Changing Women: Mothers and Their Adolescent Daughters

Budding fecundity in the female child is a matter of family concern. The authors used the grounded theory method to explore the process of communication between mothers and their adolescent daughters concerning sexuality issues within the context of the age changes of both. A core category of changing women was identified along with three maternal and three daughter processes. Changes that occur during this time period can lead to lasting separation between the pair if they fail to develop insight as a way of protecting themselves and one another. The findings may assist health professionals to understand these changes and facilitate the process of communication in these dyads.     

青春发动时相提前与青少年性及生殖健康服务

与青春发动时相提前相关的不良结局涉及多个方面,包括心理与躯体健康、性行为、社 会与学业适应方面,其中性危险行为增多和（或）提前因影响青少年的性与生殖健康而备受重视。引入进 化论观点和青春期脑发育进程观点,有助于阐明青春发动时相提前与青少年性和生殖健康之间的交互效 应,同时对早期预防和干预也有一定的实践意义。青少年性及生殖健康研究是一个跨学科、跨专业的领 域,需要多学科的充分参与。中国应大力开拓实证研究,同时建立青少年性及生殖健康的研究队列及其干 预研究。积极推进和发展青少年健康服务措施和项目,如亲青服务、青少年积极发展规划,尤其是以学校 为基础的生活技能教育,将青少年性及生殖健康服务内容融入其中。     

The Influence of Sexual Risk Communication Between Parents and Daughters on Sexual Risk Behaviors*

Two hundred thirty‐four 19‐ to 21‐year‐old women completed interviews that assessed parent‐adolescent relations, sexual communication, and selected sexual risk behaviors and outcomes. Overall, Hispanic–Latina respondents reported less parent‐adolescent sexual communication than others. Early parent‐adolescent sexual communication was associated with later age of sexual initiation, consistent condom use and, indirectly, less likelihood of sexually transmitted diseases. Mother‐daughter communication about condoms was associated with consistent condom use. Recommendations for family‐based HIV–STD prevention are presented.     

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

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

Improving Adolescent Perceptions of Barriers and Facilitators to Sexual and Reproductive Health Services Through Sexual Health Education

PurposeThis study examines whether comprehensive sexual health education that provides information on clinical services can change adolescents’ perceptions of barriers, facilitators, and intention to use services and whether changes in perceptions differ by participant characteristics.MethodsAdolescent participants in a statewide sexual health education program in California were surveyed at baseline and at exit about their perceptions of barriers, facilitators, and intention to use clinical services. Linked baseline and exit surveys (n = 7,460) assessed change in perceptions after program completion. Logistic regression analyses that accounted for the clustered data structure assessed associations between participant characteristics and improvement in perceptions.ResultsAfter the program, there were significant reductions in two perceived barriers (worry about cost and judgment by staff), but there were also small but significant increases in perceptions of two barriers (worry about confidentiality of services and test results). There were significant increases in all three perceived facilitators and intention to use sexual and reproductive health services, which rose from 90.6% at baseline to 96.2% at exit. Younger youth were more likely than older youth to show improvement in all perceived facilitators and intentions. Girls and Black youth were more likely than boys and Hispanic youth to show improvement in two facilitators (knowing what to expect and access). No sociodemographic characteristics were consistently associated with reductions in perceived barriers.DiscussionComprehensive sexual health education that addresses adolescents’ questions and concerns regarding clinical services can help to reduce perceived barriers, increase facilitators, and increase intention to use services if needed.     

When Mothers Turn to Their Adolescent Daughters: Predicting Daughters' Vulnerability to Negative Adjustment Outcomes*

Mother‐to‐daughter disclosure regarding two sensitive topic areas—financial concerns and complaints/anger toward the ex‐husband (the adolescent girl's father)—was examined in a sample of 62 mother/adolescent‐daughter dyads following the mother's divorce. Most mothers in the current sample have disclosed to their daughters on these two topics, but with varying levels of detail and diverse motivations. Daughter perceptions of maternal disclosure were associated with daughter psychological distress, regardless of daughter age.     

Adolescent Mothers and Their Children:

No abstract available for this article.     

