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I. PROGRAM RESOURCES
1. Children Having Children, State of the World's Mothers
2. World Youth Report 2003: The Global Situation of Young People
3. Making Commitments Matter: A Toolkit for Young People to Evaluate National Youth Policy
4. Learning to Survive: How Education for All Would Save Millions of Young People from HIV/AIDS
5. The Intergenerational Approach to Development: Bridging the Generation Gap
6. Voices of Youth: What Young People Are Saying
7. The ABC of All the Questions We Never Dare To Ask
8. HIV and Sexual Behavior Among Young South Africans: A National Survey
II. RESEARCH ARTICLES
1. Community Group Participation: Can It Help Young Women to Avoid HIV?
2. Do Family-planning Workers in China Support Provision of Sexual and Reproductive Health Services to Unmarried Young People?
3. Economic Empowerment and Reproductive Behaviour of Young Women in Osun State, Nigeria
4. Effects of a Community-based Sex Education and Reproductive Health Service Program on Contraceptive Use of Unmarried Youths in Shanghai
5. Impact of a School-based Peer Sexual Health Intervention on Normative Beliefs, Risk Perceptions, and Sexual Behavior of Zambian Adolescents
6. Predictors of maternal HIV infection at the primary care level in inner city Ibadan.
7. Reproductive and Sexual Health among Young Adults in Uzbekistan
8. Review of STI and HIV Epidemiological Data from 1990 to 2001 in Urban Burkina Faso: Implications for STI and HIV Control
9. Safe Motherhood Perspectives and Social Support for Primigravidae Women in Lusaka, Zambia
10. The Sexual and Reproductive Health of Young People in Adjumani District, Uganda
11. The Sexual Health of Pupils in Years 4 to 6 of Primary Schools in Rural Tanzania
12. Socialization Ambiguity in Samoan Adolescents: A Model for Human Development and Stress in the Context of Culture Change
13. Uganda AIDS Prevention: A,B,C and Politics
14. Research from Developed Countries: summaries of 17 studies covering girls perception of sexual debut, bone mineral density and DMPA use, sexual abuse and homeless females, advance provision of emergency contraception, and other issues
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I. PROGRAM RESOURCES
1. Children Having Children, State of the World's Mothers (2004)
The report focuses on the tens of millions of girls around the world who marry and have babies while they are still children themselves, resulting in maternal and child mortalities and for those who survive, a struggle to overcome poor health, limited education, and grinding poverty. The report recommends ways to help girls delay marriage and motherhood until they are emotionally and physically ready to give birth and raise children. It also suggests programmatic and policy solutions to help child mothers and their babies survive and thrive. An Early Motherhood Risk Ranking analyzes 50 places where the problem is particularly severe, and a Mothers' Index includes data on health, nutrition, education and other issues in over 100 countries.
2. World Youth Report 2003: The Global Situation of Young People (2004)
This report provides an overview of the global situation of youth with regards to the progress made in meeting the World Programme of Action for Youth identified by the United Nations in 1995. This comprehensive review highlights the major challenges and opportunities that young people are presented with today including health, HIV, education, employment, and other issues.
3. Making Commitments Matter: A Toolkit for Young People to Evaluate National Youth Policy (2004) (PDF, 777K)
Designed for national youth organizations and/or representatives working with youth, the toolkit can be used to: assess progress in reaching the goals of the World Programme of Action for Youth, prioritize activities, and initiate action at the national level. Topics covered include health, HIV, education, employment, drug abuse, youth participation, and more.
4. Learning to Survive: How Education for All Would Save Millions of Young People from HIV/AIDS (2004) (Word document, 814K)
This report suggests that universal primary education could prevent 7 million cases of HIV over a decade. It outlines actions needed by both donor and developing countries to increase access to education and thus, prevent HIV infection.
5. The Intergenerational Approach to Development: Bridging the Generation Gap (2003) (PDF, 116K)
Working with UNICEF, the ICRW reviewed the literature and interviewed staff from 25 projects to see what role an intergenerational approach can have on youth development. The brief report includes short case studies and a five-part framework for approaching intergenerational programs, covering such issues as recognizing the interdependence of adolescent and adult lives, respect for each generation's unique experiences through open dialogue, and different age adolescents needing different types of adults to play supportive roles at various stages in adolescents' lives.
6. Voices of Youth: What Young People Are Saying (2004) (PDF, 332K)
UNICEF's newsletter and Web site provide a valuable resource for youth and groups serving youth, with this issue focusing on the need for excellence in youth media . Ideas on the issue of quality media for youth from around the world are available.
7. The ABC of All the Questions We Never Dare To Ask (2003)
This 144-page book addresses sensitive issues, such as sex, gender, body, and relationships in a youth-friendly format with cartoons, diagrams, and catchy characters. Using actual questions asked by youth in Africa, the book targets youth, but is also a helpful resource for parents, teachers, and other family members. It also discusses cultural vales and practices within society.
