上海市区家庭生殖健康教育现状及其对青少年生理知识的影响

目的:了解城市家庭中生殖健康教育状况,探讨其对青少年生理知识的影响。方法:采用整群随机抽样的方法,在上海市徐汇区3个街道57个居委会中随机抽取核心家庭,并就青春期生理知识及家庭生殖健康教育情况对核心家庭中的536名青少年进行问卷调查。结果:回答父母曾主动与之谈及生殖健康问题的青少年占51.31%,女孩(67.97%)多于男孩(36.07%);回答父亲主动谈的比例为19.48%,母亲主动谈的比例为44.03%。主动向父母询问生殖健康问题的青少年占37.69%,主动向父亲询问者占11.19%,主动向母亲询问者占33.58%。青少年基本生理知识答对率较低,平均得分为42.30分。父母与之谈论过生殖健康问题的青少年生理知识得分比父母未与之谈论相关问题者高近15分。结论:青少年基本生理知识缺乏,虽然家庭生殖健康教育能明显提高青少年的生理知识水平,但家庭中生殖健康教育明显不足。     

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.     

Health care information sources for adolescents: age and gender differences on use, concerns, and needs.

OBJECTIVES: To assess adolescents' sources of health care information, explore beliefs about topics which health care providers should address and about those which have been addressed, and identify topics that are embarrassing for adolescents to discuss with providers. METHODS: Participants included a nationally representative sample of 3153 boys and 3575 girls in 5th through 12th grades who completed the Commonwealth Fund survey. Data were analysed by inspection of percentages and bivariate associations. RESULTS: Boys (41.7%) and girls (58.4%) identified their mother as the primary resource for health care information. Younger boys and girls (grades five and six) were more likely than older boys and girls (grades 10 to 12) to ask their mother first about health issues (boys 54.4% vs. 35.2%; girls 71.7% vs. 46.4%). Doctors, nurses, or school nurses were also frequently identified as the first person asked about health issues (boys 23.9%, girls 18.2%). Most adolescents indicated that providers should address the following topics: drugs (65.0%); smoking (58.5%); sexually transmitted diseases (61.4%); alcohol use (56.2%); and good eating behaviors (56.8%). However, fewer adolescents reported that providers have actually discussed these issues with them; only 23.1% to 34.2% of adolescents reported having discussed the first four topics with them. Many youth noted that it would be embarrassing for them to discuss these issues with their providers. CONCLUSIONS: Adolescents report that parents and health care providers are key sources of health-related information. Although adolescents may be embarrass having discussions with their health care providers, adolescents do believe that these topics should be addressed. Adolescents' embarrassment about discussing sensitive health topics highlights the importance of providers initiating and facilitating these discussions.     

Correlates of using dual methods for sexually transmitted diseases and pregnancy prevention among high-risk African-American female teens.

PURPOSE: To identify correlates of consistent dual-method use among African-American female adolescents at risk of sexually transmitted diseases (STDs) and pregnancy. METHODS: A convenience sample of 522 sexually active female teens attending adolescent medicine clinics, health department clinics, and school health classes volunteered. Recruitment sites were in low-income neighborhoods of Birmingham, Alabama. Adolescents completed a questionnaire and a face-to-face interview and provided vaginal swab specimens for laboratory diagnosis of STDs. Those reporting use of condoms and at least one other method of contraception, for each of the last five occasions they had sex were classified as consistent dual-method users. The questionnaire assessed frequency of adolescents' communication with their parents and partners about sex. The questionnaire also assessed two measures of parental supervision and adolescents' desire to avoid pregnancy. Multiple logistic regression assessed the independent contribution of each correlate of consistent dual-method use. RESULTS: Seventy-one adolescents (13.6%) were classified as consistent dual-method users. A strong desire to avoid pregnancy was the most influential correlate of consistent dual-method use [odds ratio (OR) =2.3]. Adolescents reporting that their parents generally knew whom they were with (OR = 2.0) and those reporting more frequent communication with parents (OR = 1.9) were also more likely to be consistent dual users. CONCLUSION: The findings suggest the need for research to examine the efficacy of interventions building on adolescent females' desire to avoid pregnancy. Study findings also suggest that interventions promoting improved parent-adolescent communication and improved parental supervision may contribute to adolescents' use of dual methods for STD and pregnancy prevention.     

