The Influence of Early Sexual Debut and Sexual Violence on Adolescent Pregnancy: A Matched Case-Control Study in Jamaica

Magnitude and associated factors of sexual violence among female housemaids attending night school in Bahir Dar City, Northwest Ethiopia: Institution-Based Cross-Sectional Study, 2022

BACKGROUND

Sexual violence is a major public health problem that affects the health and well-being of millions of young people. Housemaids are the most vulnerable group to sexual violence due to their nature of work. It leads to various physical, mental, sexual, and reproductive health problems, especially in our country's context. However, they have limited information regarding the magnitude and the factors associated with sexual violence among housemaids. As a result, the purpose of this study was to determine the magnitude and risk factors for sexual violence among female housemaids attending night school in Bahir Dar, Northwest Ethiopia, in 2022.

METHOD

An institution-based cross-sectional study design was conducted among 340 housemaids attending night school in Bahir Dar city from May 15 to June 20, 2022. Participants were selected using simple random sampling through computer-generated techniques. An interviewer-administered, structured questionnaire was used. Data were entered, coded, and cleaned using EPI Data version 4.6.0.2, and exported to SPSS version 26 for further analysis. Both bivariable and multivariable logistic regression were done to identify factors associated with sexual violence. P-value and 95% confidence interval were used to declare the statistical association.

RESULT

The magnitude of sexual violence after being a housemaid was 30.3% with a 95% confidence interval (25.3-35.38). Ever had sex [Adjusted Odds Ratio(AOR) = 4.67; 95%; Confidence Interval(CI) (2.60, 8.39)], no discussion of sexual and reproductive issues [Adjusted Odds Ratio(AOR) = 2.32; 95%; Confidence Interval(CI) (1.29, 4.16)], poor social support [Adjusted Odds Ratio(AOR) = 2.69; 95%; Confidence Interval(CI) (1.32, 5.52)], were identified as factors associated with sexual violence among housemaids. Similarly, academic performance [Adjusted Odds Ratio (AOR) = 0.96; 95%; Confidence Interval (CI) (0.93, 0.99)], and distance to reach school [Adjusted Odds Ratio (AOR) = 2.04; 95%; Confidence Interval (CI) (1.19, 3.48)] were identified as factors associated with sexual violence among housemaids.

CONCLUSION

This study identified that the magnitude of sexual violence among housemaids was high. Housemaids who ever had sex, no discussion of sexual and reproductive health (SRH) with anyone, poor social support, poor academic performance, and distance to reach school were factors associated with sexual violence. Therefore, creating a sexual and reproductive health (SRH) discussion session for housemaids is important for securing their sexual rights.

The invisible problem of early adolescent pregnancy in the Dominican Republic: a descriptive analysis

Study objectives

The aim of this article is to describe the problem of pregnancy in girls under 15 years of age in the Dominican Republic in the period 2000-2021, to develop a specific indicator for this age group and describing the related factors.

Methods

This is an exploratory ecological study, based on secondary data sources, such as birth records from the National Statistics Office (NSO) and the Ministry of Public Health (MPH). We calculated the rates of fertility and pregnancy in early adolescence, as well as analyzed their main determining factors and consequences.

Results

Fertility Rate in Early Adolescence (FREA) decreases from 6.27 to 1.04 per thousand in the period 2001-2021. The average FREA for 2015-2021 was 1.78. The average Estimated Rate of Pregnancy in Early Adolescence (ERPEA) for the same period was 3.39. Disability-Adjusted Life Years (DALYs) were 11,620 years. Years of Life Lost (YLL) were 9,665.9 years. The prevalence of Low Birth Weight (LBW) in the under 15-year-old age group was 14.2 %.

Conclusions

Pregnancy in childhood implies risks for both the mother and the child, including low birth weight. The official fertility rate is substantially underreported (2.84 vs. 1.79).The fertility rate indicator traditionally used does not accurately measure the number of pregnancies in women, particularly in specific age groups or populations where pregnancies may be interrupted by various factors. Therefore, the use of ERPEA is recommended.We emphasize the need for implementing the proposed indicator for the target group, as well as monitoring Sustainable Development Goal indicator 3.7.2.

Adverse Childhood Experiences, Acculturation, and Risky Sexual Behaviors in Hispanic Young Adults: Findings from Project RED

While adverse childhood experiences (ACE) are well-documented predictors of maladaptive behaviors in adulthood, including risky sexual behaviors (RSB), the influence of acculturation in this association remains unknown. Although Hispanics are a rapidly growing population in the United States and are disproportionately affected by adverse sexual health outcomes, there is a paucity of research examining the interplay of ACE, acculturation, and RSB in this population. We observed the ACE-RSB association and how this relationship varies across U.S. and Hispanic acculturation levels, in a sample of Hispanic young adults (n = 715). Data for this study were from Project RED, a longitudinal study of Hispanic health. We ran regression models to test associations between ACE (0, 1-3, 4+) and several RSB (e.g., early sexual initiation (≤14 years), condomless sex, lifetime sexual partners, and alcohol/drug use before intercourse), and assessed moderation by U.S./Hispanic acculturation. Compared with those without ACE, individuals with 4 + ACE had higher odds of early sexual initiation (AOR: 2.23), alcohol/drug use before last intercourse (AOR: 2.31), and condomless sex (AOR: 1.66), as well as a higher number of lifetime sexual partners (β: 0.60). For those reporting 4 + ACE, high U.S. acculturation was protective in the association between ACE and using alcohol/drugs before intercourse. Future research implications are discussed.

Predictors and differences in fertility level among Nigerian women of reproductive age: a function of subgroup social norms fertility behaviour

Fertility rates in Nigeria are declining at such a modest rate, that if more proactive measures are not employed to reduce fertility, the nation may double its population before long. We empirically examined fertility behaviour as derivatives of specific subgroup social norms, and the variations in the factors responsible for different fertility behaviours, using the 2018 Nigeria Demographic and Health Survey. Descriptive bivariate, and multinomial logistic regression analyses were used to predict the contribution of demographic and sociocultural factors contributing to the fertility level, and findings were reported as odds ratios. Results revealed that age, religion and level of education are the most significant predictors of fertility level, with remarkable differences in birth rate across subgroups, whereas North-West Nigeria had the highest fertility level. Furthermore, marriage had a significantly negative effect on high fertility among North-Western women, whereas higher education significantly increased high fertility among North-Eastern women. In conclusion, subgroup social norms fertility behaviour is responsible for the persistent fertility differential outcome in Nigeria. Thus, the paper strongly advocates the need to intensify community-led, norm-based solution and not a universal approach in addressing fertility control in Nigeria.

Socioeconomic inequality in teenage pregnancy in Papua New Guinea: a decomposition analysis

BACKGROUND

Teenage pregnancy is a global public health issue, and it poses a serious threat to the health and socioeconomic status of mothers and their newborn children. Although Papua New Guinea has recorded one of the highest teenage pregnancy rates among Asia-Pacific countries, few studies have conducted research on the related inequality in the country. Therefore, this study aimed to assess socioeconomic inequality in teenage pregnancy and its contributing factors in Papua New Guinea.

METHODS

Data for this cross-sectional study were obtained from the 2016-2018 Papua New Guinea Demographic and Health Survey. The analytical sample consisted of 2,864 girls aged 15-19 years. We employed Erreygers normalized concentration index (ECI) and concentration curves to measure and depict socioeconomic inequality in teenage pregnancy. Decomposition analysis was likewise performed to identify the contributions of determinants to the observed inequality.

RESULTS

Weighted ECI for teenage pregnancy was - 0.0582 (P < 0.001), thereby indicating that teenage pregnancy in Papua New Guinea is disproportionately concentrated among poor girls. Decomposition analysis suggested that education level (65.2%), wealth index (55.2%), early sexual debut (25.1%), region (8.5%), and sex of household head (4.1%) are the main determinants explaining the pro-poor socioeconomic inequality in teenage pregnancy.

CONCLUSIONS

A pro-poor socioeconomic inequality of teenage pregnancy was present in Papua New Guinea. This inequality may be alleviated by such interventions as ensuring that teenage girls receive education; implementing poverty alleviation projects, eliminating child, early, and forced marriages; strengthening promotion for household head to support teenagers in accessing sexual and reproductive health education; improving geographical accessibility to health facilities on contraceptive services, and taking necessary precautions and responses to sexual misconduct.

Prevalence and factors associated with early childbearing in sub-saharan Africa: evidence from demographic and health surveys of 31 countries

BACKGROUND

Early childbearing remains a public health concern in sub-Saharan Africa (SSA) because it has substantial implications for women's and children's health and population control. However, little is known about recent changes in early childbearing in the region following the implementation of the Family Planning 2020 initiative (FP2020) national-level interventions. Thus, this study examined factors associated with early childbearing among women in SSA.

