Sexual Orientation and Sexual and Reproductive Health Among Adolescent Young Women in the United States

PurposeWe studied sexual and reproductive health among self-identified bisexual, lesbian, and heterosexual adolescent young women. Prior research has suggested that bisexual and lesbian young women may be at greater risk for many negative health outcomes, including risky sexual and reproductive health behavior.MethodsUsing data from the U.S. nationally representative 2006–2010 National Survey of Family Growth (NSFG), we examined sexual and reproductive health among young women 15–20 years of age as a function of sexual orientation. We used logistic regression and ANCOVA to examine differences in sexual and reproductive health across groups while controlling for demographic group differences.ResultsBisexual and lesbian young women reported elevated sexual and reproductive health risks. Bisexual and lesbian participants reported being younger at heterosexual sexual debut, and having more male and female sexual partners, than did heterosexual participants. Further, they were more likely than heterosexual young women to report having been forced to have sex by a male partner. Bisexual young women reported the earliest sexual debut, highest numbers of male partners, greatest use of emergency contraception, and highest frequency of pregnancy termination.ConclusionsOverall, sexual minority young women—especially those who identified as bisexual—were at higher sexual and reproductive risk than their heterosexual peers.     

Perceived,anticipated and experienced stigma: exploring manifestations and implications for young people’s sexual and reproductive health and access to care in North-Western Tanzania

Abstract

Young people – particularly girls and young women in sub-Saharan Africa – face significant challenges accessing sexual and reproductive health information and services. These challenges are shaped in part by sociocultural factors, including stigma. This paper presents findings from a qualitative study that explored the micro-level social process of stigma surrounding young people’s sexual and reproductive health in two communities in Tanzania. Respondents described an environment of pervasive stigma surrounding the sexual and reproductive health of unmarried young people. Stigma manifested itself in multiple forms, ranging from verbal harassment and social isolation to physical punishment by families, community members, peers and healthcare providers. Respondents perceived that stigma was a barrier to young people accessing sexual and reproductive health services and identified excessive questioning, scolding and requirements to bring sexual partners or parents to receive services at health facilities as obstacles to accessing care. The pervasiveness and complexities of stigma surrounding young people’s sexual and reproductive health in the two study communities and its potential consequences for health suggest both a need for care in using the term stigma as well as further studies on the feasibility of incorporating stigma-reduction strategies into young people’s sexual and reproductive health programmes.     

Salud sexual y reproductiva,y crisis económica en España. Informe SESPAS 2014

Sexual and reproductive health (SRH) is protected by the public authorities to ensure that people enjoy a free, satisfying, and safe sexual life. Despite the approval of the National Sexual and Reproductive Health Strategy in 2011, the progress achieved may be jeopardized by recent proposals for legislative changes affecting this area (abortion Law and 16/2012 Law) and by the impact of the current economic crisis. This article aims to describe the current situation of sexual and reproductive health in the Spanish population and to identify the potential impact of the economic crisis. To this end, we used the following information sources: the National Sexual Health Survey, the DAPHNE surveys, births and fetal deaths statistics from the Spanish National Institute of Statistics, the Registry of Voluntary Pregnancy Interruptions, reports from the National Epidemiology Center, and the National AIDS Registry. Sexual health and the availability of information are rated as good by the Spanish population. Among young people, schools and health services have become less important as information sources and the internet has become more important. Since the beginning of the crisis, contraceptive use and fertility have declined and maternity has been delayed. The economic crisis seems to have affected some indicators of sexual and reproductive health. However, the potential effects on other indicators should continue to be monitored because insufficient time may have passed for accurate determination of the full effect of the crisis.     