8. HIV and Sexual Behavior Among Young South Africans: A National Survey of 15-24 Year Olds (2004) (PDF, 909K)
This 86-page document reports on the results of a national survey of more than 11,000 South African youth. The survey attempted to identify trends and related determinants in HIV infection as well as the relative impact of the loveLife program on HIV and related risk behaviors. Selected topics include pregnancy, STIs, contraceptive use, sexual coercion and violence, sexual attitudes and behavior, and awareness, participation and response to loveLife.
- Organization: loveLife and the Reproductive Health Research Unit, University of Witwatersrand
- Contact: talk@lovelife.org.za
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II. RESEARCH ARTICLES
Most of these articles are not available on-line without a subscription to the journal. To obtain the full article, you will need to contact the journal directly or through your organization's library.
Community group participation: Can it help young women to avoid HIV? An exploratory study of social capital and school education in rural Zimbabwe. Gregson S, Terceira N, Mushati P, et al. Soc Sci Med 2004;58(11):2119-32.
Using cross-sectional data from a large-scale, population-based survey in rural eastern Zimbabwe, the study found that participation in local community groups is often positively associated with successful avoidance of HIV, which, in turn, is positively associated with psychosocial determinants of safer behavior. Whether or not these relationships hold depends on a range of factors that include how well the group functions, the purpose of the group, and the education level of the individual participant. Young women with secondary education participate disproportionately in well-functioning community groups and are more likely to avoid HIV when they do participate. Longitudinal studies are needed to establish whether community group membership supports the development of safer lifestyles or merely has greater appeal to individuals already predisposed towards such lifestyles, and to pinpoint directions of causality between possible mediating factors. In-depth research is needed on the specific qualities of community groups that enhance their contribution to HIV control. Even so, the findings suggest that promotion of and organizational development and training among community groups could well be an effective HIV control strategy.
2. Do family-planning workers in China support provision of sexual and reproductive health services to unmarried young people? Tu X, Lou C, Gao E. Bull World Health Organ 2004;82(4):274-80.
To ascertain the perspectives of family planning service providers in eight sites in China on the provision of sexual and reproductive services to unmarried young people, the study analyzed data from a survey of 1,927 family planning workers and 16 focus group discussions conducted in eight sites in China in 1998-99. While family planning workers recognized the need to protect the sexual health of unmarried young people and were unambiguous about the need for government agencies to provide information and education on sexual and reproductive health to unmarried young people, perceptions about the appropriate age for and content of such education remained conservative. About 70% of family planning workers were willing to provide contraceptives to unmarried young people, and about 60% approved government provision of contraceptive services to unmarried young people, but only one quarter agreed that the services could be extended to senior high schools. Training programs for family-planning workers are urgently needed to address the need to provide services to unmarried youth.
3. Economic empowerment and reproductive behaviour of young women in Osun state, Nigeria. Odutolu O, Adedimeji A, Odutolu O, et al. Afr J Reprod Health 2003;7(3):92-100.
This paper utilizes qualitative data collected as part of an intervention program designed to increase access to reproductive health information/services and economic resources among young women in Osogbo, Nigeria. The aim was to provide reproductive health information and training in basic business skills and micro-credit facilities to enable beneficiaries to establish private businesses. Findings from the study highlight the importance of the relationship between female education and access to economic resources as a means of furthering empowerment of women especially in terms of their reproductive behavior.
4. Effects of a community-based sex education and reproductive health service program on contraceptive use of unmarried youths in Shanghai. Lou C-H, Wang B, Shen Y, et al. J Adolesc Health 2004;34(5):433-40.
The study evaluated the effectiveness of a youth-friendly intervention in Shanghai, China, comparing changes in an intervention and control site. Baseline and post-intervention surveys (20 months later) were conducted with about 1,000 youth ages 15 to 24 in each site, about half out of school and half in high school. The intervention intended to build awareness and offer counseling and services related to sexuality and reproduction among unmarried youths, in addition to the routine program activities, which were exclusively provided in the control site. At baseline, there was no statistical difference in contraceptive use between the intervention and control groups. After intervention, the proportions reporting regular contraceptive use and condom use in the intervention group were much higher than in the control group. After adjusting for demographic factors, the subjects from the intervention group were 14.6 times as likely to use contraceptives at onset of intercourse as those from the control group.
5. Impact of a school-based peer sexual health intervention on normative beliefs, risk perceptions, and sexual behavior of Zambian adolescents. Agha S, Van Rossem R. J Adolesc Health 2004;34(5):441-52.