METHODS

The study used data from the most recent Demographic and Health Surveys conducted in 31 countries in sub-Saharan Africa between 2010 and 2021. The analysis included a pooled sample of 54,671 parous young women aged 20-24 years. A multivariable binary logistic regression model was used to examine the association between early childbearing and individual and household-level factors. All analyses were weighted to account for complex survey design.

RESULTS

The study shows that the mean prevalence of early childbearing was high in SSA at 39% (95% CI: 35, 43). Chad had the highest prevalence of early childbearing, 62% (95% CI: 60, 64) while Rwanda had the lowest prevalence of 13% (95% CI: 11, 15). Completing secondary school (aOR = 0.57; 95% CI: 0.52, 0.62) or attaining tertiary level education (aOR = 0.32; 95% CI: 0.22, 0.45), first sexual debut in the age range 15-24 years (aOR = 0.15; 95% CI: 0.14, 0.16) and desire for a small family size (aOR = 0.63; 95% CI: 0.58, 0.69) were associated with reduced odds of early childbearing among young women in SSA.

CONCLUSION

The study has established that the prevalence of early childbearing is high in SSA. Level of education, age at first sexual debut, household size, and desired family size are associated with early childbearing in SSA. Governments of SSA countries should enhance sexual and reproductive health interventions to change reproductive behaviour, particularly in adolescents and young women.

The association between violence victimization and subsequent unplanned pregnancy among adolescent girls in Uganda: Do primary schools make a difference?

Violence victimization is a risk factor for adolescent pregnancy in high-income, low violence prevalence countries, but longitudinal data are lacking from settings where violence and adolescent pregnancy are common, including sub-Saharan Africa. We also know little about contextual factors which modify this association. We analyzed data from the Contexts of Violence in Adolescence Cohort (CoVAC) study in Luwero District, Uganda. Primary students in 42 schools completed surveys in 2014 (Wave 1) and 2018 (Wave 2). Our outcome was unplanned pregnancy. Our exposure was violence victimization, including any violence, type of violence (physical, emotional, sexual), perpetrator group (teacher, peer, family member), and polyvictimization. We fit mixed-effects logistic regression models and examined school factors (e.g., connectedness, absenteeism) as effect modifiers, using data from students (n = 3,431) and staff (n = 591) at the 42 schools. 1,449 girls were included in analyses (78% follow-up). At Wave 1, 88% (n = 1,281/1,449) reported any violence (mean age = 12.73, SD = 1.44 years). At Wave 2, 13.9% (n = 201/1,449) reported an unplanned pregnancy. In adjusted models, compared to no violence, significant associations (p<0.05) were observed for any violence (OR = 1.99, 95%CI = 1.03-3.85), physical violence (OR = 1.96, 95%CI = 1.02-3.79), teacher violence (OR = 1.96, 95%CI = 1.01-3.79), peer violence (OR = 2.00, 95%CI = 1.00-4.03), family violence (OR = 2.23, 95%CI = 1.07-4.65), violence from one perpetrator group (OR = 2.04, 95%CI = 1.01-4.15), and violence from three perpetrator groups (OR = 2.21, 95%CI = 0.99-4.95). Sexual and emotional violence were associated in crude but not adjusted analyses. School and peer connectedness modified the association (p<0.05); girls who experienced violence had higher odds of unplanned pregnancy in schools with lower versus higher connectedness. Violence victimization in early adolescence is strongly associated with subsequent unplanned pregnancy among adolescent girls in Uganda but attending schools with more school or peer connectedness attenuated this link. Interventions should seek to reduce violence against girls to prevent unplanned pregnancy. Interventions promoting positive connections to school may be especially important for violence victims.

"Our parents kiss in front of us": Reasons for early sexual debut among in-school youth in the Manzini Region in Eswatini

BACKGROUND

Early sexual debut (i.e., sex before the age of 15 years), especially if it is unprotected, may increase the risk of acquiring HIV, sexually transmitted infections, and unwanted pregnancies. We investigated the reasons for early sexual debut among in-school youth in Eswatini, a setting with high HIV incidence among youth.

METHODS

This was a qualitative, exploratory-descriptive study whereby data were collected from 81 sexually active in-school youth through seven focus group discussions (FGDs) in four purposively selected public high schools (two urban and two rural) in the Manzini region, Eswatini. In each school, except one, two FGDs (one for boys and one for girls) were conducted. Qualitative data were coded and analyzed thematically in Dedoose version 8.2.14.

RESULTS

Nearly 40% of the participants reported having initiated sexual activity before 18 years. Six major themes emerged from the data: i) Intrapersonal factors (feeling mature, religiosity, nutritional or dietary patterns); ii) Parenting and household factors (living arrangement, lack of sexuality education, working parents, negative role-modeling from adults); iii) Peer and partner pressure (pressure from friends, threats from sexual partners, intergenerational sexual partnerships and transactional sex, testing sexual prowess, desire to fit in); iv) Contextual factors (neighborhood, location); v) Mass media (cell phone ownership, social media, and television shows or movies); and vi) Cultural factors (attending traditional ceremonies, loss of cultural norms, values, and traditions, and dress code).

CONCLUSION AND RECOMMENDATIONS

The poor monitoring and negative role-modeling by elders highlight the importance of involving parents or guardians as key stakeholders when designing interventions targeting risky sexual behavior among youth. The multifaceted nature of the cited reasons for early sexual debut calls for interventions aimed at curbing risky sexual behavior to be culturally sensitive and responsive to the themes identified in this study.

Prevalence of and factors associated with unintended pregnancies among sexually active undergraduates in mainland China

BACKGROUND

Unintended pregnancies (UIP) among unmarried sexually active college students in mainland China have emerged as a major reproductive health issue with detrimental personal and socioeconomic consequences. This cross-sectional study aimed to determine the prevalence and factors associated with UIP among sexually active undergraduates in mainland China.

METHODS

Between September 8, 2019 and January 17, 2020, a total of 48,660 participants were recruited across the Chinese mainland to complete the self-administered, structured, online questionnaire. This analysis was restricted to 6347 sexually experienced, never-married 15-26 year old undergraduates. Pearson's Chi square tests and multivariate Logistic regression analyses were performed to identify sociodemographic, familial and individual variables associated with UIP.

RESULTS

The overall prevalence of UIP was 17.7%. More specifically, 19.5% of male college students reported they had unintentionally gotten a partner pregnant, while 14.9% of female college students became unintentionally pregnant. Students who experienced UIP were more likely to belong to the older age group (23-26 years), live with only one parent or live without parents at home, report that their family members approve of premarital sex, initiate sexual activity younger than 14 years old and have casual sex partners. Furthermore, females with multiple partners and males who came from low- income households, experienced sexual abuse, perceived difficulties in acquiring condoms and did not know how to use condoms correctly were also at higher risk of experiencing an unintended pregnancy.

CONCLUSION

In order to prevent UIP, a comprehensive intervention measure should be taken to target older students and those engaging in risky sexual behaviors, work with young male students to improve condom use skills, improve the availability of free condoms, optimize the involvement of parents and other family members in their children's sex education.

Early Sexual Debut and Neighborhood Social Environment in Latinx Youth

OBJECTIVES

To examine whether social aspects of the neighborhood environment are associated with early sexual initiation in a California agricultural community of predominantly Latinx adolescents.

METHODS

In a prospective cohort study of 599 eighth graders recruited from middle schools in Salinas, California (2015-2019), participants completed five interviews over 2 years. Social environment measures included neighborhood social dynamics (neighborhood disorder, social cohesion, and social network gang exposure); experiences of discrimination; and school connectedness. We estimated associations between baseline social environment and early sexual initiation (<15 years) using Poisson regression with robust standard errors. We compared contraceptive self-efficacy and attitudes by sexual initiation status using ANOVA.

RESULTS

Most youth were Latinx (94%) and age 13 (70%) at enrollment; 53% were female and 49% had a parent employed in agriculture. Additionally, 14% reported first vaginal sex before age 15. Neighborhood disorder (relative risk [RR], 1.13; 95% confidence interval [CI], 1.05-1.21), social network gang exposure (RR, 2.23; 95% CI, 1.49-3.33), and experiences of discrimination (RR, 1.67 [1-2 events versus none], 95% CI, 1.09-2.55; RR, 2.33 [3+ events versus none], 95% CI, 1.07-4.64) were associated with early sexual initiation. School connectedness was protective (RR, 0.44, 95% CI, 0.29-0.69). Youth who initiated sex before age 15 had more negative birth control attitudes and expressed lower motivation to use contraceptives.

CONCLUSIONS

Findings underscore opportunities to promote early adolescent sexual health through strengthening supportive and safe neighborhood environments with the promise of addressing disparities in unintended pregnancy and sexually transmitted infection rates in later adolescence.

