Sexuality, contraception, and the media. Committee on Public Education

Sexual and reproductive health literacy among young people in Sub-Saharan Africa: evidence synthesis and implications

BACKGROUND

Sexual and reproductive health literacy is a key to attaining and maintaining sexual and reproductive health, especially among young people in low-income countries, such as sub-Saharan Africa. While the importance of sexual and reproductive health literacy is gaining wider recognition, studies on the topic have been mainly concentrated in high-income (developed) countries.

OBJECTIVE

The aim of this study was to provide a coherent summary and synthesis of the available evidence on sexual and reproductive health literacy among young people in sub-Saharan Africa, with implications for policy, interventions, and research.

METHODS

The review was conducted using the Joanna Briggs Institute's methodology for reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline to enhance the clarity and transparency of the reporting process. PubMed, CINAHL, AJOL, AIM, and Google Scholar were searched for evidence from 18 March to 20 May 2022.

RESULTS

The search provided 2,682 articles in total, of which only 24 met the eligibility criteria and were included in this review. The findings revealed persistent sexual and reproductive health information/knowledge gaps, poor sexual and reproductive health-related knowledge and practices, lack of exercising sexual and reproductive health knowledge, and multiple determinants of sexual and reproductive health literacy among young people, ranging from personal to larger structural conditions.

CONCLUSION

The review found that sexual and reproductive health literacy among young people in sub-Saharan Africa is concerning and has not been fully researched. A deeper understanding of the issue is essential for designing and implementing effective interventions to improve sexual and reproductive health literacy and health outcomes among young people.

Sexual-Related Knowledge, School and Family Sexuality Education and Its Association with Experience of Sexual Intercourse among Vocational Secondary School Students in China

Objectives: To investigate the associations between sexual-related knowledge, access to school and family sexuality education, and the experience of sexual intercourse, in order to make recommendations on sexuality education for vocational secondary school students in China. Methods: A cross-sectional study was conducted among 3180 vocational secondary school students in the Shanghai municipality and the Shaanxi province, China. Data were collected through an online, electronic questionnaire, which included socio-demographics, sexual-related knowledge, sources of information, and sexual-related behaviors. Results: The score on sexual-related knowledge among girls (53.8) is higher than that of boys (48.8), and that of participants from Shanghai (55.2) is higher than their counterparts from Shaanxi (47.6). The proportions of girls (70% and 41.7%, respectively) and participants from Shanghai (65% and 35.7%, respectively) who reported acquiring sexual information from their schools/teachers and parents are higher than that of boys (54.3% and 21.0%, respectively) and their counterparts from Shaanxi (59.7% and 27.4%, respectively). About 6% of participants had experienced sexual intercourse and 10% had watched porn actively. Experience of sexual intercourse was associated with higher sexual-related knowledge scores (OR = 1.01, 95% CI: 1.00–1.02) and active porn watching (OR = 2.63, 95% CI: 1.79–3.84) but was not associated with school and family sexuality education. Conclusions: Vocational secondary school students had poor sexual knowledge and inadequate school and family sexuality education. School and family-based comprehensive sexuality education should be promoted among vocational secondary school students.

Youths' Knowledge and Perceptions of Health Risks Associated With Unprotected Oral Sex

PURPOSE

Although rates of sexually transmitted infections (STIs) and human papillomavirus (HPV)-related head and neck cancers associated with oral sex are increasing, less than 10% of youths report using protection. This study aims to assess youths' knowledge and perceptions of oral sex risk and barriers to protection use.

METHODS

Our study uses MyVoice, a national text message poll of youths aged 14-24 years. Four open-ended probes were fielded to 1,215 youths in March 2019. Qualitative data were analyzed using thematic analysis and quantitative data were summarized with descriptive statistics.

RESULTS

Nine hundred and nine youths responded to the survey (relative risk [RR]=74.8%). Youths' responses regarding why protection is frequently not used centered around: lack of education (22.4%), no perceived STI risk (19.8%), decreased pleasure (19.3%), and no pregnancy risk (15.7%). Youths believed that comprehensive education (53.7%), normalization in popular culture and media (19.1%), increased access to protection (15%), and improved protection options (10.5%) would increase protection use during oral sex.

