What do we know about sexual and reproductive health of adolescents in Europe?

Factors Associated With Parent-Adolescent Communication on Sexual and Reproductive Health Issues in Urban Slums of Ibadan, Southwest Nigeria

In Nigeria, adolescents in urban slums are increasingly at risk of adverse sexual and reproductive health (SRH) outcomes. However, little is known about how individual factors predict parent-adolescent communication on SRH issues in a resource-poor urban setting in Ibadan. Thus, this study investigated individual factors associated with parent-adolescent communication on SRH issues in urban slums of Ibadan, southwest, Nigeria. This study is part of a larger project that explores the socio-ecological factors influencing parent-adolescent communication on SRH issues in selected slums in Ibadan, Nigeria. Within this broader framework, this paper relies on the quantitative data obtained in 10 selected slums. Interviewer-administered structured questionnaire [scripted on open data kits (ODK)] was utilized to collect data from a sample of 796 parent-adolescent dyads. Six SRH topics were investigated to describe the issues discussed. Analytical techniques utilized include; frequency counts, chi-square, and multinomial logistic regression. Parent-adolescent communication regarding SRH issues is not uncommon in urban slums of Ibadan but characterized by indirect communication, threat and warning. Parents and adolescents' age, gender, marital/relationship status, educational attainments and religion played influential role in parent-adolescent communication regarding SRH issues. These factors were identified to be significantly associated with the pattern of parent-adolescent discussion of SRH issues. Age-specific SRH education should be available to adolescents and parents need to be educated on appropriate SRH information and the best way to engage their adolescents on SRH issues.

Effectiveness of Psycho-Religious Sexuality Education upon Anger and Depression of Iranian Female Adolescents: The Relationship of Quality Family Relationships and Birth Order

Sexually active adolescents tend to have a wider range of psychosocial problems, including depression, anger, poor academic achievement, low self-esteem, and substance use. Developing a high-quality and curriculum-based comprehensive sexuality education (CSE) program is of great importance for adolescents following Iranian culture. Due to the lack of such an educational program, the purpose of this study was to investigate the effectiveness of psycho-religious CSE upon anger and depression of Iranian female adolescents, as well as the relationship of quality family relationships and birth order. The research design is quasi-experimental with pre-test and post-test with experimental and control groups. The statistical population of this study comprised all Iranian female adolescents aged 15 to 18 years in Mashhad who participated in this workshop voluntarily. For data collection, the Child and Adolescent Depression Inventory and Spielberger's State-Trait Anger Expression Inventory (STAXI) were used. SPSS 21 software and analysis of variance (ANOVA) and covariance (ANCOVA) were used for data analysis. The results showed that there was a significant difference in the mean difference between depression and anger in the control and experimental groups (p-Value < 0.05). The results also showed a significant relationship between birth order and the quality of family relationships on depression and anger. Psycho-religious-based SE can reduce depression and anger in female students. These findings can be used in planning educational interventions with a psycho-religious-based approach to reducing anger, depressive symptoms and dangerous sexual behaviors among adolescents.

Factors associated with sexual intercourse initiation: a retrospective cohort of Lebanese adolescents in schools

OBJECTIVES

Early sexual initiation is known to be associated with deleterious health outcomes. The objective of this study was to evaluate factors (bullying, weight status, smoking and alcohol consumption, peer influence, relations with parents) associated with the initiation of sexual intercourse among Lebanese adolescents in schools.

METHODS

A retrospective cohort was formed using a convenient sampling of Lebanese students (n=1635) in private schools from Beirut and Mount Lebanon.

RESULTS

Younger age of adolescents at first sexual intercourse was significantly associated with finding it very easy to talk about things that worry them with an older brother, having a best friend who drinks sometimes compared to no drinking, and a best friend who smokes sometimes or every day compared to not smoking. Moreover, older age at the first sexual relationship was significantly associated with female gender (HRa=0.25), as was older age at first time drinking alcohol, first time getting drunk, and smoking cigarettes.

CONCLUSION

This study sheds light on some of the factors associated with age at first sexual intercourse in Lebanese adolescents.

Risky sexual behaviour among Russian adolescents: association with internalizing and externalizing symptoms

BACKGROUND

Risky sexual behaviour (RSB) is regarded as a major health problem during adolescence. Russia has one of the highest rates of teenage pregnancy, abortion and newly diagnosed HIV infections in the world, but research on RSB in Russian youth has been limited. To address this deficit, this study examined the role of several factors, including internalizing and externalizing symptoms, in RSB among Russian adolescents.

