Communication as a protective factor: evaluation of a life skills HIV/AIDS prevention program for Mexican elementary-school students

Patterns of Sexual Well-Being in Mexican Adolescents and Associations with Psychological Adjustment: A Latent Profile Analysis Approach

We examined Mexican adolescent sexual well-being tasks, defined as the positive cognitive and emotional evaluations of one's sexuality. We assessed three dimensions: acceptance of sexual desire, sexual decision-making involving mutual consent, and, when sexually active, the practice of safe sex. We utilized a person-centered approach to examine how patterns marked by different aspects of sexual well-being predict psychological adjustment. Participants were 1123 Mexican high or middle school (72%) students (54% girls; Mage = 15.1, SD = 1.52). We found a 6-profile model: 1) Average Sexual Health (40%); 2) High Protective Low Acceptance (20%); 3) Multidimensional Healthy (19%); 4) Multidimensional Risky (11%); 5) High Acceptance Low Contraception and Consent (6%); and 6) High Consent Low Contraception (4%). These profiles included some adolescents who experienced both low and high sexual scores on different sexual well-being indicators. For example, adolescents who belonged to the High Protective, Low Acceptance profile understood the importance of safe sex and mutual consent; but still felt sexual guilt. Profile membership was associated with gender, religion, age, and sexual experience. Adolescents in classes marked by high levels of well-being reported high levels of psychological adjustment. Findings may help educators develop more targeted sexual risk and violence prevention programs.

Psychological Resilience Level after Cognitive-Behavior Therapy in Old People with Empty Nest Syndrome - A single-case Experimental Design

OBJECTIVES

The aim of this study was to investigate the impact of Cognitive-Behavior Therapy (CBT) on resilience in old people with "empty nest syndrome."

METHODS

Three older adults with empty nest syndrome underwent CBT for 8 weeks in a single-case experimental design. Changes in resilience were tracked through measurements at baseline, intervention, and follow-up. Visual analysis as well as an effect size index of Percentage of Nonoverlapping Data (PND) were then analyzed.

RESULTS

CBT resulted in a significant increase in psychological resilience for all three participants across the intervention phase. Follow-up data showed that all subjects were able to maintain their resiliency four weeks after the intervention.

CONCLUSIONS

This single-case experimental study supports the hypothesis that CBT improves resiliency in old people with empty nest syndrome.

CLINICAL IMPLICATIONS

Cognitive Behavior Therapy is effective in increasing resiliency in old people with empty nest syndrome. The culture dynamics is an important component in the emergence and persistence of empty nest syndrome.

Interventions Promoting Child Sexual and Reproductive Health and Rights in LMICs: A Systematic Review

OBJECTIVE

Middle childhood is a critical period for physical, social, behavioral, and cognitive changes. A positive and healthy sexual and reproductive health and rights (SRHR) foundation can minimize SRHR risks, leading to better outcomes. Our objective is to identify effective educational interventions promoting or supporting the SRHR of school-age children in low and middle-income countries.

DATA SOURCES

Medline, Embase, CINAHL, APA PsycInfo, ERIC, Cochrane Central Register of Controlled Trials, Education Source, Web of Science, SciELO Citation Index, Global Health, and Sociological Abstract were searched from 2000 to December 2020.

STUDY SELECTION

Eligible articles had a sample mean age between 5 and 10 years, quantitatively tested the effects of educational interventions against a comparison group, and measured SRHR related outcomes.

DATA EXTRACTION

Data extracted from the 11 eligible articles were study methods, participant characteristics, interventions and comparisons, outcome measures, and results.

RESULTS

The review found evidence of significant intervention effects on protective knowledge, attitudes, behaviors, and skills for preventing sexual violence and HIV infection. The strongest evidence was for significant improvements in children's knowledge of child sexual abuse prevention concepts and strategies.

LIMITATIONS

A meta-analysis could not be performed because most studies lacked randomization, included no information on the magnitude of effects, and had inadequate follow-up evaluations to truly assess retention. Only a few studies contributed to findings on protective attitudes, behaviors, and skills against child sexual abuse, gender-based violence, and human immunodeficiency virus infection, as well as physiologic outcome.

CONCLUSIONS

The educational interventions demonstrated significant improvements in primary school children's protective capacities, especially in their protective knowledge against sexual abuse.

Three Decades of Research: The Case for Comprehensive Sex Education

PURPOSE

School-based sex education plays a vital role in the sexual health and well-being of young people. Little is known, however, about the effectiveness of efforts beyond pregnancy and sexually transmitted disease prevention. The authors conducted a systematic literature review of three decades of research on school-based programs to find evidence for the effectiveness of comprehensive sex education.

METHODS

Researchers searched the ERIC, PsycINFO, and MEDLINE. The research team identified papers meeting the systematic literature review criteria. Of 8,058 relevant articles, 218 met specific review criteria. More than 80% focused solely on pregnancy and disease prevention and were excluded, leaving 39. In the next phase, researchers expanded criteria to studies outside the U.S. to identify evidence reflecting the full range of topic areas. Eighty articles constituted the final review.

