Long-term influence of sexual norms and attitudes on timing of sexual initiation among urban minority youth

This study assessed whether sexual norms and attitudes expressed during early adolescence by minority youth from economically disadvantaged urban areas produce a sustained influence on the timing of sexual initiation. African American and Latino youth attending three middle schools were enrolled in the Reach for Health study in seventh grade and followed from an average age of 12.2 to 16.1 years. Some 849 respondents answered the question, "Have you ever had sexual intercourse" at four time points: fall seventh, spring seventh, spring eighth, and spring 10th grade. Culturally tailored scales assessed sex norms and outcome expectancies, sexual responsibility, and refusal attitudes at fall seventh grade. Influence of these norms and attitudes in early adolescence on timing of first reported sexual intercourse was examined using ANOVA controlling for gender. At fall seventh grade, 30.7% of boys and 7.7% of girls reported sexual intercourse; by spring 10th grade, the figures were 74.8% and 56.4%, respectively. Those reporting greater peer involvement in sex and more positive sex outcome expectancies were more likely to have initiated sex by fall seventh grade. Through 10th grade, the higher the scores on peer norms (f = 41.08, p < .0001) and outcome expectancies (f = 5.87, p = .002) at entry into seventh grade, the earlier the timing of initiation. Higher scores on sex responsibility at baseline were associated with delayed sexual intercourse (f = 7.36, p < .001), as are refusal attitudes (f = 15.62, p < .0001). Despite significant gender differences in timing of initiation and mean scale scores, these relationships were similar for males and females. Findings suggest the importance of addressing sexual norms and attitudes of minority youth in interventions to delay early sexual initiation in urban environments where this risk is high. Given their sustained influence on timing of sexual initiation, such interventions must begin prior to middle school and continue through mid-adolescence, years when early sexual experience can lead to negative health and social outcomes.     

Early sexual initiation and subsequent sex-related risks among urban minority youth: the reach for health study.

CONTEXT: Since the 1980s, the age at which U.S. teenagers, especially minority youth, begin having sex has decreased. There is limited information on the relationship between early sexual initiation and subsequent risky sexual behaviors. METHODS: A sample of 1,287 urban minority adolescents completed three surveys in seventh and eighth grade, and 970 completed a follow-up in 10th grade. Logistic regression was used to test the effects of timing of initiation on 10th-grade sexual behaviors and risks, adjusting for gender, ethnicity and age. RESULTS: At baseline, 31% of males and 8% of females reported sexual initiation; by the 10th grade, these figures were 66% and 52%, respectively. Recent intercourse among males increased from 20% at baseline to 39% in eighth grade; 54% reported recent sex and 6% had made a partner pregnant by 10th grade. Among females, recent intercourse tripled from baseline to eighth grade (5% to 15%); 42% reported recent sex and 12% had been pregnant by grade 10. Early initiators had an increased likelihood of having had multiple sex partners, been involved in a pregnancy, forced a partner to have sex, had frequent intercourse and had sex while drunk or high. There were significant gender differences for all outcomes except frequency of intercourse and being drunk or high during sex. CONCLUSIONS: Minority adolescents who initiate sexual activity early engage in behaviors that place them at high risk for negative health outcomes. It is important to involve parents and schools in prevention efforts that address sexual initiation in early adolescence and that target youth who continue to place themselves and their partners at risk.     

Sexual intercourse and oral sex among public middle school students: prevalence and correlates