METHODS

Self-reported data were collected from 2573 Russian adolescents aged 13-17 years old (59.4 % girls; Mean age = 14.89) regarding RSB (unprotected sex, early pregnancy, multiple sexual partners and substance use during sexual encounters). Information was also obtained on externalizing (conduct problems and delinquent behaviour) and internalizing (depression, anxiety and posttraumatic stress) symptoms, as well as interpersonal risk and protective factors (affiliation with delinquent peers, parental involvement and teacher support). Hierarchical multiple binary logistic regression analysis was used to examine the associations between these variables and RSB.

RESULTS

Boys reported engaging in more RSB than girls. Externalizing symptoms and affiliation with delinquent peers were most strongly associated with RSB, whereas symptoms of anxiety were negatively associated with RSB. There was an interaction effect for sex and affiliation with delinquent peers on RSB with boys reporting RSB when having more delinquent peers. Neither parental involvement nor teacher support were protective against RSB.

CONCLUSIONS

Early detection of and interventions for RSB and associated externalizing symptoms may be important for adolescent physical and mental wellbeing. Affiliation with delinquent peers should, especially among boys, be regarded as a risk marker for RSB.

SECRET® - SExual Chronicle REcording Table: Validation and reliability

BACKGROUND

Recording the entire sexual history of a patient from the very first sexual experiences to the current sexual habits is a challenging issue that physicians usually address with partial and non-standardized interviews.

OBJECTIVES

To validate the SExual Chronicle REcording Table (SECRET^® ), a structured written interview, developed and copyrighted both in English and Italian languages.

MATERIALS AND METHODS

A multicenter national validation study was performed asking 300 male patients affected by uro-andrological diseases to complete SECRET^® . The structured interview is based on four sexual dimensions (masturbation, oral, vaginal and anal sex), declined in seven items (1.Have you ever performed/Do you perform; 2.At what age did you first experience; 3.How many times a month; 4.With how many partners; 5.How much did/do you enjoy; 6.How many times did/do you use a condom; 7.How many times did/do you use the pull-out method). Data were stratified according to four stages of life (<30; 30-45; 45-60; >60 years old). Validity and reliability were assessed by using standard statistical methods for SECRET^® validation.

RESULTS

Overall, 295 patients (98.4%) filled all the questions. SECRET^® showed a high level of internal coherence (Cronbach's alpha coefficient ranged from 0.85 to 0.97) and reproducibility (paired sample t-test at Test-Retest: p > .10).

CONCLUSIONS

SECRET^® represents a novel, simple instrument to record a patient's sexual history in daily clinical practice and clinical research. SECRET^® has shown a good validity, internal consistence and reliability in different clusters of patients with uro-andrological diseases.

Prevalence Rates of Sexual Behaviors, Condom Use, and Contraception Among Australian Heterosexual Adolescents

BACKGROUND

The development of effective health promotion practices and education programs to reduce rates of sexually transmitted infections and unintended pregnancy requires accurate, up-to-date information about young people's sexual behaviors.

AIMS

To provide prevalence rates on sexual behaviors and condom and contraceptive use for Australian year 10-12 heterosexual students in a nationally representative sample.

METHODS

A nationally representative sample of 2,301 male and 2,055 female year 10 through 12 heterosexual students were recruited to an online survey about their lifetime sexual behaviors and condom and contraceptive use. Means and 95% confidence intervals of weighted data, based on the national census, were reported.

OUTCOMES

The main outcomes of this study were prevalence of sexual behaviors by gender (excluding trans and gender diverse) and prevalence of contraception and condom use among sexually active students by gender.

RESULTS

The most common sexual behavior was masturbation (96.3% of male students, 78.9% of female students), and the least common behavior was anal or vaginal sex (43.7% of male students, 48.5% of female students). Of the sexually active students, condoms were used by 78.1% of male students and 77.5% of female students at first sexual experience and by 65.1% of male students and 56.8% of female students at their most recent sexual experience, whereas 91.6% of male students and 92.3% of female students used some form of contraception at most recent sexual experience.

CLINICAL TRANSLATION

Results provide up-to-date information on the practices clinicians who are likely to encounter with heterosexual cisgender adolescent populations in Australia.

STRENGTHS & LIMITAITONS

The study represents the largest representative cohort of adolescents in Australia to date. However, comparisons with previous representative studies were limited owing to differing samples by age and culture.