Country watch: India

An acquired immunodeficiency syndrome (AIDS) education program sponsored by World Vision of India was effective in reaching low-income adolescent girls in Bombay. During the preparatory phase, household surveys, interviews, and focus group discussions were conducted to gain insight into the daily lives, interests, sexual activities, and health problems of female adolescents. These activities identified a need for support and cooperation of the parents of these girls and the broader community, services such as child care for younger siblings to facilitate attendance, promotion of self-confidence and self-expression, and discussion of AIDS within the broader context of women's status and rights. The curriculum covered topics such as being a woman, puberty, sexuality, sexual exploitation and harassment, the human immune system, and protection against AIDS and other sexually transmitted diseases. These messages were communicated through lectures, videos, plays, puppet shows, quizzes, story telling, role plays, and group discussions. The course was supplemented by a community awareness program involving community leaders, mothers of adolescent females, young men, and adolescent boys. A total of 76 girls (average age, 14 years) attended the 7-session course. A follow-up survey indicated that knowledge about AIDS, menstruation, and reproduction increased significantly over baseline; 62% of participants reported they had talked to others about AIDS since the course. World Vision has since expanded its Women and AIDS project to male and female adolescents and adults in 21 slums and two industrial complexes in Bombay.     

Child sexual abuse as a risk factor for sexual risk behaviours among socially disadvantaged adolescents in Ibadan,Nigeria

This study documents the prevalence and association between child sexual abuse (CSA) and risky sexual behaviours among in-school adolescents in Ibadan, Nigeria. A cross-sectional study with 1,079 boys and 1,211 girls was conducted in 22 socially disadvantaged public secondary schools in a suburb of Ibadan, Nigeria. A 70-item sexual risk behaviour questionnaire was used to collect information on lifetime and current sexual experiences. Fifty-five per cent of students reported to have ever experienced at least one form of CSA. Thirty-six per cent reported a history of intra-family CSA, whereas 46% had experienced inter-family CSA. Five hundred and sixty-four (24.6%) of these adolescents were sexually active at the time of the study. There was a strong relationship between having ever experienced CSA and sexual risk behaviours: adolescent boys and girls with CSA were three-fold as likely not to use condom at last vaginal intercourse; thrice as likely to engage in casual sex with a partner known for a day; twice as likely to drink alcohol heavily before sex; thrice for tobacco smoking and three- fold for STD. Logistic regression shows that the relationship between CSA and non-use of condom at last vaginal intercourse remained after controlling for age, family type, parents staying together and hawking after school. We found that experiences of CSA may precipitate risky sexual behaviours in this population. A structural and educational approach towards educating both adolescents and parents of the possible effect of CSA to sexual risk behaviours is presented in this article.     

Parent-adolescent relationships and the development of weight concerns from early to late adolescence

OBJECTIVE: This work describes the developmental course of adolescents' weight concerns and examines links with changes in parent-adolescent relationships for girls and boys. METHOD: Adolescents and parents in 191 families participated in 3 annual home interviews; adolescents rated their weight concerns and their intimacy and conflict with parents. Parental knowledge was measured based on the match between adolescents' and parents' reports of youth's experiences each day during 7 evening telephone calls. RESULTS: Girls' weight concerns increased from age 11 to 16 and then declined, whereas boys' concerns declined beginning at age 11. Increases in girls' weight concerns were linked to increases in conflict with mothers and fathers and decreases in maternal intimacy and knowledge. At a trend level, declines in boys' weight concerns were associated with declines in father conflict. CONCLUSION: Mothers and fathers may have unique influences on adolescent weight concerns. Intervention programming should target parent-adolescent relationships.     

Influences on adolescent eating patterns: the importance of family meals.

PURPOSE: To provide national estimates of the frequency and determinants of adolescents' consumption of fruits, vegetables, and dairy foods. METHODS: Analyses were based on 18,177 adolescents in the first interview of the National Longitudinal Study of Adolescent Health. Multivariate logistic regressions provide estimates of the unique contribution of sociodemographic characteristics, body weight perception, and parental influences on adolescent food consumption. RESULTS: Almost one in five adolescents reported skipping breakfast the previous day. A large percentage of adolescents reported eating less than the recommended amount of vegetables (71%), fruits (55%), and dairy foods (47%). Adolescents with better-educated parents had better consumption patterns than those with less-educated parents. Consumption patterns differed significantly by race. Adolescents who perceived themselves to be overweight were significantly more likely to have poor consumption patterns. Parental presence at the evening meal was associated with a lower risk of poor consumption of fruits, vegetables, and diary foods as well as the likelihood of skipping breakfast. CONCLUSION: Parental presence at the evening meal is positively associated with adolescents' higher consumption of fruits, vegetables, and dairy foods. Nutrition and health professionals should educate parents about the role of family mealtimes for healthy adolescent nutrition.     