Prevalence of first adolescent pregnancy and its associated factors in sub-Saharan Africa: A multi-country analysis

INTRODUCTION

In low-and middle-income countries, pregnancy-related complications are major causes of death for young women. This study aimed to determine the prevalence of first adolescent pregnancy and its associated factors in sub-Saharan Africa.

METHODS

We undertook a secondary analysis of cross-sectional data from Demographic and Health Surveys conducted in 32 sub-Saharan African countries between 2010 and 2018. We calculated the prevalence of first adolescent (aged 15 to 19 years) pregnancy in each country and examined associations between individual and contextual level factors and first adolescent pregnancy.

RESULTS

Among all adolescents, Congo experienced the highest prevalence of first adolescent pregnancy (44.3%) and Rwanda the lowest (7.2%). However, among adolescents who had ever had sex, the prevalence ranged from 36.5% in Rwanda to 75.6% in Chad. The odds of first adolescent pregnancy was higher with increasing age, working, being married/cohabiting, having primary education only, early sexual initiation, knowledge of contraceptives, no unmet need for contraception and poorest wealth quintile. By contrast, adolescents who lived in rural areas and in the West African sub-region had lower odds of first adolescent pregnancy.

CONCLUSION

The prevalence of adolescent pregnancy in sub-Saharan African countries is high. Understanding the predictors of first adolescent pregnancy can facilitate the development of effective social policies such as family planning and comprehensive sex and relationship education in sub-Saharan Africa and can help ensure healthy lives and promotion of well-being for adolescents and their families and communities.

Disordered eating behaviours and attitudes among adolescents in a middle-income country

PURPOSE

Adolescent-disordered eating behaviours and attitudes (DEBA) are noted to be increasing in prevalence internationally. The aim of this study was to explore the DEBAs among Jamaican adolescents and identify those adolescents most at risk.

METHODS

521 high school participants (females, n = 292), ages 11-19 years, completed measures assessing socio-demographic factors, self-esteem, symptoms of anxiety and depression, behavioural factors, and anthropometry. Weight-related behaviours and attitudes were explored using the Eating Attitudes Test (EAT-26).

RESULTS

Thirty-one percent of participants reported engaging in at least one disordered eating behaviour, with bingeing as the most common. Female participants had significantly higher mean body mass index (p < 0.01) and mean EAT-26 score (p < 0.05) compared to males. Adolescents with EAT-26 score ≥ 20 were more desirous of being thinner (p < 0.01) and having a lighter skin complexion (p < 0.05). A greater proportion of adolescents with an EAT-26 score ≥ 20 had engaged in self-harm (p < 0.05), had smoked cigarettes (p < 0.05), had been sexually active (p < 0.01), and gave a history of sexual abuse (p < 0.01). Adolescents with overweight/obesity reported higher use of chemical weight manipulation (laxatives, diuretics, and diet pills) (p = 0.01).

CONCLUSIONS

Our data are consistent with the global figures showing both male and female adolescents endorsing disordered eating behaviours and attitudes (DEBAs). While this study highlights weight and shape dissatisfaction and associated DEBAs, it also raises the concern of an association with skin bleaching and elevated EAT-26 scores among Jamaican adolescents.

LEVEL OF EVIDENCE

Level V: cross-sectional descriptive study.

Experiences of violence among adolescent girls and young women in Nairobi's informal settlements prior to scale-up of the DREAMS Partnership: Prevalence, severity and predictors

INTRODUCTION

We sought to estimate the prevalence, severity and identify predictors of violence among adolescent girls and young women (AGYW) in informal settlement areas of Nairobi, Kenya, selected for DREAMS (Determined Resilient Empowered AIDS-free, Mentored and Safe) investment.

METHODS

Data were collected from 1687 AGYW aged 10-14 years (n = 606) and 15-22 years (n = 1081), randomly selected from a general population census in Korogocho and Viwandani in 2017, as part of an impact evaluation of the "DREAMS" Partnership. For 10-14 year-olds, we measured violence experienced either in the past 6 months or ever using a different set of questions from those used for 15-22 year-olds. Among 15-22 year-olds we measured prevalence of violence, experienced in the past 12 months, using World Health Organization (WHO) definitions for violence typologies. Predictors of violence were identified using multivariable logit models.

RESULTS

Among 606 girls aged 10-14 years, about 54% and 7% ever experienced psychological and sexual violence, respectively. About 33%, 16% and 5% experienced psychological, physical and sexual violence in the past 6 months. The 10-14 year old girls who engaged in chores or activities for payment in the past 6 months, or whose family did not have enough food due to lack of money were at a greater risk for violence. Invitation to DREAMS and being a non-Christian were protective. Among 1081 AGYW aged 15-22 years, psychological violence was the most prevalent in the past year (33.1%), followed by physical violence (22.9%), and sexual violence (15.8%). About 7% experienced all three types of violence. Severe physical violence was more prevalent (13.8%) than moderate physical violence (9.2%). Among AGYW aged 15-22 years, being previously married/lived with partner, engaging in employment last month, food insecure were all risk factors for psychological violence. For physical violence, living in Viwandani and being a Muslim were protective; while being previously married or lived with a partner, or sleeping hungry at night during the past 4 weeks were risk factors. The odds of sexual violence were lower among AGYW aged 18-22 years and among Muslims. Engaging in sex and food insecurity increased chances for sexual violence.

CONCLUSIONS

Prevalence of recent violence among AGYW is high in this population. This calls for increased effort geared towards addressing drivers of violence as an early entry point of HIV prevention effort in this vulnerable group.

Why Too Soon? Early Initiation of Sexual Intercourse Among Adolescent Females in Ethiopia: Evidence from 2016 Ethiopian Demographic and Health Survey

BACKGROUND

Early sexual initiation - sexual activity that begun earlier than 18 years of age - is among risky sexual behaviors which may be associated with increased risks of adverse outcomes such as sexually transmitted infections (STIs), unwanted pregnancy and unsafe abortions. However, there is no nationally representative evidence on early initiation of sexual intercourse and its determinant factors among adolescent females in Ethiopia.

METHODS

Data were extracted from the 2016 Ethiopian Demographic and Health Survey (EDHS) to assess early initiation of sexual intercourse and factors contributing to it in adolescent females. The analysis included a weighted sample of 3881 adolescent females aged 15-19 years. A multivariable logistic regression analysis was conducted and the results were presented as adjusted odds ratio (AOR) at 95% confidence interval (CI), declaring statistical significance at a p-value <0.05 in all analyses.

RESULTS

About 1 in 5 (21.9%, 95% CI: 20.5%, 23.33%) adolescent females experienced early sexual debut. Administrative regions (Amhara, AOR = 2.3, 95% CI: 1.30, 4.09 and Gambella, AOR = 4.89, CI 95%: 1.08, 22.07), religion (Muslim, AOR = 1.76, 95% CI: 1.24, 2.49), substance use (e.g., ever chewed khat, AOR = 2.02, 95% CI: 1.47, 2.77, ever drunk alcohol, AOR = 1.83, 95% CI: 1.35, 2.48) and having no knowledge on family planning (AOR = 4.47, 95% CI: 2.22, 8.99) were found to have statistically significant association with early sexual debut in adolescent females. Whereas any levels of formal education decreased the odds of early sexual debut (primary, AOR = 0.44, 95% CI: 0.35, 0.56; secondary, AOR = 0.19, 95% CI: 0.13, 0.28, and higher, AOR= 0.31, 95% CI: 0.15, 0.63). Similarly, all categories of wealth indices as compared to the poorest were protective of early sexual initiation in adolescent females (AOR = 0.40-0.57) as was for education as compared to no education (AOR = 0.19-0.44).

CONCLUSION

A significant proportion of adolescent females initiate early sexual intercourse in Ethiopia and multifaceted factors appear to determine their early sexual experiences. Contextualized interventions including strengthening information, education and communication on adverse consequences of early sexual initiation in regions and improving contraceptive knowledge of teenagers will play a paramount role.

Early sexual debut and associated factors among secondary school students of central zone of Tigray, Northern Ethiopia, 2018

Introduction

Early sexual debut is common among young people and it has several sexual and reproductive health consequences. But, its burden and the associated factors leading to this behavior haven't received due attention. The main purpose of this study was to investigate the prevalence and associated factors of sexual debut in the preparatory and high school students of Aksum town.

Methods

A school-based quantitative cross-sectional study design was used for this research work. A total of 519 preparatory and high school regular students participated in the survey. The sample population was obtained by using a simple random sampling technique from each schooling proportion with their number of students. Data, that were collected using self administered questionnaires, were entered into EpiData 3.02 and analyzed in SPSS 22.0. Results were presented using frequencies, tables and graphs. Statistical significance was declared at a P-value <0.05.