RESULTS

Outcomes include appreciation of sexual diversity, dating and intimate partner violence prevention, development of healthy relationships, prevention of child sex abuse, improved social/emotional learning, and increased media literacy. Substantial evidence supports sex education beginning in elementary school, that is scaffolded and of longer duration, as well as LGBTQ-inclusive education across the school curriculum and a social justice approach to healthy sexuality.

CONCLUSIONS

Review of the literature of the past three decades provides strong support for comprehensive sex education across a range of topics and grade levels. Results provide evidence for the effectiveness of approaches that address a broad definition of sexual health and take positive, affirming, inclusive approaches to human sexuality. Findings strengthen justification for the widespread adoption of the National Sex Education Standards.

Barriers to mother-adolescent communication about sex, maternal monitoring and sexual behaviour among adolescents in Mexico

Mexican mothers have an important role in adolescent sexuality; however, they report multiple barriers to parent-child sex communication, which may impact adolescent sexual behaviour. This cross-sectional study examines whether adolescent perceptions of maternal barriers to communication are associated with adolescent sexual behaviour frequency indirectly through its association with maternal monitoring, and whether these associations differ by age and gender. Mexican adolescents (N = 1433), ages 12-19 (53% girls), completed a survey on normative sexual behaviours, adolescent perceptions of maternal barriers to sex communication, and maternal monitoring. Structural equation modelling analyses revealed that more barriers to communication (adolescent perceptions) were associated with more sexual behaviour frequency (i.e., oral and vaginal sex) among Mexican adolescents indirectly through its association with maternal monitoring. Findings were stronger for adolescents in 8th grades, but no differences were found by gender. This model expands our understanding of the parenting factors that impact Mexican adolescent sexuality.

Impact of teachers training on HIV/AIDS education program among secondary school students in Bangladesh: A cross-sectional survey

BACKGROUND

In 2007, the Government of Bangladesh incorporated a chapter on HIV/AIDS into the national curriculum for an HIV-prevention program for school students. For the efficient dissemination of knowledge, an intervention was designed to train the teachers and equip them to educate on the topic of HIV/AIDS. The present study intended to understand the impact of this intervention by assessing the knowledge, attitudes and behaviours related to HIV/AIDS, among the targeted students.

METHODS

A cross-sectional survey was conducted with the students at randomly selected schools from two adjacent districts. Considering exposure to intervention, one district was assigned for intervention and the other as a control. In total, 1,381 students, aged 13-18 years (or above) were interviewed, 675 from the control areas and 706 from the intervention areas. Univariate and bivariate analyses were performed on the collected data.

RESULTS

A significantly higher proportion (p<0.001) of students in the intervention areas attended HIV/AIDS classes, demonstrated better knowledge and fewer misconceptions regarding the transmission and prevention of HIV. The same was derived regarding their attitude towards people living with HIV, as a higher proportion (p<0.001) responded positively, compared to the control groups of the study. Additionally, multinomial logistic regression analysis showed that students in intervention area were more likely to have good knowledge on HIV transmission (OR 2.71, 95% CI 1.74-4.22) and prevention (OR 2.15, 95% CI 1.41-3.26) compared to the students in the control areas.

CONCLUSIONS

The training programme needs to be scaled up, since it is likely to have an impact among students; we have witnessed that the interventions particularly helped increase HIV/AIDS knowledge among students and positively change the students' attitudes towards HIV/AIDS.

An Evaluation of the Effectiveness of School-Based Breastfeeding Education

School-based interventions aimed at modifying the knowledge, attitudes, social norms, and intended future practice regarding breastfeeding may be an effective way of improving breastfeeding rates. A systematic review of relevant literature was conducted to identify scientifically rigorous studies on school-based interventions and promotion activities that focus on breastfeeding. Of the 1990 citations reviewed, only 6 empirical articles on school-based interventions to promote breastfeeding were found and these interventions vary greatly in terms of format, duration, outcome measures, and significance of the results. Overall, these studies demonstrated positive effects on perceptions and attitudes toward breastfeeding and increased behavioral intention of breastfeeding later in life. School-based breastfeeding promotion programs hold promise for increasing knowledge of breastfeeding and support for breastfeeding, promoting positive attitudes, creating a culture where breastfeeding is the norm, and increasing future intentions to breastfeed.

