Type of contraception method used at last intercourse and associations with health risk behaviors among US adolescents

Background

This study was conducted to examine associations with contraception methods used at last sexual intercourse among US adolescents.

Study Design

Data consisted of sexually active adolescents (9th–12th grade, weighted n=24,638) from the 1999–2007 Youth Risk Behavior Surveillance System (YRBSS). We performed multinomial multivariable logistic regression analyses with condom users at last sexual intercourse as the reference group.

Results

Males who used alcohol, cigarettes, marijuana and cocaine were more likely to use no method/unsure of method (OR=2.4, CI=1.7–3.4) or rely on withdrawal (OR=2.6, CI=1.5–4.3). Females with six or more sexual partners were more likely to rely on withdrawal (OR=2.9, CI=2.1–3.9) or contraception methods that offer no STI protection [i.e., birth control pills: OR=1.9, CI=1.4–2.5; and depot medroxyprogesterone acetate (DMPA, marketed as Depo-Provera): OR=2.6, CI=1.6–4.2]. Earlier age of sexual debut was also associated with nonuse.

Conclusion

Prevention efforts should focus on at-risk adolescents including substance-using males, females with six or more sexual partners, and those who initiate sexual intercourse at an early age.     

Older boyfriends and girlfriends increase risk of sexual initiation in young adolescents

Purpose: To explore the prevalence and impact of older boyfriends or girlfriends on sexual behavior in sixth graders (mean age 11.5 years).

Methods: Students in 19 ethnically diverse middle schools in an urban area were surveyed (n = 2829, response rate 68%). Instrument measured demographics, age of oldest boyfriend or girlfriend, unwanted sexual advances, peer norms, and sexual behavior. Students with older, same-age, or no boyfriend or girlfriend were compared on demographic and psychosocial variables using analysis of variance. Separate multivariate logistic regressions for both boys and girls were used to predict sexual behavior from demographics, psychosocial variables, and age categories of boyfriend or girlfriend.

Results: One-half of the respondents (56%) had never had a serious boyfriend or girlfriend, 35% reported that their oldest boyfriend or girlfriend was <2 years older than they, and 8.5% reported a partner ≥2 years older. Those reporting an older boyfriend or girlfriend were more likely to be Hispanic, were less acculturated, reported more unwanted sexual advances and more friends who were sexually active, and, among girls, were more likely to have experienced menarche. Overall, 4% of students reported ever having had sex. Students with an older boyfriend or girlfriend were over 30 times more likely than those with no boyfriend or girlfriend ever to have had sex (odds RATIO = 33.8 for boys and 44.2 for girls). In the multivariate logistic regressions, peer norms about sexual behavior, having experienced unwanted sexual advances, and having a boyfriend or girlfriend were strongly associated with having had sex.

Conclusions: Having an older boyfriend or girlfriend, although rare, is associated with early sexual onset and unwanted sexual activity in this population of sixth graders.     

Demographic and lifestyle factors associated with sexual activity among adolescents in Malaysia

Having a better understanding of the factors associated with sexual behaviour among adolescents is important as it may assist government in lowering the prevalence of teen pregnancy. The objective of the present study is to examine the effects of demographic and lifestyle factors on the likelihood of engaging in sexual intercourse with a focus on Malaysian adolescents. Using a nationally representative data collected by the Ministry of Health Malaysia, the present study finds that age, self-rated academic performance, parents’ marital status, alcohol consumption and cigarette smoking can significantly affect the sexual behaviour among adolescents. The present study concludes by discussing the policy implications of these findings. As a measure towards reducing underage sex, successful policies should be targeted primarily at adolescents who aged more than 16 years self-rate their academic performance as poor, have single parents, and adopt alcohol drinking and cigarette smoking behaviours.     