CONCLUSION

Youths demonstrated limited knowledge of the risks of oral sex, dissatisfaction with current protection options, and a need for normalization in popular culture. Programs developed with youths in mind may be able to successfully increase protection use and decrease rates of STI transmission and oral sex-related HPV head and neck cancer.VISUAL ABSTRACT.

Sexual health of very young adolescents in South Western Uganda: a cross-sectional assessment of sexual knowledge and behavior

BACKGROUND

In most Sub-Saharan African countries, little is known about young adolescents' sexual and reproductive health (SRH). Though some efforts have been made to understand and improve SRH of older adolescents, very young adolescents (VYAs) are often overlooked, and little is known about their sexual knowledge and behaviors. The goal of this study was to describe SRH knowledge, information-seeking, and sexual behavior of VYAs in Uganda.

METHODS

A cross-sectional survey was administered in 33 primary schools in June and July of 2016. Trained interviewers administered surveys to adolescents ages 10-14 regarding SRH knowledge, information-seeking, sexual behavior, and relevant covariates. Continuous variables were summarized as means (SD) or medians (IQR) whereas categorical variables were summarized as proportions (percentages).

RESULTS

A total of 1096 adolescents were included in this analysis, 81.8% of which were from rural areas, with a median age of 12. Regarding sexually transmitted infections (STIs) knowledge; 95% knew HIV while 37% knew other STIs apart from HIV. Although 47% knew at least one way in which HIV is acquired only 8% knew at least four ways. Regarding contraceptive knowledge, 56% mentioned at least one modern method of preventing pregnancy (condoms, pills, intrauterine devices, implants, or injections). The majority (85%) of VYAs reported accessing SRH information in the media with 35% reporting accessing media with sexual content while 10% vs 22% consulted their father or mother respectively and 31% a school source. At least 7.6% of VYAs had ever had sexual intercourse, 90% of which were not using any protection.

CONCLUSION

Comprehensive SRH knowledge was low among VYAs in this study. Media remains an important source of information for SRH for this age group though it may be misused as some adolescents reported accessing sexual content that may be inappropriate. A large proportion of sexually active VYAs reported sexual risky behaviors. This study highlights the need for an accurate and more comprehensive SRH education approach for VYAs in Uganda at an opportune age before the majority engage in sexual behavior.

"When You're a Baby You Don't Have Puberty": Understanding of Puberty and Human Reproduction in Late Childhood and Early Adolescence

Basic knowledge of human reproduction can help youth prepare for puberty and make later classes focused on advanced reproductive health topics manageable. With the intention of potentially informing the creation of learning materials, we conducted a needs assessment among children ages 7 to 12 in our suburban Chicago community to ascertain their current understanding of, and beliefs and misconceptions about, human reproduction, and to determine their needs for additional reproductive health education. We held qualitative focus group interviews with local children. Participants primarily reported learning about these topics from their parents prior to receiving school-based education in fifth grade. Their level of understanding was relatively low. They had little knowledge of internal sexual organs, expressed a range of beliefs about conception ranging from inaccurate to accurate but incomplete, and voiced concerns about transitioning into adolescence. This suggests a need for additional resources that provide comprehensible descriptions of reproductive health processes and mitigate puberty-related concerns.

The role of media literacy in shaping adolescents' understanding of and responses to sexual portrayals in mass media

This study was a theory-based, pretest-posttest quasi-experiment conducted in the field (N = 922) to determine whether and how a media literacy curriculum addressing sexual portrayals in the media would influence adolescents' decision-making processes regarding sex. Results of the evaluation, based on the Message Interpretation Process Model, indicated that participants who received media literacy training better understood that media influence teens' decision making about sex and were more likely to report that sexual depictions in the media are inaccurate and glamorized. In addition, participants who received media literacy lessons were more likely than were control group participants to believe that other teens practice abstinence and reported a greater ability to resist peer pressure. An interaction effect existed between gender and condition on attitudes toward abstinence, suggesting that the lessons helped girls and boys in somewhat different ways. Overall, the results indicated that media literacy strengthened key aspects of participants' logic-oriented decision-making process.

Tobacco, alcohol, and other risk behaviors in film: how well do MPAA ratings distinguish content?