Results

Of the total participants, 266 (51.3%) were males. The age of the participants ranged from 13 to 23 years with a mean age of 16.3 ± 1.47 years. Of the total participants, 137(26.2%) had sexual experience, among which 119 (87.5%) had an early sexual debut at an average age of 13.7 + 1.4 years. Factors that were found to be significantly associated with an early sexual debut were gender (AOR=3.41; 95% CI: 1.54, 6.99), residence (AOR=0.44; 95% CI: 0.27, 0.81), alcohol drinking (AOR=5.5; 95% CI: 2.2, 14.8), cigarette smoking (AOR=3.3; 95% CI: 2.3, 7.5), exposure to pornography, such as reading/seeing pornographic materials (AOR=7.4; 95% CI: 4.4, 11.78), living arrangement for educational purpose (AOR= 0.43; 95% CI: 0.13, 0.89), grade (AOR=0.38; 95% CI: 0.06, 0.68) and monthly living allowance (AOR=0.419; 95% CI: 0.2, 0.9).

Conclusion

A significant number of students reported early sexual debut. Gender, place of residence, alcohol drinking, cigarette smoking, exposure to pornography, grade and living arrangement for educational purpose and monthly living allowance were significant predictors of an early sexual debut.

Cultural factors influencing teenage pregnancy in Jamaica

A literature review was undertaken to identify key factors associated with teenage pregnancy in Jamaica. Using the PEN-3 cultural model, we first categorised these factors to develop a theoretical taxonomy that can be used to help health intervention planners to understand and address the phenomenon. Next, we examined the validity of this initial taxonomy by comparing it with cultural factors identified in semi-structured focus group discussions with Jamaican teenage mothers. Cultural factors identified in the initial literature review - such as parental interaction and control, the intergenerational transmission of teenage pregnancy and experiences of sexual abuse - were largely confirmed and built upon. Results highlight promising opportunities for health communication among young women in Jamaica with a focus on self-efficacy, resilience and positive cultural factors.

Adverse childhood experiences (ACEs) are associated with forced and very early sexual initiation among Black women accessing publicly funded STD clinics in Baltimore, MD

PURPOSE

To examine the association between adverse childhood experiences (ACEs) and early sexual initiation.

METHODS

We analyzed retrospective data of (n = 241) Black women recruited from public STD clinics in Baltimore, MD. Multinomial logistic and linear regression models estimated associations between ACEs and early sexual initiation; contextual variables at initiation were examined as mediators.

RESULTS

Twelve percent of our sample reported very early sexual initiation (11-12 years) and 29% reported early sexual initiation (13-14 years). Each additional ACE reported was associated with greater risk of very early sexual initiation (RRR = 1.49; 95%CI:1.23,1.80). Specifically, emotional abuse (RRR = 3.71; 95%CI:1.55,8.89), physical abuse (RRR = 9.45; 95%CI:3.56,25.12), sexual abuse (RRR = 8.60; 95%CI:3.29,22.51), witnessing maternal abuse (RRR = 5.56; 95%CI:2.13,14.52), and household substance misuse (RRR = 3.21; 95%CI:1.38,7.47) at or before the age of 18 were associated with very early sexual initiation. As for context of initiation, age at sexual initiation was younger if the man at initiation was a non-partner (ß = -0.88; 95%CI:-1.36,-0.40), was ≥3 years older (ß = -1.30; 95%CI:-1.82,-0.77), had pressured or forced sexual intitiation (ß = -1.09; 95%CI:-1.58,-0.59), and was under the influence of drugs/alcohol (ß = -0.97; 95%CI:-1.62,-0.32). Contextual variables at first sex, including being pressured or forced, and the man being ≥3 years older fully mediated the association between ACEs and early sexual initiation.

CONCLUSIONS

This study highlights the critical need to develop interventions that reduce the impact of ACEs on women's health and delay age at sexual initiation. Health education efforts are needed for clinicians and parents to identify and prevent childhood abuse and to identify and report sexual coercion and abuse for girls and adolescents.

"I Kept It to Myself": Young Jamaican Men Who Have Sex with Men's Experiences with Childhood Sexual Abuse and Sexual Assault

The prevalence of HIV is exceptionally high among Jamaican men who have sex with men (JMSM) compared to similar populations within the Caribbean. A noticeable gap in the literature is the impact of childhood sexual abuse (CSA) and sexual assault on the state of the epidemic among this population. This study focused on JMSM's experiences with CSA and sexual assault and how these domains relate to HIV prevention. We analyzed qualitative data from 20 semi-structured in-depth interviews and focus group discussions with 10 men. Common themes emerged that highlight the patterns and nature of the abuse, the characteristics of the perpetrators, and the ways in which participants engage agency and resiliency as a basis to reclaim personal power. These findings serve as a catalyst for understanding how experiences with CSA and sexual assault affect the lives of young JMSM; how those experiences may impact attitudes and behaviors regarding HIV testing, engagement in care; and have implications for shaping legal policy, clinical, and mental health services for JMSM survivors.

Pregnancy and early motherhood among adolescents in five East African countries: a multi-level analysis of risk and protective factors

BACKGROUND

Adolescent pregnancy remains a major challenge in both developed and developing countries. Early and unintended pregnancies among adolescents are associated with several adverse health, educational, social and economic outcomes. The aim of this study was to identify the contextual factors that influence adolescent pregnancy and early motherhood in five East African countries.

METHODS

We use DHS data from five East African countries to examine trends and risk factors associated with adolescent pregnancy. DHS surveys collect detailed information on individual and household characteristics, sexual behavior, contraception, and related reproductive behaviors. Our analysis focuses on a weighted subsample of adolescent's age 15-19 years (Kenya, 5820; Tanzania, 2904; Uganda, 4263; Malawi, 5263; Zambia, 3675). Multilevel logistic regression analysis was used to identify the net effects of individual, household and community level contextual variables on adolescent pregnancy after adjusting for potential confounders.

RESULTS

Adolescent pregnancy and early motherhood is common in the five countries, ranging from 18% among adolescents in Kenya (2014) to 29% in Malawi (2016) and Zambia (2014). Although all five countries experienced a decline in adolescent pregnancy since 1990, the declines have been largely inconsistent. More than half of the adolescent's most recent pregnancies and or births in these countries were unintended. The regression analysis found that educational attainment, age at first sex, household wealth, family structure and exposure to media were significantly associated with adolescent pregnancy in at least one of the five countries after adjusting for socio-demographic factors.

CONCLUSION

The study highlights the importance of considering multi-sectoral approaches to addressing adolescent pregnancy. Broader development programs that have positive impacts on girls educational and employment opportunities may potentially influence their agency and decision-making around if and when to have children. Likewise, policies and programs that promote access to and uptake of adolescent sexual and reproductive health services are required to reduce barriers to the use of adolescent Sexual and Reproductive Health (SRH) services.

The protective role of family structure for adolescent development in sub-Saharan Africa

Several studies have focused on the risk factors associated with adolescent developmental outcomes, but the literature on the role of protective factors at the family and community level for positive adolescent development is scarce, especially in sub-Saharan Africa (SSA). We hypothesize that ensuring a supportive environment for adolescents may result in delayed sexual debut for adolescents in SSA. The relationship between family structure and positive adolescent sexual behaviour, measured as delay in sexual debut, was examined using the bioecological theory framed by a risk and resilience perspective. We used nationally representative data on female and male adolescents (aged 15–17 years) from 12 countries in SSA. We modelled logistic regressions to test for associations between family structure and delayed sexual debut while controlling for other covariates in SSA. The majority (90%) of the young adults delayed sexual debut, and this delay varied by family structure. After controlling for other covariates, adolescents living with neither parent had lower odds of delaying sexual debut although results were only significant for males. Interaction terms with community socio-economic status showed an interaction between community education and males living with neither parent. Future studies must investigate the gender differentials in the relationship between family structure and delayed sexual debut among adolescents in SSA.

Comprehensive understanding of risk and protective factors related to adolescent pregnancy in low- and middle-income countries: A systematic review

Introduction

Adolescent pregnancy causes serious problems not only for girls, but also for their family, and society. This study aimed to understand factors related to adolescent pregnancy in low- and middle-income countries using a multilevel approach adopted by Bronfenbrenner's ecological model.

Methods

A total of 11,933 studies published in between 2000 and 2015 were identified in 4 databases. Based on inclusion criteria and risk of bias assessment, a total of 67 articles were retrieved for analysis.

Results

Thematic analysis revealed that early marriage, sexual risk behaviors, substance use, family experience of adolescent birth, peer pressure, and lack of sex education and health service increased the hazards of adolescent pregnancy. Communication with parents, school activities, community meetings, laws, and government policies protected adolescents from pregnancy.

Conclusions

Results of this study suggests that the background of adolescents and complex interactions among various factors should be considered for pregnancy. In future research, mixed-method that supplements the methodological weaknesses of previous studies is also recommended.