广州市青少年性相关行为发生情况分析

目的 了解广州市青少年性相关行为现况,为制定干预措施提供科学依据.方法 采用“中国青少年健康相关行为调查问卷”,对分层整群随机抽取的广州市66所大中学校11939名学生进行问卷调查.结果 15.22％的中学生看过色情书籍和音像制品,农村(16.46％)高于城市(14.44％);男生(25.07％)高于女生(6.23％);职中生最高(25.41％),普通中学(13.93％)高于重点中学(10.71％),差异均有统计学意义(P值均＜0.01).在看过色情书籍、音像制品的学生中,曾发生性行为率高达22.35％.在高中、职中学生中,35.82％曾单独约会异性朋友,34.95％有亲密行为,7.26％曾经发生过性行为,2.10％学生有被迫性行为,73.97％从学校接受过有关艾滋病知识教育,63.44％知道艾滋病病原体是病毒,31.76％对艾滋病感染者持正确态度.8.87％大学生有过性行为,使用安全套的比例占68.52％.结论 广州市青少年性相关行为频发但预防教育不足,要加强对青少年性观念及行为的正确引导.     

Family structure effects on early sexual debut among adolescent girls in Rakai,Uganda

This study assessed the association between household family structure and early sexual debut among adolescent girls, ages 15–19, in rural Rakai District, Uganda. Early sexual debut is associated with detrimental physical, emotional, and social outcomes, including increased risk of HIV. However, research on the family’s role on adolescents’ sexual risk behaviors in sub-Saharan Africa has been minimal and rarely takes into account the varying family structures within which African adolescents develop. Using six rounds of survey data (2001–2008) from the Rakai Community Cohort Study, unmarried adolescent girls (n = 1940) aged 15–17 at their baseline survey, were followed until age 19. Parametric survival models showed that compared to adolescent girls living with both biological parents, girls who headed their own household and girls living with stepfathers, grandparents, siblings, or other relatives had significantly higher hazards of early sexual debut before age 16. Adolescent girls were significantly more likely to debut sexually if neither parent resided in the household, either due to death or other reasons. In addition, the absence of the living biological father from the home was associated with a higher risk of sexual debut, regardless of the biological mother’s presence in the home. Our study’s findings suggest that family structure is important to adolescent girls’ sexual behavior. There is need for research to understand the underlying processes, interactions, and dynamics of both low and high-risk family structures in order to devise and strategically target interventions for specific types of family structures.     

Secular trends and sociodemographic regularities of coital debut age in Norway

Gender and birth cohort differences and the influence of social background variables on the coital debut age were investigated in the general population of Norway. The data derive from a 1987 questionnaire on sexual behavior mailed to a random sample of 10,000 Norwegians of both sexes, ages 18 through 60; 63% responded to the questionnaire. 94.5% reported that they had experienced intercourse. The median coital debut age was 18.2 years. There were both cohort and gender differences. Younger cohorts have lower coital debut ages, and women younger than 35 years experienced their first intercourse at an earlier age than men in the same age group. When each independent variable was analyzed separately, there were substantial differences between educational levels and social classes with respect to age of coital debut. Multivariate analysis of six separate cohorts revealed independent effects of gender in the two youngest cohorts, whereas educational level had significant independent effects in all but the oldest cohort. Social class did not reveal any independent effect on coital debut age. Population density of the place of residence of the respondents was not substantially related to age of coital debut. Seen together, the independent variables explain about 13% of the variance in coital debut age (by multiple regression).This project was supported by grants from the Norwegian Research Council for Science and the Humanities and by the Ministry of Health and Social Affairs.     

Delaying sexual debut amongst out-of-school youth in rural southwest Uganda

This paper focuses on ‘sexual debut’ among out-of-school youth in Masaka District, Uganda, factors influencing its timing and assistance young people feel they need to delay sexual initiation. Data were drawn from a sexual health needs assessment using applied anthropological techniques with young people aged 13–19 years. Parents, guardians and community leaders were also consulted. All participants felt that young people begin their sexual lives too early. Young men feel under pressure from friends and older men to prove their masculinity. Most delay further activity after debut and want assistance to resist the pressure. Young women's debut after physical maturation prompts ‘pestering’ for sex from boys and men who offer gifts. After debut, young women remain sexually active but believe younger women need assistance to resist pressure. Programmes are needed to help young people achieve these goals. Structurally, the community needs to develop means of preventing men from pestering young women for sex and of redeveloping both the social role and pathway to marriage for young women who are marrying later than is traditional.     