CONCLUSIONS

Compared with earlier Australian studies, young heterosexual cisgender people today engage in slightly less oral and penetrative sexual behaviors, with the exception of more women receiving oral sex, and are generally consistent in condom and contraceptive use. Fisher CM, Kauer S, Mikolajczak G, et al. Prevalence Rates of Sexual Behaviors, Condom Use, and Contraception Among Australian Heterosexual Adolescents. J Sex Med 2020;17:2313-2321.

Prevalence of sexual experience among Korean adolescent: age-period-cohort analysis

OBJECTIVES

Since exposure to sexual content and early sexual initiation among adolescents have become serious social issues in Korea, an in-depth analysis of trends in the prevalence of sexual experience among Korean adolescents is necessary to project the trends and policies required for the next 10 years. The objective of this study was to identify the contributions of age, period, and birth cohort effects on the prevalence of sexual experience in Korean adolescents.

METHODS

We analyzed age-specific, period-specific, and birth cohort–specific trends in the prevalence of sexual experience among 911,502 adolescents (469,593 boys, 51.5%; 441,909 girls, 48.5%) aged 12 years to 17 years from the 2006 to 2017 Korean Youth Risk Behavior Web-based Survey. Joinpoint regression analysis was conducted to examine significant changes in the prevalence of sexual experience and to find the optimal number and location of places where trends changed.

RESULTS

The prevalence of sexual experience generally increased with age in all periods in both boys and girls. In boys, the prevalence of sexual experience increased in recent periods, especially in the age group of 12-13 years, while the prevalence of sexual experience decreased in the age group of 16-17 years. In girls, the age group of 12-13 years showed an increased prevalence of sexual experience in recent periods. However, the prevalence showed a decreasing trend in the age group of 16-17 years.

CONCLUSIONS

In boys and girls, sexual experience increased with age, although this tendency has slowed in recent cohorts. Therefore, early sex education is needed.

Socio-demographic factors of early sexual debut and depression among adolescents

Background

Adolescent early sexual debut as it relates with socio-demographic factors and depression of secondary school adolescents. During the adolescent stage, attitudes, values and behaviours that shape a young person's behavior in the future develop. Age of sexual debut is generally low, yet there is dearth of knowledge on sexuality in the area of this study-Nsukka Education zone of Enugu State, Nigeria.

Objective

To determine the socio-demographic factors of early sexual debut and depression among adolescents in secondary schools in Nsukka Education zone of Enugu state, Nigeria.

Materials and methods

A cross-sectional longitudinal study of 408 secondary school adolescents in Nsukka Education zone of Enugu state, Nigeria during the 2016/2017 school year. Data was collected using pre-tested, observation schedule, structured interview and well-structured questionnaire. Tests of statistical significance were carried out using chi-square and t-tests. A p value of < 0.005 was found to be significant.”

Results

The age group at which respondents had their first sexual intercourse ranged between 13 to 19 years, the mean ages are 12.1±1.2 and 14.5±1.5 for males and females, while the modal and median ages at first sexual intercourse for male and female are 14 and 13 years respectively with a cumulative frequency percent of 56.5. The girls-initiated sex earlier than the boys (p= 0.001). Those brought up by one parent-initiated sex at an earlier age (p= 0.000), while age of sex initiation increased with maternal (p=0.000) and paternal education (p= 0.001). Depressed adolescent boys and girls were more likely than their non-depressed peers to have experienced sexual intercourse. The youngest adolescents who were depressed were more likely to have experienced intercourse than the older ones who were not depressed. Respondents sharing room with parents or adult relations of opposite sex were found to have initiated sex earlier than those staying alone or sharing room with same sex peers.

Conclusion

Age at sexual debut was found to be associated with younger age, gender, living with a one parent and parents' educational status.

Psychopathology is associated with reproductive health risk in European adolescents

Background

Reproductive and mental health are key domains of adolescent wellbeing but possible interrelationships are poorly understood. This cross-sectional study evaluated the association between psychopathology and reproductive health risk among European adolescents.

Methods

A structured self-report questionnaire was delivered to 12,395 pupils of 179 randomly selected schools in 11 European countries within the EU funded “Saving and Empowering Young Lives in Europe” (SEYLE) project. The questionnaire included items about sexual initiation and reproductive health risk factors, such as number of sexual partners, frequency of condom use, and pregnancy involvement. Psychopathology was evaluated with validated instruments and/or ad-hoc questions.