CONTEXT: Early sexual initiation is associated with elevated teenage pregnancy and STD risk, yet little is known about the prevalence and correlates of sexual behavior among young adolescents. Better information is needed to guide interventions to prevent early sexual debut. METHODS: Data from a 2005 survey of 4,557 sixth‐, seventh‐ and eighth‐grade students at 14 urban public schools in Southern California were analyzed using chi‐square tests and logistic regression, to identify correlates of oral sex, intercourse and both. RESULTS: Overall, 9% of youth had ever had sexual intercourse, and 8% had had oral sex. Three percent reported having had oral sex only, 4% intercourse only and 5% both. Among those who reported intercourse, 69% had used a condom at last intercourse, and 43% had had multiple partners. Being male, being black and having at least one friend who had ever been involved in a pregnancy were positively associated with having had intercourse only and both intercourse and oral sex (odds ratios, 1.7–4.2). Being in eighth grade, expecting to have intercourse in the next six months and currently having a boyfriend or girlfriend were positively associated with all three outcomes (2.1–7.2). Intercourse and oral sex were highly correlated. CONCLUSIONS: Interventions addressing oral sex, intercourse and multiple partners should begin before sixth grade and continue throughout the middle school years. Health professionals should target adolescent risk reduction counseling toward males, blacks, youth with a boyfriend or girlfriend, and those with a friend who has been involved in a pregnancy.     

Behavioral and Psychosocial Effects of Two Middle School Sexual Health Education Programs at Tenth-Grade Follow-Up

PurposeAn earlier randomized controlled trial found that two middle school sexual education programs—a risk avoidance (RA) program and a risk reduction (RR) program—delayed initiation of sexual intercourse (oral, vaginal, or anal sex) and reduced other sexual risk behaviors in ninth grade. We examined whether these effects extended into 10th grade.MethodsFifteen middle schools were randomly assigned to RA, RR, or control conditions. Follow-up surveys were conducted with participating students in 10th grade (n = 1,187; 29.2% attrition).ResultsParticipants were 60% female, 50% Hispanic, and 39% black; seventh grade mean age was 12.6 years. In 10th grade, compared with the control condition, both programs significantly delayed anal sex initiation in the total sample (RA: adjusted odds ratio [AOR], .64, 95% confidence interval [CI], .42–.99; RR: AOR, .65, 95% CI, .50–.84) and among Hispanics (RA: AOR, .53, 95% CI, .31–.91; RR: AOR, .82, 95% CI, .74–.93). Risk avoidance students were less likely to report unprotected vaginal sex, either by using a condom or by abstaining from sex (AOR: .61, 95% CI, .45–.85); RR students were less likely to report recent unprotected anal sex (AOR: .34, 95% CI, .20–.56). Both programs sustained positive impact on some psychosocial outcomes.ConclusionsAlthough both programs delayed anal sex initiation into 10th grade, effects on the delayed initiation of oral and vaginal sex were not sustained. Additional high school sexual education may help to further delay sexual initiation and reduce other sexual risk behaviors in later high school years.     

Early adolescents' cognitive susceptibility to initiating sexual intercourse

CONTEXT: Better methods for investigating sexual risk before the initiation of sexual intercourse are needed to support programming for younger adolescents, especially for abstinent adolescents who are susceptible to initiating intercourse. METHODS: A sample of 854 adolescents in seventh or eighth grade who had never had sexual intercourse completed sexuality surveys in 2002 and 2004. A five-item index that assessed beliefs and expectations about the onset of intercourse was created to indicate adolescents' cognitive susceptibility to initiating intercourse. Logistic regression analysis was used to assess associations between levels of susceptibility and initiation of intercourse by follow-up. The construct and predictive validity of the index were examined using a variety of tests. RESULTS: Thirty-eight percent of respondents were classified as being nonsusceptible to initiating intercourse, 34% as having low susceptibility and 28% as being highly susceptible. Adolescents who were susceptible were more physically mature, had greater sexual feelings and competency, perceived that more peers were sexually active and had fewer positive connections with parents, school and religion than nonsusceptible respondents. Males, blacks and older adolescents were more susceptible than females, whites and younger adolescents, respectively. Compared with nonsusceptible respondents, those with low and high susceptibility had higher odds of initiating intercourse two years later (odds ratios, 2.5 and 8.1, respectively). CONCLUSIONS: The cognitive susceptibility index provides a valid method for assessing sexual risk before the onset of intercourse. Assessing susceptibility among early adolescents could support efforts to delay the onset of intercourse through targeted research and health programming.     

