The Association Between Sexual Initiation and Membership in Dyadic Profiles of Perceived Shared Power

There is scarce empirical evidence examining whether sexual initiation and power are associated with each other. Utilizing latent profile analyses, we examined in a nationally representative sample of US newlywed heterosexual couples (N = 1,948 couples) whether wives' and husbands' sexual initiation patterns and satisfaction with these patterns were associated with membership in different profiles of wives' and husbands' perceptions of shared relational power while accounting for both partner's satisfaction with sexual frequency. We found four profiles of wives' and husbands' perceptions of power. The most common profile was when both wives and husbands perceived high levels of power compared to other profiles, but wives had significantly higher reports of perceived power than husbands (High Power, Wife Higher; 40.8%). Husbands' sexual initiation patterns were not associated with profile membership. Wives who reported equal sexual initiation patterns had a higher probability of being in the High Power, Wife Higher profile compared to the Wife Low Power, Husband Moderate Power profile. Both wives' and husbands' satisfaction with sexual initiation patterns were associated with profile membership. Wives and husbands that were satisfied with sexual initiation patterns had a higher probability of being in the High Power, Wife Higher profile compared to the profile where both wives and husbands had high perceptions of shared relational power compared to other profiles, but their scores were not significantly different from each other (High Power, Equal).

Who Benefits from School-Based Teen Pregnancy Prevention Programs? Examining Multidimensional Moderators of Program Effectiveness Across Four Studies

Recent research has suggested the importance of understanding for whom programs are most effective (Supplee et al., 2013) and that multidimensional profiles of risk and protective factors may moderate the effectiveness of programs (Lanza & Rhoades, 2012). For school-based prevention programs, moderators of program effectiveness may occur at both the individual and school levels. However, due to the relatively small number of schools in most individual trials, integrative data analysis across multiple studies may be necessary to fully understand the multidimensional individual and school factors that may influence program effectiveness. In this study, we applied multilevel latent class analysis to integrated data across four studies of a middle school pregnancy prevention program to examine moderators of program effectiveness on initiation of vaginal sex. Findings suggest that the program may be particularly effective for schools with USA-born students who speak another language at home. In addition, findings suggest potential positive outcomes of the program for individuals who are lower risk and engaging in normative dating or individuals with family risk. Findings suggest potential mechanisms by which teen pregnancy prevention programs may be effective.

Early Sexual Debut and Its Associated Factors Among Young Women Aged 15-24 in Mali: A Multilevel Analysis

Early sexual debut is associated with increased risk of several sexual and reproductive health problems, including unwanted pregnancies and sexually transmitted infections. Hence, determining factors that promote early sexual initiation is significant to guide policy and inform interventions aimed to promote the health of young people through to adulthood. This study examined the prevalence of early sexual debut and its associated factors among young women in Mali. Using cross-sectional nationally representative data from the 2018 Mali Demographic and Health Survey, a total of 4063 young women aged 15-24 were included in the study. Multilevel binary logistic regression analysis was done to determine the factors associated with early sexual debut. The results were presented using adjusted odds ratios (aOR) and 95% confidence intervals (CIs). The prevalence of early sexual debut in Mali was 17.8% (95% CI; 16-19.7%). Young women who attended higher school had lower odds of early sexual debut (aOR = 0.10, 95% CI; 0.01-0.82) compared to young women who had no formal education. Young women from richest households had lower odds of early sexual debut compared to those from the poorest households (aOR = 0.48, 95% CI; 0.27-0.82). Young women from households with large family size also had lower odds of experiencing early sexual debut compared to those in small family size (aOR = 0.81, 95% CI; 0.66-0.99). Furthermore, the odds of early sexual debut were lower among young women in Koulikoro (aOR = 0.59, 95% CI; 0.39-0.90), Sikasso (aOR = 0.35, 95% CI; 0.21-0.56), Segou (aOR = 0.40, 95% CI; 0.25-0.64), and Mopti (aOR = 0.44, 95% CI; 0.23-0.82) regions compared to young women in Kayes region. Higher odds of early sexual debut were found among currently employed compared to not currently employed young women (aOR = 1.74, 95% CI; 1.42-2.12) and currently married compared to not currently married young women (aOR = 4.64, 95% CI; 3.64-5.92). Young women from the Peulh ethnic groups compared to those from the Bambara ethnic groups were at a higher odds of early sexual debut (aOR = 1.43, 95% CI; 1.03-1.99). The findings suggest the need for interventions aimed at addressing early sexual debut among young women. These can include emphasizing the promotion and importance of female education, addressing the cultural practices that promote negative sexual norms/practices such as child marriages, and ensuring social change through efforts such as creating employment or economic opportunities for families.