Risk factors for self-report of not receiving an HIV test among adolescents in NYC with a history of sexual intercourse, 2013 YRBS

The Centers for Disease Control and Prevention has previously recommended that all adolescents undergo HIV testing in the United States (US). Despite these recommendations, national HIV testing among US adolescents has remained low. This study estimated the prevalence of and identified risk factors for not receiving an HIV test among adolescents with a history of sexual intercourse in New York City (NYC), an urban area that has been greatly impacted by the HIV epidemic. Cross-sectional data on 1199 NYC high school students who completed the 2013 NYC Youth Risk Behavior Survey were used. Modified Poisson regression models were used to assess whether demographic factors, alcohol/drug use and sexual behaviors were associated with self-report of lack of HIV testing. In the weighted study population, about 72% were ≥16 years old, approximately 35% were African-American and nearly half were male. Sixty percent reported no history of HIV testing. In adjusted analyses, younger age, male gender, White race/ethnicity, heroin use, as well as reporting one prior sexual partner, were significantly and positively associated with no prior history of HIV testing. Our findings suggest that among NYC adolescents with a history of sexual intercourse, the prevalence of HIV testing is low. HIV testing may have been low in part because of limited experience with current screening guidelines among clinicians. Furthermore, many of the adolescents identified as being more likely to not be tested may have not been screened because of inadequate knowledge about HIV, a low perceived HIV risk or an unstable lifestyle. Therefore, to increase HIV testing among NYC adolescents, interventions that enhance HIV knowledge among adolescents as well as interventions that promote review and application of current screening guidelines among clinicians should be implemented in NYC. Educational interventions should especially be targeted at the adolescents identified in this study.     

青少年性健康行为研究概况

目前全球人口中1/4以上是青少年。处于性活跃年龄的他们,道德观念、生活方式、交往范围和性行为等方面都发生着巨大的变化,生理需求、观念转变、经济状况和知识缺乏等因素使他们更容易发生不安全性行为。自20世纪70年代以来,青少年的不良性行为问题及其带来的相关问题日益突出,在全球已引起了强烈关注并进行了相关研究。对涵盖与青少年性健康有关的各项性行为的调查及研究情况进行分析概括。     

3441名普通高校大学生艾滋病知识及性行为调查

目的 了解我国普通高校大学生艾滋病相关知识的掌握情况及性行为状况,探讨适合我国大学生特点的艾滋病健康教育和行为策略并提供依据。方法 采用自行设计问卷,对全国5所普通高校共3441名大学生进行了问卷调查,内容包括艾滋病相关知识的掌握情况、性行为发生率、艾滋病健康教育需求及高校开展艾滋病健康教育的现状。结果 大学生对艾滋病相关知识的总知晓率为76.2%。艾滋病相关知识的掌握情况在不同性别和年级间存在统计学差异（P〈0.05）。性行为发生率为9.5%;发生过性行为的大学生中,只有20.1%每次都用安全套。87.6%的大学生希望了艾滋病相关知识,只有21.5%的学生表示满意学校当前的艾滋病健康教育活动。结论 应进一步改进高校的健康教育模式和内容,注重艾滋病预防技能的培养。     

HIV感染的吸毒人群的艾滋病知识和行为调查

目的了解有吸毒史的艾滋病病毒（HIV）感染者的艾滋病知晓情况、吸毒行为、性行为特征,为HIV/AIDS干预提供合理依据。方法采用横断面调查,于2009年4～8月,对澜沧县109名有吸毒史的HIV感染者进行面对面的调查,用SPSS13.0进行统计分析。结果 109名吸毒者中,20～40岁年龄组占74.31%,小学和初中分别占38.53%和33.03%,农民67.89%,少数民族66.06%。艾滋病知识总体知晓率为84.40%,不同文化程度、婚姻状况的人艾滋病知识知晓率差异有统计学意义（χ^2值分别为8.49,9.18;P值分别为0.037,0.027）;2009年4～8月期间,有7人曾共用注射器吸毒;46人与固定性伴有性行为,其中32.61%的人坚持使用安全套;4人与非商业非固定性伴有不安全性行为;8人与异性商业性伴有过性行为,5人未坚持使用安全套。结论有吸毒史的HIV感染者共用针具行为、多性伴和不安全性行为仍然存在,提示应采取宣传教育和行为干预并重的预防措施。     

