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PubMed1998

New materials for AIDS education at school.

According to a newly-published Joint UN Programme on HIV/AIDS (UNAIDS) review of data from four continents, good-quality sex education helps delay first intercourse and leads to lower levels of teenage pregnancy and sexually transmitted diseases (STDs). The following materials may be useful: 1) Learning and teaching about AIDS at school, Geneva: UNAIDS Technical Update, October 1997. An eight-page document analyzes why AIDS education in schools is often denied to young people and suggests ways to overcome these problems; 2) Integrating HIV/STD prevention in the school setting: a position paper, Geneva: UNAIDS, 1997. This is a two-page document with programming principles, best practice to date, and goals in school AIDS education, from a life skills perspective; 3) Impact of HIV and sexual health education on the sexual behavior of young people: a review update, Geneva: UNAIDS, 1997. From a comprehensive literature review of evaluated interventions, 46 are presented that had an impact on behavior. Effects on age at first intercourse, sexual activity and protected sex, as well as gender and media issues in the context of education programs, are discussed.

Acquired Immunodeficiency Syndrome↗
PubMed2004

The effect of methylenetetrahydrofolate reductase polymorphism C677T on cervical cancer in Korean women.

OBJECTIVES: Methylenetetrahydrofolate reductase (MTHFR) gene is associated with DNA hypomethylation, an established hallmark of human cancer cells. The aim of this study was to examine the effect of MTHFR polymorphism C677T on cervical carcinogenesis in the context of other environmental factors, such as smoking, parity, and age at the first intercourse. METHODS: The study subjects were patients who were pathologically diagnosed with cervical neoplasia and who had a positive result for human papillomavirus (N = 462), and they were compared to normal healthy women as normal controls (N = 454). Genotypes of the patients and control samples were assayed by single base primer extension assay using SNapShot assay kit. RESULTS: Compared with MTHFR C/C, the odds ratio (95% confidence interval) for MTHFR T/T was 1.4 (0.9-2.3) for invasive cervical cancer and 1.3 (0.8-2.3) for cervical intraepithelial neoplasia (CIN) II or III. The risks for invasive cervical cancer were higher with less than 40 years old at diagnosis (2.1, 1.0-4.3), than with over 40 years old at diagnosis (1.2, 0.7-2.2). Current smoking women with early onset with MTHFR T/T had a 4.7 (0.6-36.2) times higher risk of cervical cancer. The risks of MTHFR T/T or C/T also increased for women with an early age of first intercourse or for women with two or more children, as compared with MTHFR C/C. CONCLUSION: Polymorphisms of MTHFR are associated with a higher risk of developing cervical cancer, and in particular for an early onset of cervical carcinogenesis.

Adult↗
PubMed1989

Risk factors for cervical cancer in Greenland and Denmark: a population-based cross-sectional study.

The incidence of cervical cancer in Greenlandic women aged 20-39 years is nearly 6 times higher than in Danish women of the same age. Possible determinants of cervical cancer incidence were investigated in a population-based cross-sectional study. From Nuuk (Greenland) and Nykøbing Falster (Denmark) a sample of 800 women aged 20-39 years was drawn at random. A total of 586 and 661 women were studied in Greenland and Denmark, respectively. All underwent a personal interview. In Greenland, 13% of the women reported first intercourse before the age of 14 in contrast to 3.5% in Denmark, and nearly 85% of the Greenlanders had their sexual debut before the end of the 16th year of age whereas this applied to only 45% of the Danish women. The prevalence of women with 0-1 lifetime sexual partner was 20.4% in Denmark, and only 1.7% in Greenland. In contrast, 53.2% of the Greenlandic women reported more than 20 partners and 22.4% more than 40 partners. The corresponding figures for Denmark were 3.6% and 0.3%, respectively. In Greenland the most common contraceptive method was the use of intra-uterine devices (73.6%), whereas, in Denmark, oral contraceptive use was most frequent (87.9%). Few Greenlanders had ever used "barrier" contraceptives (diaphragm: 1.4%; condom: 18.1%) compared to Denmark (diaphragm: 10.1%; condom: 53.9%). As many as 87.4% were current smokers in Greenland (Denmark: 53.6%) and 5.6% claimed to have never smoked, whereas this applied to 35.3% in Denmark. The indications of a higher sexual activity (multiple partners, early age at first intercourse) in Greenland compared to Denmark are in line with the observed higher rates of sexually transmitted diseases and with the hypothesis that differences in cervical cancer incidence between Greenland and Denmark are determined by aspects of sexual background.

