Effective approaches to reducing adolescent unprotected sex,pregnancy, and childbearing

In the United States, there exist a multitude of different approaches to reducing adolescent sexual risk-taking, unintended pregnancy, childbearing, and sexually transmitted disease, including HIV. While many of these approaches have some positive effects upon some outcomes (such as greater knowledge), only some of these programs actually delay the initiation of sex, increase condom or contraceptive use, and reduce unprotected sex among youth. This article summarizes a review of 73 studies and their respective programs, and describes four groups of programs which have reasonably strong evidence that they delay sex, increase condom or contraceptive use, or reduce teen pregnancy or childbearing. These four groups of programs include (a) sex and HIV education curricula with specified characteristics, (b) one-on-one clinician-patient protocols in health settings with some common qualities, (c) service learning programs, and (d) a particular intensive youth development program with multiple components.     

Sexual Education,Gender Ideology,and Youth Sexual Empowerment

Sexual education plays an essential role in preventing unplanned pregnancy and the transmission of sexually transmitted infections (STIs). School-based sexual education programs, in particular, may be well positioned to address social factors that are empirically linked to negative sexual health outcomes, such as traditional social norms surrounding gender and sexuality. However, youth are seldom granted access to sexual education programs that explicitly address these issues. This study presents findings from a pretest–posttest survey of a sexual education program that did. It was designed for eighth graders (N=95) in the context of a school–community collaboration. The study assessed the links between several components of sexual empowerment, including gender ideology, sexual knowledge, and contraceptive beliefs. Findings link participation in the sexual education program to more progressive attitudes toward girls and women, less agreement with hegemonic masculinity ideology, and increases in sexual health and resource knowledge. Structural equation models suggest that traditional attitudes toward women were significantly related to hegemonic masculinity ideology among both boys and girls, which was in turn negatively related to safer contraceptive beliefs.     

Peer-led interventions to reduce HIV risk of youth: A review

One approach in HIV prevention programming targeting youth is to use peer leaders in what is referred to as peer education programming. This paper critically reviews and synthesizes the results and lessons learned from 24 evaluated peer-led programs with an HIV/AIDS risk reduction component that target youth in the communities where they live and are delivered in low- and middle-income countries. Interventions were identified through a comprehensive search of the peer reviewed AIDS-related literature as well as publication lists of major organizations in the UN family that address HIV and AIDS. Our synthesis of study results finds that these programs have demonstrated success in effecting positive change in knowledge and condom use and have demonstrated some success in changing community attitudes and norms. Effects on other sexual behaviors and STI rates were equivocal. We include an overview of characteristics of successful programs, a review of program limitations, and recommendations for the development and implementation of successful community-based peer-led programs in low-income countries.     

Clinic-based service programs for increasing responsible sexual behavior

Three general classes of clinic-based programs to increase responsible sexual behavior are considered: (a) clinic-based educational/counseling programs, (b) school clinic-based condom distribution programs, and (c) clinic-based STD/HIV screening programs. Consistent condom use may double in response to clinic-based counseling. However, consistent use seldom exceeds 50% of coital exposures. Extensive and personalized counseling interventions reduce incident sexually transmitted infections by 5% to 10%. Increases in responsible sexual behavior following school-based condom distribution programs is reported in some but not in all studies. Screening programs for sexually transmitted infections are associated with decreases in rates of some infections. STD/HIV screening should be considered an important aspect of healthy sexuality and an adjunct to other counseling efforts.     

Asking Only “Did You Use a Condom?” Underestimates the Prevalence of Unprotected Sex Among Perinatally HIV Infected and Perinatally Exposed But Uninfected Youth

Among young adults who use condoms, incomplete condom use (putting a condom on after beginning or taking a condom off before finishing sex) and condom failure (condom breaking or slipping off during sex) are common. Therefore, sexual behavior surveys that ask only if a condom was used are likely to underestimate the actual prevalence of unprotected sex. This study examined data from 135 sexually active perinatally HIV-infected (PHIV+) youth and perinatally exposed but uninfected (PHIV?) youth, ages 13 to 24. Participants were asked whether they used a condom on their first and their most recent occasion of vaginal sex. Youth who reported using a condom were asked a follow-up question about whether there was any time during that occasion when sex was not protected by a condom. This follow-up question identified additional participants— almost double the proportions who initially said they did not use a condom—who had unprotected sex. Incomplete condom use was similar among PHIV+ and PHIV?youth, boys and girls, Latinos and African Americans, and younger and older youth. These findings illustrate the importance of asking specifically about whether any unprotected behavior occurred from start to finish of sex to achieve more valid estimates of sexual risk behavior.     