Birth Cohort Differences in Sexual Identity Development Milestones Among HIV-Negative Gay and Bisexual Men in the United States

The coming-out process for gay and bisexual men (GBM) involves crossing sexual identity development (SID) milestones: (1) self-awareness of sexual attraction to the same sex, (2) self-acceptance of an identity as gay or bisexual, (3) disclosure of this sexual identity to others, and (4) having sex with someone of the same sex. We examined trends in SID milestones by birth cohort in a 2015 U.S. national sample of GBM (n = 1,023). Birth cohort was independent of when men first felt sexually attracted to someone of the same sex (median age 11 to 12). However, with the exception of age of first same-sex attraction, older cohorts tended to pass other milestones at later ages than younger cohorts. Latent class analysis (LCA) of SID milestone patterns identified three subgroups. The majority (84%) began sexual identity development with same-sex attraction around the onset of puberty (i.e., around age 10) and progressed to self-identification, same-sex sexual activity, and coming out-in that order. The other two classes felt same-sex attraction during teen years (ages 12.5 to 18.0) but achieved the remaining SID milestones later in life. For 13% of men, this was during early adulthood; for 3% of men, this was in middle adulthood. Findings highlight the need to monitor ongoing generational differences in passing SID milestones.

Age at Sexual Initiation and Sexual and Health Risk Behaviors Among Jamaican Adolescents and Young Adults

Current policies limit access to sexual and reproductive health services for adolescents younger than 16 years in Jamaica. Using data from a national survey, we explored the relationship between age at sexual initiation and subsequent sexual risk behaviors in a random sample of 837 Jamaican adolescents and young adults aged 15-24 years. In the sample overall, 21.0% had not yet had sex. Among the 661 sexually active participants, the mean age at first sex was 14.7 years. High percentages of sexually active youth reported engaging in risk behaviors such as inconsistent condom use (58.8%), multiple sex partners (44.5%), and transactional sex (43.0%). Age of sexual initiation for males was unrelated to subsequent sexual risk behaviors. However, earlier sexual debut for females was associated with their number of partners during the preceding year. Findings underscore the potential benefits of access to sexual and reproductive education and services at earlier ages than current policies allow. Interventions before and during the period of sexual debut may reduce sexual risk for Jamaican adolescents and young adults.

AGE AT MENARCHE AND SEXUAL DEBUT AMONG YOUNG FILIPINO WOMEN

There has been a secular decline in age at menarche since the 19th century. Early-maturing women are more likely to have their sexual debut at a younger age, which in turn gives rise to a host of reproductive health and social problems. This study used data from five waves of National Demographic and Health Surveys conducted in the Philippines between 1993 and 2013 to examine the trends and socioeconomic differentials in age at menarche and sexual debut. The changing trend in age at menarche and sexual debut was examined across birth cohorts, and logistic regressions were used to identify the determinants of early sexual debut. In the Philippines, the mean and median ages at menarche declined from 13.2 years and 12.6 years, respectively, among young women born in 1973-1977, to 12.9 years and 12.3 years, respectively, among those born in 1993-1997. The proportion who had their sexual debut by age 20 increased from 41.2% for the 1968-1972 birth cohort to 53.4% for the 1988-1992 birth cohort. Filipino women with low education, from poor families and living in rural areas were more likely to have earlier sexual debut despite attaining menarche at a later age as compared with their higher educated counterparts, and those from wealthier families and urban areas. Logistic regression analysis showed that, besides marital status, women's education and age at menarche were important determinants of early sexual debut. However, ethnicity, place of residence and family wealth had no significant effects on age at menarche. An increasing proportion of young women were found to be having unprotected sexual debut and at a younger age, with health and social ramifications. Hence, apart from increasing the enrolment of girls in schools and discouraging teenage marriage, there is a need for social and health agencies to implement appropriate adolescent sexual and reproductive health programmes such as counselling and educational campaigns, as well as support services, to address sexual problems among the youth.

Does women's caste make a significant contribution to adolescent pregnancy in Nepal? A study of Dalit and non-Dalit adolescents and young adults in Rupandehi district

Background

Adolescent pregnancy is a public health concern worldwide. There are disparities in the occurrence of adolescence pregnancy in different social groups and settings; however, few studies have focused on the contribution of a woman’s caste in early pregnancy in Nepal. This study aimed to examine the association between caste and adolescent pregnancy; and investigate factors that influence this among women of Dalit and non-Dalit caste groups.

Methods

A cross sectional survey among 457 women, age between 14 and 24 years was carried out in Rupandehi district of Nepal. Bivariate and multivariate logistic regression analysis using a stepwise entry method was performed to assess the association of women’s caste, ethnicity and other socio-demographic and individual factors with early pregnancy.

Results

Over two thirds of the participants (69%) were pregnant during adolescence. The highest percentage of adolescent pregnancies were reported among women from Janajati groups (77%) and the lowest in Brahmin/Chhetri caste groups (45%); while 72.5% of women from Dalit caste groups reported adolescent pregnancy. When adjusted for demographic and individual variables, early pregnancy was less likely among women who were from Brahman/Chhetri (OR: 0.60; 95% CI: 0.30, 1.22) and Madhesi/Muslim (OR 0.56; 95% CI: 0.23, 1.36) compared to women from the Dalit caste, but multivariate regression analysis found none of these were statistically significant. Women who had secondary level education (OR: 0.34; 95% CI: 0.17, 0.65), had married after 17 years of age (OR: 0.02; 95% CI: 0.01, 0.14) and had attended fairs/clubs (OR: 0.40; CI: 0.21, 0.79) were significantly less likely to experience early age pregnancy. Women who drank alcohol (OR: 5.18; 95% CI: 1.02, 26.32) were significantly more likely to become pregnant during adolescence compared to women who did not drink alcohol.

Conclusions

Women’s caste had no direct contributory role in the early pregnancy of the sample. Education, age at marriage and individual behaviours were the key contributing factors. Reducing the number of adolescent pregnancies requires addressing the factors that lead to and perpetuate child marriage; keeping girls within education systems for longer; increase the knowledge and control of girls over their own reproductive health and planning; and actions that promote gender respect within relationships, decision-making and negotiation among both girls and boys.

Electronic supplementary material

The online version of this article (10.1186/s12905-018-0513-4) contains supplementary material, which is available to authorized users.

Impact of first sexual intercourse on the sexual and reproductive life of young people in a capital city of the Brazilian Northeast

This study aimed to analyze the repercussion of first sexual intercourse on the number of pregnancies and partners of teenagers with obstetric history in Teresina (PI), Brazil. This is a cross-sectional study with 464 young women selected by accidental sampling who gave birth at 15-19 years of age in the first four months of 2006 in six maternity hospitals of the municipality. Primary data was collected from May to December 2008 at the participants' homes after tracking them in the hospital medical records. The univariate and bivariate analysis were performed by descriptive statistics and Pearson's Correlation Coefficient Test or T-test, respectively. Tukey's post hoc test was used as post hoc test and significant variables on the bivariate analysis (p < 0.05) were also included in the multifactor analysis of variance model. Schooling (p < 0,001) and menarche's age (p < 0,001) influenced the age of first sexual intercourse and this, in turn, showed significant negative correlation (p < 0.01) with the number of partners and pregnancies of young women. Thus, the earlier the young women start sexual activity, the higher the number of pregnancies and sexual partners until the moment of their reproductive life. Thus, early first sexual intercourse had a negative repercussion on these variables.

Validation of the child and youth resilience measure among South African adolescents

Resilience is a dynamic, interactive process between resources that contribute to safeguarding a person and the adversities they experience. Within this promotional framework of resilience, this study sought to validate the Child and Youth Resilience Measure (CYRM-28) among a sample of South African adolescents (N = 1854). Confirmatory factor analysis supported a superior level of fit for a 24-item, three-factor model (i.e., individual/social, familial, and community/spiritual). Internal consistency and test-retest reliability estimates at a 12-month interval (N = 648) supported the reliability of the scales. Higher scores on the scales were associated with feeling more connected at school, greater parental monitoring perceptions, and lower sexual risk, confirming the convergent and criterion validity of the instrument. Partial discriminative power was evidenced based on selected scale distinctions according to age and sex groupings. Collectively, the findings suggest the 24-item CYRM is a valid and reliable self-report measure to assess the availability of resources associated with resilience in South African youth.

Perceptions of Adolescent Pregnancy Among Teenage Girls in Rakai, Uganda

The leading causes of death and disability among Ugandan female adolescents aged 15 to 19 years are pregnancy complications, unsafe abortions, and childbirth. Despite these statistics, our understanding of how girls perceive adolescent pregnancy is limited. This qualitative study explored the social and contextual factors shaping the perceptions of adolescent pregnancy and childbirth among a sample of 12 currently pregnant and 14 never pregnant girls living in the rural Rakai District of Uganda. Interviews were conducted to elicit perceived risk factors for pregnancy, associated community attitudes, and personal opinions on adolescent pregnancy. Findings indicate that notions of adolescent pregnancy are primarily influenced by perceptions of control over getting pregnant and readiness for childbearing. Premarital pregnancy was perceived as negative whereas postmarital pregnancy was regarded as positive. Greater understanding of the individual and contextual factors influencing perceptions can aid in development of salient, culturally appropriate policies and programs to mitigate unintended adolescent pregnancies.