Using a quasi-experimental, longitudinal panel design, the study evaluated the impact of a peer sexual health education intervention in Zambian secondary schools (three intervention schools, two control sites). Three rounds of data from male and female adolescents in grades 10 and 11 were collected at baseline in July 2000, at first follow-up in September 2000, and at second follow-up in April 2001. A total of 416 respondents ages 14 to 23 (at baseline) were interviewed in all three survey rounds. Student self-reports showed positive changes in normative beliefs about abstinence immediately after the intervention, and these improvements were largely sustained until 6 months after the intervention. Students became more likely to approve of condom use and to intend using condoms immediately after the intervention, but these positive outcomes could not be sustained during the 6 months that followed the intervention. Normative beliefs regarding condom use took longer to develop: these were only observed at 6 months follow-up. Students reported reductions in multiple regular partnerships. There was no change in condom use. More regular efforts may be required to sustain the approval of, and the intention to use, condoms. The intervention was successful in reducing multiple regular partnerships.
6. Predictors of maternal HIV infection at the primary care level in inner city Ibadan. Lawoyin TO, Adewole DA. Int J STD AIDS. 2004 Mar; 15(3):165-8.
In a study of 343 consenting pregnant women attending a randomly selected primary health care clinic in inner city Ibadan from April to November 2001, followed till delivery of their babies, sociodemographic and reproductive health data were collected by questionnaire and all mothers were screened for HIV/AIDS using an enzyme-linked immunosorbent assay based rapid test. About one in three teenage mothers screened positive, having the highest HIV rate. HIV prevalence rate reduced, though not significantly, in mothers 20-29 years and those 30-39 years with mothers in these groups having similar rates. No mother over 39 years screened positive. Following logistic regression analysis, young age 15-19 years, was associated with a significantly increased risk for infection at the primary health care level. Christian religion was associated with a lower risk, and mothers who booked late in pregnancy or had husbands in the lower socio-economic class were less likely to be infected. None of the women were aware of their HIV status prior to the study. With a predominantly heterosexual mode of HIV transmission, it is necessary to identify infected pregnant women early through voluntary counseling and testing (VCT), so that they can be given the option to take preventive drugs, which would among other benefits reduce mother-to-child transmission, and help infected mothers stay healthy and productive for longer.
7. Reproductive and sexual health among young adults in Uzbekistan. Buckley C, Barrett J, Asminkin YP. Stud Fam Plann 2004;35(1):1-14.
Since 1991, contraceptive use has risen significantly in Uzbekistan while reliance on abortion has declined. However, prevalence of sexually transmitted diseases increased significantly in the 1990s, and UNAIDS currently identifies the Central Asian region as a high HIV-growth zone. Structural, institutional, and attitudinal factors have contributed to the disconnection between reproductive and sexual health in Uzbekistan. Integrating state statistics, Demographic and Health Survey data, and focus-group-discussion results, the study highlights ways in which a heavily centralized program focusing on reproductive health did little to better sexual health, especially among young adults. The example of Uzbekistan reveals pathways by which reproductive health efforts may continue to be compartmentalized, decreasing their potential contributions to sexual health, especially among young adults.
8. Review of STI and HIV epidemiological data from 1990 to 2001 in urban Burkina Faso: implications for STI and HIV control. Nagot N, Meda N, Ouangre A, et al. Sex Transm Infect 2004;80(2):124-9.
The study reviewed epidemiological studies performed over the past decade in Bobo-Dioulasso, the second city of Burkina Faso, looking at trends in STI prevalence among commercial sex workers and the general population. Variations in etiologies of vaginal discharge, urethral discharge, and genital ulcers were also evaluated among patients consulting for genital infection complaints. Antenatal clinic based surveys provided data to assess HIV trend among the general population. Classic bacterial STI such as syphilis, Neisseria gonorrhoea, and Chlamydia trachomatis declined in all study groups. Trichomoniasis also declined but to a lesser extent. HIV infection followed the same trend at the same time, with a significant decline in the 15-19 year age group of pregnant women, suggesting a possible decrease of HIV incidence. Although no evidence of a causal relation can be drawn from this review, adoption of safer sex behavior, introduction of the syndromic management (SM) approach, or higher antibiotic use may have contributed to these changes. Classic bacterial STI declined over the past decade in parallel with a stabilization of HIV infection. Variations in syndromes etiology and sexual behaviors should be monitored as part of STI surveillance in order to improve STI syndromic management algorithms and to adapt HIV/STI prevention efforts.
9. Safe motherhood perspectives and social support for primigravidae women in Lusaka, Zambia. Maimbolwa M, Ahmed Y, Diwan V, et al. Afr J Reprod Health 2003;7(3):29-40.
Almost all (93%) of Zambian pregnant women attend antenatal care, though only 43% deliver in maternity units. This study explored the preparation of low-risk Zambian women in their first pregnancy (primigravidae), including contraceptive use, content of antenatal care, preparation for childbirth, and the extent of social support. Structured interviews were conducted with 299 healthy primigravidae at an antenatal clinic, mean age of 20.7 years; of these, 78% had never used any contraceptive method. The main source of information on sexual issues was friends and the mass media. Only 2% of the women had received information on sexual and reproductive health matters from health staff. Nearly half did not want the pregnancy; 63% had made their first antenatal visit during the second trimester; 85% had identified a social support person to assist them during pregnancy and after childbirth. None received preparation for parenting during antenatal visits. The study recommended that as part of the integrated reproductive health approach, parenthood classes should be organized and social support network should be utilized and involved in the care.
