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Zhao X, Liu L. 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. Front Psychiatry 2024; 15:1287934. [PMID: 38651010 PMCID: PMC11033313 DOI: 10.3389/fpsyt.2024.1287934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 03/25/2024] [Indexed: 04/25/2024] Open
Abstract
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.
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Affiliation(s)
- Xuemin Zhao
- Department of Internal Medicine, Chengde Medical University, Chengde, China
| | - Linfei Liu
- Sericultural Research Institute, Chengde Medical University, Chengde, China
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Valli JL, Shearer K, Zachry AH, Weisser-Pike O, Boughter JD. A Missing Piece of Occupational Therapy Education: Attitudes About Sex. Occup Ther Health Care 2024:1-16. [PMID: 38557162 DOI: 10.1080/07380577.2024.2325069] [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: 07/31/2023] [Accepted: 02/26/2024] [Indexed: 04/04/2024]
Abstract
Following a lecture on sexual health and function, occupational therapy students were surveyed regarding their past sex education and their comfort level with the topic of sex. Students indicated a lack of sexual education received from parents/guardians and a prevalence of fear-based education from formal or informal sources. Results reflected a significant increase in students' perceived comfort level with the topic following the lecture from a provider trained and certified in sexual health. As sexuality falls within the domain of occupational therapy, these results suggest a need for comprehensive sex education taught to students by qualified instructors.
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Affiliation(s)
- Jennifer L Valli
- Department of Urology, University of TN Health Science Center, Memphis, TN, USA
| | - Katie Shearer
- School of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Anne H Zachry
- Department of Occupational Therapy, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Orli Weisser-Pike
- Department of Occupational Therapy, University of Tennessee Health Science Center, Memphis, TN, USA
| | - John D Boughter
- Department of Anatomy & Neurobiology, University of Tennessee Health Science Center, Memphis, TN, USA
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Mousavi ZS, Janighorban M, Noroozi M. Development, implementation, and evaluation of the effectiveness of an intervention program to improve the sexual competence of young adult women about to get married: a protocol study. Reprod Health 2024; 21:24. [PMID: 38365733 PMCID: PMC10874025 DOI: 10.1186/s12978-024-01754-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 02/09/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Having competence in initiating sexual interactions is one of the challenges of sexual health in any society. Given that the social, cultural, and religious background of some societies can prevent the acquisition of sexual competence in young women, this study will be done to design, implement, and determine the effectiveness of an intervention program to improve the sexual competence of young women on the eve of marriage. METHODS The current research is a mixed-method study in a qualitative-quantitative sequence. In the first phase, a qualitative study will be conducted to explore the needs of sexual competence in young adult women about to get married and ways to improve it. Then, after the literature review and combining it with the results of the qualitative study, a draft of the intervention program will be developed. After reviewing the content of the program and validating it in the panel of experts, the final program will be developed. In the second phase, the effect of the program to promote the sexual competence of adult women about to get married will be determined in a quantitative study with a two-group quasi-experimental method. DISCUSSION Providing a comprehensive and practical intervention program to promote sexual competence based on cultural, social, and religious background can help to improve the quality of sexual interactions of young women about to get married, reduce harm caused by lack of sexual competence, and ensure women's sexual health.
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Affiliation(s)
- Zahra Sadat Mousavi
- Sexual and Reproductive Health, Student Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mojgan Janighorban
- Reproductive Sciences and Sexual Health Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
| | - Mahnaz Noroozi
- Department of Midwifery and Reproductive Health, Isfahan University of Medical Sciences, Isfahan, Iran
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Díaz-Rodríguez MV, Perelló VBI, Granero-Molina J, Fernández-Medina IM, Ventura-Miranda MI, Jiménez-Lasserrotte MDM. Insights from a Qualitative Exploration of Adolescents' Opinions on Sex Education. CHILDREN (BASEL, SWITZERLAND) 2024; 11:110. [PMID: 38255423 PMCID: PMC10814457 DOI: 10.3390/children11010110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/10/2024] [Accepted: 01/16/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND Adolescence is a crucial time in the development of young people's identity, and sexuality is a key issue. Comprehensive sex education provides the knowledge and skills to help adolescents protect their sexual and reproductive health and rights. Policies on sex education in secondary schools are highly influential in the development of quality programmes that support comprehensive sex education. The aim of this study was to explore, describe and understand adolescents' experiences of sex education. METHODS A qualitative study based on Gadamer's phenomenology was used. Two focus groups and four in-depth interviews were conducted with 12 private school students, followed by inductive data analysis using ATLAS.ti software 9.0. RESULTS Two main themes were identified in the analysis: (1) sex education is a challenge for secondary schools and (2) student expectations of sex education. CONCLUSION It is essential for adolescents to have access to comprehensive sex education that is adapted to the different stages of their development, is provided by specialised teachers, and involves their families in the process.