To evaluate the usefulness of Motion Picture Association of America (MPAA) ratings for parental selection of appropriate films for children, the 100 top grossing movies each year from 1996 through 2004 (N = 900) were content analyzed to measure risk behaviors in each film. More restrictive MPAA ratings (R and PG-13) were associated with increased mean seconds of portrayals of tobacco use, alcohol use, and sexual content; increased frequency of violent content; and increased salience of drug use. MPAA ratings, however, did not clearly distinguish films based on tobacco or alcohol use. Fifty percent of R-rated movies contained 124 seconds or more of tobacco use, comparable with 26% of PG-13 and 17% of PG movies. Fifty percent of R-rated movies contained 162 seconds or more of alcohol use, comparable with 49% of PG-13 and 25% of PG movies. Because of the high degree of overlap in alcohol and tobacco content between rating categories, the MPAA rating system, as currently defined, is not adequate for parents who wish to limit their children's exposure to tobacco or alcohol content in movies.

Relationships, love and sexuality: what the Filipino teens think and feel

BACKGROUND

In order to achieve a change among teens' sexual behavior, an important step is to improve our knowledge about their opinions concerning relationships, love and sexuality.

METHODS

A questionnaire including topics on relationships, love and sexuality was distributed to a target population of 4,000 Filipino students from third year high school to third year college. Participants were obtained through multi-stage sampling of clusters of universities and schools. This paper concentrates on teens aged 13 to 18.

RESULTS

Students reported that they obtained information about love and sexuality mainly from friends. However, they valued parents' opinion more than friends'. They revealed few conversations with their parents on these topics. A majority of them would like to have more information, mainly about emotion-related topics. Almost half of respondents were not aware that condoms are not 100% effective in preventing STIs or pregnancies. More girls, compared to boys, were sensitive and opposed to several types of sexism. After adjusting for sex, age and institution, the belief of 100% condom effectiveness and the approval of pornography and sexism were associated with being sexually experienced.

CONCLUSION

There is room for further encouraging parents to talk more with their children about sexuality, specially aspects related to feelings and emotions in order to help them make better sexual choices. Indeed, teens wish to better communicate with their parents on these issues. Condoms are regarded as safer than what they really are by almost half of the participants of this study, and such incorrect knowledge seems to be associated with sexual initiation.

Translating research on healthy lifestyles for children: meeting the needs of diverse populations

This article provides two examples of approaches nursing can take to reach diverse populations of children and their families to enhance health lifestyles. First, a descriptive summary of a brief after-school intervention program aimed at influencing 8- and 9-year-old children's media habits and the prevention of negative health behaviors is presented. Design consideration for translating health lifestyles research findings into a nurse-managed inner city primary care practice is reviewed in the second example.

Effects of a peer-led media literacy curriculum on adolescents' knowledge and attitudes toward sexual behavior and media portrayals of sex

The United States has the highest rates of teenage pregnancy and birth in the Western industrialized world, and research indicates that television and other mass media are important sources of sexual information for young people. The purpose of this study was to determine if a teen-led, media literacy curriculum focused on sexual portrayals in the media would increase adolescents' awareness of media myths concerning sex, decrease the allure of sexualized portrayals, and decrease positive expectancies for sexual activity. A posttest-only quasi-experiment with control groups was conducted at 22 school and community sites in Washington state (N = 532). The intervention, a 5-lesson media literacy curriculum targeted primarily to middle school students, encouraged sexual abstinence because of federal government funding requirements. Adolescents evaluated the program positively, with 85% rating it as better than other sex education programs. Compared to control-group participants, students were less likely to overestimate sexual activity among teens, more likely to think they could delay sexual activity, less likely to expect social benefits from sexual activity, more aware of myths about sex, and less likely to consider sexual media imagery desirable. The results showed that media literacy has promise as part of a sex education program by providing adolescents with a cognitive framework necessary to understand and resist the influence of media on their decision making concerning sex.

Can media promote responsible sexual behaviors among adolescents and young adults?

PURPOSE OF REVIEW

The paper reviews the most recent US and non-US literature on media interventions designed to decrease sexual risk behaviors among adolescents and young adults, and their impact on youth's sexual knowledge, attitudes and behaviors. This review focuses on interventions using mass media, computers and the Internet.