Parental Health and Adolescent Behavioral Adjustment

This study compared the frequency of problem behaviors in adolescents of parents with chronic health conditions and adolescents of healthy parents. Eighty-one families of 6th, 7th, and 8th graders in rural Florida completed a battery of questionnaires including a health history form, the SF-36 Health Survey, the Child Behavior Checklist, and the Youth Self-Report. The presence of a chronic health condition in the father was strongly related to more behavior problems in adolescents. The presence of a chronic health condition in the mother was not significantly associated with adolescent behavior problems. However, lower health-related quality of life in both mothers and fathers was associated with more behavior problems. Contrary to past findings, no significant interactions between the sex of the child and the health status of the same-sex parent were found. Parental health status should be considered in the evaluation and treatment of adolescent behavior problems. In addition, further research examining the relation between fathers' health status and childhood adjustment is needed.     

江苏省青少年生殖健康项目家长问卷分析报告

目的:了解江苏省青少年家长掌握性知识的情况以及对青少年开展生殖健康教育的态度。方法:采用整群随机抽样方法,对全省19个项目点的7055名家长进行了问卷调查。结果:67·9%的家长认为对青少年进行性教育是必要的,40%认为由母亲来谈性教育比较好,70%同意孩子阅读有关性方面的书籍,并且认为这是理想的教育方法,而>90%的家长不会主动替孩子购买性科学的书籍;家长对性病艾滋病知识回答的正确率为63·3%,只有20%的家长了解手淫问题;>90%的家长会阻止孩子看色情录相,反对孩子在学校期间谈恋爱和婚前性行为的家长为87·6%和62·4%。结论:性教育进入家庭,在江苏省是完全必要的,而且是可能的。     

Family structure and sexual and reproductive health outcomes among adolescents in rural Sierra Leone

Orphanhood is common in sub-Saharan Africa, and is a critical issue shaping global assistance for children. Care arrangements for children are often fluid, and many ‘orphaned’ children have a surviving biological parent. This study examines the protective effects of family-level factors on early sex and pregnancy in rural Sierra Leone. A survey of 530 adolescents in 2 districts in Sierra Leone was analysed to evaluate associations between living arrangement and orphanhood on recent sexual activity and pregnancies out of wedlock. After controlling for confounders, living with one's mother (AOR = 0.46, 95% CI: 0.22–1.00) and living with both parents (AOR = 0.36, 95% CI: 0.17–0.73) were protective against recent sexual activity. Orphan status was not significantly associated with recent sexual activity. Among 164 sexually active adolescents, neither living arrangement nor orphanhood was associated with pregnancy. This study demonstrates the protective effect of living with a surviving biological parent to delay early sexual debut. Once an adolescent becomes sexually active; however, living arrangement is not associated with the risk of pregnancy out of wedlock. The findings suggest that supporting family connectedness and preventing unnecessary family separation may benefit at least some aspects of adolescent sexual and reproductive health in Sierra Leone.     

Confidential reproductive health services for minors: the potential impact of mandated parental involvement for contraception

CONTEXT: Recent legislative efforts to implement mandated parental involvement for minor adolescents seeking family planning services threaten the rights of adolescents younger than 18 to access reproductive health care. METHODS: State and federal laws and policies pertaining to minor adolescents' rights to access services for contraception and sexually transmitted diseases are reviewed, and research examining issues of parental involvement among adolescents using clinic-based reproductive health services is synthesized. RESULTS: Attempts to mandate parental involvement for reproductive health care often focus on contraceptive services and are typically linked to federal or state funding. Studies of teenagers using clinic-based family planning services suggest that slightly more than one-half would obtain contraceptives at family planning clinics even if parental notification were required. Mandated parental involvement for contraception would discourage few teenagers from having sex, but would likely result in more teenagers' using the least effective methods, such as withdrawal, or no method at all. Family planning clinics encourage teenagers to voluntarily talk to their parents, but relatively little information is available about the extent to which activities to promote parent-child communication have been adopted. CONCLUSIONS: Mandated parental involvement for teenagers seeking contraceptive care would likely contribute to increases in rates of teenage pregnancy. Research that will help clinics implement and improve efforts to encourage voluntary parental involvement is urgently needed.     