EFFECT OF EARLY SEXUAL DEBUT ON HIGH SCHOOL COMPLETION IN SOUTH AFRICA

Early sexual debut is of major concern because it is a correlate for health and economic shocks experienced in adulthood. In South Africa, this concern has provided impetus for research directed at the HIV and AIDS epidemic, teenage pregnancy and the effect of adolescent sexual behaviour on persistence in school. Of interest to the present study is high school completion, which is a well-established empirical barometer of adult socioeconomic opportunities. Using data from the five waves of the Cape Area Panel Study (CAPS), this paper examines the association between sexual behaviours initiated in pre- and early adolescence and high school completion rates. The CAPS study is a longitudinal survey that was designed to investigate young people's (aged 14-22 years) educational attainment and sexual behaviours in Cape Town, South Africa. The sample was constituted from 3213 individuals who had initiated sex during their teenage years and the analysis was undertaken when the youngest cohort was aged 21, an age at which they should have completed high school if they were on time. Logistic regression models were fitted separately for males and females. Overall, the results reveal that early sexual debut is correlated with long-term negative educational outcomes. Individuals who experience early sexual debut are less likely to complete high school than their counterparts who make their sexual debut later on in life. This effect is worse for Africans, who also disproportionately have an earlier sexual debut than other race groups. Apart from race however, the findings also reinforce the effect of other demographic factors on high school completion, namely, place of residence and family socioeconomic status as measured by parental education and household income. Hence, early sexual debut adds another layer of inequality and worsens the plight of Africans, females, those living in rural areas and those who come from low-income families.

An intersectional approach for understanding the vulnerabilities of English-speaking heterosexual Caribbean youth to HIV/AIDS and sexually transmitted infections: Prevention and intervention strategies

Caribbean youth comprise about 30 percent of the English-speaking Caribbean population, and about 81,000 Caribbean and Latin American youth are HIV infected. AIDS is the leading cause of death for 15- to 24-year-old English-speaking Caribbean youth. This article relies on intersectionality theory in the assessment of the macro-level, or structural variables, and micro-level, or individual level, variables that influence the risk-taking sexual behaviors of heterosexual English-speaking Caribbean youth and increase their vulnerability to HIV/sexually transmitted infections. This article offers macro- and micro-level prevention/intervention strategies for reducing the prevalence of sexually transmitted infections in English-speaking Caribbean youth, including the promotion of condom use, voluntary male circumcision, and HIV testing and counseling. Suggestions are offered for future research investigations to explore the contributing factors to youth's vulnerability to sexually transmitted infections and to empirically verify the relationship between and among variables that account for desired outcomes, including decreases in risky sexual behaviors.

The impact of armed conflict on adolescent transitions: a systematic review of quantitative research on age of sexual debut, first marriage and first birth in young women under the age of 20 years

Background

Young women in conflict-affected regions are at risk of a number of adverse outcomes as a result of violence, economic deterioration and the breakdown of community structures and services. This paper presents the findings of a systematic review of quantitative literature reporting how key sexual and reproductive health (SRH) outcomes among young women under the age of 20 years are affected by exposure to armed conflict; namely, sexual debut, first marriage and first birth. Increases in these outcomes among young women are all associated with potential negative public health consequences. It also examines and documents possible causal pathways for any changes seen.

Methods

To fit with our inclusion criteria, all reviewed studies included outcomes for comparable populations not exposed to conflict either temporally or spatially. A total of 19 studies with results from 21 countries or territories met our inclusion criteria; seven presented findings on marriage, four on fertility and eight on both of these outcomes. Only one study reporting on sexual debut met our criteria.

Results

Findings show clear evidence of both declines and increases in marriage and childbirth among young women in a range of conflict-affected settings. Several studies that showed increases in marriage below the age of 20 years reported that such increases were concentrated in the younger teenagers. Trends in fertility were predominantly driven by marriage patterns. Suggested causal pathways for the changes observed could be grouped into three categories: involuntary, gender and psycho-social and economic and material factors.

Conclusion

The review reveals a paucity of literature on the impact of conflict on SRH outcomes of young women. Further quantitative and qualitative studies are needed to explore how conflict influences SRH events in young women over both the short- and longer-term.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-016-2868-5) contains supplementary material, which is available to authorized users.

Early Sexual Debut: A Risk Factor for STIs/HIV Acquisition Among a Nationally Representative Sample of Adults in Nepal

While early sexual debut is highly prevalent in Nepal, its link to sexually transmitted infections (STIs/HIV) risk factors has not been explored at a national level. The objective of this study was to assess potential association between early sexual debut and risk factors for STIs/HIV acquisition, including sexual risk behaviors, sexual violence, and teenage pregnancy among adults in Nepal. Data were taken from the nationally representative Nepal Demographic Health Survey (2011), which employed a two-stage complex design to collect data. A sample of 12,756 adults (ages 15-49 years) were included. Multivariate logistic models were conducted, adjusted for demographic characteristics, to assess the association between early sexual debut and STIs/HIV-related risk factors. The prevalence of early sexual debut in this sample was 39.2%, with a mean age of coital debut at 17.9 years. After adjusting for potential confounders, individuals with early sexual debut were significantly more likely to report a history of STIs (aOR 1.19; 95% CI 1.06-1.35) and had a significantly higher risk profile, including having multiple sex partner (aOR 2.14; 95% CI 1.86-2.47), inconsistent condom use (aOR 0.72; 95% CI 0.61-0.86), paid for sex (aOR 1.61; 95% CI 1.14-2.27), a history of sexual violence (aOR 1.99; 95% CI 1.63-2.43), and teenage pregnancy (aOR 12.87; 95% CI 11.62-14.26). Individuals who have early sexual debut are more likely to engage in risk behaviors that place them at increased risk of STIs/HIV acquisition. STIs/HIV prevention strategies should aim at delaying sexual debut to decrease the disproportionate burden of adverse health outcomes, including STIs/HIV, among individuals in Nepal.

Effective dual method contraceptive use and HPV vaccination among U.S. adolescent and young adult females

BACKGROUND

Problem Behavior Theory posits that risky behaviors cluster in individuals, implying that protective behaviors may follow a similar pattern. The purpose of this study was to determine whether the protective behavior of effective dual method contraception use at first and most recent sexual intercourse is associated with HPV vaccination among adolescent and young adult females.

METHODS

National Survey of Family Growth (2006-2010) data were used to examine the association between women's contraception use during first and most recent sexual intercourse and HPV vaccination. Women aged 15 to 24 years (n = 1,820) served as the study sample.

FINDINGS

At first and last sexual intercourse, effective dual method contraception use was reported by 15.3% and 16.8% women, respectively; 27.8% reported receiving at least one dose of the human papillomavirus (HPV) vaccine. Higher HPV vaccination rates were observed among dual method users at first and last sexual intercourse (36.4% and 48.2%, respectively). This trend was also observed across age groups (15-19 year olds vs. 20-24 year olds). In adjusted models, among all respondents, dual users at last sexual intercourse were significantly more likely to be vaccinated, whereas at first sexual intercourse only younger dual users were more likely to report HPV vaccination.

CONCLUSIONS

Findings suggest that the protective behavior of dual method contraceptive use at first and most recent sexual intercourse may serve as a predictor of another complementary health behavior, HPV vaccination, particularly among adolescent females. More research is needed to understand behavioral clustering to design related multi-focused women's health interventions.

Gender-based violence against adolescent and young adult women in low- and middle-income countries

PURPOSE

Gender-based violence (GBV) is a global health and human rights issue with individual and social determinants. Youth are considered high risk; national influences include norms, policies and practices. By age, nation, and region, we contrast key GBV indicators, specifically intimate partner violence (IPV) and forced sexual debut among adolescent and young adult women using Demographic and Health Surveys across low- and middle-income countries.

METHODS

National prevalence estimates were generated among adolescents (15-19 years) and young adults (20-24 years) for lifetime and the past-year physical and sexual IPV among ever-married/cohabitating women (30 nations) and forced sexual debut among sexually experienced women (17 nations). Meta-analyses provided regional estimates and cross-national comparisons, and compared the past-year IPV prevalence among adolescent and young adult women to adult women.