Sexual risk avoidance and sexual risk reduction interventions for middle school youth: a randomized controlled trial

PurposeTo evaluate the efficacy of two, theory-based, multimedia, middle school sexual education programs in delaying sexual initiation.MethodsThree-armed, randomized controlled trial comprising 15 urban middle schools; 1,258 predominantly African American and Hispanic seventh grade students followed into ninth grade. Both programs included group and individualized, computer-based activities addressing psychosocial variables. The risk avoidance (RA) program met federal abstinence education guidelines; the risk reduction (RR) program emphasized abstinence and included computer-based condom skills-training. The primary outcome assessed program impact on delayed sexual initiation; secondary outcomes assessed other sexual behaviors and psychosocial outcomes.ResultsParticipants were 59.8% females (mean age: 12.6 years). Relative to controls, the RR program delayed any type of sexual initiation (oral, vaginal, or anal sex) in the overall sample (adjusted odds ratio [AOR]: .65, 95% CI: .54–.77), among females (AOR: .43, 95% CI: .31–.60), and among African Americans (AOR: .38, 95% CI: .18–.79). RR students also reduced unprotected sex at last intercourse (AOR: .67, 95% CI: .47–.96), frequency of anal sex in the past 3 months (AOR: .53, 95% CI: .33–.84), and unprotected vaginal sex (AOR: .59, 95% CI: .36–.95). The RA program delayed any sexual initiation among Hispanics (AOR: .40, 95% CI: .19–.86), reduced unprotected sex at last intercourse (AOR: .70, 95% CI: .52–.93), but increased the number of recent vaginal sex partners (AOR: 1.69, 95% CI: 1.01–2.82). Both programs positively affected psychosocial outcomes.ConclusionsThe RR program positively affected sexually inexperienced and experienced youth, whereas the RA program delayed initiation among Hispanics and had mixed effects among sexually experienced youth.     

Boyfriends, girlfriends and teenagers' risk of sexual involvement

CONTEXT: Having a boyfriend or girlfriend, especially an older one, is associated with increased sexual risk in early adolescence. The mechanisms underlying this association are unclear. METHODS: Middle school students in Northern California were surveyed annually from 1997 to 2000. For a sample of 1,214 males and 1,308 females who were sexually inexperienced in seventh grade, logistic and linear regression were used to explore associations between relationship status in seventh grade and sexual activity in ninth grade, controlling for sixth-grade and eighth-grade characteristics. RESULTS: Males who had had a girlfriend their age by seventh grade were more likely than those who had had no relationship to report sexual activity in ninth grade (odds ratio, 2.1). Similarly, for females, the odds of being sexually active in ninth grade were elevated among those who had had a boyfriend their age (2.9); however, they also were higher among those who had had an older boyfriend than among those who had had one their age (2.1). With sixth-grade risk factors controlled, relationship status in seventh grade remained significant only for females; the association was explained by early menarche and by participation in situations that could lead to sex and riskier peer norms in eighth grade. For males, eighth-grade situations that could lead to sex, Hispanic ethnicity and sixth-grade peer norms explained ninth-grade sexual behavior. CONCLUSIONS: To reduce the risk of adolescent sexual activity, parents and communities should encourage youth in middle school, especially females who experience early menarche, to delay serious romantic relationships.     

Postponing sexual intercourse among urban junior high school students-a randomized controlled evaluation.

PURPOSE: To describe a randomized, controlled evaluation of a school-based intervention to delay sexual intercourse among urban junior high school students. METHODS: Six Washington, D.C., junior high schools were randomly assigned to the intervention or nonintervention control condition for an educational program. During the first school year, seventh graders (n = 582) from the six schools obtained written parental consent to participate. Three health professionals (one per intervention school) implemented the program, which consisted of reproductive health classes, the Postponing Sexual Involvement Curriculum, health risk screening, and "booster" educational activities during the following (eighth grade) school year. Cross-sectional surveys were administered at baseline, the end of the seventh grade, and the beginning and end of the eighth grade. Intervention and control group differences in virginity, attitudes toward delayed sex and childbearing, and sexual knowledge and behavior were assessed at all four time points. RESULTS: At baseline, 44% of the seventh grade males and 81% of the seventh grade females reported being virgins. At the end of the seventh grade (first follow-up), after controlling for baseline study group differences, intervention-group females were more likely to report virginity, self-efficacy to refuse sex with a boyfriend, and the intention to avoid sexual involvement during the following 6 months. At the end of the eighth grade, significantly more intervention- than control-group females reported virginity, birth control use at last intercourse (for nonvirgins), and knowledge of adolescent reproductive health and confidentiality rights. No changes in virginity, self-efficacy to refuse sex, or sexual intent for the next 6 months were observed among male participants at any time during the study. However, on all three follow-up surveys, intervention-group males scored significantly higher than their control-group counterparts in knowledge of birth control method efficacy. No change in attitudes toward abstinence was observed for either gender at any follow-up point. CONCLUSIONS: Gender differences in baseline sexual activity rates and in various study outcomes suggest a possible need for separate, gender-specific intervention activities that can adequately address the social and cognitive needs of both sexes.     