Condom Failure: Examining the Objective and Cultural Meanings Expressed in Interviews With African American Adolescents

The purpose of this study was to explore the meaning and context of self-reported “condom failure” among sexually active African American adolescents. Semistructured interviews regarding methods of protection from pregnancy and sexually transmitted disease (STD) with 124 youth (ages 14–19 years) were content analyzed. The findings suggested three meanings of condom failure. First, condom failure represents a legitimate and important risk related to sexual activity. Second, it can serve as an excuse repertoire for adolescents who engaged in unprotected sex and later experienced either pregnancy or a STD. Third, it may serve as an explanation for males who deceive their partners into having unprotected sex. The findings are discussed with regard to their implications for HIV or STD prevention and research.     

Investigating the Timing of First Sexual Intercourse Among Youth in EDO State,Nigeria in the Context of the Aids Epidemic

ABSTRACT

Objectives: This study examined the timing of sexual debut among youth in Edo state, Nigeria given the role that sexual abstinence plays in HIV prevention in sub-Saharan Africa. Methods: Survey data were collected from rural youth aged 11 to 17 years old enrolled in Junior Secondary Schools in Edo State, Nigeria. Discrete-time hazard techniques were used to examine the effects of theoretically relevant covariates on the timing of sexual debut among youth in Edo State. Results: Results indicate strong, significant relationships between psychosocial predictors and age at first sex for boys and girls. Youth with higher levels of knowledge about HIV as well as those who rejected common myths about HIV transmission delayed first sexual intercourse. Early sexual intercourse was strongly associated with experiencing pressure to engage in sex, while delay was associated with greater confidence that one could decline to participate in sex. On the other hand, youth with higher condom use self-efficacy engaged in first sexual intercourse at an earlier age. Conclusions: These results support the relevance of programs such as Nigeria's Family Life and HIV Education to contribute to delaying sexual intercourse focusing precisely on the forms of knowledge, myth rejection, motivation, and behavioral self-efficacy measured here. They provide policymakers with concrete evidence to increase support for such programming as a means to combat the spread of HIV among youth.     

Quasi-experimental evaluation of a national primary school HIV intervention in Kenya

This study examined the impact of a primary-school HIV education initiative on the knowledge, self-efficacy and sexual and condom use activities of upper primary-school pupils in Kenya. A quasi-experimental mixed qualitative-quantitative pre- and 18-month post-design using 40 intervention and 40 matched control schools demonstrated significant program impact on targeted objectives of (1) adequate program delivery and, for standard 6 and 7 pupils (ages 11-16 years), (2) increased HIV-related knowledge; (3) increased communication with parents and teachers about HIV and sexuality; (4) increased assistance to fellow pupils to avoid sexual activity; (5) increased self-efficacy related to abstinence and condom use; (6) decreased exposure to HIV through delayed first intercourse, decreased sexual activity and increased condom. Results support the conclusions that the existing infrastructure is adequate for national roll-out of the program; that the program has its most beneficial effect on sexually inexperienced youth and should therefore be implemented with the youngest age groups possible; and that gains are gender specific, with boys reporting increased condom use while girls are more likely to decrease or delay sexual activity. Based on these results, the program began national roll-out to all primary schools in 2005. By June 2006, the program was operating in 11,000 of the country's nearly 19,000 schools.     