RESULTS

An estimated 28% of adolescent and 29% of young adult women reported lifetime physical or sexual IPV, most prevalent in the East and Southern Africa region. Regional and cross-national variation emerged in patterns of violence by age; overall, young adult women demonstrated higher risk for the past-year IPV relative to adult women (meta-analysis odds ratio, 1.20; 95% confidence interval, 1.10-1.37) and adolescents had a comparable risk (meta-analysis odds ratio, 1.07; 95% confidence interval, .91-1.23). Forced sexual debut was estimated at 12% overall, highest in the East and Southern Africa region.

CONCLUSIONS

GBV is pervasive among adolescent and young adult women in low- and middle-income countries. The unique risk to youth varies across nations, suggesting an age-place interaction. Future research is needed to clarify contextual determinants of GBV. Findings provide direction for integrating youth within GBV prevention efforts.

Community Violence Exposure and Sexual Behaviors in a Nationally Representative Sample of Young Adults: The Effects of Race/Ethnicity and Gender

This study examined whether exposure to community violence was related to sexual risk behaviors in a nationally representative sample of young adults and if there were gender or racial/ethnic differences in these relationships. The analytic sample for this study was drawn from the National Longitudinal Study of Adolescent Health and was composed of 7,726 unmarried, heterosexual African American, Caucasian, and Hispanic/Latino young adults aged 18 to 27 years old. Approximately 12% of participants reported some community violence exposures, with men and African Americans reporting the highest rates of such exposures. Regression analyses controlling for age, gender, parental education, and family structure indicated that exposures to community violence were associated with earlier sexual debut history, a higher number of sexual partners within the previous 12 months, and a higher number of total sexual partners. Additionally, violence exposures had stronger effects for males and weaker effects for African Americans. Primary and secondary sexual risk prevention initiatives would need to consider how patterns of sexual risk behaviors may be related to exposure to community violence and how such relationships may differ based on gender and race/ethnicity. Future research should also seek to illuminate pathways connecting these 2 major public health concerns.

Early childbearing, human capital attainment and mortality risk: Evidence from a longitudinal demographic surveillance area in rural-KwaZulu-Natal, South Africa

Using a rich longitudinal dataset, we examine the relationship between teen fertility and both subsequent educational outcomes and HIV related mortality risk in rural South Africa. Human capital deficits among teen mothers are large and significant, with earlier births associated with greater deficits. In contrast to many other studies from developed countries, we find no clear evidence of selectivity into teen childbearing in either schooling trajectories or pre-fertility household characteristics. Enrolment rates among teen mothers only begin to drop in the period immediately preceding the birth and future teen mothers are not behind in their schooling relative to other girls. Older teen mothers and those further ahead in school for their age pre-birth are more likely to continue schooling after the birth. In addition to adolescents' higher biological vulnerability to HIV infection, pregnancy also appears to increase the risk of contracting HIV. Following women over an extended period, we document a higher HIV related mortality risk for teen mothers that cannot be explained by household characteristics in early adulthood. Controlling for age at sexual debut, we find that teen mothers report lower condom use and older partners than other sexually active adolescents.

Predictors of sexual risk behaviour among adolescents from welfare institutions in Malaysia: a cross sectional study

BACKGROUND

In welfare institutions, it is essential to address the health-related needs of adolescent populations who often engage in sexual activities. This study examines the association between individual and interpersonal factors concerning sexual risk behaviour (SRB) among adolescents in welfare institutions in Malaysia.

METHODS

Data were derived from a cross-sectional study of 1082 adolescents in 22 welfare institutions located across Peninsular Malaysia in 2009. Using supervised self-administered questionnaires, adolescents were asked to assess their self-esteem and to complete questions on pubertal onset, substance use, family structure, family connectedness, parental monitoring, and peer pressure. SRB was measured through scoring of five items: sexual initiation, age of sexual debut, number of sexual partners, condom use, and sex with high-risk partners. Multivariate logistic regression analysis was used to examine the various predictors of sexual risk behaviour.

RESULTS

The study showed that 55.1% (95%CI = 52.0-58.2) of the total sample was observed to practice sexual risk behaviours. Smoking was the strongest predictor of SRB among male adolescents (OR = 10.3, 95%CI = 1.25-83.9). Among females, high family connectedness (OR = 3.13, 95%CI = 1.64-5.95) seemed to predict the behaviour.

CONCLUSION

There were clear gender differences in predicting SRB. Thus, a gender-specific sexual and reproductive health intervention for institutionalised adolescents is recommended.

HIV prevalence and risk behaviours among foreign migrant women residing in Cape Town, South Africa

HIV prevalence and risk behaviour among foreign migrants in South Africa has not been explored. This paper describes the effectiveness of respondent-driven sampling (RDS) to recruit foreign migrant women residing in Cape Town, reports HIV prevalence, and describes key characteristics among them. We conducted a biological and behavioural surveillance survey using RDS. After written informed consent, participants completed an audio computer assisted self-interview and provided a dried blood sample for HIV analysis. HIV prevalence was estimated to be 7 % (CI 4.9-9.5) among 935 women. HIV sero-positivity was associated with older age (p = 0.001), country of origin (p < 0.000), being unmarried (p < 0.000), having lived in South Africa for 3-5 years (p = 0.023), sexual debut at ≥15 years (p = 0.047), and having used a condom at last sex with a main partner (p = 0.007). Few women reported early sexual debut, or multiple sexual partners. RDS was successful in recruiting foreign migrant women.

Association between abuse history and adolescent pregnancy: a meta-analysis

PURPOSE

Although a purported risk factor for early pregnancy is abuse history, the strength of this association has been inconsistent across studies and may vary as a function of abuse type. The purpose of this meta-analysis was to examine the extent to which sexual, physical, and emotional abuse, as well as neglect, increased the risk of adolescent pregnancy.

METHODS

A search of studies through MEDLINE, EMBASE, PsycINFO, Social Work Abstracts, and Web of Science was conducted. Studies were retained if they included (1) women who became pregnant before 20 years of age; (2) a comparison group of nonpregnant adolescents; and (3) abuse experience (<18 years of age).

RESULTS

Thirty-eight independent samples provided 70 estimates of effect sizes, derived from 75,390 participants. Both sexual and physical abuse were associated with an increased risk of adolescent pregnancy (odds ratio [OR], 2.06; 95% confidence interval [CI], 1.75-2.38 and OR, 1.48; CI, 1.24-1.76, respectively). The strongest effect was for the co-occurrence of sexual and physical abuse (OR, 3.83; CI, 2.96-4.97]). Nonsignificant effect sizes were found for emotional abuse (OR, 1.01; CI, .70-1.47) and neglect (OR, 1.29; CI, .77-2.17]), although these were moderated by journal impact factor, that is, greater effect sizes were reported in higher impact journals.

CONCLUSIONS

The results of this meta-analysis reveal that the strength of the association between abuse and adolescent pregnancy varies as a function of abuse subtype. Sexual and physical abuse were associated with increased risk for adolescent pregnancy, whereas emotional abuse and neglect were not.

Exploration of Social, Environmental, and Familial Influences on the Sexual Health Practices of Urban African American Adolescents

Despite efforts to examine social influences and provide interventions that lead to safer sexual practices for African American (AA) adolescent girls, statistics have demonstrated this population continues to have the highest rates of teen pregnancy and sexually transmitted infections (STIs) including HIV when compared with adolescent girls of other races. Guided by the principles of Black Feminist Thought and Photovoice and focus group methodology, this descriptive study aimed to discover the social realities influencing a group of eight AA adolescent girls aged 15 to 19 years. Data from individual interviews and a focus group session were collected from November 11, 2012, to February 1, 2013. Analysis of selected photographs, interviews, and focus group conversations through a feminist lens suggests AA adolescents of low socioeconomic status continue to foster racial and mental inferiority stereotypes by using their sexuality as a bargaining tool for acceptance, value, and even love.

Prevalence and risk factors for inter-generational sex: a cross-sectional cluster survey of Barbadian females aged 15-19

Background

The aim of this study was to establish the prevalence and risk factors for intergenerational (IG)-sex in females aged 15–19 residing in Barbados.

Methods

This cross sectional cluster survey was conducted in a 2.6% national sample in the age range (n = 261) recruited from multiple polling districts chosen with a probability proportional to size. Consent was obtained from participants aged ≥18 years or from parents/guardians of participants <18 years, with participant assent. The prevalence of age at first sex was analyzed using a life table approach and risk factors for IG sex (defined as sexual relations with a male 10 or more years older) were analyzed by logistic regression, adjusting for age.

Results

51.0% of adolescent females in the survey reported ever having had sex, among whom prevalence of IG-sex was 13.2% (95% CI: 6.7-19.8) at first sex, 29.0% (22.3-35.7) within the preceding twelve months, and 34.8% (24.3-45.4) ever. Condom use at first sex was positively related to willingness to have sex (F statistic = 9.8, p = 0.001). The strongest determinant for IG-sex was age of sexual debut (age adjusted Odds Ratio [95% CI]: 0.58[0.41-0.83]), followed by money or gifts received from the partner (2.91[1.17-7.23] and self-esteem (0.33[0.11-0.95]).