Exposure to information and communication about HIV/AIDS and perceived credibility of information sources among young people in northern Tanzania

Young people in sub-Saharan Africa constitute an important group for HIV prevention efforts. Determining their exposure to HIV/AIDS information and communication and their perceived credibility of information sources is imperative to the development of interventions. However, the majority of studies on this topic have been conducted among school-based populations, with few focused on those out of school or on comparing the two groups. A structured face-to-face interview was completed by 993 young people out of school, between the ages of 13 and 18, in Kilimanjaro, Tanzania; additionally, the questionnaire was self-administered by 1 007 students attending either their last year of primary or first year of secondary school. Significant factors associated with the frequency of exposure to HIV/AIDS information and frequency of communication about HIV/AIDS included urban/rural location, sex, socio-economic status, and educational attainment. Both groups ranked the radio as the most frequent source of HIV/AIDS information. The in-school group reported significantly more frequent exposure to all sources of HIV/ AIDS information and they communicated more frequently about the topic than did the out-of-school group. Among both groups, exposure to HIV/AIDS information occurred more frequently than discussing the topic. The in-school group gave high credibility ratings to medical doctors, the radio and parents as sources of information, while the out-of-school group attributed the most credibility to the mass media. Irrespective of school attendance, the young people ranked friends, parents and doctors as preferred communicators of sexual and reproductive health information. Interventions that address the determinants of educational attainment are needed, as well as ones specifically intended to reach girls or those out of school. The preferences and credibility rankings for sources of HIV/AIDS information suggest the need for evidence-based programmes that utilise peers and promote the involvement of parents or doctors. Particularly needed are interventions that explicitly aim to stimulate discussion among young people about HIV/AIDS and that foster the development of interpersonal skills.

Protective factors and HIV risk behavior among South African men

The primary mode of HIV transmission in South Africa is heterosexual sexual behavior. HIV prevention research specifically focusing on men in South Africa is limited. We assessed self-reported HIV risk behaviors in 1,181 men ages 18 to 45 years in randomly selected neighborhoods in Eastern Cape Province, South Africa. Older men were less likely to report having multiple partners. Religiosity was a protective factor for condom use and unprotected sex with steady partners. Discussing using condoms was a protective factor for condom use and unprotected sex with both steady and casual partners. Having a child was associated with decreased condom use with steady partners and employment was associated with decreased condom use with casual partners. The findings suggest the need for HIV risk-reduction behavioral interventions tailored for South African men with regard to age, religiosity, and types of sexual partners. Implications for the development of such interventions are discussed.

School based sex education and HIV prevention in low- and middle-income countries: a systematic review and meta-analysis

OBJECTIVES

School-based sex education is a cornerstone of HIV prevention for adolescents who continue to bear a disproportionally high HIV burden globally. We systematically reviewed and meta-analyzed the existing evidence for school-based sex education interventions in low- and middle-income countries to determine the efficacy of these interventions in changing HIV-related knowledge and risk behaviors.

METHODS

We searched five electronic databases, PubMed, Embase, PsycInfo, CINAHL, and Sociological Abstracts, for eligible articles. We also conducted hand-searching of key journals and secondary reference searching of included articles to identify potential studies. Intervention effects were synthesized through random effects meta-analysis for five outcomes: HIV knowledge, self-efficacy, sexual debut, condom use, and number of sexual partners.

RESULTS

Of 6191 unique citations initially identified, 64 studies in 63 articles were included in the review. Nine interventions either focused exclusively on abstinence (abstinence-only) or emphasized abstinence (abstinence-plus), whereas the remaining 55 interventions provided comprehensive sex education. Thirty-three studies were able to be meta-analyzed across five HIV-related outcomes. Results from meta-analysis demonstrate that school-based sex education is an effective strategy for reducing HIV-related risk. Students who received school-based sex education interventions had significantly greater HIV knowledge (Hedges g = 0.63, 95% Confidence Interval (CI): 0.49-0.78, p<0.001), self-efficacy related to refusing sex or condom use (Hedges g = 0.25, 95% CI: 0.14-0.36, p<0.001), condom use (OR = 1.34, 95% CI: 1.18-1.52, p<0.001), fewer sexual partners (OR = 0.75, 95% CI:0.67-0.84, p<0.001) and less initiation of first sex during follow-up (OR = 0.66, 95% CI: 0.54-0.83, p<0.001).

CONCLUSIONS

The paucity of abstinence-only or abstinence-plus interventions identified during the review made comparisons between the predominant comprehensive and less common abstinence-focused programs difficult. Comprehensive school-based sex education interventions adapted from effective programs and those involving a range of school-based and community-based components had the largest impact on changing HIV-related behaviors.

HIV prevention among African American youth: how well have evidence-based interventions addressed key theoretical constructs?

Certain constructs are demonstrated in the research literature to be related to HIV risk behaviors among African American adolescents. This study examines how well these constructs are addressed in evidence-based interventions (EBIs) developed for this population. A literature review on variables for sexual risk behaviors among African American adolescents was undertaken. Simultaneously, a review was conducted of the contents of HIV-prevention EBIs. To facilitate comparison, findings from both were organized into constructs from prominent behavior change theories. Analysis showed that environmental conditions and perceived norms were frequently associated with sexual risk behaviors in the literature, while EBIs devoted considerable time to knowledge, skills, and self-efficacy. Findings imply that (a) EBIs might be complemented with activities that focus on important constructs identified in the literature and (b) researchers should better assess the relationship between skill development and HIV risk behaviors. Implications for practice and research are discussed.