The Sexual Self-Consciousness Scale: Psychometric Properties

An investigation of the Sexual Self-Consciousness Scale (SSCS) is reported that aims to measure individual variability with regard to the construct of self-consciousness as experienced in sexual situations. The construct relates to the attentional-capacity model of sexual arousal. Sexual self-consciousness may constitute a vulnerability factor for the development of sexual dysfunction. In the present study, men and women with sexual dysfunction and healthy control participants were investigated (N = 282). Principal component analysis and multitrait scaling analysis showed that a two-component, oblimin-rotated solution based on 12 items and explaining 53.7% of the total variance could be well interpreted. The Sexual Embarrassment subscale (Cronbach’s α = .84), the Sexual Self-Focus subscale (α = .79), and the full scale (α = .85) were found to have satisfactory to good internal consistency. Test–retest reliability was satisfactory for the Sexual Embarrassment subscale (r = .84), the Sexual Self-Focus subscale (r = .79), and total score (r = .83). An effect of sex was found on the Sexual Embarrassment subscale, with female participants scoring higher than male participants. Compared with sexually functional participants, sexually dysfunctional participants scored higher on the Sexual Embarrassment and Sexual Self-Focus subscales. Convergent and divergent construct validity was investigated by comparing the associations of SSCS subscales with general self-consciousness and psychological distress scales. The pattern of correlations was interpreted as providing support for the instrument’s construct validity. In conclusion, the SSCS was found to have satisfactory reliability and validity characteristics, and is expected to contribute to the field of sex research and clinical sexology.     

Truth Be Told: Adolescents’ Disclosure of Sexual Activity to Healthcare Providers

PurposeThe purpose of this study was to describe whether adolescent and young adult patients truthfully disclose sexual activity to providers during a sexual history and explore associations between disclosure and receipt of recommended services.MethodsData from the 2018 National Survey of Sexual Health and Behavior were used to describe self-reported disclsoure of sexually active 14- to 24-year-olds who had a health care visit in the previous year where a sexual history was taken (n = 196). We examined bivariate associations between disclosure and age, race/ethnicity, sex, sexual identity, and receipt of sexual health services.ResultsMost (88%) respondents reported telling their provider the truth about sexual activity. A higher proportion of the younger adolescents (14- to 17-year-olds) did not disclose compared with the 18- to 24-year-old respondents (25.4% vs 3.9%; p < .001). A higher proportion of patients who disclosed reported having a sexually transmitted disease test (69.6% vs 26.7%; p < .001); being offered a sexually transmitted disease test (44.3% vs 4.5%; p < .001); and being asked by providers about number of partners (54.3% vs 15.4%; p < .01).ConclusionsMost young patients disclose their sexual history to their provider, but younger patients might be less likely to do so. Positive patient-provider relationships may encourage disclosure of sexual activity and support receipt of indicated sexual and reproductive health services.     

性暴力与生殖健康研究

目的:了解未婚人工流产(人流)女青少年中的性暴力发生现状及其对生殖健康的影响。方法:于2002年10月~2003年2月在北京、郑州、深圳、南宁市8所医院对2002名自愿要求人流的未婚女青少年进行了自填式问卷调查和妇科检查以及有关性传播疾病(STDs)的实验室检测。结果:2002名未婚人流女青少年中有282名报告曾遭受了性暴力,其发生率为14·08%。在首次性行为和近1年中曾遭受了性暴力的比例分别为7·99%和8·39%。性暴力施暴者中最常见的是男朋友(76·24%)。在性暴力受害者中,有46·10%的人被证实目前患有STDs(包括滴虫性阴道炎、念珠菌性阴道炎、沙眼衣原体感染、淋病、尖锐湿疣、生殖器疱疹)。性暴力受害者更可能首次性行为年龄<18岁、有多个性伴侣、在月经期有性行为、受教育程度低和有吸烟、饮酒嗜好。单因素分析显示,性暴力受害者中有STDs感染史和目前有STDs感染的比例明显高于无性暴力的女青少年,差异有极显著性(P<0·01);多因素分析表明,性暴力经历、首次性交年龄<18岁、性伴侣数≥2个、不使用避孕方法、父母关系不良是未婚人流女青少年是否感染性传播疾病的预测因子。与未遭受性暴力的女青少年相比,性暴力受害者目前有STDs感染的风险增加了1·3倍。结论:未婚人流女青少年中有较高的性暴力发生率和性传播疾病患病率,对未婚人流女青少年的生殖健康造成了明显的影响。     