Validity of scales measuring the psychosocial determinants of HIV/STD-related risk behavior in adolescents.

We examined the content, construct and concurrent validity of scales to assess beliefs and self-efficacy related to adolescents' sexual risk behavior. We addressed content validity in the scale development process by drawing on literature and theory, and by pre-testing items with focus groups. We used confirmatory factor analysis of two models, an intercourse involvement model and a condom use model, to assess construct validity. The final intercourse involvement model included three scales: norms about sexual intercourse, attitudes about sexual intercourse and self-efficacy in refusing sex. The final condom use model included five scales: norms about condoms, attitudes about condom use, self-efficacy in communicating about condoms, self-efficacy in buying/using condoms and barriers to condom use. After two alterations to the models, the chi 2 and other indices indicated that the data fit the models well. Supporting the concurrent validity of the scales, high school students who had never had sexual intercourse had more negative attitudes toward sexual intercourse among teenagers, perceived norms toward sexual intercourse among teenagers to be more negative and expressed greater self-efficacy in refusing sex than did those who had experienced sexual intercourse. Consistent condom users had more positive attitudes and norms about condoms, had higher self-efficacy in communicating about and buying/using condoms, and perceived fewer barriers to condom purchase and use than did inconsistent condom users.     

Long-term reductions in sexual initiation and sexual activity among urban middle schoolers in the reach for health service learning program.

PURPOSE: To evaluate the sustained effectiveness of a middle school service learning intervention on reducing sexual initiation and recent sex among urban African-American and Latino adolescents from 7th grade through the 10th grade. METHODS: During the fall of seventh grade and again in eighth grade, students were randomly assigned by classroom to participate either in community youth service (CYS) or not (controls). Service learning is an educational strategy that couples meaningful service in the community with classroom instruction. Students in both intervention and control conditions received classroom health lessons. Surveys were conducted at seventh grade baseline and at the end of 10th grade, approximately 2 years after intervention. Self-reported sexual behaviors of youths who had participated in CYS were compared with those of controls receiving classroom curriculum alone (n = 195). RESULTS: CYS participants were significantly less likely than controls to report sexual initiation (2 years CYS, odds ratio [OR] = 0.32; 1 year, OR = 0.49) as well as recent sex (2 years CYS, OR = 0.39; 1 year CYS, OR = 0.48). Among those who were virgins at seventh grade, 80% of males in the curriculum-only condition had initiated sex, compared with 61.5% who received 1 year of CYS, and 50% who received 2 years. Among females, the figures were 65.2%, 48.3%, and 39.6%, respectively. CONCLUSION: A service learning intervention that combines community involvement with health instruction can have a long-term benefit by reducing sexual risk taking among urban adolescents.     