Adolescent girls' and boys' preferences for provider gender and confidentiality in their health care.

PURPOSE: To assess the influence of demographic variables and health risk status on adolescents' preferences and actual receipt of services regarding provider gender, sharing a physician with parents, and private examinations. METHODS: Data from students participating in the Commonwealth Fund 1997 Survey of the Health of Adolescent Girls were analyzed. The weighted sample included 6748 students from grades 5-12. The influence of demographic variables and health risk status on preferences regarding physician gender, sharing a physician with parents, and parental presence during examinations and on actual physician gender, sharing a physician with parents, and receipt of confidential care was assessed for the 5067 students who indicated that they had a health check-up or physical examination within the past 2 years. Associations were examined using SAS to determine preliminary estimates of significance and correlation coefficients, and SUDAAN to generate proportions and Cochran Mantel-Haenszel Chi-squared values. A multiple logistic regression procedure in SUDAAN was used to assess interaction among demographic variables. RESULTS: Gender, race/ethnicity, grade level, and risk status were associated with preferences regarding provider gender and sharing a physician with parents. 50% of girls preferred a female provider; 48% had no preference. 23% of boys preferred a male provider; 65% had no preference. Most adolescents had no preference regarding whether they shared a physician with parents. Gender, race/ethnicity, grade level, and risk status were associated with preference regarding parental presence during examinations. Most younger girls preferred to have a parent present; most younger boys had no preference. Most older girls and boys preferred private examinations. For actual care situation, most adolescents were cared for by male health providers and did not share a physician with parents. 57% of girls and 66% of boys spoke privately with their health provider. Girls who had a female physician were more likely to have private time than were girls receiving care from a male physician. Gender, grade level, and risk status were associated with having private time with a physician. CONCLUSIONS: Gender was a significant variable in adolescents' preferences regarding health care. Preferences were also influenced by race/ethnicity, grade level, and risk status. A substantial proportion of adolescents, including those involved in health risk activities, report not having private time with their health provider.     

Risky parental behavior and adolescent sexual activity at first coitus

Data from the National Longitudinal Study of Adolescent Health (Add Health) were used to examine the impact of parents' behavior on adolescents' sexual experience and contraceptive use. All else being equal, adolescents whose parents engage in risky behaviors are especially likely to be sexually active and to have had sex before age 15. These findings are only partly attributable to the link between parents' risky behaviors (smoking, drinking, driving without seatbelts) and adolescents' risky behaviors (smoking, drinking, delinquent activity, association with substance-using peers). Although parental behaviors are effective predictors of adolescents' sexual activity, they are not effective predictors of contraceptive use or of method choice at first coitus. Overall, parents with low levels of self-efficacy seem to be especially likely to have children at risk of engaging in problem behaviors.     

Impact of an Integrated Adolescent Reproductive Health Program in Brazil

An impact evaluation of an integrated school- and health-clinic-based adolescent reproductive health initiative was undertaken by the State Secretariats of Health and Education in Bahia, Brazil during 1997-99. The project was initiated in response to continued high pregnancy rates among adolescents and growing numbers of new HIV infections among young adults. It sought to promote responsible sexual and health-seeking behaviors among public secondary-school students, including the use of public health clinics. The study design included a matched control group used to measure project impact. The findings indicate that the project was successful in increasing the flow of sexual and reproductive health information to secondary-school students and that it had an impact on adolescents' intentions to use public health clinics in the future. No effects on sexual or contraceptive-use behaviors or on use of public clinics were observed, however. Client exit-interview data from a subset of project clinics indicate that adolescents who use clinic-based services are overwhelmingly female and considerably older on average and much more likely ever to have been pregnant than are adolescents in the target population for the project.     

Do parents still matter regarding adolescents' alcohol drinking? Experience from South Africa

The purpose of this cross-sectional study was to improve our understanding of adolescents' perceptions of parental practices relating to their (adolescents') alcohol use. A total of 704 students were conveniently selected and completed self-administered questionnaires. More than half (54%) of the adolescents reported that they had consumed alcohol at some time in their life. Parental marital status was significantly associated with whether adolescents ever consumed alcohol or not (p < 0.05). A large number of mothers/female guardians (66.3%) and fathers/male guardians (69.3%) did not allow alcohol use at home. More mothers (54.6%) and fathers (65.3%) were not aware of their adolescents' alcohol consumption (p < 0.05). Adolescents were more likely to use alcohol when they reported that they had often seen either their father or mother drunk or both (p < 0.05). There were also significant associations between parents' views against alcohol use and their adolescents' alcohol use (p < 0.05). Prevalence of alcohol uptake was quite high among these adolescents. Compulsory parenting programmes and skills development should be practiced by education, health, cultural and religious groups. Parents should be motivated to delay the age at which their children are initiated into alcohol use and be provided with guidance on how to counteract social pressures.     