10. The sexual and reproductive health of young people in Adjumani district, Uganda: qualitative study of the role of formal, informal and traditional health providers. Kiapi-Iwa L, Hart GJ. AIDS Care. 2004 Apr; 16(3):339-347.
This qualitative study of young people and health care workers in Uganda found that young people are generally very knowledgeable about STD spread and prevention as well as methods for prevention of pregnancy. Health workers are the most important category of people providing information on sexual and reproductive health (SRH) for young people. However, many health workers are conservative with regard to adolescent sexuality. There is a lack of training in and guidelines for working with adolescents, plus inadequate access to SRH services for young people, leading to inadequate assistance for young people's problems. Physical, social, psychological and economic factors create barriers to service accessibility, including religious and cultural factors, making some young people vulnerable, particularly young women. In an effort to find alternative services that meet their needs better, young people visit informal and traditional health care providers despite having to pay for these services. The confidentiality and privacy that they offer could be a lesson for formal health care providers. Further training and integration of traditional health care providers is essential as they already play a major part in SRH service delivery to young people.
11. The sexual health of pupils in years 4 to 6 of primary schools in rural Tanzania. Todd J, Changalucha J, Ross DA, et al. Sex Transm Infect. 2004 Feb; 80(1):35-42.
Through a cross sectional survey, the project assessed the the sexual health of pupils in years 4 to 6 of 121 rural primary schools in north western Tanzania, before the implementation of an innovative sexual health intervention in 58 of the schools. The survey of about 9,300 youth gathered basic demographic information and asked about knowledge and attitudes towards sexual health issues and their sexual experience. A urine specimen was requested and tested for HIV, Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and, for females, pregnancy. Male pupils were significantly older than females (mean age 15.5 years v 14.8 years), but all other demographic characteristics were similar between the sexes. 14 (0.2%) of the enrolled pupils (four male and 10 female) were HIV positive, 83 (0.9%) were positive for CT, and 12 (0.1%) for NG. 32 female pupils (0.8%) were positive by pregnancy test. Sexual experience was reported by one fifth of primary school girls, and by almost half of boys. Only 45/114 (39%) girls with biological markers of sexual activity reported having had sex. HIV, CT, NG, and pregnancy were present though at relatively low levels among pupils in years 4 to 6 of primary school. A high proportion of pupils with a biological marker of sexual activity denied ever having had sex. Alternative ways of collecting sensitive data about the sexual behavior of school pupils should be explored.
12. Socialization ambiguity in Samoan adolescents: a model for human development and stress in the context of culture change. McDade TW, Worthman CM. J Res Adolesc 2004;14(1):49-72.
Rapid globalization is forcing youth around the world to confront new developmental challenges, and conceptual models are needed that can capture this experience and its developmental implications. Exposure to nontraditional lifestyles opens up new socialization opportunities and raises the possibility of stress-inducing dissonance between participating socializing agents and the messages they deliver. Socialization ambiguity is introduced as a model for culture change and adolescent stress, and it is applied to a sample of 10- to 20-year-olds (N=295) in the islands of Samoa. A physiological marker of stress (antibodies against the Epstein-Barr virus) is employed to overcome some of the difficulties associated with measuring stress outcomes. Socialization ambiguity is found to be a significant source of stress on the remote island of Savai'i and the transitional area of rural Upolu, although the direction of the association is different, possibly reflecting divergent socialization goals in these two regions.
13. Uganda AIDS prevention: A,B,C and politics. Blum RW. J Adolesc Health 2004;34(5):428-32.
Uganda is one of the few countries in the world that has experienced a significant reduction in HIV prevalence over the past decade. In contrast to many of its neighbors, Uganda has had an explicit national policy that includes: Abstinence, Be faithful, and Condoms. This strategy, known as "ABC," has garnered wide attention in the United States as the efficacy of abstinence-based sex education is debated. This commentary is based on published and unpublished data together with personal observations derived from a Department of Health and Human Services (DHHS)-led delegation to Uganda in December 2002. The empirical bases for both an abstinence-only and a combined (ABC) strategy are reviewed; and the political consequences of the debate for both Africa and the United States are explored.
14. Developed Country Summaries
Adolescent girls' perceptions of the timing of their sexual initiation: "too young" or "just right"? Cotton S, Mills L, Succop PA, et al. J Adolesc Health 2004;34(5):453-8.