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Affiliation(s)
| | - Vicent Bataller i Perelló
- Facultad Ciencias de la Salud, Universidad de Almería, 04120 Almería, Spain; (M.V.D.-R.); (V.B.i.P.)
| | - José Granero-Molina
- Department of Nursing Physiotherapy and Medicine, University of Almería, 04120 Almería, Spain; (I.M.F.-M.); (M.I.V.-M.); (M.d.M.J.-L.)
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Santiago 7500000, Chile
| | - Isabel María Fernández-Medina
- Department of Nursing Physiotherapy and Medicine, University of Almería, 04120 Almería, Spain; (I.M.F.-M.); (M.I.V.-M.); (M.d.M.J.-L.)
| | - María Isabel Ventura-Miranda
- Department of Nursing Physiotherapy and Medicine, University of Almería, 04120 Almería, Spain; (I.M.F.-M.); (M.I.V.-M.); (M.d.M.J.-L.)
| | - María del Mar Jiménez-Lasserrotte
- Department of Nursing Physiotherapy and Medicine, University of Almería, 04120 Almería, Spain; (I.M.F.-M.); (M.I.V.-M.); (M.d.M.J.-L.)
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Tolliver KM, Phipps EJ. Sexual health in adolescents with liver disease: How to counsel kids. Clin Liver Dis (Hoboken) 2024; 23:e0111. [PMID: 38283306 PMCID: PMC10810599 DOI: 10.1097/cld.0000000000000111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Accepted: 11/13/2023] [Indexed: 01/30/2024] Open
Affiliation(s)
- Kyla M. Tolliver
- Department of Pediatrics, Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Erin J. Phipps
- Eskenazi Health/Indiana University Health, Indianapolis, Indiana, USA
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Zhu K, Lin Z, Luo Q, Jiang Z, He R, Wu H, Yu J, Liu X, Sheng J, Zhu H, Huang H. Sexual behavior and cardiovascular diseases: univariable and multivariable Mendelian randomization. Front Cardiovasc Med 2023; 10:1250404. [PMID: 38116537 PMCID: PMC10728475 DOI: 10.3389/fcvm.2023.1250404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 11/13/2023] [Indexed: 12/21/2023] Open
Abstract
Background To assess the relationship of genetically predicted sexual behavior (age at first sex (AFS) and the number of sexual partners (NSP)) on cardiovascular diseases (CVDs). Methods and results We performed two-sample Mendelian randomization (MR) with publicly available datasets from the UK Biobank and FinnGen Study, and analyzed genome-wide association results for sexual behaviors and twelve types of CVDs. The univariable MR method provided a total effect of AFS and NSP on CVDs, and showed evidence that early AFS rather than NSP was associated with CVDs, including angina pectoris (AP), atrial fibrillation and flutter (AFF), coronary atherosclerosis (CAS), deep vein thrombosis of the lower extremity (DVT-LE), heart failure (HF), hypertension (HTN), ischaemic stroke (IS), and myocardial infarction (MI). Given sex as a social determinant of CVD risk, we used gender-stratified SNPs to investigate gender differences in the development of CVDs. These results showed a stronger causal relationship of AFS on CVDs in females than in males. Further multivariable MR analyses indicated a direct effect after accounting for insomnia, number of days of vigorous physical activity 10 + minutes (VPA 10 + min), and time spent watching television (TV). Two-step MR demonstrated these three risk factors act as a mediator in AFS associated AP/HTN/HF. Conclusions We provide evidence that early AFS increased the risk of CVDs. These associations may be partly caused by VPA 10 + min, insomnia, and the time spent on TV. The causality of AFS on CVDs in females was stronger than in males. Conversely, genetically predicted NSP was not associated with CVDs.