"We are not aliens, we're people, and we have rights." Canadian human rights discourse and high school climate for LGBTQ students

Canadian law protects people from discrimination on the grounds of sexual orientation, but our public schools do not fulfill their ethical and legal obligations where sexual and gender minority youth are concerned. This article reports on a national survey study on homophobia and transphobia in Canadian high schools. Participants (n = 3,607) were questioned about school climate, harassment, school attachment, and institutional interventions. We found that schools were neither safe nor respectful for sexual and gender minority students, and we argue that ongoing exposure to this situation undermines students' respect for the Charter of Rights and their faith in adults.     

“Female ejaculation” and urinary stress incontinence

A substantial increase in religious identification has been observed in most European post-communist countries. As religiosity has been associated with sexually transmitted infection (STI) and HIV vulnerability among young people, this article examined the impact of religious upbringing and personal religiosity (religiousness) on sexual risks among University of Zagreb first-year undergraduate students, using data collected in 1998, 2003, and 2008. Female participants who reported strict religious upbringing were less knowledgeable about human sexuality than other women. Religiousness was negatively correlated with basic knowledge of human sexuality, but again only among women. Contrary to expectations, no significant associations were found between religious upbringing or religiousness and condom use. Both measures of religiosity, however, were related to decreased odds of sexual debut among young women. In the case of male participants, the impact of religiosity was marginal. Religious upbringing was associated (negatively) with sexual literacy and sexual debut—but only at the beginning of the observed period. Overall, religiosity does not seem to substantially reduce STI- and HIV-related risk-taking, particularly among men. Since the observed increase in the proportion of sexually active students during the 1998 through 2008 period was not matched by an increase in condom use, reducing STI and HIV vulnerability among Croatian youth remains an essential task.     

Effect of Sex Education on the Sexual and Contraceptive Practices of Female Teenagers in Mexico City

After having carried out a review of the literature on the relationship between sex education and sexual and contraceptive behavior, the National Research Council (1987) recently concluded that the existing evaluation of the effects of sex education on sexual and contraceptive practices is helpful but not sufficient. One possible explanation for the different results obtained are the diverse sociodemographic characteristics of the sample or samples of teenagers under consideration. Another aspect that can account for the differences found in the literature focuses on the areas covered in the course. In Mexico no studies have been carried out which deal with the relationship between sex education and sexual and contraceptive behavior. A study was carried out with 392 female teenagers between 16 and 17 years old of lower and middle lower socioeconomic level. Results show that the mere fact of attending a sex education course did not affect the initiation or continuation of sexual activity, contraceptive behavior or even the perception of accessibility to contraception. Providing information on sexuality, relationship with the partner and where to obtain contraceptives does not have an effect on sexual activity. Receiving information on pregnancy prevention and on where to obtain contraceptives was found to be related to contraceptive use. Although less dramatic, information about the relationship with the partner and on sexuality also produced increases in contraceptive use.     

Understanding Condom Use Decision Making Among Homeless Youth Using Event-Level Data

This is one of the first qualitative event-based studies to understand the various mechanisms through which multiple factors influence condom use decision making among homeless youth. Event-level interviews that explore characteristics of the environment surrounding sexual events were conducted with 29 youth who were asked to describe two recent sexual encounters. In thematic analyses of data across events, reasons that youth gave for engaging in unprotected sex included the expectation of having sex and use of alternative methods of protection against pregnancy. Other nonevent factors that influenced condom use decision making were related to attributes of the partnership (e.g., testing, trust and love, and assessments of risk) and attributes of the youth (e.g., perceptions of diseases, concerns over pregnancy, and discomfort using condoms). Additional event analyses conducted within the same individuals found that decision making was influenced by multiple interacting factors, with different pathways operating for event and nonevent factors. Future interventions should consider taking a multilevel and individualized approach that focuses on event-based determinants of risky sex in this population.     