It Takes Two to Tango: Links Between Traditional Beliefs About both Men's and Women's Gender Roles and Comfort Initiating Sex and Comfort Refusing Sex

Traditional gender roles dictate rigid rules and standards prescribing which behaviors, thoughts, and feelings are considered masculine and feminine within sexual contexts, and thus internalizing these beliefs (higher traditional gender ideology) may influence sexual attitudes. Prior theorizing has primarily focused on how women's traditional beliefs about women's gender roles (traditional femininity ideology) and men's traditional beliefs about men's gender roles (traditional masculinity ideology) influence their sexual assertiveness. Yet, men can hold traditional beliefs about women, and women can hold traditional beliefs about men, and these beliefs should have important implications for sexual assertiveness. We addressed this gap by testing how both heterosexual women's (n = 389) and men's (n = 393) traditional masculinity and femininity ideologies associate with their reported comfort initiating sex and comfort refusing sex in their relationships. When accounting for both sets of beliefs, women's traditional beliefs about men's and women's roles interacted to predict comfort initiating sex, but not comfort refusing sex. Men's traditional beliefs about men's roles predicted less comfort refusing sex, and their traditional beliefs about women's roles predicted less comfort initiating sex. This novel research underscores the importance of considering beliefs about both sets of traditional gender roles for understanding people's sexual attitudes.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11199-023-01366-w.

Sexual behavior of Lithuanian High School Students

OBJECTIVE

to evaluate the sexual behavior of Lithuanian high school students.

STUDY DESIGN

School-based anonymous self-administered survey of high school students, conducted from February to June 2017.

RESULTS

Of 167 invited schools, 113 (67.7%) agreed to participate in the survey with a response rate of 75% among invited students (8143/10,811). Respondents' median age was 18 (range 16-20) years. Nearly one third of students (31.3%) reported sexual intercourse with a median age at coitarche of 17 years. Most (82.9%) used contraception at coitarche. Contraception at coitarche was more common among those who were sober at coitarche (aOR 2.2, 95% CI 1.5-3.2). Students whose parents had discussed sex with them were more likely to plan coitarche (aOR 1.3, 95% CI 1.1-1.5). Students searching for information about sexual life more often had their coitarche sober than those not searching for information (29.7% (n = 60) vs 21.1% (n = 497, p = 0.006).

CONCLUSIONS

Every fifth high school student reported contraceptive nonuse; however, only 6% indicated the use of reliable dual contraception during the first sexual intercourse.

IMPLICATIONS

Efforts are needed to improve the sexual education offered to Lithuanian adolescents to ensure the many sexually active adolescents are aware of how to protect themselves from infection and undesired pregnancy.

Timing of First Sexual Experience with a Same-Sex Partner: A Life Course Approach

Theories of sexual identity development recognize the initiation of sexual experience with same-sex partners (SESSP) to be a significant event in the coming-out process, yet the research literature lacks a population-based description of its timing and variation across population subgroups. Using data from the 2011-2017 National Survey of Family Growth and guided by the life course paradigm, we explored the timing and correlates of first SESSP among individuals (1425 women; 545 men) who identified as lesbian (n = 307), gay (n = 285), or bisexual (n = 1378) (LGB). Descriptive findings revealed that the median age at first SESSP was about 19 years for lesbian women and gay men and one to two years later for bisexual women and men. Notably, initiation of SESSP occurred over a wide age range, particularly among bisexual men. Multivariable results indicated that the probability of first SESSP did not vary by demographic characteristics or family background among men. Among women, nativity status, family stability, and independent living were associated with probability of first SESSP. Coital experience predicted timing among both women and men. Tests for statistical interactions suggested that age at first SESSP was contingent on mother's education (women), sexual identity (men), family stability (men), and birth cohort (women and men). Our findings highlight the complicated nature of LGB sexual experiences, and we end with a call for greater effort to ensure that LGB individuals are represented in national surveys designed to provide data on sexual and reproductive health.