Sociodemographic Patterns in Retrospective Sexual Orientation Identity and Attraction Change in the Sexual Orientation Fluidity in Youth Study

PurposeThis study examined sociodemographic patterns of retrospective fluidity in sexual orientation identity (i.e., any change from one identity to another) and attractions (i.e., any change in attractions to one or more gender(s)) in a large sample of US youth.MethodsParticipants were 4,087 youth (58% cisgender girls/women, 38% cisgender boys/men, 5% transgender or nonbinary individuals), ages 14–25 years, from across the United States, who were recruited from an online survey panel. Sexual and gender minorities and people of color were oversampled. Participants completed the Wave 1 survey of the longitudinal Sexual Orientation Fluidity in Youth study, which assessed sociodemographic characteristics and retrospective fluidity in sexual orientation identity and attractions.ResultsAcross the sample, 17% reported a retrospective change in identity and 33% reported a change in attractions. Participants who were most likely to report identity change were in the younger age group (14–17 years), were transgender or nonbinary, had a plurisexual identity (pansexual, queer), and reported attractions to more than one gender. Participants who were most likely to report attraction change were nonbinary, had a plurisexual identity (pansexual, queer, bisexual), and reported attractions to more than one gender.DiscussionThis study found retrospective changes in sexual orientation identity and attractions were common in this sample of youth, with the prevalence of these changes differing by sociodemographic characteristics. Results from this study inform future research on adolescent health and have implications for supporting and caring for this age group, for whom sexual fluidity is common.     

Development and Validation of a Reproductive Autonomy Scale

No validated measures are currently available to assess women's ability to achieve their reproductive intentions, also referred to as “reproductive autonomy.” We developed and validated a multidimensional instrument that can measure reproductive autonomy. We generated a pool of 26 items and included them in a survey that was conducted among 1,892 women at 13 family planning and 6 abortion facilities in the United States. Fourteen items were selected through factor analysis and grouped into 3 subscales to form a Reproductive Autonomy Scale: freedom from coercion; communication; and decision‐making. Construct validity was demonstrated by a mixed‐effects model in which the freedom from coercion subscale and the communication subscale were inversely associated with unprotected sex in the past three months. This new Reproductive Autonomy Scale offers researchers a reliable instrument with which to assess a woman's power to control matters regarding contraceptive use, pregnancy, and childbearing, and to evaluate interventions to increase women's autonomy domestically and globally.     

性感觉寻求与青少年男男性行为人群危险性行为的关系

目的 研究25岁及以下青少年男男性行为人群(YMSM)性感觉寻求与其艾滋病相关危险性行为的关系。方法 于2013年5-11月通过互联网宣传、外展活动以及例行的艾滋病自愿咨询检测服务招募403名YMSM, 采用匿名问卷调查, 回收375份(93.05%)有效问卷。结果 YMSM中有37.9%首次同性性行为未使用安全套, 最近6个月有55.7%发生多性伴行为, 51.7%有“419”(一夜情)行为, 5.6%有群交行为。性感觉寻求与首次同性性行为未使用安全套、多性伴行为、“419”行为、群交行为呈正相关(偏相关系数分别为0.247、0.218、0.296、0.252)。分别以首次同性性行为未使用安全套、多性伴行为、“419”行为、群交行为作为因变量进行logistic回归分析, 结果显示性感觉寻求高者更有可能发生以上危险性行为。结论 青少年性感觉寻求水平对危险性行为有影响, 应加强基于人群性感觉寻求分析的艾滋病相关知识及行为教育, 强化艾滋病相关危险性行为的风险意识, 从而更有效开展YMSM艾滋病干预。     

The knowledge,education and behaviour of young people with regard to Chlamydia trachomatis in Aarhus,Denmark and Bonn,Germany: Do prevention concepts matter?