Adult↗
PubMed1999

Risk factors for high-risk type human papillomavirus infection among Mexican-American women.

Minority women in the United States experience a disproportionately high burden of the more than 2 million yearly cases of squamous intraepithelial lesions of the cervix. Risk factors for squamous intraepithelial lesions of the cervix are infection with the sexually acquired human papillomavirus (HPV), an early age at first intercourse, history of multiple sexual partners, oral contraceptive use, high parity, lower socioeconomic status, poor diet, immunosuppression, and promiscuous male sexual partners. Although Hispanics are the largest growing minority population in the United States, few HPV risk factor studies have either included or focused on Hispanics in the United States. To determine risk factors for HPV infection among Mexican-American women, we conducted a cross-sectional study from 1992-1995. Nine hundred and seventy-one women, 18-47 years of age, with cytology results were included in this analysis. Overall, 13.2% of participants were HPV positive by the Hybrid Capture tube method for high-risk types 16, 18, 31, 33, 35, 45, 51, 52, or 56. Age [adjusted odds ratio (AOR) = 0.3 for ages >36 years compared with ages 18-20] and duration of oral contraceptive use (AOR = 0.4 for > or =4 years relative to nonusers) were inversely associated with these high-risk types of HPV infection. Marital status (AOR = 1.9 among single women compared with married) and lifetime number of sexual partners (AOR = 2.3 for women > or =5 partners relative to monogamous women) were positively associated with an increased risk. Participants born in Mexico were significantly (P < 0.05) older, had fewer sex partners, and older age at first intercourse. Despite this lower behavioral risk profile, women born in Mexico were significantly more likely (AOR = 1.9; CI = 1.2-3.2) to have an HPV infection compared with United States-born, Mexican-American women after adjustment for potential confounders. Collectively, these results suggest that an unmeasured factor, such as the sexual behavior of the male partner, may be influencing HPV risk. Further research is needed to define this factor and to assess cultural norms of sexual behavior.

Adolescent↗
PubMed1992

Prepubertal initiation of sexual experiences and older first partner predict promiscuous sexual behavior of delinquent adolescent males--unrecognized child abuse?

Sexual experiences of 1580 delinquent adolescent males ages 9-19 years admitted to a juvenile detention center from January 1985 to July 1990 were determined through a structured health history interview. A total of 89.6% admitted to prior sexual activity; 26.8% claimed sexual experience by age 11 years. Only 3.2% reported sexual abuse or incest. Of 334 sexually active adolescents who revealed both age of their first partner and their age of first intercourse, 42% had their first experience with a female 2 or more years older. Males who had their first sexual experience before age 11 years or with a female 2 or more years older, reported significantly larger numbers of sexual partners in their lifetime and during the year preceding their incarceration. Girls with similar first sexual experiences in terms of age of initiation and age difference from partner are considered to be abused. Practitioners who work with children and adolescents need to recognize the possibility of sexual activity among pre-adolescent males and to be aware of its implications.

Adolescent↗
PubMed1992

Reliability of sexual behavior data among high school students in Rome.

We compared findings on sexual behavior from a self-administered questionnaire and a face-to-face interview, separated by 2-4 weeks, directed at 383 Italian secondary school students. The correlation coefficients or kappa values for reported prevalence of coital experience, age at first intercourse, and age of first partner were all greater than 0.7. The interview underreported coitus and overreported condom use, when administered before the questionnaire. The students thought that 18.4% of their classmates had ever had coitus, compared with 23.5% on self-report. We conclude that despite an overall high reproducibility of sexual behavior measures, distortions due to perceptions of social desirability might occur.

Adolescent↗
PubMed2002

Meta-analysis of measures of sexual activity and prostate cancer.