Psychosocial determinants of sexual norms and their impact on sexual debut in Polish adolescents

OBJECTIVES

In an attempt to describe composite scales relating to sexual norms, we present their structure, psychosocial determinants, and the association with adolescent sexual initiation.

METHODS

A representative sample of Polish students was surveyed in 2015 (n = 1024, mean age 17.8 ± 0.31). Three scales of sexual norms were identified using principal component analysis. Logistic regression and path models were applied.

RESULTS

The scales concerning stereotype gender norms, as well as restrictive and permissive sexual norms, were developed. Restrictive norms lead to later sexual initiation and were more frequent in combination with love for the first partner. The variability of all the indices was significantly correlated with the peer environment. A number of direct and indirect paths were found among the above indices, family relationships (support, communication), and socio-emotional strengths, such as the meaning of life, coherence, and self-esteem.

CONCLUSIONS

The norms of sexual morality should be included in the analysis of the determinants of adolescent sexual behaviours along with an investigation of complex causal models. The results may contribute to improvement in sexual health promotion.

Early sexual debut and risky sex in young adults: the role of low self-control

BACKGROUND

The purpose of this study was to examine the role of low self-control as a mediator or moderator between early age at sexual debut and risky sexual behavior in young adulthood.

METHODS

Data on 5734 male and female Add Health participants were used. Self-control (waves 1 & 3), age at sexual debut (wave 3) and risky sexual behavior (wave 4) were used in a structural equation modeling framework to assess the relationships of interest.

RESULTS

Approximately 17% of respondents were < 15 years at first sexual intercourse. Among females only, both early age at first intercourse (Parent-report: z = 5.08, p < .001; Self-report: z = 2.05, p < .05) and low self-control at wave 3 (Parent-report: z = 2.30, p < .05; Self-report: z = 2.31, p < .05) mediated the relationship between low self-control at wave 1 and risky sexual behaviors in young adulthood. Similarly in the male-only model, both early age at first intercourse (Parent-report: z = 2.92, p < .01; Self-report: z = 3.04, p < .01) and low self-control at wave 3 (Parent-report: z = 1.99, p < .05; Self-report: z = 3.15, p < .01) mediated the relationship between low self-control and risky sexual behaviors in young adulthood. There was evidence of moderation in the male-only model (- 0.26, p < .01), such that lower impulsivity strengthened the relationship between early sex and risky sex.

CONCLUSIONS

This study confirms the role of executive functions in sexual behaviors and suggests that interventions aimed at improving self-control may be beneficial in reducing risky sexual behavior.

Adolescent sexual initiation and pregnancy: what more can be learned through further analysis of the demographic and health surveys in the Philippines?

Background

Adolescent pregnancy poses risks to the life of a young mother and her baby, and can affect their health, educational and future employment outcomes. In many low- and middle-income countries like the Philippines, the Demographic and Health Surveys (DHS) Program is among the most reliable and easily accessible sources of demographic and health data for researchers, development workers, and policymakers. Data on adolescent sexual and reproductive health (SRH) are often limited, but in the absence of other sources, there is room to make the most of the adolescent health data gathered by the DHS. The aim of this study is to explore what more can be learned about adolescent sexual initiation and pregnancy through the further analysis of demographic and health data, using DHS data from the Philippines as an example.

Methods

This study conducted trend analysis of DHS data over three survey rounds (2003, 2008 and 2013) to explore the context of adolescent sexual initiation and pregnancy over time. Bivariate and multivariate logistic regression were then used to study associations between adolescent pregnancy experience and selected demographic, socioeconomic and SRH variables using data from the 2013 DHS.

Results

This study found that between 2003 and 2013, proportions of Filipino young women experiencing adolescent sexual initiation and adolescent pregnancy have increased. Multivariate logistic regression affirmed the protective effect of education and belonging to higher wealth quintiles on the risk of adolescent pregnancy. Ever use of contraception was positively associated with adolescent pregnancy but is likely indicative of use after a prior pregnancy, and/or other factors relating to improper/inconsistent contraceptive use.