Results

Of 11,406 respondents (median age 15; interquartile range [IQR] 14–15; 57% females), 18.8% reported sexual initiation. Sixty percent of them also reported at least one reproductive risk factor. Sexual initiation was significantly more common among pupils older than 15 years (38% versus 13.2% younger pupils) and males (21.3% versus 16.9% females). It was also more common among pupils with depression (age/sex-adjusted odds ratio [aOR] 1.871), anxiety (aOR 2.190), severe suicidal ideation (aOR 2.259), self-injurious behaviour (aOR 2.892), and suicide attempts (aOR 3.091). These associations were particularly strong among pupils ≤15 years old and, for overt psychopathology, among pupils with low non-sexual risk behaviour profile and females. Depression (aOR 1.937), anxiety (aOR 2.282), severe suicidal ideation (aOR 2.354), self-injurious behaviour (aOR 3.022), and suicide attempts (aOR 3.284) were associated with higher reproductive health risk, defined by an increasing number of coexisting reproductive risk factors.

Conclusions

These findings suggest an alignment between mental and reproductive health risk and support the value of cross-domain collaboration in adolescent health. The association between psychopathology and reproductive health risk, as well as its variations with age, sex, and associated risk behaviours, should be considered when designing health-promoting or disease-preventing interventions for adolescents.

Ecological study on the use of hormonal contraception, abortions and births among teenagers in the Nordic countries

OBJECTIVES

Compare hormonal contraceptive use, birth and abortion rates among teenagers in the Nordic countries. A secondary aim was to explore plausible explanations for possible differences between countries.

DESIGN

Ecological study using national registry data concerning births and abortions among all women aged 15-19 years residing in Denmark, Finland, Iceland, Norway and Sweden 2008-2015. Age-specific data on prescriptions for hormonal contraceptives for the period 2008-2015 were obtained from national databases in Denmark, Norway and Sweden.

SETTING

Denmark, Finland, Iceland, Norway and Sweden.

PARTICIPANTS

Women 15-19 years old in all Nordic countries (749 709) and 13-19 years old in Denmark, Norway and Sweden (815 044).

RESULTS

Both annual birth rates and abortion rates fell in all the Nordic countries during the study period. The highest user rate of hormonal contraceptives among 15-19-year-olds was observed in Denmark (from 51% to 47%) followed by Sweden (from 39% to 42%) and Norway (from 37% to 41%). Combined oral contraceptives were the most commonly used methods in all countries. The use of long-acting reversible contraceptives (LARC), implants and the levonorgestrel-releasing intrauterine systems, were increasing, especially in Sweden and Norway. In the subgroup of 18-19-year-old teenagers, the user rates of hormonal contraceptives varied between 63% and 61% in Denmark, 56% and 61% in Norway and 54% and 56% in Sweden. In the same subgroup, the steepest increase of LARC was seen, from 2% to 6% in Denmark, 2% to 9% in Norway and 7% to 17% in Sweden.

CONCLUSIONS

Birth and abortion rates continuously declined in the Nordic countries among teenagers. There was a high user rate of hormonal contraceptives, with an increase in the use of LARC especially among the oldest teenagers.

Emergency contraception in adolescents. A grey area in Italian legislation

OBJECTIVE

To explore Italian legislation and the social climate regarding the issue of emergency contraception (EC) in adolescents.

RESULTS

In recent years, in Italy, we have seen changes in the law and in attitudes towards EC. Since 2016, EC has been approved for sale as a non-prescription drug to women over the age of 18. However, the requirement for a prescription is still in force for women under 18. This raises questions such as the minor's ability to consent to family planning services to prevent pregnancy, and whether physicians require parental consent before providing an EC prescription to minors. This article explores these issues within the social and legislative context of adolescent reproductive health care, demonstrating a need for EC among Italian adolescents.

CONCLUSION

Making EC difficult for minors to access seems to respond to a political stance that clashes with existing social needs and with medical evidence that shows that EC is safe and reliable for use in adolescents, and that the increased use of EC has no negative effects on regular, ongoing contraceptive use or encourages risky sexual behaviour. Future interventions by Italian policy-makers should target these themes in order to make EC easily available to adolescents throughout the country.

Sexual intercourse, age of initiation and contraception among adolescents in Ireland: findings from the Health Behaviour in School-aged Children (HBSC) Ireland study

Background

The need to tackle sexual health problems and promote positive sexual health has been acknowledged in Irish health policy. Young people’s sexual behaviour however remains under-researched with limited national data available.