To examine variables associated with adolescent girls' perceptions of the timing of their first consensual intercourse, a 3-year longitudinal study of the psychosexual development of 174 primarily African-American adolescent girls, aged 12 to 15 years, asked whether they believed their age of initiation was "too young," "too old," or "just right." At the end of the study, 73 percent reported being sexually experienced. Ninety-nine (78%) said that they were "too young" and 28 (22%) said that their age had been "just right." Variables associated with perceiving age of first consensual intercourse as "just right" included younger chronological age, an older age of first consensual intercourse, endorsement of being "in love" as a reason for first consensual intercourse, greater indirect parental monitoring (vs. "none" or "direct parental monitoring"), and a higher level of education for mothers. Most of these adolescents thought their age of initiation was too young. Factors associated with perceiving the timing of consensual intercourse as "just right" are similar to those reported in the literature to be associated with delaying the initiation of consensual intercourse.
Attachment style, childhood adversity, and behavioral risk among young men who have sex with men. Gwadz MV, Clatts MC, Leonard NR, et al. J Adolesc Health 2004;34(5):402-13.
The study examined relationships among childhood adversity, attachment style (one's core beliefs regarding the self and others), and the following risk behaviors and contexts among young men who have sex with men (YMSM): homelessness, daily substance use, participation in sex work, involvement in the criminal justice system, and being out of school or work. Using a targeted sampling approach, the study recruited 569 YMSM aged 17-28 years from natural venues in New York City including bars, clubs, parks, and bus stations. Youth completed a structured interview assessing lifetime and current risk and protective contexts and behavior. Data were analyzed using univariate and multivariate statistical methods. After controlling for demographic characteristics and childhood adversity, YMSM with a fearful attachment style were more likely to have been homeless, to have participated in sex work, to use substances daily, to have been involved in the criminal justice system, and to be out of school/work. Three subgroups were particularly vulnerable: YMSM who identified as heterosexual, bisexual, and/or transgender. A fearful attachment style contributes to some YMSM remaining outside of the protective systems of family, school, and work, and is associated with risky contexts where they are less likely to encounter pro-social peers and adults. Further, it is associated with risk behavior. Although gay-identified youth are generally found to have poor outcomes when compared with the general population of adolescents, in the present report, YMSM who identified as heterosexual were at particular risk. Attachment theory can guide interventions by informing how individuals experience relationships and manage developmental transitions.
Bone mineral density in adolescent females using depot medroxyprogesterone acetate. Lara-Torre E, Edwards CP, Perlman S, et al. Pediatr Adolesc Gynecol 2004;17(1):17-21.
A non-randomized prospective study examined bone mineral density (BMD) on a semi-annual basis among control subjects and adolescent females receiving depot medroxyprogesterone acetate (DMPA) injection or oral contraceptives. The study recruited adolescent females who were new users of DMPA injection (N=58, age 12-21) or the oral contraceptive pill (N=71, age 11-19) and normal menstruating girls (N=19, age 15-18) at a teenage pregnancy prevention intervention clinic. The study did baseline and 6-monthly measures of lumbar vertebral BMD using dual-energy X-ray absorptiometry over a 2-year period and compared percent change on BMD over time between DMPA users, pill users, and normal menstruating girls. There was no difference on group characteristics at baseline except for the ethnicity between the controls and the DMPA group. There was a statistically significant decrease in BMD between DMPA users and controls at 6 months, 12 months, 18 months, and 24 months. There was no statistical difference between pill users and controls. There is a relationship between DMPA use and a decrease in BMD compared to normal menstruating controls that seems to persist up to 24 months.
A descriptive analysis of STD prevalence among urban pregnant African-American teens: data from a pilot study. Diclemente RJ, Wingood GM, Crosby RA, et al. J Adolesc Health 2004;34(5):376-83.
To assess the prevalence of sexually transmitted diseases (STDs) among a sample of African-American adolescent females at the time of their first prenatal visit and to assess key characteristics of those testing positive for sexually transmitted diseases. The study also determined differences in these characteristics between adolescents who were and those who were not diagnosed with an STD. The study recruited 170 pregnant African-American adolescents (aged 14-20 years; mean = 17.5 years) at their first prenatal visit at a prenatal clinic in a large urban hospital. Biological assessment included nucleic acid amplification testing for gonococcal, chlamydial, and trichomonal infections. Rapid plasma reagin testing assessed infection with syphilis. A self-administered survey and in-depth face-to-face interview were used to collect detailed information assessing adolescents' sociodemographic characteristics, psychosocial indices, and their recent sexual risk behaviors. Overall, 23.5% tested positive for one of the four STDs: 13% were infected with Chlamydia trachomatis, 1.2% with Neisseria gonorrhoeae, 8.9% with Trichomonas vaginalis, and 1.2% with Treponema pallidum. More than half reported recent (past 6 months) treatment for an STD; 30% of these tested positive for at least one of the four STDs assessed. Adolescents testing positive for STDs held favorable attitudes toward condom use, but levels of sexual risk were generally high. There were no sociodemographic, psychosocial, and sexual-risk differences between those testing positive and negative. Findings support STD screening efforts targeting pregnant adolescents. Providing clinic-based counseling and prevention education programs to pregnant adolescents regardless of apparent risk factors may also be warranted.