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Affiliation(s)
- Kejing Zhu
- Department of Obstetrics and Gynecology, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu, China
- Key Laboratory of Reproductive Genetics (Ministry of Education), Department of Reproductive Endocrinology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhongliang Lin
- Department of Obstetrics and Gynecology, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu, China
- Key Laboratory of Reproductive Genetics (Ministry of Education), Department of Reproductive Endocrinology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qinyu Luo
- Key Laboratory of Reproductive Genetics (Ministry of Education), Department of Reproductive Endocrinology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhaoying Jiang
- Department of Obstetrics and Gynecology, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu, China
- Key Laboratory of Reproductive Genetics (Ministry of Education), Department of Reproductive Endocrinology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Renke He
- Department of Obstetrics and Gynecology, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu, China
- Key Laboratory of Reproductive Genetics (Ministry of Education), Department of Reproductive Endocrinology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Haiyan Wu
- Key Laboratory of Reproductive Genetics (Ministry of Education), Department of Reproductive Endocrinology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jiaen Yu
- Key Laboratory of Reproductive Genetics (Ministry of Education), Department of Reproductive Endocrinology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xueying Liu
- Department of Obstetrics and Gynecology, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu, China
- Key Laboratory of Reproductive Genetics (Ministry of Education), Department of Reproductive Endocrinology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianzhong Sheng
- Department of Obstetrics and Gynecology, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu, China
- Key Laboratory of Reproductive Genetics (Ministry of Education), Department of Reproductive Endocrinology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Research Units of Embryo Original Diseases, Chinese Academy of Medical Sciences (No. 2019RU056), Shanghai, China
| | - Hong Zhu
- Research Units of Embryo Original Diseases, Chinese Academy of Medical Sciences (No. 2019RU056), Shanghai, China
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China
| | - Hefeng Huang
- Department of Obstetrics and Gynecology, The Fourth Affiliated Hospital, International Institutes of Medicine, Zhejiang University School of Medicine, Yiwu, China
- Key Laboratory of Reproductive Genetics (Ministry of Education), Department of Reproductive Endocrinology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Research Units of Embryo Original Diseases, Chinese Academy of Medical Sciences (No. 2019RU056), Shanghai, China
- Obstetrics and Gynecology Hospital, Institute of Reproduction and Development, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Reproduction and Development, Shanghai, China
- State Key Laboratory of Cardiology, Shanghai, China
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Navarro-Prado S, Tovar-Gálvez MI, Sánchez-Ojeda MA, Luque-Vara T, Fernández-Gómez E, Martín-Salvador A, Marín-Jiménez AE. Type of Sex Education in Childhood and Adolescence: Influence on Young People's Sexual Experimentation, Risk and Satisfaction: The Necessity of Establishing School Nursing as a Pillar. Healthcare (Basel) 2023; 11:1668. [PMID: 37372786 DOI: 10.3390/healthcare11121668] [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: 05/02/2023] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
The aim is to identify the source of sexuality education used during childhood and adolescence and to analyse whether this education influences their sexual attitudes, their ability to cope with unwanted situations they experience and their satisfaction with their sexual lives. This is a non-experimental, quantitative, ex post facto, cross-sectional study. The sample is formed of 675 young people, with 50% of the ages included being between 20 (Quartile 1) and 22 (Quartile 3) years. The data collection was done by means of an online questionnaire, including sociodemographic and Likert questions about their sex life. Fisher "Independence Contrasts"and correlations were used to see and quantify the relationship among the variables. The main source of education was pornography (29.3%) and the internet (12.4%). The source of education has a significant relationship with whether the use of contraceptives is accepted or not (p < 0.001), refusal to use contraceptives (p < 0.001), engaging in risky sexual practices (p < 0.001), facing unwanted sexual situations (p < 0.001) and dissatisfaction with their sex life (p < 0.001). It is necessary that children and adolescents have sex education in safe environments, such as in a home or school setting, and the school nurse plays a vital part in this education. This would reduce the need for adolescents and young people to use the internet and pornography as a source of education. School nurses should be the educational axis to offer children and adolescents a reliable point of information about sex education. A joint work with teachers, nurses, students and parents would contribute positively to reduce the number of risky situations young people are facing, and it would promote and improve healthy attitudes towards sex and interpersonal relationships.
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Affiliation(s)
- Silvia Navarro-Prado
- Department of Nursing, Faculty of Health Sciences, University of Granada, 52071 Melilla, Spain
| | | | | | - Trinidad Luque-Vara
- Department of Nursing, Faculty of Health Sciences, University of Granada, 52071 Melilla, Spain
| | | | - Adelina Martín-Salvador
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18071 Granada, Spain
| | - Ana Eugenia Marín-Jiménez
- Department Quantitative Methods for Economics and Business, Faculty of Economics and Business Administration, University of Granada, 18071 Granada, Spain
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Shibuya F, Estrada CA, Sari DP, Takeuchi R, Sasaki H, Warnaini C, Kawamitsu S, Kadriyan H, Kobayashi J. Teachers' conflicts in implementing comprehensive sexuality education: a qualitative systematic review and meta-synthesis. Trop Med Health 2023; 51:18. [PMID: 36973712 PMCID: PMC10042670 DOI: 10.1186/s41182-023-00508-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 02/19/2023] [Indexed: 03/29/2023] Open
Abstract
INTRODUCTION Comprehensive sexuality education (CSE) enables children and young people to learn about the cognitive, emotional, physical, and social characteristics of sexuality. Teachers experience conflicts in teaching CSE due to different cultural and religious backgrounds. This qualitative systematic review aimed to describe the conflicts experienced by teachers in the implementation of CSE in schools. Furthermore, this study aimed to identify the causes of conflict among teachers in implementing CSE. METHODS This article focused on teachers' conflicts in implementing CSE from 2010 to 2022. Online bibliographic databases, such as PubMed, Web of Science, and ERIC, were used to search for relevant articles. The following search term was used: Teacher, Comprehensive Sexuality Education, and Conflict. RESULTS A total of 11 studies were included in the review. All 11 studies were conducted in countries with a predominantly Christian population. The majority of the studies were conducted in Africa. The study respondents included teachers, school principals, and school coordinators. The studies identified that CSE implementation is related to multiple conflicts, depending on the context of the country. Five themes on the causes of conflict emerged from the thematic meta-synthesis: (1) Hesitancy in talking about sex education among teachers due to the cultural and religious context; (2) non-integration of traditional sex education into comprehensive sexuality education, (3) fostering effective facilitation of CSE among teachers, (4) determining the appropriate age to start sex education, and (5) roles of stakeholders outside the school. CONCLUSIONS This qualitative systematic review and thematic meta-synthesis highlighted several conflicts among teachers in CSE implementation. Despite the teachers having a perception that sex education should be provided, traditional sex education has not yet transformed to CSE. The study findings also emphasize the need to identify the teacher's role in CSE implementation. The thematic meta-synthesis also strongly reflected the context of Christianity in Europe and Africa; thus, further research on the religious context in other regions is needed.