Methods

This study presents the first nationally representative and internationally comparable data on young people’s sexual health behaviours in Ireland. Self-complete questionnaire data were collected from 4494 schoolchildren aged 15–18 years as part of a broader examination of health behaviour and their context. The prevalence of sexual initiation, very early sexual initiation (< 14 years) and non-condom use at last intercourse are reported and used as outcomes in separate multilevel logistic regression models examining associations between sociodemographic characteristics, lifestyle characteristics and young people’s sexual behaviours.

Results

Overall, 25.7% of boys and 21.2% of girls were sexually initiated. Older age was consistently predictive of initiation for both boys and girls, as were alcohol, tobacco and cannabis involvement, living in poorer neighbourhoods and having good communication with friends. Involvement in music and drama was protective. Very early sexual initiation (< 14 years) was reported by 22.8% of sexually initiated boys and 13.4% of sexually initiated girls, and was consistently associated with rural living, cannabis involvement and bullying others for both. Boys’ very early initiation was predicted by alcohol involvement, receiving unhealthy food from parents and taking medication for psychological symptoms, whereas better communication with friends and more experience of negative health symptoms were protective. Girls’ very early initiation was predicted by being bullied and belonging to a non-Traveller community, whereas taking medication for physical symptoms and attending regular health checks was protective. Condom use was reported by 80% of sexually initiated students at last intercourse. Boys’ condom use was associated with older age, higher family affluence, bullying others, more frequent physical activity and health protective behaviours. For girls, condom use was predicted by belonging to a non-Traveller community, healthy food consumption, higher quality of life and being bullied, whereas taking medication for physical and psychological symptoms was associated with non-condom use.

Conclusions

These nationally representative research findings highlight the importance of focusing on young people as a distinct population subgroup with unique influences on their sexual health requiring targeted interventions and policy.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5217-z) contains supplementary material, which is available to authorized users.

Awareness of HIV Transmission Risks and Determinants of Sexual Behaviour: Descriptive and Multivariate Analyses among German Nursing Students

BACKGROUND AND AIM

Nursing students play a crucial role in sexual health education. Evidence suggests, however, that nursing students had several gaps in their knowledge of HIV transmission. This study investigates how nursing students in Germany assess the potential risks of spreading HIV in defined situations and which factors influence the self-expressed sexual behaviour patterns of these students.

METHODS

A standardized anonymous questionnaire was administered to a sample (N=617) of nursing students in 2008 and 2013. The survey was conducted during lessons, resulting in a response rate of 100%.

RESULTS

For 17.4% of the students, assistance with personal hygiene was associated with higher HIV transmission risk. Also, changing dirty linen (17.6%) and physical examination (14.1%) were also noted similarly risky. The average age of first sexual intercourse was 15.5 years and the number of lifetime sexual partners was 4.3. The higher the average number of lifetime sexual partners, the higher the likelihood to use condoms only sometimes or never (OR 1.11). Forty students reported an unintended pregnancy. The likelihood to be unintentionally pregnant was six times higher among students aged 25 years or older (OR 6.16).

CONCLUSIONS

The results clearly show that students overestimated HIV transmission risks in most of the situations encountered during health services provided by nurses, but overall sexual health behaviour indicated rather less risky behaviour. Nonetheless, the relatively high rate of unintended pregnancies is quite concerning. The findings underline the need for stronger integration of HIV and sexual education in the curricula of nursing schools in Germany.

Italian Adolescents and Emergency Contraception: A Focus Group Study

STUDY OBJECTIVE

Using a qualitative method, the purpose of this study was to: (1) obtain information directly from the adolescents on their attitudes and knowledge regarding emergency contraception; and (2) investigate the presence of differences between male and female participants' attitudes and knowledge.

DESIGN AND PARTICIPANTS

This study consisted of 24 single-sex focus groups with 160 adolescents (male = 46.3% (74 of 160); female = 53.7% (86 of 160)) aged 15-19 years conducted among high schools in 3 regions of Italy.

RESULTS

Data were analyzed through thematic analysis taking into account gender differences and 2 main themes emerged. The first was labeled "Adolescents' attitudes toward emergency contraception" and it was divided into 3 subthemes: You should be aware; It's a life line; and Everything but a child. The second theme was labeled "Adolescents' knowledge toward emergency contraception" and it was divided into 3 subthemes: False myths; Baseline information; and Just take it.

