onset, while others varied by context. In multivariable analyses, voice was linked to all forms of SRH communication in Kinshasa and Cuenca with adjusted odds ratios ranging from 1.6 to 2.2, but not in Shanghai. In Cuenca, decision-making was associated with a 50% and 60% increase in odds of communication about pregnancy and contraception, respectively. In Kinshasa, a stronger association between voice and pregnancy discussions was observed for girls than boys. CONCLUSIONS Developmental characteristics and voice were linked to communication about SRH among young adolescents across two contexts. Results suggest agency may play a role in shaping antecedents, like communication, to sexual behaviors.
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Affiliation(s)
- Leah R. Koenig
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland,Address correspondence to: Leah R. Koenig, M.S.P.H, Department of Population, Family, and Reproductive Health, Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.
| | - Mengmeng Li
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Linnea A. Zimmerman
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Patrick Kayembe
- Department of Epidemiology and Biostatistics, School of Public Health, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, the Democratic Republic of the Congo
| | - Chaohua Lou
- National Health Commission Key Lab of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Fudan University, Shanghai, China
| | - Eric Mafuta
- Department of Epidemiology and Biostatistics, School of Public Health, Kinshasa School of Public Health, University of Kinshasa, Kinshasa, the Democratic Republic of the Congo
| | - José Ortiz
- Faculty of Medical Sciences, University of Cuenca, Cuenca, Ecuador
| | - Caroline Moreau
- Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Ssebunya RN, Matovu JKB, Makumbi FE, Kisitu GP, Maganda A, Kekitiinwa A. Factors associated with prior engagement in high-risk sexual behaviours among adolescents (10-19 years) in a pastoralist post-conflict community, Karamoja sub-region, North eastern Uganda. BMC Public Health 2019; 19:1027. [PMID: 31366339 PMCID: PMC6670181 DOI: 10.1186/s12889-019-7352-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Accepted: 07/22/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescent sexual risky behaviours continue to be significant drivers of the HIV epidemic globally. The objective of this study was to determine factors associated with prior engagement in high-risk sexual behaviours among adolescents (10-19 years) in Karamoja sub-region, a pastoralist and post-conflict community in North-eastern Uganda. METHODS Between August and September 2016, we conducted a cross-sectional study among 1439 adolescents receiving primary healthcare services at nine public health facilities located in five of the seven districts that make up Karamoja sub-region. High-risk sexual behaviour was defined as engaging in sex with two or more (2+) sexual partners in the 6 months preceding the survey or exchanging sex for money or gifts with no or inconsistent use of condoms over the same period of time. Factors associated with prior engagement in high-risk sexual behaviours were analysed using a modified Poison regression model with log-link and Poisson-family via a generalized linear model. RESULTS Eighty-two percent (81.8%, n = 1177) of the respondents had ever tested for HIV while 62 % (61.5%, n = 885) had ever had sex. Of those that had ever had sex, 11.4% (n = 101) reported prior engagement in high-risk sexual behaviours. Prior engagement in high-risk sexual behaviours was lower among men than women (adjusted prevalence ratio (adj. PR) = 0.46; 95% Confidence Interval (95% CI): 0.33, 0.62) and those whose sex debut was above 14 years (adj.PR = 0.63; 95% CI: 0.57, 0.69). However, prior engagement in high-risk sexual behaviours was significantly higher in adolescents who were not aware of their recent sexual partner's HIV status (adj.PR = 2.43; 95% CI: 1.68, 3.52) and those who used illicit drugs (adj.PR = 2.76; 95% CI: 1.88, 4.05). CONCLUSION Prior engagement in high-risk sexual behaviours was significantly associated with having sex with partners of unknown HIV sero-status and use of illicit drugs. These findings suggest a need for targeted interventions to improve mutual HIV status disclosure between sexual partners while minimizing their use of illicit drugs/substances.
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Affiliation(s)
- Rogers N Ssebunya
- Directorate of Research, Monitoring and Evaluation, Baylor College of Medicine Children's Foundation, P.O. Box 72052, Kampala, Uganda.
| | - Joseph K B Matovu
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.,Department of Community and Public Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Fredrick E Makumbi
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Grace P Kisitu
- Directorate of Research, Monitoring and Evaluation, Baylor College of Medicine Children's Foundation, P.O. Box 72052, Kampala, Uganda
| | - Albert Maganda
- Directorate of Research, Monitoring and Evaluation, Baylor College of Medicine Children's Foundation, P.O. Box 72052, Kampala, Uganda
| | - Adeodata Kekitiinwa
- Directorate of Research, Monitoring and Evaluation, Baylor College of Medicine Children's Foundation, P.O. Box 72052, Kampala, Uganda
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