Early sexual abuse, street adversity, and drug use among female homeless and runaway adolescents in the midwest. Chen X, Tyler KA, Whitbeck LB, et al. Drug Issues 2004;34(1):1-22.
Research on homeless and runaway adolescents has shown that this population is at high risk for illicit drug use. Though sexual abuse has been widely considered in the etiology of illicit drug use, we know less about how early sexual abuse affects young people's decisions to run away, to use drugs, and to engage in other deviant behavior on the streets. Based on interviews with 361 female homeless and runaway adolescents in four midwestern states, the study revealed a high prevalence of drug use, especially use of cocaine among youths with sexual abuse histories. Path analyses showed that early sexual abuse indirectly affected drug use on the streets via running away at an earlier age, spending more time on the street, and use of deviant strategies to survive (e.g., affiliation with deviant peers, trading sex, and use of nonsexual deviant subsistence strategies).
The effects of advance provision of emergency contraception on adolescent women's sexual and contraceptive behaviors. Gold MA, Wolford JE, Smith KA, et al. J Pediatr Adolesc Gynecol 2004;17(2):87-96.
To determine whether adolescents given advance EC have higher sexual and contraceptive risk-taking behaviors compared to those obtaining it on an as-needed basis, a randomized trial was conducted at an urban, hospital-based adolescent clinic in Pittsburgh, PA, from June 1997 to June 2002, with 301 predominantly minority, low-income, sexually active adolescent women, age 15-20 years, who were not using long-acting contraception. The study compared advance EC vs. instruction on how to get emergency contraception. They study used monthly 10-minute telephone interviews for 6 months post-enrollment to get self-reported data on unprotected intercourse and use of condoms, EC, and hormonal contraception, as well as reported timing of EC use after unprotected intercourse. At both 1- and 6-month follow-up interviews, there were no differences between advance EC and control groups in reported unprotected intercourse within the past month or at last intercourse. At 6 months, more advance EC participants reported condom use in the past month compared to control group participants but not at last intercourse (advance EC 83% vs control 78%). There were no significant differences by group in hormonal contraception use reported by advance EC or control groups in the past month (44% vs 53%) or at last intercourse (48% vs 58%). At the first follow-up, the advance group reported nearly twice as much EC use as the control group (15% vs 8%) but not at the final follow-up (8% vs 6%). Advance EC group participants began their EC significantly sooner (11.4 hours vs 21.8 hours). Providing advance EC to adolescents is not associated with more unprotected intercourse or less condom or hormonal contraception use. In the first month after enrollment, adolescents provided with advance EC were nearly twice as likely to use it and began EC sooner, when it is known to be more effective.
An evaluation of the use of the transdermal contraceptive patch in adolescents. Rubinstein ML, Halpern-Felsher BL , Irwin CE Jr. J Adolesc Health 2004;34(5):395-401.
To evaluate the acceptability and feasibility of using the new transdermal contraceptive patch in adolescents, a 3-month longitudinal trial was conducted using the Ortho Evra trade mark transdermal contraceptive patch in 50 adolescent girls. All healthy girls aged 15-18 years were invited to participate from two San Francisco Bay Area teen clinics. Participants were followed after 1 month and 3 months of treatment. Data were collected on patch detachments, perceived advantages and disadvantages, side effects, and compliance. Forty participants (80%) completed 1 month of treatment and 31 (62%) completed all 3 months of the study. There were no pregnancies during treatment. At the 3-month follow-up, 87% of participants reported perfect compliance. Ease of use, the fact that it does not require daily attention, and the ease of concealment were among the main reported advantages. Roughly 77% of participants who completed the study were planning to continue using the patch. The 35% rate of complete or partial detachment of at least one patch was considerably higher than reported in previous studies of adults. As in adults, the most commonly reported complaints were application site reactions and breast discomfort. This evaluation found an overall positive impression of the new transdermal contraceptive patch, with good rates of short-term compliance and few side effects among adolescents. However, the high degree of detachment unique to this sample of adolescents is concerning and requires further evaluation.
Gonorrhea and chlamydia screening in sexually active young women: the processes of change . Chacko MR, Von Sternberg K, Velasquez MM. J Adolesc Health 2004;34(5):424-7.
A pilot study conducted with young women in an urban clinic examined a Transtheoretical Model processes of change measure to better understand strategies and behavioral mechanics that facilitate seeking gonorrhea and chlamydia screening. This information may be useful in developing interventions to improve sexually transmitted infection (STI) screening. Consistent with other studies, greater use of experiential and behavioral processes was associated with the action/maintenance stages for seeking gonorrhea and chlamydia screening.
Navigating between cultures: the role of culture in youth violence. Soriano FI, Rivera LM, Williams KJ, et al. J Adolesc Health 2004;34(3):169-76.