Condom use among high-risk adolescents: anticipation of partner disapproval and less pleasure associated with not using condoms

OBJECTIVE: We determined the association of demographic, psychosocial, and contextual factors with condom use among a large community sample of at-risk adolescents recruited from four locations in the U.S. METHODS: We enrolled 1,410 adolescents/young adults between the ages of 15 and 21 with a history of unprotected sex in the past 90 days at four study sites. Subjects completed an audio-assisted, computerized assessment that gathered information about sexual behavior and its contexts, substance use, and relevant risk and protective attitudes. RESULTS: Nearly two-thirds of adolescents did not use condoms at the time of last intercourse and adolescents reported a mean of 15.5 (median = 5) unprotected intercourse occasions in the past 90 days. Controlling for relevant demographic variables, not using condoms was associated with the perception that condoms reduce sexual pleasure, the perception that partners will not approve of condom use, and less discussion with partners about condoms. CONCLUSIONS: Even across racial/ethnic groups, gender, and geographic locations, several important correlates of adolescents' sexual risk reduction were identified. Many adolescents may feel that condoms reduce their sexual pleasure and fear partner reactions if they initiate condom use. These attitudes may be malleable through clinical and community-based interventions.     

Perceived smoking environment and smoking initiation among multi-ethnic urban girls

PurposeTo examine associations between the perceived smoking environment and smoking initiation among urban multi-ethnic adolescent girls in New York City.MethodsSelf-report surveys completed in grades 7, 8, and 9 assessed girls’ (n = 858) smoking initiation, and perceived smoking environment (family smoking, friends’ smoking, smoking norms, and cigarette availability). Carbon monoxide breath samples were collected from girls using a variation of the bogus pipeline procedure.ResultsDifferences were found in smoking prevalence with white girls reporting the highest prevalence of smoking at baseline and greatest increase in smoking prevalence from seventh to eighth grade. Black girls reported an initial increase in smoking prevalence from seventh to eighth grade followed by a decrease from eighth to ninth grade. Family smoking, friends’ smoking, smoking norms, and cigarette availability were all associated with smoking initiation at eighth grade but only friends’ smoking was associated with smoking initiation at ninth grade. Few ethnic differences were found in risk factors at baseline and racial/ethnic group did not modify associations between risk and smoking initiation.ConclusionsUrban adolescent girls of different racial/ethnic backgrounds had similar perceptions of the smoking environment. Despite the similarity of risk factors across racial/ethnic groups, urban white girls are at increased risk to initiate smoking. Preventive interventions that target girls’ perceived smoking environment during early adolescence should be effective across ethnic groups.     

Predictors of HIV-preventive sexual behavior in a high-risk adolescent population: the influence of perceived peer norms and sexual communication on incarcerated adolescents' consistent use of condoms.

Data were collected from 112 sexually active adolescents incarcerated in a juvenile detention facility to identify predictors of consistent use of condoms during sexual intercourse. Adolescents completed an anonymous epidemiologic survey instrument developed by the Centers for Disease Control. The self-report survey assessed demographic, psychosocial, and behavioral factors. Three factors were identified as associated with consistent condom use. These significant bivariate factors were entered into a multivariate logistic regression model to identify the independent contribution of each factor. Non-Black adolescents, adolescents who communicate with their sex partners about AIDS, and those who perceive peer norms as supporting condom use were significantly more likely to be consistent condom users. The findings suggest that Human Immunodeficiency Virus (HIV) prevention programs for incarcerated adolescents that emphasize training in communication skills and modifying perceptions of peer normative behavior may be more effective in increasing the adoption and maintenance of condom use.     

Correlates of sexual experience among a nationally representative sample of alternative high school students

Little is known about risk and protective factors associated with sexual experience among alternative school students that might prove useful in targeting and guiding early interventions to prevent onset of sexual risk behavior. Researchers analyzed data from the national Alternative High School Youth Risk Behavior Survey. Principal components analysis identified six risk and protective factors: weapon carrying; tobacco use; cocaine, inhalant, and needle use; alcohol and marijuana use; participation in sports; and fighting. Composite variables with significant bivariate relationships to sexual experience, as well as demographic variables, were entered into a logistic regression analysis to determine independent effects of these correlates on students' sexual experience (N = 6.037). Nearly 90% of students reported having sexual intercourse. In multivariate analysis, significant demographic correlates of sexual experience included female gender (58% more likely than males to report ever having sex), African American race (2.83 times more likely than non-Hispanic Whites), and age (28% more likely with each advancing year). Attending school in a rural or suburban region corresponded to a 31% decrease and 46% decrease, respectively, in the odds of ever having sex. Weapon carrying, and cocaine, inhalant, and needle use, were associated with a 35% and 46% increase, respectively, in the odds of ever having sex. Students reporting they had ever used alcohol or marijuana, and those reporting recent fighting behavior, were 2.7 and 1.6 times more likely, respectively, to report sexual experience. Most alternative school students have had sexual intercourse, with those students engaging in substance use, weapon carrying, and fighting behaviors being at greater risk for sexual experience. Prevention programs for high-risk youth attending alternative high schools need to consider how to promote continued abstinence among the small but important minority of alternative school students not yet sexually experienced.     