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Affiliation(s)
- Fumiko Shibuya
- Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
- Japanese Consortium for Global School Health Research, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Crystal Amiel Estrada
- Department of Environmental and Occupational Health, College of Public Health, University of the Philippines Manila, 625 Pedro Gil Street, Ermita Manila, Philippines
| | - Dian Puspita Sari
- Faculty of Medicine, University of Mataram, Jalan Pendidikan 37, Mataram, West Nusa Tenggara, 83125, Indonesia
| | - Rie Takeuchi
- Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
- Japanese Consortium for Global School Health Research, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Hirono Sasaki
- Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
- Japanese Consortium for Global School Health Research, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Cut Warnaini
- Faculty of Medicine, University of Mataram, Jalan Pendidikan 37, Mataram, West Nusa Tenggara, 83125, Indonesia
| | - Saki Kawamitsu
- Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan
| | - Hamsu Kadriyan
- Faculty of Medicine, University of Mataram, Jalan Pendidikan 37, Mataram, West Nusa Tenggara, 83125, Indonesia
| | - Jun Kobayashi
- Department of Global Health, Graduate School of Health Sciences, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan.
- Japanese Consortium for Global School Health Research, 207 Uehara, Nishihara, Okinawa, 903-0215, Japan.
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Promoting teen-to-teen contraceptive communication with the SpeakOut intervention, a cluster randomized trial. Contraception 2021; 105:80-85. [PMID: 34520728 DOI: 10.1016/j.contraception.2021.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 08/25/2021] [Accepted: 08/28/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND To improve teen contraceptive use, the SpeakOut intervention combines structured counseling, online resources, and text reminders to encourage teens to share their experiences using intrauterine contraception (IUC) or an implant with peers. METHODS To evaluate the effectiveness of remote delivery of the SpeakOut intervention in increasing teen contraceptive use, we conducted a cluster randomized trial involving female adolescents who were recruited online. Primary participants (n = 520) were randomly assigned to receive SpeakOut or an attention control; each primary participant recruited a cluster of up to 5 female peers as secondary participants (n = 581). We assessed contraceptive communication, knowledge, and use, at baseline, 3 and 9 months after participants enrolled. We examined differences between study groups, controlling for clustering by primary participant and baseline characteristics. RESULTS The trial's primary outcome, contraceptive use by secondary participants, was similar between groups at both 3 and 9 months postintervention. Compared to controls, primary participants receiving SpeakOut tended to be less likely to discontinue contraception within 9 months (4.8% vs 7.8%, p = 0.11 for IUC; 7.8% vs 9.8%, p = 0.45 for implants), but this did not reach statistical significance. SpeakOut failed to increase contraceptive communication; regardless of study group, most secondary participants reported peer communication about contraception (86% vs 88%, p = 0.57). Most secondary participants were aware of the hormonal IUC (91.4% vs 90.4%, p = 0.72), copper IUC (92.9% vs 88.6%, p = 0.13), and implant (96.5% vs 96.1%, p = 0.83) 3 months after enrolling, regardless of the intervention their primary participant received. However, contraceptive knowledge remained incomplete in all study groups. CONCLUSION Remote delivery of the SpeakOutintervention did not improve contraceptive communication, knowledge or use among participating teens or their peers. IMPLICATIONS Efforts to support teen-to-teen contraceptive communication and ensure that teens have accurate information about the full range of contraceptive methods, including highly effective reversible contraceptives, require refinement.
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