Young people are at high risk of sexually transmitted infections, especially Chlamydia trachomatis, the most prevalent bacterial sexually transmitted disease in the developed world. Young people lack knowledge about sexually transmitted diseases (STDs) and are more aware of the risks of unwanted pregnancy than their risk of acquiring a STD. Different STD prevention concepts in different countries focus on different STDs. Based on explorative data analysis (Categorical Principal Component Analysis, CatPCA) this study, conducted in 2005, investigates the associations between self-estimation of sexual knowledge, active knowledge of chlamydia and HIV/AIDS, differing sex education and the sexual behaviour of 15–19 year old pupils from Aarhus, Denmark (N = 97), and Bonn, Germany (N = 93). A constructed knowledge, education and behaviour space model shows interesting associations between active STD knowledge and the sex education provided by both media and professionals. Sexual behaviour depends especially on sex education acquired through TV, Internet and print media. The young people from Aarhus and Bonn have significantly differing knowledge levels of chlamydia and HIV/AIDS. This is understood to be an effect of the different STD prevention concepts in Denmark and Germany.     

Married men's first time experiences of early childbearing and their role in sexual and reproductive decision making: a qualitative study from rural Vietnam

Male partners' involvement in women's sexual and reproductive health has been increasingly emphasised in international health. A qualitative approach with open-ended qualitative interviews was used to explore young, married men's first time experiences of early childbearing, their sexual and reproductive decision making and the meanings they make of their role as husbands and fathers. The results offer a nuanced picture of the men's vulnerability in becoming young fathers and having to assume their role as family decision-makers, while still being inexperienced in matters related to the health of their wives and newborn child. Constraints to gender equality and traditional norms and values continue to pose barriers to both young men and women making independent decisions in relation to marriage and childbearing. Men's involvement is necessary in healthcare programmes designed to improve women's sexual and reproductive health and the health of the newborn. Young, first-time fathers, in particular, need support and empowerment.     

青年学生性健康特征与教育需求调查的聚类分析

目的 通过聚类分析识别青年学生群组,探索不同群组的特征和需求差异,为预防艾滋病开展性健康教育提供依据。方法 基于广东省教育部门组织的青年学生预防艾滋病性健康教育需求调研,对使用方便抽样法获得3 884份网络调查的有效数据进行两步聚类分析,结合专业领域认识判断确定纳入分析的变量和群组数,比较群组间的性健康、人口学特征、性教育内容与形式需求的差异。结果 经聚类分析确定聚类变量共6个,分别包括自慰行为认知和发生率、性行为发生率、性资讯获取频率、接纳性伴开放程度、艾滋病知识知晓率。根据以上性健康知信行特征、HIV感染风险将学生分为3个群组,其中高风险组1 810人（46.6%）、中风险组1 549人（39.9%）、低风险组525人（13.5%）。人口学特征,高风险组中位年龄19岁,男生（65.9%）、性取向为非异性恋（15.2%）、来自城镇（58.2%）、独生子女（30.8%）和在读本科（54.7%）的比例最高;中风险组中位年龄19岁,女生（82.7%）、在读高职（34.0%）的比例最高;低风险组中位年龄18岁,来自农村（52.4%）、非独生子女（80.6%）、在读高中（41.3%）、非寄宿（17.5%）、无实习/打工经验（43.2%）的比例最高。在教育内容需求方面,高风险组对自我认同、性安全、性决定、避孕流产和STD/AIDS防治的需求高,中风险组则更关注婚恋观、性侵害,低风险组更需要了解青春期生理知识。与低风险组相比,高风险组对同伴教育、互联网/多媒体、匿名咨询等性教育形式需求更高,差异均有统计学意义。结论 不同群组的青年学生自身特点、性知识、性态度、性行为和教育需求存在区别,应分类开发教材和方法,针对不同学生群组特点施教,增强学生的接受度和积极性,以提高教育质量。     

Relative power between sexual partners and condom use among adolescents.