We conducted a meta-analysis of the association between prostate cancer and aspects of sexual activity. The data suggest an elevated relative risk (RR) of prostate cancer among men with a history of sexually transmitted infections. This was observed with both random- and fixed-effects models (RR = 1.4; 95% CI = 1.2-1.7; N = 17 studies; heterogeneity P = 0.14), especially for syphilis (RR = 2.3; 95% CI = 1.3-3.9; N = 6; heterogeneity P = 0.47). Risk of prostate cancer is also associated with increasing frequency of sexual activity (RR = 1.2 for an increase of three times per week; 95% CI = 1.1-1.3; N = 12). However, these studies are heterogeneous (P < 0.001). Increasing number of sexual partners is also associated with prostate cancer (RR = 1.2 for an increase of 20 partners; 95% CI = 1.1-1.3; N = 16; heterogeneity P = 0.11). The data do not support associations with multiple marriages, age at first intercourse, or age at first marriage. These results indicate an association between prostate cancer and sexually transmitted infections, suggesting that infections may represent one mechanism through which prostate cancer develops. The mechanism through which frequency of sexual activity may be related to prostate cancer is unclear.

Adult↗
PubMed1990

Correlates of age at first sexual intercourse in a national sample of young women.

A subsample of 814 sexually experienced adolescent females from the 1979 U.S. National Survey of Young Women was analyzed to assess the correlates of age at 1st sexual intercourse. Multiple regression procedures were used to examine sets of variables sequentially. In the hierarchical regression model, the control variables (respondent's age, race, religion, and age at menarche), along with 3 independent variables (household income, ideal age at 1st marriage, and ideal age for 1st birth), predicted age at 1st intercourse. The control variables accounted for a major portion of the variance in the model. Of the controls, chronological age and age at menarche were highly significant across all models tested.

Adolescent↗
PubMed2006

Friends' influence on adolescents' first sexual intercourse.

CONTEXT: Social-psychological theories of health behavior suggest that adolescents' sexual behaviors are influenced by the sexual attitudes and behaviors of their friends. METHODS: Data on 2,436 participants in the National Longitudinal Study of Adolescent Health (Add Health) who were sexually inexperienced at Wave 1 (1994-1995) were analyzed to examine whether friend-related variables predicted initiation of vaginal intercourse by Wave 2 (1996). Analyses also assessed whether predictive relationships varied by level of involvement with friends. Odds ratios were generated by logistic regression analysis. RESULTS: In the 9-18 months between Waves 1 and 2, 18% of participants initiated intercourse. In analyses controlling for gender, family structure and romantic relationships, the higher the proportion of a youth's friends who were sexually experienced, the greater the odds of sexual debut (odds ratio, 1.01); the odds also were elevated among youth who believed that they would gain their friends' respect by having sex (1.2). Relationships between friend variables and sexual initiation did not vary by level of involvement with friends. CONCLUSIONS: To maximize the likelihood of success, programs focused on delaying teenage sexual intercourse should address norms for sexual behavior among adolescents' close friends as well as the perceptions, skills and behaviors of individual youth.

Adolescent↗
PubMed2006

Asian American adolescents' first sexual intercourse: gender and acculturation differences.

CONTEXT: Interventions aimed at adolescents need to be culturally specific. The dearth of data on Asian American adolescents has made it difficult to meet their needs. METHODS: Data from the National Longitudinal Study of Adolescent Health were used, with a sample of 323 Asian American female adolescents and 366 Asian American male adolescents. Logistic regression analysis was used to assess the association between acculturation at Wave 1 (1995) and sexual experience at Wave 2 (1996), controlling for demographic, psychosocial and family variables. RESULTS: Overall, 24% of young women and 20% of young men had had sexual intercourse. Among young women, the most acculturated were more likely to have had sexual intercourse than the least acculturated (odds ratio, 4.9); acculturation was not associated with sexual intercourse for young men. Medium and high levels of parental attachment were associated with decreased odds of sexual experience for young women (0.4 and 0.2), but not for young men. Binge drinking was associated with an increased risk of sexual experience for young women (6.4), and tobacco use was associated with increased risk for young men (3.0). CONCLUSIONS: Like all adolescents, Asian Americans are at high risk for the consequences of sexual activity. For this fast-growing population, there is a crucial need for preventive programs that are culturally sensitive, inclusive of family and gender-specific.