The purpose of this paper is to review three cultural concepts (acculturation, ethnic identity, bicultural self-efficacy) and their relationship to the known risk and protective factors associated with youth violence. We conducted a review of the relevant literature that addresses these three cultural concepts and the relationship among culture, violent behavior, and associated cognition. The available literature suggests that ethnic identity and bicultural self-efficacy can be best thought of as protective factors, whereas acculturation can be a potential risk factor for youth violence. We examine the connection between these cultural concepts and the risk and protective factors described in the 2001 Surgeon General's Report on Youth Violence, and present a summary table with cultural risk and protective factors for violence prevention. These concepts can assist physicians in identifying risk and protective factors for youth violence when working with multicultural adolescents and their families. Physicians are more effective at providing appropriate referrals if they are aware that navigating among different cultures influences adolescent behavior.
Perceived STD risk, relationship, and health values in adolescents' delaying sexual intercourse with new partners. Rosengard C, Adler NE, Millstein SG, et al. Sex Transm Infect 2004;80(2):130-7.
This study examined the amount of time adolescents waited to have intercourse with past partners (main and casual), intentions to delay with future partners, and psychosocial factors that predict delay intentions among adolescents. Data from 205 participants at an adolescent STD clinic who had previous experience with both main and casual partners participated in the study. Adolescents waited less time to have intercourse with most recent casual than with most recent main partners. The amount of time waited with past partners was shorter than intended time to wait in future relationships -- medians of 1 month v 2 months (main); medians of 2 weeks v 1 month (casual). Factors influencing intentions to delay intercourse with future main partners differed by sex; males were negatively influenced by importance of sex in relationships, while females were positively influenced by importance of intimacy in relationships, perceived risk of STDs, and health values.
Peripubertal girls' romantic and platonic involvement with boys: associations with body image and depression symptoms. Compian L, Gowen LK, Hayward C. J Res Adolesc 2004;14(1):23-47.
This study explored the relationship of both romantic and platonic involvement with boys, as well as pubertal status, to body image and depression symptoms among an ethnically diverse sample of sixth-grade girls. Participants were 157 early adolescent girls (ages 10-13) who completed self-report measures designed to assess girls' level of involvement with boys, pubertal status, and psychological adjustment. Girls' degree of romantic involvement was positively associated with higher depression scores. More advanced pubertal status was associated with both lower body image satisfaction and higher depression scores. A significant interaction between platonic involvement and pubertal status emerged. Girls who were less sexually mature but who also reported more platonic involvement with boys reported greater body image satisfaction. These findings suggest that the type of involvement with boys (romantic vs. platonic) and a girl's pubertal status influence psychological adjustment.
The potential protective effects of youth assets from adolescent sexual risk behaviors. Vesely SK, Wyatt VH, Oman RF, et al. J Adolesc Health 2004;34(5):356-65.
To examine the relationship among individual youth assets and adolescent sexual risk behaviors, a cross-sectional, in-home interview was conducted with 1,253 randomly selected inner-city neighborhood teenagers and their parents. Demographic information (e.g., age, parental income, family structure) was statistically controlled for while investigating the relationships among youth asset and sexual activity outcomes using logistic regression analyses. The five sexual risk behaviors included never had sexual intercourse, current sexual activity, number of lifetime sexual partners, current use of birth control, and age at first intercourse. Sixty-three percent reported never having had sexual intercourse. After controlling for the demographic variables and other significant assets, Non-Parental Adult Role Models, Peer Role Models, Use of Time (Religion), and Future Aspirations were independently significantly related to whether or not youth had ever participated in sexual intercourse. Individual multiple logistic regression analyses indicated that, after controlling for the demographic variables, Peer Role Model and Family Communication assets were each significantly associated with birth control use by sexually active youth. Specific youth assets may have a protective effect from certain sexual risk behaviors.
Prevalence and correlates of chlamydia infection in Canadian street youth. Shields SA, Wong T, Mann J, et al. J Adolesc Health 2004;34(5):384-90.
To determine the prevalence and correlates of Chlamydia trachomatis in Canadian street youth, a cross-sectional study of street youth between the ages of 15-24 years was conducted over a 9-month period in seven large urban centers across Canada. Youth were recruited through "drop-in" centers, outreach work, and mobile vans in each city. Information was collected through a nurse-administered questionnaire. Youth were asked to provide urine to test for chlamydia trachomatis by polymerase chain reaction. Separate logistic regression models were run for males and females controlling for age. The prevalence rate of chlamydia was 8.6% in 1355 youth. Higher prevalence rates were found in females than in males (10.9% vs. 7.3%) and in Aboriginal youth than in non-Aboriginal youth (13.7% vs. 6.6%). Four variables were associated with increased risk of chlamydia infection in females: Aboriginal status; self-perceived risk; having no permanent home; and having been in foster care. One predictor of chlamydia for males was having had a social worker. A high prevalence of chlamydia was found in this vulnerable population in comparison to other Canadian youth. Having been in foster care and having had a social worker were found to have a strong association with chlamydia.
