Condom use: slippage, breakage, and steps for proper use among adolescents in alternative school settings

BACKGROUND : School‐based human immunodeficiency virus (HIV)/sexually transmitted infection (STI), and pregnancy prevention programs often focus on consistent and correct condom use. Research on adolescents' experience using condoms, including condom slippage/breakage, is limited. This exploratory study examines proper condom use and the occurrence of condom slippage/breakage among alternative school youth. METHODS : Data are from an HIV/STI prevention trial for youth in continuation school settings (N = 776). Analyses included separate hierarchical logistic regression analyses to explore the relationship between potential correlates and each outcome variable. RESULTS : Students' use of steps for proper condom use varied—73.8% put on the condom before sexual contact, 71.1% squeezed air from the tip, and 92.0% unrolled the condom fully. Notably, 28.5% reported condom slippage/breakage. Results from the regression analyses showed that 4 sets of variables (demographic, substance use, sexual risk behaviors, and condom psychosocial factors) were associated with putting on a condom before sexual contact; none of the variable sets were associated with the other 2 condom steps measured. For slippage/breakage, the demographic and sexual risk behaviors were significant correlates; steps for proper condom use approached statistical significance (p = .058). CONCLUSIONS : This study extends the limited research on how adolescents use condoms, and highlights important targets for prevention interventions.     

Patterns of Vaginal, Oral, and Anal Sexual Intercourse in an Urban Seventh-Grade Population

Background:  This study examines the prevalence of vaginal, oral, and anal intercourse among a population of urban, public middle school students, the characteristics of early sexual initiators, and the sequence of sexual initiation. Such data are limited for early adolescents.
Methods:  A total of 1279 seventh-grade students (57.3% female, 43.6% black, and 41.8% Hispanic), mean age 12.5 years (SD = 0.63) from 10 middle schools in a large southeastern US public school district completed a cross-sectional survey using audio computer-assisted self-interviews. Main outcomes included lifetime and past 3-months' experience of vaginal, oral, and anal sex; condom use; age of initiation; and number of lifetime partners.
Results:  Overall, 12.0% of students had engaged in vaginal sex, 7.9% in oral sex, and 6.5% in anal sex. Among students who had initiated intercourse, approximately two thirds were currently sexually active and one quarter reported ≥4 lifetime partners. Six percent had engaged in 1 type of intercourse, 4% in 2 types of intercourse, and 4% in all 3 types of intercourse; vaginal sex was typically initiated at an earlier or at the same age as other types of intercourse. Only 2% had engaged in oral sex without engaging in vaginal sex. Although black students were significantly more likely to have initiated sex compared to other racial/ethnic groups, Hispanic students who had initiated each type of intercourse were more likely to be currently sexually active and to have engaged in recent unprotected sex.
Conclusions:  A small percentage of early adolescents are engaging in multiple sexual behaviors. These findings have implications for early adolescent school-based sexual health education.     

How Florida youths measure up to US youths in sexual and reproductive health: implications for youths across the United States

The United States surpasses other developed nations in teen birthrates and sexually transmitted infections, and Florida youths are disproportionately affected. Projections have placed Florida to have the second largest population of youths in the nation by 2025. The racial and ethnic diversity as well as a growing number of youths in Florida make sexual and reproductive health (SRH) outcomes in this state reflective of the increasing diversity of youths throughout the United States. The purpose of this research was to compare a representative sample of Florida youths and US high school youths sexual behaviors, overall and by gender and race/ethnicity, to identify disparities. Employing 2011 Centers for Disease Control and Prevention Youth Risk Behavior Survey data, outcomes of interest were ever having had sexual intercourse; intercourse before age 13 years (early sex); condom use; oral contraceptive pill (OCP) use; and use of Depo-Provera^®, Nuva Ring^®, Implanon^®, or any intrauterine device (IUD) at last sex. The analysis calculated relative risk and corresponding 95% confidence interval between Florida (N = 6,212) and US youths (N = 15,425) using SAS version 9.3 (SAS Institute, Inc., Cary, NC, USA). There were statistically significant differences in four of five behaviors, all of which were worse for Florida youths compared with US youths (except for condom use). Florida youths were more likely to report early sex and less likely to have used OCPs. Florida youths were less likely to have used Depo-Provera^®, Nuva Ring^®, Implanon, or any IUD, including differences by grade level and among male, female, Hispanic, and white youths. This study can inform policy and the need to develop strategies for intervention or service provision among Florida youths so resources can be allotted to priority populations. In addition this study, highlights areas of SRH that may be faced by a growing and diverse population of youths in the United States.     