Sociodemographic correlates of virginity in seventh-grade black and Latino students.

PURPOSE: To examine rates of virginity in seventh-grade black and Latino students and assess the extent to which various sociodemographic factors are correlated with virginity. METHODS: A total of 523 seventh-grade students from five junior high schools and one middle school in the District of Columbia completed an anonymous self-administered questionnaire. Students responded to questions about age at first intercourse, demographics, grades, educational expectations, and risk behaviors. Multivariate analysis was used to determine the independent strength of the association of these variables with virginity. RESULTS: Eighty-one percent of girls and 44% of boys reported never having had sexual intercourse, i.e., being virgins. Black and Latino students were equally as likely to report being virgins. Younger age and absence of other risk behaviors, including smoking and alcohol use, were associated with virginity for males and females. For boys, reporting high academic achievement and living with both parents was significantly correlated with virginity and appeared to be protective. CONCLUSIONS: Although prevalent particularly in seventh-grade black and Latino boys, sexual activity was clearly associated with other risk behaviors in both boys and girls. Sociodemographic correlates of virginity were gender-specific. School-based efforts to delay the onset of initiation of sexual activity in high-risk populations should be targeted at boys 12 years and younger with interventions which are gender-specific. This study underscores a need to examine correlates of virginity to generate practical approaches to prevention of early sexual activity.     

Sexual intentions of black preadolescents: associations with risk and adaptive behaviors

CONTEXT: Adolescent sexual activity in the United states is prevalent and occurring increasingly early, particularly among minority groups. Other risk behaviors (e.g., alcohol consumption) often co-occur with sexual behavior. By examining the association of risk and adaptive behaviors with precursors of sexual behavior--specifically, sexual intentions--it may be possible to identify preadolescents who are at increased risk for early sexual initiation. METHODS: Data from 1,090 black fourth and fifth graders and their parents from the Parents Matter! Program were used in logistic regression analyses to assess covariation between preadolescents' risk and adaptive behaviors, and their intentions to initiate sexual intercourse in the next year. RESULTS: Risk and adaptive behaviors, as reported by both preadolescents and parents, were associated with sexual intentions; the findings were not qualified by youth's gender. Alcohol consumption and having been in trouble with the police were the primary youth-reported risk behaviors associated with the odds of intending to have intercourse (odds ratios, 2.3 and 1.8); the preadolescent's being in trouble at home was the primary parent-reported risk behavior (2.1). In both sets of reports, performing well on schoolwork was associated with reduced odds of intending to engage in sex (0.5 - 0.6). CONCLUSIONS: Risk and adaptive behaviors are markers of sexual intentions among black preadolescents. Prevention programs can use these behaviors to identify black youth who may be at high risk for early sexual initiation.     

Virginity pledges among the willing: delays in first intercourse and consistency of condom use

PURPOSE: We examine longitudinal relationships between virginity pledging in adolescence and both sexual initiation and condom use. Prior studies have had mixed results and may not adequately control for prepledge differences between pledgers and nonpledgers. METHODS: Data came from a national sample of 12- to 17-year-olds surveyed in 2001 and reinterviewed 1 and 3 years later. Logistic regression models estimated the association between making a pledge and each outcome. Selection bias was reduced through propensity-score weighting and a rich set of demographic and psychosocial covariates. RESULTS: Pledgers and nonpledgers differed substantially in preexisting characteristics. However, after propensity weighting and statistical controls, pledging was still associated with delayed intercourse. We estimate that in the absence of pledging 42.4% of virgins with characteristics indicating an inclination to pledge initiate intercourse within 3 years; in the presence of the pledge, 33.6% of such youth initiate intercourse. Among those who had sex during this period, pledging was unassociated with condom use. Among those who did not have sex during this period, pledging was unassociated with engagement in noncoital sexual behavior. CONCLUSIONS: Making a virginity pledge appears to be an effective means of delaying sexual intercourse initiation among those inclined to pledge without influencing other sexual behavior; pledging does not appear to affect sexual safety among pledgers who fail to remain abstinent.     