CONCLUSION

Italian adolescents believed it is important to prevent the risk of unprotected sex by using contraceptive methods and their motivation to use emergency contraception is related to critical attitudes toward the consequences of irresponsible/ineffective contraception. Although adolescents have an awareness of emergency contraception, more comprehensive knowledge is needed. These findings can inform specific interventions aimed at educating adolescents in need of emergency contraception.

Prevention of unintended pregnancy and use of contraception-important factors for preconception care

Preservation of fertility and optimizing health before pregnancy is becoming increasingly important in societies where childbirth often is postponed. Research shows that as women postpone childbirth they achieve higher levels of education and higher incomes. This leads to advantages for their children and for society. However, as women postpone childbearing they are at risk for contracting conditions which may affect fertility and/or pregnancies, pregnancy outcome, and the newborn child. Preconception counseling is therefore becoming increasingly important. Women are often unaware of the added health benefits of contraception and have the right to be well informed so they can make decisions to fulfill their reproductive desires. Contraception can reduce the risk of unintended pregnancies, ectopic and molar pregnancies, and sexually transmitted infections. In addition, hormonal contraceptives reduce the risk of some types of cancer, dysmenorrhea, heavy menstrual bleeding, and anemia and are a treatment for endometriosis. Contraception should increasingly be looked upon as a means of preserving fertility and optimizing health status before a planned pregnancy. Thus, effective contraception can provide women with a possibility of achieving their long-term reproductive goals, although childbearing is actually postponed. The most effective contraceptive methods are the long-acting reversible contraceptives, which have been shown to be highly effective especially in young women who have difficulties with adherence to user-dependent methods. Therefore, these methods should increasingly be promoted in all age groups.

Factors Associated with Unwanted Pregnancy among Adolescents in Russia

STUDY OBJECTIVE

To identify social and behavioral factors associated with unintended pregnancy among adolescents in Russia.

DESIGN

Cross-sectional.

SETTING AND PARTICIPANTS

The investigation group consisted of 145 adolescents aged 15-19 years admitted to a youth-friendly clinic for induced abortion. The control group consisted of 77 sexually active never pregnant adolescent girls of similar age admitted for other reasons.

INTERVENTIONS

Both groups completed a self-administered questionnaire about their occupation, educational level of their mother, family structure and socioeconomic status, relationship with their mother, sexual behavior, and substance use.

MAIN OUTCOME MEASURES

Factors associated with unintended pregnancy.

RESULTS

In the bivariate analysis pregnant adolescents tended to have a lower educational level, to live in a nonintact family, to prefer stronger alcohol drinks, and to have a younger age at sexual debut and more frequent sexual intercourse. In the log-linear model six factors appeared to be directly linked to pregnancy: mother's lower education, alcohol consumption, nonintact family structure, low academic grades, higher frequency of sexual intercourse, and lower age at sexual debut.

CONCLUSION

Although the issue of unwanted pregnancy and possible ways to prevent it should be kept in mind in the psychosocial assessment of any adolescent, the results of our study suggest that some adolescents are at increased risk of unwanted pregnancy. This group includes adolescent girls with low educational attainment, living in a disrupted family, and reporting other risk behaviors. These adolescents might specially benefit from specific preventive programs to reduce the number of adverse outcomes.

Determinants and Correlates of Preventive Behaviors at First Sex With a First Partner and Second Partner: Analysis of the FECOND Study

PURPOSE

This study explores transitions in contraceptive use in early sexual life in France and has three objectives: describe predictors of contraceptive use at first sex with first and second partners, describe contraceptive trajectories in these partnerships, and test associations between use at first sex and switching in first partnership on use with second partner.

METHODS

Our analyses include 1,823 participants, aged 15-29 years, of the 2010 French national sexual health survey who reported at least two lifetime sexual partners and a subset of 1,593 people who report contraceptive use throughout their first partnership. We use logistic regression and generalized estimating equation models to investigate the three objectives.

RESULTS

Our results reveal a decline in contraceptive use between first and second partner, driven primarily by decreases in condom use, from 87.9% to 79.5% between first and second partner. This is partially offset by an increase in use of effective methods (from 7.8% to 38.1%), particularly by women. Any method use and discontinuation with first partner were predictors of patterns with second partner.

CONCLUSIONS

Analysis of early transitions in contraceptive use of adolescents in early sexual life reveals shifts from sexually transmitted infection to pregnancy prevention and an increase in unprotected sex.