Conclusions

The survey establishes a high rate of IG-sex in Barbados, a ‘high income’ country. Most insightful is that risk of IG-sex nearly halved for every year at which first sex was delayed. A high proportion of coerced sex was reported at first sexual experience and this was linked to poor condom use. Affirmative prevention approaches are recommended to boost self-acclamation of adolescent women within less coercive relationships, especially during their first sexual encounter.

Demographic, psychosocial, and contextual factors associated with sexual risk behaviors among young sexual minority women

Young sexual minority women are at risk for negative sexual health outcomes, including sexually transmitted infections and unintended pregnancies, yet little is known about these risks. We examined factors that may influence sexual risk from a psychosocial and contextual perspective. Analyses were conducted to examine within group relationships between sexual behaviors, negative outcomes, and related factors in a sample of young sexual minority women. Participants (N = 131) were young (mean = 19.8) and diverse in terms of race/ethnicity (57% non-White). Sex under the influence, having multiple partners, and having unprotected sex were common behaviors, and pregnancy (20%) and sexually transmitted infection (12%) were common outcomes. Risk behaviors were associated with age, alcohol abuse, and older partners. Results support the need for further research to understand how these factors contribute to risk in order to target risk reduction programs for this population.

Entry into motherhood among adolescent girls in two informal settlements in Nairobi, Kenya

The contribution of adolescents' childbearing to total fertility rates in many sub-Saharan African countries is higher than in other parts of the world. In this paper, data collected from 897 female adolescents aged 15-19 years are analysed to investigate patterns and determinants of entry into motherhood in two informal settlements in Nairobi, Kenya, using Kaplan-Meier estimates and Cox regression models. About 15% of these adolescents have had a child. The findings show that marriage, being out of school and having negative models in peer, family and school contexts are associated with early childbearing among females aged 15-17 years. For adolescents aged 18-19 years, school attendance considerably delays entry into motherhood while marriage hastens its timing. Furthermore, older adolescents with high levels of social controls (parental monitoring or perceived peer orientation to or approval of prosocial behaviours) and individual controls (high religiosity and positive orientation to schooling) are likely to delay childbearing. Programmes aiming to reduce risky sexual behaviours that could lead to childbearing among adolescents should be introduced very early, and before the onset of sexual activity. Also, the findings underscore the need to identify and address the risky factors and reinforce the protective ones in order to improve sexual and reproductive health outcomes of adolescent girls in Nairobi slum settlements.

Early sexual debut and condom nonuse among adolescents in South Korea

BACKGROUND

The purpose of this study was to investigate the factors related to sexual debut among adolescents, and to examine the association between subject characteristics and condom nonuse among those who experienced sexual intercourse in South Korea.

METHODS

Data were obtained from the 2009 Korean Youth Risk Behaviour Survey, a nationally representative sample. Logistic regression analysis was conducted to investigate the factors related to sexual debut, associations of condom nonuse and subject characteristics.

RESULTS

Among male adolescents, age, early age at first emission, low academic achievement, living with a step-parent, perceived low level of household income, frequent drinking and smoking, and depressive feelings were associated with early sexual debut. Attending a coeducational school, living with a single biological parent and step-parent, risky health behaviour such as drinking and smoking, and depressive feelings were related risks factors for early sexual debut among female students. Factors associated with condom nonuse included early sexual debut (less than 16 years of age) (odds ratio (OR)=1.79, 95% confidence interval (CI)=1.32-2.43) and frequent smoking behaviour (OR=1.49, 95% CI=1.08-2.05) for males and early sexual debut (OR=4.37, 95% CI=1.02-18.68) and frequent drinking (OR=2.05, 95% CI=1.12-3.75) for females.

CONCLUSIONS

Appropriate interventions should be implemented for adolescents in Korea to delay sexual debut and educate them on the proper use of condoms.

Pre-marital sexual debut and its associated factors among in-school adolescents in Eastern Ethiopia

Background

More adolescents in Ethiopia are in school today than ever, but few studies have assessed the sexual behaviour of these learners. Thus, this study tried to assess pre-marital sexual debut and factors associated with it among in-school adolescents in Eastern Ethiopia.

Methods

A cross-sectional school-based study was conducted using a facilitator guided selfadministered questionnaire. Respondents were students attending regular school classes in fourteen high schools. The proportion of adolescents involved in pre-marital sexual debut and the mean age at sexual debut was computed. Factors associated with pre-marital sexual debut were assessed using bivariate and multivariable logistic regression.

Results

About one in four, 686 (24.8%) never married in-school adolescent respondents reported pre-marital sexual debut of these 28.8% were males and 14.7% were females (p < 0.001). Pre-marital sexual debut was more common among adolescents who had their parents in urban areas (Adjusted OR and [95% CI] =1.42 [1.17–1.73]), who received higher pocket money per month (Adjusted OR and [95% CI] = 1.56 [1.19–2.04]), who perceived low self-educational rank (Adjusted OR and [95% CI] =1.89 [1.07–3.34]) and who lived in rented houses (Adjusted OR and [95% CI] =1.32 [1.03–1.70]). The females and those who were less influenced by external pressure were more protected against pre-marital sexual debut (Adjusted OR and [95% CI] = 0.44 [0.35–0.56; 0.62 [0.52–0.74, respectively]) than their counterparts.

Conclusion

A significant proportion of in-school adolescents were engaged in sexual relationship. Thus, public health interventions should consider the broader determinants of premarital sexual debut, including the ecological factors in which the behavior occurs.

Protective and risk factors associated with adolescent sexual and reproductive health in the English-speaking Caribbean: a literature review

PURPOSE

To identify risk and protective factors associated with adolescent sexual and reproductive health (ASRH) in the English-speaking Caribbean through a structured literature review.

METHODS

Peer-reviewed articles published between January 1998 and December 2009 focused on the sexual and reproductive health of adolescents, aged 10-19 years, were included in this review. Articles were organized according to Bronfenbrenner's ecological systems theory. Research gaps were also identified.

RESULTS

A total of 30 studies assessed ASRH. At the individual level, gender, psychosocial well-being, and mental health were key factors associated with ASRH. Within the microsystem, the quality of the parent-adolescent relationship, the presence of violence, substance abuse or mental health problems in the family, and peer relationships were important determinants of ASRH. Within the macrosystem, cultural attitudes had an effect on youth's sexual behavior and generally, safer sex practices appear to be increasing. Within the chronosystem, a history of physical and sexual abuse was associated with several ASRH outcomes.

CONCLUSION

A research agenda that incorporates a multisystem approach and advocates for the inclusion of socially marginalized youth is needed to fully understand and adequately address ASRH in the Caribbean.

Sexual violence and associated factors among women in HIV discordant and concordant relationships in Uganda

HIV serodiscordance is a sexual partnership in which one partner is infected with HIV while the other is not. Managing emotional and sexual intimacy in HIV serodiscordant unions can be difficult due to concerns about HIV transmission and the challenge of initiating and maintaining safe sex. In situations where couples are jointly aware of their HIV status, women in serodiscordant unions may face increased risk of partner violence. We conducted an investigation to assess risk factors for HIV serodiscordance and determine if HIV serodiscordance is associated with incident sexual violence among a cohort of women attending HIV post-test club services at three AIDS Information Centers (AICs) in Uganda. Using a prospective study of 250 women, we elicited information about sexual violence using structured face-to-face interviews. Sexual violence and risk factors were assessed and compared among HIV positive women in HIV discordant unions, HIV negative women in discordant unions, and HIV negative women in negative concordant unions. Multivariable logistic regression was used to assess the association between participants' serostatus and sexual violence. HIV negative women in serodiscordant relationships (36.1±11.1 years, range: 19-65 years) were significantly older than either HIV positive women in serodiscordant relationships (32.2±9.0 years, range: 18-56 years), or HIV negative women in concordant relationships (32.3±11.0 years, range: 18-62), (p=0.033). Early age at sexual debut was associated with a 2.4-fold increased risk of experiencing sexual violence (OR 2.4, 95% CI 1.27-4.65). Based on unadjusted analysis, HIV positive women in discordant relationship were at highest risk for sexual violence compared to HIV negative women in discordant unions, and HIV negative women in negative concordant unions. HIV negative women in discordant relationships and those in concordant negative relationships showed no increased risk for sexual violence. However, couples' HIV serostatus was not significant related to incident sexual violence after controlling for potential confounding covariates. Nevertheless, the results were able to elucidate the sexual violence risk factor profile of participants based on couples' HIV serostatus. Couple counseling protocols at HIV voluntary counseling and testing centers in Uganda should identify those at risk for sexual violence and develop interventions to reduce its incidence.