Sex education and contraceptive use at coital debut in the United States: results from Cycle 6 of the National Survey of Family Growth

Background

The study was conducted to characterize the relationship between formal sex education and the use and type of contraceptive method used at coital debut among female adolescents.

Methods

This study employed a cross-sectional, nationally representative database (2002 National Survey of Family Growth). Contraceptive use and type used were compared among sex education groups [abstinence only (AO), birth control methods only (MO) and comprehensive (AM)]. Analyses also evaluated the association between demographic, socioeconomic, behavioral variables and sex education. Multiple logistic regression with adjustment for sampling design was used to measure associations of interest.

Results

Of 1150 adolescent females aged 15-19 years, 91% reported formal sex education (AO 20.4%, MO 4.9%, AM 65.1%). The overall use of contraception at coitarche did not differ between groups. Compared to the AO and AM groups, the proportion who used a reliable method in the MO group (37%) was significantly higher (p=.03) (vs. 15.8% and 14.8%, respectively).

Conclusions

Data from the 2002 NSFG do not support an association between type of formal sex education and contraceptive use at coitarche but do support an association between abstinence-only messaging and decreased reliable contraceptive method use at coitarche.     

First Time Cannabis Use and Sexual Debut in U.S. High School Adolescents

Purpose

Use of illicit drugs by adolescents might facilitate or trigger other risky behaviors, including early sexual initiation (ESI), multiple partners, and unprotected sex. This study examines whether the age at which adolescents initiate cannabis use is associated with the age of their first sexual intercourse in the U.S. in 2015.

中国18省市大学生首次性行为年龄的人群分布特征及其影响因素

目的 了解中国大学生首次性行为年龄的人群分布特征,为制定适宜的性教育提供依据.方法 采取无记名自填问卷方式,按照分层整群抽样方法,对18个省(市、区)33 653名大学生进行中国青少年健康危险行为问卷调查.结果 中国大学生14岁前发生性行为的报告率为1.9%,男、女生分别为2.8%和1.1%(P＜0.01);15～18岁发生性行为的报告率男、女生分别为6.4%和2.1%;19岁后发生性行为的报告率男、女生分别为6.9%和2.6%.大学生首次性行为的发生年龄与父母学历、所在地区和家庭结构密切相关.来自大家庭和核心家庭、居住在东中部地区、父母文化程度较低的大学低年级学生,首次性行为发生年龄较晚.结论 应加强对两部地区、父母文化程度较高以及家庭结构不完整的青少年的性教育.

Abstract：

Objective To describe the characteristics of sexual debut among college students in China to provide appropriate sex education in that population. Methods An anonymous questionnaire survey was conducted among 33 653 college students selected by multi-stage stratified cluster sampling method in 18 provinces and cities of China. Results The percentage of students who had initiated sexual intercourse before age 14 was 1.9%. Overall, male students (2.8%) were significantly more likely to have initiated sexual intercourse before age 14, than female students (1.1%). The percentage of students who had initiated sexual intercourse from age 15 to 18 was 6.4% in males versus 2.1% in females. while the rates of students who had initiated sexual intercourse after age 19 were 6.9% in males and 2.6% in females. The first sexual intercourse was significantly associated with parental educational attainment, geographic location and family structure. Students whose parents were relatively well educated, living in the western areas of the country China, or with nucleus/extensive families were more likely to have early sex in their puberties. Conclusion Sexual education should be strengthened especially in the western areas, and targeted on the students whose parents with relatively higher educational background or who were from extensive families.     