Reported heterosexual intercourse and related behaviours among primary school pupils in Kinondoni district,Dar es Salaam,Tanzania

A cross-sectional questionnaire survey was conducted among 2820 pupils in 22 randomly selected primary schools in Kinondoni district, Tanzania. The objective was to identify the proportion of pupils who reported ever having had sexual intercourse, as well as sociodemographic and psychosocial factors and other sexual-related behaviours associated with heterosexual intercourse among pupils. About 13% (376) of participating pupils reported having had heterosexual intercourse. The proportion of pupils who reported doing so varied significantly by age, sex, school grade and parents' education. Regarding psychosocial factors, pupils who agreed that having sexual intercourse implies love for a partner and that sexual intercourse creates peer approval were significantly more likely to report having had heterosexual intercourse. Pupils who reported having a girl/boy friend, kissed a boy/girl, engaged in light petting, engaged in heavy petting or practised oral sex and anal sex were more likely to report ever having heterosexual intercourse. The implications for programme and intervention development are discussed.     

Geographical variations and contextual effects on age of initiation of sexual intercourse among women in Nigeria: a multilevel and spatial analysis

Background  

The age of initiation of sexual intercourse is an increasingly important issue to study given that sexually active young women are at risk of multiple outcomes including early pregnancies, vesico-vaginal fistula, and sexually transmitted infections. Much research has focused on the demographic, familial, and social factors associated with sexual initiation and reasons adolescents begin having consensual intercourse. Less is known, however, about the geographical and contextual factors associated with age of initiation of sexual intercourse. Therefore, the purpose of this study was to examine the extent of regional and state disparities in age of initiation of sexual intercourse and to examine individual- and community-level predictors of early sexual debut.     

Contextual factors associated with sexual behavior among Brazilian adolescents

PurposeThere are few studies about the influence of the context on sexual behavior among adolescents in developing countries, such as Brazil. Adolescent pregnancy and the high incidence of sexually transmitted disease (STDs) among Brazilian youngsters are a public health problem. The object of this study was to investigate whether factors from family and school contexts are associated with sexual behavior among Brazilian adolescents.MethodsThis study used data from 60,973 adolescent participants in the National Survey of School Health. The response variable was sexual behavior, described in three categories (never had sexual intercourse, had protected sexual intercourse, had unprotected sexual intercourse). The explanatory variables were grouped into sociodemographic characteristics, number of risk behavior factors (regular use of alcohol, smoking, and experimenting with illicit drugs), and family and school context. Variables associated with having protected and unprotected sexual relations in each context were identified by means of multinomial logistic regression. The reference was "never had sexual intercourse."ResultsApproximately one fourth of adolescents have already had sexual intercourse, most frequently boys. Among the adolescents who declared sexual initiation, the most part had their first sexual relation with age of 13 years or younger. Almost 21% did not use protection the last time they had sex. The greater the number of risk factors involved, the higher the incidence of protected and unprotected sex. In the family context, living with only one or with neither parent and low parental supervision increased the frequency of protected and unprotected sex. Never eating meals with the parents augmented the incidence of unprotected sex (odds ratio [OR], 1.60). In the school context, students from private schools were less likely to have had protected and unprotected sex (OR, 0.58 and 0.68). Not receiving instructions at school about pregnancy prevention increased the frequency of protected and unprotected sex (OR, 1.33 and 1.74, respectively).ConclusionsFamily and school context factors are associated with sexual behavior. These associations are generally stronger for unprotected sex. Information about the prevention of pregnancy and STDs/AIDS has to be disseminated very early owing to the young age of sexual initiation.