PURPOSE: To examine how the relative power of adolescent sexual partners in the domain of emotional intimacy is related to condom use. METHODS: Interviewed 228 adolescents who visited an STD clinic in San Francisco. Adolescents were aged 14-19 years, 69% were female, and they were ethnically diverse. We developed a measure of relative power in the domain of emotional intimacy, by adapting five items from existing measures and developing three items ourselves. The partner who had less desire for emotional intimacy was considered to have more power in that domain. We also measured relative decision-making power. Data were analyzed using logistic regression and Student's t-tests. RESULTS: Adolescents who had more power than their partners in the domain of emotional intimacy were more likely to get their way about condom use than adolescents who had less power in this domain. Decision-making power was not related to whether adolescents got their way about condom use. Young men reported greater emotional intimacy power and greater decision-making power than young women. However, gender was not related to getting one's way about condom use. CONCLUSIONS: The results suggest the importance of assessing relative power in the sexual relationships of adolescents when predicting condom use.     

Sexual Health in a Young City in Peru: a community-based intervention

The Cayetan Heredia University in Lima, Peru, developed a community-based intervention program on sexual and reproductive health of the youth. The Sexual Health in a Young City program covers all individuals aged 15-24 years living in two communities in Lima, Brena, and Pueblo Libre. The program departed from the argument that the youth could organize themselves and act for change in regard to their own sexual and reproductive lives. Rooted on the strategies of community education and empowerment, the intervention also seeks to mobilize community resources to improve the reproductive and sexual health of the youth. The 3 major components of the program are: 1) motivating and involving community actors; 2) strengthening and publicizing adolescent health services; and 3) designing and implementing a campaign for youth sexual health. However, the program encountered constraints and limitations. Despite these flaws, the program showed that the more important social actors in a community could be involved in coordinating efforts to promote reproductive and sexual health of the youth.     

Married men's first time experiences of early childbearing and their role in sexual and reproductive decision making: a qualitative study from rural Vietnam

Male partners' involvement in women's sexual and reproductive health has been increasingly emphasised in international health. A qualitative approach with open-ended qualitative interviews was used to explore young, married men's first time experiences of early childbearing, their sexual and reproductive decision making and the meanings they make of their role as husbands and fathers. The results offer a nuanced picture of the men's vulnerability in becoming young fathers and having to assume their role as family decision-makers, while still being inexperienced in matters related to the health of their wives and newborn child. Constraints to gender equality and traditional norms and values continue to pose barriers to both young men and women making independent decisions in relation to marriage and childbearing. Men's involvement is necessary in healthcare programmes designed to improve women's sexual and reproductive health and the health of the newborn. Young, first-time fathers, in particular, need support and empowerment.     

Impacts of a Cash Plus Intervention on Gender Attitudes Among Tanzanian Adolescents

PurposeInequitable attitudes toward men’s and women’s roles, rights, and responsibilities are associated with poor health–related outcomes, particularly for girls and women. Yet, we know relatively little about what interventions work to improve gender-equitable attitudes among adolescents in low-income countries. This study examines the impact of a government-implemented “cash plus” intervention on gender-equitable attitudes among adolescents in Tanzania. The intervention includes discussions and activities related to gender norms, embedded in broader life skills, livelihoods, and health training.MethodsThe study utilizes a cluster randomized design, using data from 1,933 males and females aged 14–19 years at baseline who took part in the baseline (2017), midline (2018), and endline (2019) surveys. Gender attitudes were measured using 24 items from the Gender-Equitable Men (GEM) Scale. We estimate intent-to-treat impacts on the GEM scale and four subscales (violence, sexual relationships, reproductive health, and domestic chores).ResultsThe “cash plus” intervention had a significant impact on the overall GEM scale at midline. The intervention increased gender-equitable attitudes on the domestic chores subscale at both midline and endline. The intervention improved gender-equitable attitudes among males on the overall GEM scale and three subscales at midline and on two subscales at endline, but it had no impacts among females.ConclusionsGender transformative social protection is currently being advocated as a way to address the gendered nature of poverty and its consequences. Initiatives such as the one studied here, which address the multifaceted drivers of gender inequities, could be a promising way forward.     