Latino Adolescent Reproductive and Sexual Health Behaviors and Outcomes: Research Informed Guidance for Agency-Based Practitioners

Latinos are the largest and fastest growing minority youth group in the United States. Currently, Latino adolescents experience higher rates of teen pregnancy compared to any other racial or ethnic group and have disproportionately high levels of sexually transmitted infections and HIV. Latino teens are also affected by a number of social problems such as school dropout, poverty, depression and limited access to healthcare, which contributes to disparities in reproductive health outcomes for this population. Relatively few intervention research studies and programs have been dedicated to reducing sexual risk among Latino youth, despite their particular vulnerabilities in experiencing negative reproductive health outcomes. We provide recommendations for identifying the unique reproductive health needs of Latino youth and specific applied strategies so that agency-based social workers and other providers can develop family-based interventions that improve adolescent Latino sexual and reproductive health.     

Structural Interpretation of Suicide

Abstract

Drawing upon longitudinal data collected from the same boys and girls in their early (13–14) and later (18–19) years of adolescence, this research models age at sexual debut, contraceptive risk-taking, and teenage pregnancy on the basis of family background and delinquency involvement during the early years of adolescence. The data also allow for control over the influence of social class while studying the effects of race, and vice-versa. Regression analyses showed that both race and delinquency independently predict age at sexual debut, but that SES, with race controlled, does not. Further analysis showed that contraceptive risk-taking was predicted by both age at sexual debut and early delinquency. With these variables controlled, however, neither SES nor race was predictive of contraceptive risk-taking. Finally, contraceptive risk-taking emerged as a substantial predictor of pregnancy.     

The Influences of Sociosexuality and Attachment Style on Reactions to Emotional Versus Sexual Infidelity

Perinatally HIV-infected (PHIV+) youth are surviving into adolescence and young adulthood. Understanding the sexual development of PHIV+ youth is vital to providing them with developmentally appropriate HIV-prevention programs. Using pooled data (N = 417) from two longitudinal studies focused on HIV among youth (51% female; 39% HIV+) and their caregivers (92% female; 46% HIV+), the rate of sexual onset during adolescence across four youth–caregiver combinations was compared: PHIV+ youth with HIV+caregivers (12%), PHIV+ youth with HIV– caregivers (27%), HIV– youth with HIV+caregivers (34%), and HIV– youth with HIV– caregivers (27%). Youth with HIV– caregivers were more likely than other youth–caregiver groups to have had their sexual onset. Youth with HIV+ caregivers reported a slower rate of onset of penetrative sex across the adolescent years. Findings are discussed by highlighting the role that both youth and caregiver HIV status play in the onset of sexual behavior across adolescence.     

A prospective study of the onset of sexual behavior and sexual risk in youth perinatally infected with HIV

Perinatally HIV-infected (PHIV+) youth are surviving into adolescence and young adulthood. Understanding the sexual development of PHIV+ youth is vital to providing them with developmentally appropriate HIV-prevention programs. Using pooled data (N = 417) from two longitudinal studies focused on HIV among youth (51% female; 39% HIV+) and their caregivers (92% female; 46% HIV+), the rate of sexual onset during adolescence across four youth-caregiver combinations was compared: PHIV+ youth with HIV+caregivers (12%), PHIV+ youth with HIV- caregivers (27%), HIV- youth with HIV+caregivers (34%), and HIV- youth with HIV- caregivers (27%). Youth with HIV- caregivers were more likely than other youth-caregiver groups to have had their sexual onset. Youth with HIV+ caregivers reported a slower rate of onset of penetrative sex across the adolescent years. Findings are discussed by highlighting the role that both youth and caregiver HIV status play in the onset of sexual behavior across adolescence.     

Self‐Efficacy About Sexual Risk/Protective Behaviors: Intervention Impact Trajectories Among American Indian Youth

For adolescents, normative development encompasses learning to negotiate challenges of sexual situations; of special importance are skills to prevent early pregnancy, HIV, and other sexually transmitted diseases. Disparities in sexual risk among American Indian youth point to the importance of intervening to attenuate this risk. This study explored the impact of Circle of Life (COL), an HIV prevention intervention based on social cognitive theory, on trajectories of self‐efficacy (refusing sex, avoiding sexual situations) among 635 students from 13 middle schools on one American Indian reservation. COL countered a normative decline of refusal self‐efficacy among girls receiving the intervention by age 13, while girls participating at age 14 or older, girls in the comparison group, and all boys showed continuing declines.