Conclusions

In the absence of reliable, easily accessible data on adolescent SRH, the DHS data can provide important insights about adolescent reproductive transitions such as sexual initiation and first pregnancy. However, there are limited variables in the datasets that could proxy for other important social determinants which prior studies have linked to adolescent SRH outcomes. There remains a need for timely and targeted collection of quantitative and qualitative data on adolescent SRH that can guide programming and policy intended to foster positive health outcomes during this crucial transition period to adulthood.

Electronic supplementary material

The online version of this article (10.1186/s12889-019-7451-4) contains supplementary material, which is available to authorized users.

The global school-based student health survey as a tool to guide adolescent health interventions in rural Guatemala

Background

Adolescents from rural areas in low-middle income countries face increasing physical and mental health challenges that are not well characterized or addressed due to resource limitations. We used the Global School-based Student Health Survey (GSHS) to describe adolescent health behaviors, and to inform prioritization of health promotion efforts in a resource-limited, rural, agricultural region in Guatemala.

Methods

In July 2015, a group of volunteers administered the GSHS to students from seven schools in four communities in the southwest Trifinio region of Guatemala. Prevalence and predictors of nutritional, mental, and sexual health behaviors were calculated from survey responses, and summarized in region- and school-level reports. Facilitated discussion of survey results with local leadership in January 2016 led to the identification of priorities for school-based health interventions.

Results

Five hundred fifty-four out of 620 (87%) students aged 12–18 years completed the survey. Prevalence of unhealthy dietary behaviors and body size was high: 61% reported high current soft drink intake, 18% were overweight, and 31% were moderate-severely stunted. In multivariable regression models, being food insecure was marginally associated with being underweight/stunted (OR = 1.95, 95%CI = 0.95–4.0). Boys were more likely than girls to report being sexually active (25% versus 6.4%, p < 0.001). Local school leadership identified food insecurity and sexual education as priority areas for intervention, and made plans for providing breakfast in schools, sexual education curriculum development and teacher training, and continued adolescent health reporting and evaluation.

Conclusions

The GSHS is a rapid, cost-efficient, useful tool for surveillance of adolescent health behaviors in vulnerable, resource-limited populations. Results of a locally-administered GSHS informed school-based interventions to decrease food insecurity, early sexual initiation, and teen pregnancy in a rural Guatemalan region.

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.

The Role of Religious Socialization and Religiosity in African American and Caribbean Black Adolescents' Sexual Initiation

This study determined the nature of the associations between religious socialization, religiosity, and adolescent sexual initiation. Data originated from the National Survey of American Life-Adolescent (n = 1170), a nationally representative study of black adolescents. Factor analysis, structural equation modeling, and logistic regression were used to evaluate hypotheses. Results indicated that as black adolescents received more messages about religious beliefs and practices, their religiosity was greater and, in turn, they were less likely to report sexual initiation; findings varied by ethnicity, gender, and age. Findings contribute to understanding religious socialization and its association with sexual initiation.

Associations Between Patterns of Sexual Initiation, Sexual Partnering, and Sexual Health Outcomes from Adolescence to Early Adulthood

The goal of this study was to examine, in a nationally representative sample, relationships between various sexual initiation patterns, subsequent sexual partnerships, and related health outcomes from adolescence through early adulthood. Data were from a subset of 6587 respondents from the National Longitudinal Study of Adolescent to Adult Health. Bivariate analyses and adjusted logistic and ordinary least squares regression models were used to determine associations between membership in three sexual initiation classes, lifetime sexual partner counts, and multiple health outcomes, including lifetime sexually transmitted infection or disease (STI/STD) diagnosis, lifetime unintended pregnancy, and romantic relationship quality. Broadly, having fewer lifetime sexual partners was associated with lower odds of STI/STD diagnosis and unintended pregnancy, and better relationship quality; however, findings also indicated both within and between sexual initiation class differences in the relationship between lifetime sexual partners and all three health outcomes. In particular, results showed little variation in health outcomes by sexual partnering among those who postponed sexual activity, but members of the class characterized by early and atypical sexual initiation patterns who had fewer lifetime partners exhibited better health outcomes than most other initiation groups. These results show that while both sexual initiation and partnering patterns add important information for understanding sexual health from adolescence to early adulthood, partnering may be more relevant to these sexual health outcomes. Findings indicate a need for more comprehensive sexuality education focused on sexual risk reduction and promotion of relationship skills among adolescents and adults.