Effects of media campaign messages targeting parents on adolescent sexual beliefs: a randomized controlled trial with a national sample

Using a randomized controlled trial, this study evaluated the effects of media messages targeting parents on the sexual beliefs of 404 adolescents. The messages aimed to increase parent-child communication about waiting to initiate sexual activity. Compared with children of unexposed parents, children of parents exposed to media messages were more likely to believe that teen sexual activity is psychologically harmful. However, effects varied by parent and adolescent gender; treatment effects were only significant among adolescents whose opposite-sex parent was exposed. Parent exposure strengthened beliefs that teen sexual activity is physically harmful only among adolescents with at least 1 sexually active friend.     

Socioeconomic status and health behaviour patterns through adolescence: results from a prospective cohort study in Norway

BACKGROUND: In this paper, we investigate cross-sectional and prospective relationships between various socioeconomic indicators and different health behaviours among boys and girls at ages 13-21, and whether socioeconomic status (SES) is related to changes in health behaviour over time. METHODS: The study is based on a 10-year, two-generation prospective cohort study of health and lifestyle factors among a sample of Norwegian adolescents and their parents. Data presented here were collected at the ages of 13 (baseline), 15, 18 and 21. Parental and adolescent reports of socioeconomic factors were assessed along with a number of health-enhancing and health-compromising behaviours, both as single behaviours and as part of health behaviour indices. RESULTS: Relatively few significant relationships are observed between parental occupation and adolescents' reported health behaviour when the latter is analysed as single behaviours. A significant, but weak, social gradient in health-enhancing behaviour is observed when measuring health behaviour as composite indices rather than single forms of behaviour. This is apparent both when applying parental SES variables or adolescents' own educational aspirations as proxy measures of their socioeconomic status. CONCLUSION: Future investigations of the presence of a social gradient in adolescent health behaviour should focus on composite measures of health behaviour. Further research is needed on potential mediating mechanisms behind the SES-health behaviour relationships in youth.     

Parental influences on adolescent physical activity: a longitudinal study

Background  

Physical inactivity is increasing among adolescents in the U.S., especially among girls. Despite growing evidence that parents are an important influence on adolescent health, few longitudinal studies have explored the causal relationship between parental influence and physical activity. This study examines how the relationships between parental influences and adolescent physical activity differ by gender and tests whether these relationships are mediated by adolescents' self-esteem and depression.     

Adolescent HMO enrollees’ utilization of out-of-plan services

Purpose: To examine use of reproductive health services, correlates of out-of-plan care, and reasons for seeking out-of-plan care among adolescent health maintenance organization (HMO) enrollees.

Methods: We mailed a self-administered questionnaire to a population-based random sample of 18-year-old members of Group Health Cooperative of Puget Sound (GHC) who had been enrolled for at least 12 months. The sample was selected from GHC’s computerized enrollment database. Questionnaire topics included reproductive history, sexual behavior, and use of health services. Analysis included Chi-square tests to examine differences by gender and out-of-plan status and multivariate analysis using logistic regression.

Results: About one-half of the 997 respondents (69% response rate) reported using out-of-plan care. In multivariate analysis, the strongest correlate of out-of-plan care was having had sexual intercourse [odds ratio (OR) = 1.84; 95% confidence interval (CI) = 1.35–2.52]. Other correlates were using alcohol (OR = 1.79; 95% CI = 1.29–2.48), living with parents (OR = 0.65; 95% CI = .46–.92), and being female (OR = 1.60; 95% CI = 1.21–2.11). During the prior year, over 80% of sexually active respondents had obtained contraceptives out-of-plan and 45% of those tested for sexually transmitted diseases (STDs) reported out-of-plan testing. The primary reasons reported for using any out-of-plan care were lack of convenience (28%), being out of town (26%), and confidentiality (23%; only reported by sexually active respondents).

Conclusions: A substantial proportion of GHC-enrolled adolescents used out-of-plan care. Those who did were more likely to have had STDs and other health problems than those who used only in-plan services. Without continuity of care, these at-risk adolescents may not be receiving optimal services.