Correlates of Condom Use Among Male High School Students in Nairobi, Kenya

BACKGROUND: Correct and consistent condom use is an effective strategy to reduce the risk of sexually transmitted infections (STIs). This study examines sociodemographic, behavioral, and psychosocial characteristics of 3 groups of adolescent males: consistent, sporadic, and non-condom users.
METHODS: The sample consisted of 931 sexually experienced male high school students in Nairobi, Kenya. Cross tabulations and general linear models were used to test the relation between each explanatory variable and condom user group.
RESULTS: Fifty-three percent of respondents reported having used condoms. Compared with nonusers and sporadic users, consistent users engaged in sexual intercourse for the first time at an older age and reported higher condom use self-efficacy, more positive peer attitudes toward safe sex, and stronger attitudes toward condom use. Compared with sporadic and consistent users, nonusers reported fewer sexual partners, less substance use, and more frequent intercourse with non-romantic partners. Sporadic users, compared with the other 2 groups, had more sexual partners and stronger attitudes that support that males and females have separate roles. The 3 groups did not differ in HIV/AIDS knowledge. On average, respondents responded correctly to two thirds of the questions. All groups perceived their risk of contracting an STI as low, and this perception did not differ by condom use. Differences in participants' age by group were minimal.
CONCLUSIONS: The study supports the need for interventions that target specific condom use groups.     

Sexually transmitted infection among adolescents receiving special education services

Background: To estimate the relative risk of sexually transmitted infections (STIs) among children identified as having learning disabilities through the special education system. Methods: This cross‐sectional study used special education data and Medicaid data from Philadelphia, Pennsylvania, for calendar year 2002. The sample comprised 51,234 Medicaid‐eligible children, aged 12‐17 years, 8015 of whom were receiving special education services. Claims associated with diagnoses of STIs were abstracted, and logistic regression was used to estimate the odds of STI among children in different special education categories. Results: There were 3% of males and 5% of females who were treated for an STI through the Medicaid system in 2002. Among females, those in the mental retardation (MR) category were at greatest risk (6.9%) and those in the emotionally disturbed or “no special education” category at lowest risk (4.9% each). Among males, STIs were most prevalent among those classified as mentally gifted (6.7%) and lowest among those in the MR category (3.0%). In adjusted analyses, males with specific learning disabilities and females with MR or who were academically gifted were at excess risk for STIs. Conclusions: The finding that children with learning disabilities are at similar or greater risk for contracting STIs as other youth suggests the need to further understand their risk behaviors and the potential need to develop prevention programs specific to their learning needs.     

Prevalence of overweight in north Florida elementary and middle school children: effects of age, sex, ethnicity, and socioeconomic status

BACKGROUND: The number of overweight children has been rapidly increasing, although its prevalence varies by age, sex, ethnicity, and socioeconomic (SES) status. METHODS: Height and weight assessments were used to calculate body mass index (BMI) and BMI percentile on more than 17,000 children in 1 north Florida school district's elementary and middle schools. Based on the child's BMI percentile, each child was placed into 1 of 4 groups: underweight, normal, at risk for overweight, and overweight. Logistic regression was used to test the relative contribution of sex, ethnicity, school (elementary vs middle), age, and SES (indicated by free/reduced vs full-pay lunch status) to a child's weight classification. RESULTS: Overall, 36.2% of the children were either overweight (18.9%) or at risk for overweight (17.4%). Approximately 30% of the kindergarten children were overweight (14.0%) or at risk for overweight (15.5%). African American children were most likely to begin kindergarten overweight. The prevalence of overweight increased for all ethnic groups during the elementary school years. However, African American girls and Hispanic boys were more likely to be overweight than any other ethnic group; Asian girls were least likely to be overweight. These findings could not be readily explained by the effects of SES. Higher SES appeared to be protective but only for white and Hispanic children. CONCLUSIONS: These results confirm the increasing prevalence of overweight in US school children, especially among African American girls and Hispanic boys.     