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.

Residential Spaces and Timing of First Sexual Intercourse Among Never-Married Youths in Nigeria

Youths in sub-Saharan Africa who initiate sex at an early age tend to be more vulnerable to HIV/AIDS and other sexually transmitted diseases because of the lack of accurate knowledge of preventive behaviors. Although sociocultural and economic factors associated with sexual initiation among youths have been studied extensively in Nigeria, little is known about the effect of place-based factors. Rural and urban disparities remain high in Nigeria, and these disparities are reinforced by stark regional inequalities between the north and south. Considering these underlying inequalities, we examined the extent to which rural and urban youths in northern and southern Nigeria differ with regard to the timing of sexual initiation using the 2013 Nigerian Demographic and Health Survey. Results from our event history analyses suggest that never-married male and female youths who lived in the urban north delayed their first sexual intercourse compared with their counterparts in the rural north, but those who lived in the rural south had their first sex earlier. Young males who lived in the urban south also experienced their first sex earlier than their counterparts in the rural north. Surprisingly, educated youths and those who had accurate knowledge about HIV/AIDS transmission experienced their first sex early. Clearly, the timing of sexual initiation among youths varies across different spatial and cultural contexts. Therefore, interventions aimed at discouraging early sexual initiation among young people in Nigeria may need to go beyond merely providing health information and services to addressing the livelihood needs of youths, especially those in rural settings.

The observational study of selected sexual behaviour issues in female organ transplant recipients

OBJECTIVE

To investigate sexual behaviour in women following solid organ transplantation.

STUDY DESIGN

A cross-sectional single-centre survey study of 230 female organ transplant recipients, aged 18-45years.

MAIN OUTCOME MEASURES

Sexual behaviour, contraceptive awareness and methods of birth control.

RESULTS

205 females declared to be post their sexual initiation. The mean age at sexual initiation in our study population was 20.3±3.3years (range: 14-32). Fifty-three percent (122/230) of the patients declared that they had only one sexual partner at enrolment. After transplantation female organ recipients became more sexually active (71% vs. 83%; p=0.018). The frequency of sexual intercourse decreased significantly in the post-transplant period (p=0.004). In the group of sexually active females before transplantation the frequency of sexual intercourses decreased significantly in the post-transplant period (mean Δ -0.16±0.79; p=0.004). An increase or lack of change in the frequency of sexual intercourse was noted amongst younger transplant-recipients (OR: 0.91; 95%CI 0.86-0.97) and women with effective birth control methods post-transplantation (OR: 3.68; 95%CI 1.60-8.49).

CONCLUSION

Sexual education of organ transplant recipients is necessary, mainly in younger patients, who present to be more sexually active, thus they need to be taught about effective family planning.

The socio-political context of migration and reproductive health disparities: The case of early sexual initiation among Mexican-origin immigrant young women

Prior research often explains the lower risk of early sexual initiation among foreign-born Mexican-origin young women by a patriarchal and sexually conservative "traditional Latino culture." This definition overlooks structural factors such as exploitation of migrant workers, and conflates gender inequality and sexual expectations. I use an intersectional framework and the theory of gender and power to explore how gender inequality and sexual expectations are both influenced by structural factors and affect reproductive health outcomes. I integrate data from qualitative interviews with 21 first and second generation Mexican-origin women in 2013-2014 with data from discrete time hazard models with 798 Mexican-origin young women in the National Longitudinal Study of Adolescent to Adult Health. Qualitative results demonstrate that gender inequality and sexual expectations in Mexican-origin immigrant households are associated with structural factors. Gender inequality occurs more often in households with family instability, greater poverty, and among parents who migrated independently. Qualitative data also demonstrate that parental gendered expectations are sometimes at odds to what parents are actually doing in the household. Finally, contrary to assumptions that a patriarchal "traditional Latino culture" protects against early sexual initiation, qualitative and multivariate quantitative data suggest that household gender inequality increases risk of early sexual initiation. These findings challenge the utility of a culturalist approach that views culture as determining health behavior among immigrants and demonstrate the need to incorporate an intersectional framework that includes structural factors. This approach may reduce stereotypes and identify meaningful interventions to reduce reproductive health disparities.