Identifying Psychosocial Variables That Predict Safer Sex Intentions in Adolescents and Young Adults

Young people are especially vulnerable to sexually transmitted infections (STIs). The triad of deliberate and effective safer sex behavior encompasses condom use, combined with additional information about a partner's sexual health, and the kind of sex acts usually performed. To identify psychosocial predictors of young people's intentions to have safer sex, as related to this triad, we conducted an online study with 211 sexually active participants aged between 18 and 24 years. Predictors [i.e., perceived behavioral control (PBC), subjective norms, and intention] taken from Fishbein and Ajzen's Reasoned Action Approach (RAA), were combined with more distal variables (e.g., behavioral inhibition, sensation seeking, parental monitoring, and knowledge about STIs). Beyond the highly predictive power of RAA variables, additional variance was explained by the number of instances of unprotected sexual intercourse (SI) during the last 12 months and reasons for using barrier protection during first SI. In particular, past condom non-use behavior moderated PBC related to intended condom use. Further, various distal variables showed significant univariate associations with intentions related to the three behaviors of interest. It may, therefore, be helpful to include measures of past behavior as well as certain additional distal variables in future safer sex programs designed to promote health-sustaining sexual behavior.

Trends in Inequalities in the Use of Condom by Urban Teenagers in Spain

Social and economic inequalities in condom use by adolescents have been reported previously. Also, condom use has declined during the last decade. The aim of the study was to describe trends in the use of condoms in our setting, and how these trends may differ between socioeconomic groups in boys, and separately in girls, aged 17-19 years attending school in Barcelona between 2004 and 2012. We analyzed data from three annual surveys on risk factors in secondary students, which included a representative sample of the city's population; individuals who had previously had sexual intercourse (n = 1570) were included in the study. We calculated adjusted prevalence ratios (aPR) and their confidence intervals (95% CI) using robust Poisson regression models. The prevalence of condom use among boys was 87.0% in 2004 and 76.2% in 2012, and 76.7 and 64.7% among girls, respectively. This decrease was greater in adolescents with a low socioeconomic level, both in boys (aPR = 0.80) and girls (aPR = 0.84). The observed increase of socioeconomic inequalities in condom use in adolescents highlights a possible deterioration in good sexual practices and policies during the studied period.

Association between long-acting reversible contraceptive use, teenage pregnancy, and abortion rates in England

Background

Since the late 1990s, the British government has launched major strategies to address high teenage pregnancy and abortion rates in England. These have focused in part on improving access to contraception through national campaigns. This study assessed teenage pregnancy and abortion rate trends since 1998 and possible associations with usage of long-acting reversible contraceptives (LARCs).

Methods

Teenage conception rates and age-specific abortion rates were obtained from the Office for National Statistics and the Department of Health. LARC usage data was obtained for Depo-Provera, Implanon/Nexplanon, intrauterine devices, Mirena, and Noristerat from the IMS British Pharmaceutical Index, IMS Hospital Pharmacy Audit, IMS Disease Analyzer, and KT-31 reports. Through linear regression methods, changes in conception and abortion-related outcomes during 1998–2011 and the associations with LARC usage were assessed.

Results

Conception rates for girls younger than 18 years of age decreased significantly between 1998–2011, from 46.6 to 30.7 per 1,000 girls. A statistically significant association was observed between this decrease and increased LARC usage (P=0.0024) in this population. Abortion rates among females aged <18 years or aged 18–19 years decreased between 1998–2011, and their associations with increased LARC usage were statistically significant (P=0.0029 and P=0.0479, respectively). The pattern in older women was complex; abortion rates in women aged 20–24 years or 25–34 years increased slightly from 1998 to 2011, with stabilization during 2007–2011.

Conclusion

Increased LARC usage in England was significantly associated with decreased teenage pregnancy rates and abortion rates in females aged <20 years. Government strategies appears to have a positive impact on these outcomes; however, abortion rates among women over 20 years of age remain an issue.

Medical students as sexual health peer educators: who benefits more?

BACKGROUND

A prospective study was conducted to evaluate the impact of an educational reproductive health program on medical student peer educators and the secondary school pupils whom they taught.

METHODS

The Marseille School of Medicine and ten public secondary schools participated in the study. Medical students were recruited and trained as peer educators to promote sexual health in the secondary schools. The medical students and secondary school pupils were evaluated before and after education program. The main outcome measure was the sexual health knowledge score on a 20-item questionnaire (maximum score 20).