Why Humans Have Sex

Historically, the reasons people have sex have been assumed to be few in number and simple in nature-to reproduce, to experience pleasure, or to relieve sexual tension. Several theoretical perspectives suggest that motives for engaging in sexual intercourse may be larger in number and psychologically complex in nature. Study 1 used a nomination procedure that identified 237 expressed reasons for having sex, ranging from the mundane (e.g., "I wanted to experience physical pleasure") to the spiritual (e.g., "I wanted to get closer to God"), from altruistic (e.g., "I wanted the person to feel good about himself/herself") to vengeful (e.g., "I wanted to get back at my partner for having cheated on me"). Study 2 asked participants (N = 1,549) to evaluate the degree to which each of the 237 reasons had led them to have sexual intercourse. Factor analyses yielded four large factors and 13 subfactors, producing a hierarchical taxonomy. The Physical reasons subfactors included Stress Reduction, Pleasure, Physical Desirability, and Experience Seeking. The Goal Attainment subfactors included Resources, Social Status, Revenge, and Utilitarian. The Emotional subfactors included Love and Commitment and Expression. The three Insecurity subfactors included Self-Esteem Boost, Duty/Pressure, and Mate Guarding. Significant gender differences supported several previously advanced theories. Individual differences in expressed reasons for having sex were coherently linked with personality traits and with individual differences in sexual strategies. Discussion focused on the complexity of sexual motivation and directions for future research.     

合肥市庐阳区娱乐场所年轻女性流动人群高危性行为及影响因素分析

目的了解合肥市庐阳区娱乐场所年轻女性流动人群艾滋病性病知识水平及性行为特征,探讨该人群高危性行为的影响因素。方法采用横断面调查的方法,采取随机抽样,抽取合肥市庐阳区22家娱乐场所为调查现场,招募符合要求的调查对象。调查内容包括社会人口学特征、艾滋病性病相关知识、安全套使用知识和自我效能、近1年患性病及生殖道感染状况、流产、近6个月性行为、性伴种类及安全套使用情况。运用EpiData3．0软件建立数据库并录入资料,运用SPSS13．0软件进行统计学分析。结果共调查娱乐场所流动女性180人,艾滋病基本知识知晓率为70．6％;30．0％的调查对象报告近1年患有性病或生殖道感染,58．3％既往有过流产;最近6个月有61．7％的调查对象发生过高危性行为,多因素Logistic分析结果显示,婚姻状态为已婚、累计打工时间〉3年、首次性行为年龄≤18岁、首次性行为未使用安全套者发生高危性行为危险性增加;随着安全套正确使用知识和安全套使用效能的增加,发生高危性行为危险降低。结论合肥市庐阳区娱乐场所女性流动人群性病艾滋病知识不足,高危性行为和生殖健康问题普遍存在,因此,需要制定针对性的干预策略和措施以提高该人群的生殖健康水平。     

The relationship between source of sexual information and sexual behavior among female adolescents

INTRODUCTION: The relationship between the source of sexual information and adolescent sexual behavior is not well understood. MATERIALS AND METHODS: As part of a larger study, 892 sexually active female adolescents between 15 and 18 years of age completed a paper-and-pencil survey which assessed discussions about sexual intercourse, contraceptive use and condom use among friends and family members and their own sexual behavior. Multivariate logistic regression analyses were performed to examine associations while controlling for key demographics. RESULTS: Adolescents who had never used condoms were less likely to report having had discussions about sexual intercourse with their friends [adjusted odds ratio (AOR) = 0.2]. Discussions about condom use among friends and family members were associated with condom use in the past 3 months, with adolescents who used condoms at least half of the time being more likely to report hearing discussions relative to adolescents who never used condoms (AORs 2.0-3.8). Furthermore, the number of sexual partners was related to whether the adolescent had heard discussions among her family about condom use; the higher the number of sexual partners, the more likely the adolescent was to have heard discussions. For adolescents reporting 2-3, 4-5 and 6 or more partners (relative to one partner), the AORs were 1.7, 2.3 and 2.7, respectively. DISCUSSION: Adolescents exposed to information about condom use among the primary individuals in their lives are more likely to be engaging in this behavior themselves.