Examination of youth sexual and reproductive health transitions in Nigeria and Kenya using longitudinal data

Background

The adolescent (ages 15–19) and young adult (ages 20–24) years are a crucial time as many sexual and reproductive health (SRH) transitions take place in these years. The study of youth SRH transitions in sub-Saharan Africa is limited due to a paucity of longitudinal data needed to examine the timing and circumstances of these transitions.

Methods

This paper uses recently collected longitudinal data from select urban areas in Kenya and Nigeria that include a large youth sample at baseline (2010/2011) and endline (2014). We control for unobserved heterogeneity in our modelling approach to correct for selectivity issues that are often ignored in similar types of analyses.

Results

We demonstrate that the transition patterns (i.e., sexual initiation, first marriage, and first pregnancy/birth) differ within and across the urban areas and countries studied. Urban Kenyan youth have more premarital sex and pregnancy than youth from the Nigerian cities. Further analyses demonstrate that more educated and wealthier youth transition later than their less educated and poorer counterparts.

Conclusions

The findings from this study can be used to inform programs seeking to serve young people based on their varying reproductive health needs in different contexts over the adolescent and young adult years.

Correlates and predictors of sexual health among adolescent Latinas in the United States: A systematic review of the literature, 2004-2015

Adolescent Latinas in the United States (US) are disproportionately affected by early pregnancy, sexually transmitted infections (STIs) and human immunodeficiency virus (HIV) in comparison to their non-Hispanic white counterparts. However, only a few studies have sought to understand the multi-level factors associated with sexual health in adolescent Latinas. Adhering to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines, we conducted a systematic literature review to better understand the correlates and predictors of sexual health among adolescent Latinas in the US, identify gaps in the research, and suggest future directions for empirical studies and intervention efforts. Eleven studies were identified: five examined onset of sexual intercourse, nine examined determinants of sexual health/risk behaviors (e.g., number of sexual partners and condom use), and three examined determinants of a biological sexual health outcome (i.e., STIs or pregnancy). Two types of variables/factors emerged as important influences on sexual health outcomes: proximal context-level variables (i.e., variables pertaining to the individual's family, sexual/romantic partner or peer group) and individual-level variables (i.e., characteristics of the individual). A majority of the studies reviewed (n=9) examined some aspect of acculturation or Latino/a cultural values in relation to sexual health. Results varied widely between studies suggesting that the relationship between individual and proximal contextual variables (including acculturation) and sexual health may be more complex than previously conceived. This review integrates the findings on correlates and predictors of sexual health among adolescent Latinas, and supports the need for strengths-based theoretically guided research on the mechanisms driving these associations.

Sexual Initiation and Complex Recent Polydrug Use Patterns Among Male Sex Workers in Vietnam: A Preliminary Epidemiological Trajectory

Little is known about the age of onset of sexual and drug risk and their association with complex patterns of recent drug use among male sex workers (MSW) in a developing country, such as Vietnam. The aim of this study was to determine whether latent class analysis (LCA) would aid in the detection of current individual and polydrug use combinations to predict how different trajectories of sexual and drug initiation contribute to different patterns of current illicit drug use. Data were collected from a cross-sectional survey administered to young MSWs between 2010 and 2011 in Vietnam (N = 710). LCA clustered participants into recent drug use groups, incorporating both the specific types and overall count of different drugs used. Men reported drug use within a 1 month period from an 11-item drug use list. LCA identified three distinct drug use classes: (1) alcohol use, (2) alcohol and tobacco use, and (3) high polydrug use. The current drug use classes are associated with sex worker status, housing stability, income level, educational attainment, marital status, sexual identity, and sexual preferences. High levels of drug use are strongly associated with being a recent sex worker, not having recent stable housing, higher than median income, more than a high school education, less likely to be currently in school and more likely to have non-homosexual preferences and heterosexual partners. An event history analysis approach (time-event displays) examined the timing of the age of onset of drug and sexual risks. Early ages of drug and sexual initiation are seen for all three classes. High current drug users show earlier onset of these risks, which are significantly delayed for moderate and low current drug users. LCA incorporating an overall count of different drugs detected three distinct current drug use classes. The data illustrates that the complexity of drug factors that must be accounted for, both in advancing our epidemiological understanding of the complexity of drug use and the use of drug and sexual risk initiation data to predict current drug use subtypes among high-risk populations.