青少年性与生殖健康服务面临的新挑战和新任务

改革开放以来,青少年所面临的各种环境发生重大变化,对其性与生殖健康也产生重要影响。本文对青少年性与生殖健康服务的新变化进行回顾总结,在现有的服务体系下探求其所面临的新挑战,以及在此挑战下如何更好地改善中国青少年的性与生殖健康教育和服务。     

Sexual Violence and Reproductive Health

Sexual violence is a significant public health problem, and has been linked to adverse effects on women's physical and mental health. Although some advances in the research have been made, more scientific exploration is needed to understand the potential association between sexual violence and women's reproductive health, and to identify measures that could be implemented in reproductive health care settings to assist women who have experienced sexual violence. Three general areas needing further study include (1) expansion of the theoretical frameworks and analytic models used in future research, (2) the reproductive health care needs of women who have experienced sexual violence, (3) and intervention strategies that could be implemented most effectively in reproductive health care settings.     

Implementing Adolescent Sexual and Reproductive Health Clinical Best Practice in the Bronx,New York

Purpose

Inequitable access to quality adolescent sexual and reproductive health (ASRH) care may contribute to the high rate of teen pregnancy in the Bronx, New York. Bronx Teens Connection (BxTC), a community-wide intervention, sought to increase the number of ASRH best practices implemented and the number of females 12–19 years old receiving services by health centers in the Bronx.

Addressing Structural and Environmental Factors for Adolescent Sexual and Reproductive Health in Low- and Middle-Income Countries

A deeper understanding of how structure and environment shape the sexual and reproductive health vulnerabilities of youths across a range of outcomes has implications for the development of successful policies and programs. We have discussed some of the key structural and environmental factors that influence the sexual and reproductive health of adolescents, particularly in low- and middle-income countries, and the importance of engaging adolescents in identifying solutions. We have highlighted 2 case studies that describe structural or environmental approaches to improving adolescent sexual and reproductive health and made recommendations to more systematically incorporate attention to structure and environment to improve global adolescent health.The global population of adolescents is vast and growing: more than 25% of the world’s population is younger than 15 years, and more than 1 billion are aged 10 to 19 years.1 Although adolescents have one of the lowest rates of mortality globally, numerous negative sexual and reproductive health (SRH) outcomes, such as early pregnancy and infection with HIV/AIDS and other sexually transmitted infections (STIs), continue to threaten the health and well-being of adolescents more than any other age group. Adolescents in low- and middle-income countries (LMICs) experience the largest SRH burdens of adolescents globally.2 In sub-Saharan Africa, for example, the birth rate per 1000 girls aged 15 to 19 years is 143, compared with the worldwide average of 65.3 Likewise, up to 6000 young people are estimated to be infected with HIV each day, the vast majority of whom live in sub-Saharan Africa; approximately 75% of those becoming infected are female.4 The United Nations Children’s Fund (UNICEF) estimates that 14% (2.5 million) of unsafe abortions that occur annually every year in LMICs involve adolescents younger than 20 years.5Despite growing recognition for the need to improve adolescent SRH outcomes, there have been few success stories. One reason for this may be that intervention strategies have largely failed to address the broader contexts that surround these adolescent behaviors and outcomes. Although theorists have been arguing for years to focus more “upstream” from an individual’s risk or protective factors to the social structures and environments that shape health behaviors, it has primarily been in the field of HIV/AIDS, in which researchers and interventionists have developed and delineated numerous examples of structural approaches to reducing risks and vulnerability to infection.6Outside the HIV/AIDS realm, however, addressing structural factors in relation to population health has been much slower paced. In fact, it was not until 2008 that there was a concerted worldwide effort to address such factors through recognition of the social determinants of health.7,8 The Commission on the Social Determinants of Health concluded that to make a difference in improving the health of a particular population, the context and social determinants that surround a particular population must be addressed. Specifically, the social determinants of health are defined as the “conditions in which people are born, grow, live, work, and age” or “the conditions or circumstances that are shaped by families and communities and the distribution of money, power, resources at global, national, and local levels.”8^(p1641) Such conditions are often out of the control of individuals, thereby limiting the effectiveness of health promotion efforts that focus solely on changing individual behaviors.The social determinants framework has 2 broad levels in which social determinants operate to influence health: the structural and the proximal. Structural determinants are structures that create social stratifications, such as economic, education, political, and social welfare systems, whereas proximal determinants are circumstances of daily life, which include individual health behaviors and relationships among family members, peers, and neighbors. Although more emphasis has been placed on examining the influence of proximal determinants on adolescent health outcomes, in a recent study Viner et al. compared the relative influence of structural and proximal determinants and found that structural determinants were stronger in terms of affecting overall health among adolescents worldwide.8 Other researchers have similarly noted that although focusing on individual behavior change is important, including the strengthening of an individual’s agency (or capacity to act),9 it is essential to have enabling structures and environments that facilitate behavior change to achieve a large-scale population health impact. Focusing on enabling structures and environments has been overlooked for too long in the realm of adolescent health in LMICs.Although the use of structural approaches to improve population health has been gaining attention, especially since the formulation of the social determinants framework,6,10–13 there is still limited understanding about how structural determinants and approaches influence adolescent health, and particularly adolescent SRH (ASRH). A shift in attention to the increased use of structural approaches could have a significant population health impact if better understood and incorporated into programs and policies. We have (1) summarized the key structural and environmental factors found to influence ASRH outcomes, emphasizing studies that have been conducted in LMIC contexts; and (2) presented 2 case studies that applied a structural determinants approach to improving ASRH.As a basis for examining the influence of structural determinants, we adapted the structural model of health behavior of Cohen et al., which focuses on 4 main categories of structural determinants: (1) availability and accessibility of resources, (2) physical structures, (3) social structures and policies, and (4) media and cultural messages.14 Although other structural frameworks have been put forth by numerous HIV researchers,11,15–17 we adapted Cohen’s model because it includes structural components that have been found to have an influence on ASRH outcomes and that are particularly useful for identifying pragmatic approaches to improving ASRH.Figure 1 illustrates our conceptualization of how these 4 structural and environmental components are situated within the broader context of forces that shape ASRH outcomes. As observed, the 4 structural and environmental determinants are strongly influenced by economic and gender inequalities, which, in turn, are shaped by macrolevel forces that consist of cultural, religious, governmental, and geographical forces. The double arrows in the figure indicate the dynamic and bidirectional relationships between each level of influence and how changes in one level (particularly at the structural and environmental level) can influence ASRH outcomes and the broader contextual forces.Open in a separate windowFIGURE 1—Adolescent sexual and reproductive health (ASRH) outcomes.Note. RH = reproductive health.     