深圳市流动人口性行为情况及影响因素分析

目的:了解深圳市流动人口的性行为发生情况,探讨潜在的影响因素,为进一步在流动人口中开展相关的干预活动提供科学依据。方法:按照拟定的筛选表,采用多级抽样的方法及知情同意的原则,选取深圳市外来流动人口1014人,采用结构式问卷进行面对面调查。应用卡方检验及多元lo-gistic回归分析流动人口性行为情况及可能的影响因素。结果:流动人口中商业性行为发生率为4·26%,47·29%的调查对象有1个以上的性伙伴。性别、知识总分、首次性行为年龄、首次性行为对象是主要的影响因素。安全套使用率为52·46%。性别、户口性质、婚姻状况、知识总分、性伴总数是性行为的主要影响因素。结论:流动人口中高危性行为发生比例较高,而流动人口中能够坚持使用安全套的比例不容乐观。迫切需要开展有针对性的性与生殖健康教育,提高流动人口的生殖健康知识和自我保健意识。     

洛阳市中学生生殖健康性行为状况调查

目的 了解中学生生殖健康性行为状况及其影响因素.方法 采取分层整群抽样方法调查,利用SAS 8.1 软件完成数据的统计分析,并利用非条件logistic回归对生殖健康性行为发生的影响因素进行分析.结果 高中生边缘性行为(接吻、拥抱、爱抚等)、独自性行为(手淫、性幻想等)及性交行为的发生率高于初中生(P<0.05),男生高于女生(P<0.05).多因素分析结果表明,有恋爱经历者较无恋爱经历者更易发生性行为(OR=2.62,95%CI:1.21～5.66);从书刊、音像或大众媒体获得生殖健康知识较其他途径易发生性行为(OR=3.09,95%CI:1.43～6.51);赞成中学生恋爱及男女交往者易发生性行为(OR=2.24,95%CI:1.32～3.75).结论 中学生缺乏必要的基本性卫生知识,主要表现在边缘性行为的发生、不能正确认识独自性行为以及不适宜的性行为发生.     

Gender, Mature Appearance, Alcohol Use, and Dating as Correlates of Sexual Partner Accumulation from Ages 16–26 Years

PURPOSE: To determine growth in sexual partnering from age 16-26 years, and to test whether biological and social factors launched these growth patterns. METHODS: A prospective design was used. Participants were 176 young people (47% female) followed from birth to age 26 years. Sexual partnering was measured as the accumulated number of different sexual intercourse partners at ages 16, 19, 23, and 26 years. Physical appearance of maturity, alcohol use, and dating were measured at ages 13-16 via observations, interviews, and questionnaires. RESULTS: Mature appearance at age 13 years, use of alcohol more than monthly at age 16, and a history of a steady romantic partner before age 16 were each associated with a greater number of sexual intercourse partners by age 16. However a more mature appearance, more frequent alcohol use, and greater dating involvement did not foreshadow a steeper accumulation of sexual partners between ages 16 and 26. Only gender had such a "growth" influence, with males accruing sexual partners more rapidly from the ages of 16-26 years when compared with females. CONCLUSIONS: Adolescents had accumulated a higher number of sexual partners by age 16 years when they looked older, drank alcohol more frequently, and were more involved with dating in early to middle adolescence. Also male gender was associated with accumulation of sexual partners more rapidly between ages 16 and 26 years, and there was little indication that the accumulation of different sexual partners had begun to slow by age 26 for the average participant.