Sexual behaviour in early adolescence: a cross-national comparison of Australian and United States youth

OBJECTIVE

This study used matched samples from schools in the states of Victoria, Australia and Washington, United States (US), to compare sexual behaviour in early adolescence. It was hypothesised that the contrasting dominant policy objectives of harm minimisation in Australia and abstinence in the US would result in state differences for markers of sexual risk, mirroring prior cross-national findings in substance use.

METHOD

A two-stage cluster sampling approach was used to recruit students from the two states. Self-reported sexual behaviour was examined for 1,596 students in annual surveys from Grade 7 in 2002 to Grade 9 in 2004. Prevalence estimates were derived for each measure of sexual behaviour, and comparisons were made between gender groups in each state.

RESULTS

State differences were found for girls' first sex, with significantly more girls in Washington than Victoria having had sex by Grade 7. By Grade 9, significantly more girls in Victoria reported sex in the last year and more sexual partners than girls in Washington. A large proportion of Grade 9 students across both states reported inconsistent contraception use.

CONCLUSIONS

Contradicting the abstinence policy objective, first sex by Grade 7 was more prevalent in Washington than Victoria. Whilst sexual behaviour was more prevalent in Grade 9 in Victoria, the sexually active showed no clear cross-national differences in markers of risk such as contraception use and pregnancy outcomes. Findings demonstrate few cross-national differences in adolescent sexual behaviour despite the different policy contexts of Victoria, Australia and Washington, US.

Father Knows Best: Paternal Presence and Sexual Debut in African-American Adolescents Living in Poverty

Adolescents found within single-parent families without a residential father have reported higher levels of sexual debut and higher levels of reported pregnancy. Using data from the Mobile Youth Survey, the purpose of this study is to determine the impact of the presence of a father figure on the sexual debut of African-American adolescents living in poverty and to determine if gender moderates the relationship between the presence of a father figure and sexual debut. Additionally, this study will examine the family processes in which the presence of a father figure can affect the sexual debut of African-American adolescents who live within economically and socially disadvantaged communities. The results revealed that African-American adolescents reporting a father figure had lower rates of sexual debut than those youth reporting no father figure. Gender was not found to be a significant moderator in the relationship between father figure presence and sexual debut. However, existing curfews and family rules did account for some of the effects of presence of a father figure and sexual debut. The results suggest that when adolescents have a father figure in their lives, it may reduce the possibility of early sexual debut.

Sexual communication intervention for African American mothers & daughters

BACKGROUND

African American girls ages 13-19 comprised nearly 3 out of 4 new cases of HIV in 2009. The goal of this study was to deliver a theoretically-driven intervention to test the feasibility for recruitment and retention of mother-daughter dyads.

METHODS

Twenty mother-daughter dyads were recruited from a community health center between February-April 2014. Comparisons were made between pre- and post-intervention scores using percent change.

RESULTS

Twelve dyads (60%) completed the intervention. There were no demographic differences between completers and noncompleters. Notable post-intervention percent increases in scores were observed in the domains: Sexual knowledge (15%), confidence to talk (23.2%); and openness of sexual communication (26.4%).

CONCLUSION

Our small-sized study showed promise in the intervention. Increasing sexual communication between African American mothers and daughters is likely to be sustainable over time and across relationships, and thus have a greater impact on HIV-prevention behaviors later in life.

Family and peer support matter for precoital and coital behaviors among adolescents in Lima

We analyzed the association between sub-scales developed with adolescents and the outcomes of precoital behaviors and vaginal sex in Lima, Peru. Adolescent participants in key informant sessions operationalized concepts identified during qualitative concept mapping into several sub-scales. Face and content validity testing and pilot application with respondent debriefing were used to refine the sub-scales. Three hundred 15-17 year olds were surveyed about the sub-scales, socio-demographics and sexual behaviors. Exploratory factor analysis confirmed six sub-scales, self-image, goals and decision-making, family education, parental rules/control, school support and peer support, which we regressed on the outcomes. Twice as many males as females reported more than three precoital behaviors and vaginal sex. Higher peer support reduced the likelihood of vaginal sex and precoital behaviors and higher family education reduced precoital behaviors. Results affirm the importance of including adolescents in the entire research process and of sex education with family- and peer-based strategies.