Maternal Pre-pregnancy BMI and Reproductive Health of Daughters in Young Adulthood

Objective To investigate the possible associations between maternal pre-pregnancy body mass index (BMI) and daughters’ age of menarche and subsequent markers of reproductive health. Methods Nine hundred eighty-five pregnant women (80 %) were enrolled at their routine 30th week examinations in 1988–1989. In 2008, a follow-up questionnaire was completed for 365 daughters (83 %), while 267 daughters (61 %) participated in a subsequent clinical examination. Main outcome measures were age of menarche, reproductive hormone profile, and ovarian follicle count in daughters. Results Daughters of mothers in the highest pre-pregnancy BMI tertile (BMI ≥ 22.0 kg/m²) had an adjusted 4.1 (0.3; 8.0) months earlier menarche compared with the middle tertile group (BMI 20.0–21.9 kg/m²). Among non-users of hormonal contraceptives, daughters of mothers in the highest pre-pregnancy BMI tertile had non-significantly lower dehydroepiandrosterone-sulphate (DHEAS), estradiol, and free estrogen index (FEI), compared to the middle BMI tertile. This was supported by a sub-analysis using the WHO classification (underweight, BMI < 18.50; normal range, BMI 18.50–24.99; overweight/obese, BMI ≥ 25.00 kg/m²) as exposure groups, in which daughters of overweight mothers had lower levels of DHEAS and estradiol, and lower FEI compared to daughters of normal weight mothers. No associations were found for ovarian follicle count in any of the groups. Conclusions for Practice We found that higher maternal BMI is associated with earlier age of menarche in daughters. A possible impact of maternal pre-pregnancy BMI on DHEAS and estradiol serum levels, and FEI in non-users of hormonal contraceptives was indicated, but the results were not statistically significant.