Impacts of a School‐Wide,Peer‐Led Approach to Sexuality Education: A Matched Comparison Group Design

BACKGROUND

Teen Prevention Education Program (PEP) is a school‐wide, peer‐led comprehensive sexuality education program currently implemented in more than 50 schools across 2 states. Many teen pregnancy prevention researchers and practitioners view peer‐led programs as a promising approach for reducing teen pregnancy and associated sexual risk behaviors. However, prior research on the effectiveness of these programs indicates mixed results.

METHODS

We randomly assigned schools to implement Teen PEP immediately (intervention group) or on a delayed schedule (comparison group) and used propensity score matching to improve the comparability of the study groups. We surveyed students at baseline and about 6 months after the program ended.

RESULTS

Teen PEP did not significantly impact rates of sexual activity or unprotected sex; however, the program led to improvements in exposure to information about sexual health topics and knowledge of preventing pregnancy and transmission of sexually transmitted infections.

CONCLUSIONS

Teen PEP succeeded in accomplishing some of its most proximal goals, increasing students' access to information and knowledge. However, we found little evidence that the program affects sexual risk‐taking within 6 months of its conclusion. Future research will examine the program's longer‐term impacts on sexual risk behaviors.

     

Methamphetamine Use Is Independently Associated With Recent Risky Sexual Behaviors and Adolescent Pregnancy

BACKGROUND: Lifetime methamphetamine use among adolescents is estimated to be between 5% and 10%. Youth substance use in general is known to be associated with risky sexual behaviors, but the effect of methamphetamine use on recent risky sexual behaviors and adolescent pregnancy has received little attention. The purpose of this analysis was to evaluate the association between lifetime methamphetamine use and recent (past 3 months) risky sexual behaviors and lifetime adolescent pregnancy, adjusting for other substance use. METHODS: We analyzed data from the 2003 National Youth Risk Behavior Survey, a school‐based paper‐and‐pencil survey that assesses risky health behaviors among a nationally representative sample of 9th‐ to 12th‐grade students. Multivariable logistic regression was used to calculate adjusted odds ratios (AORs) to examine the association between methamphetamine use and being recently sexually active, having 2 or more recent sex partners, and ever being pregnant or getting someone pregnant. RESULTS: Lifetime methamphetamine use was reported by 7.6% of students. After adjustment for demographic covariates and lifetime use of cigarettes, alcohol, marijuana, and other illicit drugs, lifetime methamphetamine use was associated with recent sexual intercourse (AOR = 1.8, 95% confidence interval [CI] = 1.5‐2.3), having 2 or more recent sex partners (AOR = 3.0, 95% CI = 2.2‐4.2), and ever being pregnant or getting someone pregnant (AOR = 2.9, 95% CI = 2.1‐3.9). CONCLUSIONS: Adolescent methamphetamine use is common and is associated with recent risky sexual behaviors and adolescent pregnancy. Prevention strategies for high school students should integrate education on substance abuse, pregnancy, sexually transmitted infections, and human immunodeficiency virus.     

Vulnerable Goth teens: the role of schools in this psychosocial high-risk culture

Background:  In recent years, a number of tragedies have been linked to the Goth culture. Most alarming have been the acts of violence, suicide, and self-harm found among teens. Teachers, parents, administrators, and fellow students are at a loss on how to relate to such students. They are unsure what role they might play in addressing some of the psychosocial issues they encounter. The purposes of this article are to describe characteristics of Goth teens, identify psychosocial risks for these teens, and describe roles school personnel can play.
Methods:  This article provides a review of the Goth culture, risk factors for Goth teens, and methods school personnel can use in identifying and addressing the psychosocial needs of this group.
Results:  The Goth culture attracts teens who are depressed, feel persecuted, have a distrust of society, or have suffered past abuse. They then surround themselves with people, music, Web sites, and activities that foster angry or depressed feelings. They have a higher prevalence of depression, self-harm, suicide, and violence than non-Goth teens.
Conclusions:  School personnel are in a position to make a difference. By preparing themselves with knowledge, skills, materials, and referral sources, they can serve as liaisons. They have a specific role in advocating for the health and safety of students, identifying students who are at risk, disseminating new knowledge, and providing guidance in the management of the troubled teens.