RECENT FINDINGS

Recent research suggests that a variety of media sources and strategies that include mass media communication, computer-assisted instruction and the Internet can be used effectively for increasing knowledge and changing attitudes on sexual health issues and for promoting responsible sexual behaviors among young people. Media interventions seem to be more effective to achieve these goals when an array of channels are used simultaneously and when these efforts are sustained over time.

SUMMARY

Policymakers, school systems, parents and health providers need to be aware that media can be used effectively to decrease sexual risk behaviors in adolescents and young adults, especially when complemented with interpersonal strategies. These interventions can be implemented in different settings such as clinics, schools and colleges and even at a national level through large media campaigns.

Contraception in the Spanish press: an analysis of the 1997-2002 period

OBJECTIVE

Based on the hypothesis that the media represent an important source of information about contraceptive methods and sexuality, this paper reviews the news items about contraception published by four important Spanish newspapers and four women's magazines.

MATERIALS AND METHODS

All news items appearing from January 1, 1997 to December 31, 2002 in the following publications: El País, El Mundo, ABC, La Vanguardia, Mía, Clara, Ragazza, and Epoca were collected during the first 6 months of 2003. Results Seven hundred and ten news items about contraception were identified during the period analysed, of which 117 (16.5%) had a negative character.

CONCLUSIONS

Over 80% of news items appearing in the Spanish press in the 1997-2002 period give a positive information about contraceptive methods.

Media literacy for clinicians and parents

Families and children are in the midst of a media revolution. Television, Internet access, instant messaging, cell phones, and interactive video games are delivering more information for more hours than ever in history. Exposure is occurring at younger and younger ages, often without parental oversight or interpretation. The impact on children is just beginning to be studied. Does media exposure prepare children for the world in which they live or deprive them of critical developmental opportunities? Does the steady display of violence contribute to violent behavior? This article presents a developmental context, discusses the research conducted to date, reviews the recommendations of major organizations, and tries to take a balanced perspective in the midst of a rising tide of media, technology, commercialism, and controversy.

Barriers to asymptomatic screening and other STD services for adolescents and young adults: focus group discussions

Background

Sexually transmitted diseases (STDs) are a major public health problem among young people and can lead to the spread of HIV. Previous studies have primarily addressed barriers to STD care for symptomatic patients. The purpose of our study was to identify perceptions about existing barriers to and ideal services for STDs, especially asymptomatic screening, among young people in a southeastern community.

Methods

Eight focus group discussions including 53 White, African American, and Latino youth (age 14–24) were conducted.

Results

Perceived barriers to care included lack of knowledge of STDs and available services, cost, shame associated with seeking services, long clinic waiting times, discrimination, and urethral specimen collection methods. Perceived features of ideal STD services included locations close to familiar places, extended hours, and urine-based screening. Television was perceived as the most effective route of disseminating STD information.

Conclusions

Further research is warranted to evaluate improving convenience, efficiency, and privacy of existing services; adding urine-based screening and new services closer to neighborhoods; and using mass media to disseminate STD information as strategies to increase STD screening.

Controversies in adolescent hormonal contraception

Unintended pregnancy and abortion rates among US adolescents remain high although hormonal contraception is safe and effective in this population. Controversies affecting the provision of hormonal contraception for adolescents include the side effects of oral contraceptives, the possibility that progestin-only injectables lead to decreased bone health, and debate as to whether emergency contraception should be available to teens without a prescription. Each of these issues is addressed with a review of relevant literature.

Television exposure in children after a terrorist incident

This study examined the influence of bomb-related television viewing in the context of physical and emotional exposure on posttraumatic stress symptoms--intrusion, avoidance, and arousal--in middle school students following the 1995 Oklahoma City bombing. Over 2,000 middle school students in Oklahoma City were surveyed 7 weeks after the incident. The primary outcome measures were the total posttraumatic stress symptom score and symptom cluster scores at the time of assessment. Bomb-related television viewing in the aftermath of the disaster was extensive. Both emotional and television exposure were associated with posttraumatic stress at 7 weeks. Among children with no physical or emotional exposure, the degree of television exposure was directly related to posttraumatic stress symptomatology. These findings suggest that television viewing in the aftermath of a disaster may make a small contribution to subsequent posttraumatic stress symptomatology in children or that increased television viewing may be a sign of current distress and that it should be monitored. Future research should examine further whether early symptoms predict increased television viewing and/or whether television viewing predicts subsequent symptoms.