Gendered differences in the predictors of sexual initiation among young adults in Cebu, Philippines

PURPOSE

Social environment and family context exert substantial influence on adolescent sexual behaviors. These influences are especially important to examine in countries undergoing rapid demographic and social change. This study employs unique, intergenerational and longitudinal data (1998-2009) to examine the effects of parental, peer, and household influences on sexual initiation among young adults in Cebu, Philippines.

METHODS

Intergenerational and longitudinal cohort data from the 1998 Cebu Longitudinal Health and Nutrition Survey (CLHNS) are analyzed to examine the effects of household, peer, family, and young adults' sexual attitudes on age at first sex by 2009 among young men and women. Gender-stratified Cox proportional hazards models and Cox regression models are used to model time to first sex.

RESULTS

Household, family, peer, and individual characteristics have disparate influences on sexual initiation among Filipino boys and girls. Boys' sexual initiation was positively associated with urbanicity, household wealth, and the presence of a family member working abroad, whereas for girls, these variables had no significant effects. Unique effects were also found for girls-mother's education was negatively associated, and girls' number of siblings was positively associated, with higher hazards of sex. Additionally, the effects of some variables on the occurrence of first sex differed across time, indicating that boys and girls may be differentially influenced by contextual characteristics across adolescence.

CONCLUSIONS

Amid substantial sociodemographic changes and persistence of traditional gender norms, this study highlights the importance of examining the unique influences and intersections of gender and context on sexual initiation in the Philippines.

Early sexual initiation and risk factors in Serbian adolescents: data from the National Health Survey

OBJECTIVES

To identify factors associated with sexual initiation before the age of 17 among Serbian adolescents and to assess whether the latter is associated with other risky behaviours, such as tobacco, alcohol and illicit drug use, and fighting.

METHODS

The study was an analysis of data gathered by the 2006 Serbian National Population Health Survey in which information concerning adolescents was obtained by means of questionnaires. Data were analysed using descriptive statistics and a logistic regression model.

RESULTS

A total of 474 adolescents aged 15 and 16 completed the survey. Multivariate logistic regression analysis showed that male respondents reporting sexual initiation were significantly more likely to smoke daily and to have experienced two or more episodes of drunkenness in the past. Female respondents reporting sexual initiation were significantly more likely to live with both parents, to feel insecure in school, to smoke daily and to drink more than once a week.

CONCLUSIONS

A strong association was found between adolescent sexual initiation and substance abuse. Although a causal relationship is evidently not established, one might contemplate including measures lowering the frequency and intensity of substance abuse in health prevention programmes and interventions aiming at reducing the risks associated with sexual initiation.

Timing and circumstances of first sex among female and male youth from select urban areas of Nigeria, Kenya, and Senegal

PURPOSE

To examine the timing and circumstances of first sex among urban female and male youth in Kenya, Nigeria, and Senegal.

METHODS

Recently collected data are used to examine youth sexual behaviors in Kenya, Nigeria, and Senegal. In each country, a large, representative sample of women (ages 15-49) and men (ages 15-59) was collected from multiple cities. Data from youth (ages 15-24) are used for the analyses of age at sexual initiation, whether first sex was premarital, and modern family planning use at first sex. Cox proportional hazard models and logistic regression analyses are performed to determine factors associated with these outcomes.

RESULTS

Across all three countries, a greater percentage of male youth than female youth report initiating sex with a nonmarital partner. More educated youth are less likely to have initiated sex at each age. In Nigeria and Senegal, poor female youth report earlier first sex than wealthier female youth. In Kenya, richer female youth are more likely to have premarital first sex and to use contraception/condom at first sex than their poorer counterparts. Older age at first sex and youth who report that first sex was premarital are significantly more likely to use a method of contraception (including condom) at first sex. City-specific distinctions are found and discussed for each outcome.

CONCLUSIONS

Programs seeking to reduce HIV and unintended pregnancy risk among urban youth need to undertake needs assessments to understand the local context that influences the timing and circumstances of first sex in each city/country-specific context.