Prevalence of sexually transmitted infections and mental health needs of female child and adolescent survivors of rape and sexual assault attending a specialist clinic. Kawsar M, Anfield A, Walters E, et al. Sex Transm Infect 2004;80(2):138-41 .
To determine the prevalence of sexually transmitted infections (STIs) and the mental health needs of female child and adolescent survivors of rape and sexual assault who were referred to a specialist genitourinary medicine (GUM) clinic, a review was conducted of retrospective case notes of 98 females aged 16 or less who attended over a 5-year period (1996-2000). The overall prevalence of STIs was 26%. Among the girls who were aged 0-12 years (n = 16), one had gonorrhoea and another had Trichomonas vaginalis infection. Prevalence of STIs in those aged 13-16 years, who were not sexually active before the index assault, was 24% and in those who gave a history of previous consensual sexual activity it was 39% (p = 0.17). Chlamydial infection was more common among the girls who disclosed previous consensual sexual activity than in those did not disclose previous sexual activity. The overall prevalence of vaginal candidiasis was 17% and bacterial vaginosis 13%. More than one third of the study population gave a history of previous sexual, physical, or other abuse. 81% reported having current psychological difficulties. Mood changes and sleep disturbances were reported more frequently than other psychological symptoms; 15% attempted self harm. 29% had no involvement with social and mental health services before their attendance at the clinic. The prevalence of STIs among female child and adolescent survivors of rape and sexual assault attending a specialist clinic was high. The range of mental health and social difficulties was wide and multiple. The importance of an early assessment for the presence of STIs and mental health difficulties was demonstrated.
Race/ethnicity and gender disparities in the utilization of a school-based hepatitis B immunization initiative. Middleman AB. J Adolesc Health 2004;34(5):414-9.
To determine if participation and completion rates in a school-based hepatitis B vaccination program differ based on individual demographic factors including insurance status, race, and gender, an analysis was conducted of a school-based free adolescent hepatitis B immunization initiative at elementary schools with a high percentage of free lunch and "at risk" students, including consent/refusal forms, participation rates, and immunization completion rates. Families of female children and those with insurance or Medicaid were more likely than those with no insurance to respond by returning a consent or refusal form and were also more likely to participate in the program by receiving at least one immunization dose. Black and Hispanic potential enrollees participated more frequently than white and Asian potential enrollees. Black, Hispanic, and Asian females were more likely to complete the vaccination series. Even when access issues are eliminated as a potential barrier to hepatitis B immunization, gender and race disparities exist in the participation in, and completion of, the immunization series. Race and gender clearly play separate and distinct roles in health care utilization, unrelated to the traditional variables of socioeconomic status often associated with access to care.
Teen pregnancy and urban youth: competing truths, complacency, and perceptions of the problem. Gallup-Black A, Weitzman BC. J Adolesc Health 2004;34(5):366-75.
To compare and contrast perceptions of community leaders, adults, and youth about the extent of the teen pregnancy problem in five American cities (Baltimore, Detroit, Oakland, Philadelphia, and Richmond), semi-structured telephone interviews were conducted with 79 key informants (leaders influential in children's policy issues) to ascertain their perceptions of the most pressing problems facing youth in their cities. Structured, computer-assisted interviews on a range of issues, including teen childbearing and sexual activity, were conducted with 7,716 randomly selected adults and 2,768 youth aged 10-18 years. The key informant interviews were transcribed and coded; reviewers were paired to validate the coding. Among the key informants, teen pregnancy was cited as a big problem by only 15%; other issues, such as crime and schools, were seen as more pressing. However, 58% of the adults in the general population thought that teen pregnancy was a big problem. Although almost 3/4 of youth in these cities believed their parents would be upset if they had sex, 87% reported that teen sexual activity before age 18 years was acceptable to their peers, 53% said that teen parenthood was considered acceptable, and 51% had at least one friend who was a teen parent. There were statistically significant differences in the adult and youth responses by race, income, and educational attainment. Although few leaders see teen pregnancy as a pressing problem, adults remain deeply concerned, and youth indicate that the problem is prevalent and accepted.
Young adults' attitudes, beliefs, and feelings about testing for curable STDs outside of clinic settings. Ford CA, Jaccard J, Millstein SG, et al. J Adolesc Health 2004;34(4):266-9.
The purpose of this paper was to elicit attitudes, beliefs, and feelings about testing for curable STDs outside of clinic settings. Telephone interviews were conducted with 120 black, Latino, and white young adults aged 18 to 25 years. Data were analyzed with descriptive frequencies and content analyses. Most (73%) reported people their age would use self-test urine STD kits if available. Perceived advantages were privacy and convenience. Disadvantages included not having an immediate "face-to-face" discussion with a medical professional about positive tests. Young adults report a range of attitudes, beliefs, and feelings that may influence the success of efforts to screen for curable STDs in nonclinic settings.