RESULTS

A total of 3350 students attended the peer-led course conducted by 107 medical students. The medical students' score increased significantly before and after the course (from 15.2 ± 1.8 to 18.3 ± 0.9; p < 0.001). The knowledge score of the pupils increased (from 7.8 ± 4 to 13.5 ± 4.4; p < 0.001). The girls' score was significantly higher than the boys' score after the course, but not before (14.5 ± 3.3 vs 12.5 ± 4.6; p < 0.001). Prior to the course, the score among the female medical students was significantly higher than that of the males. The overall knowledge increase was not significantly different between medical students and secondary school pupils (mean 3.1 ± 1 and 5.7 ± 4 respectively; p > 0.05).

CONCLUSIONS

The program was effective in increasing the knowledge of medical students as well as secondary school pupils. Male sexual health knowledge should be reinforced.

An exploration of pregnant teenagers' views of the future and their decisions to continue or terminate their pregnancy: implications for nursing care

AIMS AND OBJECTIVES

To explore teenagers' views of the future in relation to their choices to continue or terminate pregnancy.

BACKGROUND

Despite recent decreases in the numbers of teenage pregnancies, across the world, the teenage pregnancy rate remains high. Consideration of views of the future (future orientation) appears to play an important part in teenage girls' decisions to continue with pregnancy. To date, no study has explored this in teenage pregnant girls at the time they make their decision to continue with or terminate their pregnancy.

DESIGN

Cross-sectional mixed methods design.

METHODS

Three groups were included: termination of pregnancy (n = 19), antenatal (n = 9) and never pregnant (n = 23). Participants were 13-18 years old. The termination of pregnancy and antenatal groups were interviewed, and the never pregnant group completed postal questionnaires.

RESULTS

Groups differed in individual aspects of future orientation, that is, education, career and family, and reasons for pregnancy resolution choice. The termination group had more clearly developed and longer-term plans for the future with a focus on career. The never pregnant group shared aspects of their future orientation with both the antenatal and termination of pregnancy groups. The impact of negative discourses about teenage pregnancy from others was identified as a significant issue.

CONCLUSIONS

How pregnant teenage girls view the future has a relationship with their decision to terminate or continue with their pregnancy.

RELEVANCE TO CLINICAL PRACTICE

The findings suggest that working with teenage girls to clarify their views of the future may be useful both in preventing future unwanted pregnancy and in supporting teenagers in making pregnancy decisions. Supporting pregnant teenagers in distancing themselves from negative stereotypes of teenage mothers may also be beneficial.

Trends in adolescent sexual behavior, impact of information, and attitudes about HIV/AIDS in Portugal

There is a recent decline in HIV in a significant number of countries due to the adoption of preventive sexual behaviors, which demonstrates that HIV reduction is possible. The goal of this research was to deepen knowledge of preventive sexual behavior in adolescents, including knowledge and attitudes about HIV/AIDS, and assessing whether they changed from 2002 to 2010. Data were collected through a self-administered questionnaire from the Portuguese sample of the Health Behavior in School-aged Children, a collaborative WHO study. The study provided national representative data of 10,587 Portuguese adolescents attending 8th and 10th grade. In terms of preventive behaviors, results showed an increasing trend regarding the percentage reporting first sexual intercourse at 14 years old or more and condom use at last intercourse and a stabilized trend concerning having had intercourse, contraceptive pill use at last intercourse and having had intercourse under the influence of alcohol or drugs. Nevertheless, results showed a systematic decreasing trend in terms of knowledge and attitudes. This suggested that sex education programs are still too limited to teaching sessions, strongly homogenized in their content and inadequate to enhance knowledge and attitudes regarding HIV, let alone personal and social skills of different target groups.

[Sexual risk factors among European young people]

The sexual transmission of the human immunodeficiency virus (HIV) and other sexually transmitted infections (STI) in Europe are still rising. In order to prioritize STI prevention strategies in Europe, it is important to describe the prevalence of different sexual risk factors for STIs among European young people. We carried out a systematic review of published articles and studies performed by European institutions. A total of 21 articles and 10 studies were identified. The data shows an increase in early sexual initiation and the number of sexual partners. Young people who use condoms inconsistently ranged from 15 to 20%. The observed risk factors are: unawareness about other STIs different from HIV, being in favour of casual sex, wrongly believing that some measures are effective in avoiding HIV, not being aware of the risks from having multiple sexual partners and unawareness about the sexual transmission of HIV. The data suggests the need to improve the information addressed to youth.