Acculturation↗
PubMed2004

Use of contraception and use of family planning services in the United States: 1982-2002.

OBJECTIVE: This report presents national estimates of contraceptive use and method choice based on the 1982, 1995, and 2002 National Surveys of Family Growth (NSFG). It also presents data on where women obtained family planning and medical services, and some of the services that they received. METHODS: Data were collected through in-person interviews with 12,571 men and women 15-44 years of age in the civilian noninstitutional population of the United States in 2002. This report is based on the sample of 7,643 women interviewed in 2002. The response rate for women in the study was about 80 percent. RESULTS: The leading method of contraception in the United States in 2002 was the oral contraceptive pill, used by 11.6 million women; the second leading method was female sterilization, used by 10.3 million women. The condom was the third-leading method, used by about 9 million women and their partners. The condom is the leading method at first intercourse; the pill is the leading method among women under 30; and female sterilization is the leading method among women 35 and older. More than 98 percent of women 15-44 years of age who have ever had sexual intercourse with a male (referred to as "sexually experienced women") have used at least one contraceptive method. Over the 20 years from 1982 to 2002, the percent who had ever had a partner who used the male condom increased from 52 to 90 percent. The proportion who had ever had a partner who used withdrawal increased from 25 percent in 1982 to 56 percent in 2002. Another important measure of contraceptive use is use at the first premarital intercourse: before 1980, only 43 percent of women (or their partner) used a method of birth control at their first premarital intercourse. By 1999-2002, the proportion using a method at first premarital intercourse had risen to 79 percent.

Adolescent↗
PubMedDate not supplied

First premarital contraceptive use: United States, 1960-82.

This study shows the first national estimates of trends and differentials in first contraceptive use for a national sample of all women. Only 47 percent of women aged 15-44 in 1982 (or their partners) used a method at first premarital intercourse. The leading method at first intercourse was the condom, followed by the pill and withdrawal. The percentage using a method increased from the early 1960s to the late 1970s, because of increases in use of the pill and withdrawal. However, in the early 1980s, use at first intercourse increased sharply because of an increase in use of the condom. The proportion who used a method at first intercourse varied from 22 percent among Hispanic women to 74 percent among Jewish women; it was higher among white than black women, and higher in higher socioeconomic categories. After first intercourse, contraceptive use did not vary significantly by socioeconomic characteristics. While the condom was the leading method at first intercourse, women who practiced contraception for the first time after first intercourse typically used the pill.

Adolescent↗
PubMed2000

Sexual behaviour and early coitarche in a national sample of 17 year old Swedish girls.

OBJECTIVE: To evaluate sexual behaviour in 17 year old girls, using data from a national survey on adolescent sexuality. METHOD: The study was based on two samples of 17 year olds, comprising 2% of the population born in 1973 and carried out in 1990. A school sample and a sample of school non-attenders were recruited in a two step procedure. Data were collected by anonymous self administered questionnaires. 2583 questionnaires were distributed. Response rates from students was 92%, for school non-attenders 44%. 1121 female students and 118 female school dropouts responded. RESULTS: 64% of the student girls had experienced their first intercourse; 16% were "early starters" with coitarche before age 15. STD and pregnancy were reported by 15% of early starters and pregnancy by 14%, p < 0.001 and 0.002 respectively when compared with later starters. The number of coital partners, experience of first date intercourse, and of oral and anal sex was higher in the early starters, p < 0.001. Early starters reported menarche at age 11 or earlier more often than the later starters (OR 2.30, 95% CI 1.48-3.56), as well as a perceived social age exceeding the chronological by 2 years (OR 1.94, 95% CI 1.34-2.80). Sexual abuse was reported by 20% of the early and 11% of the later starters, p = 0.002. Among school non-attenders no significant differences were found with regard to age for coitarche. A majority of 83% of the girls had experienced voluntary intercourse, and 49% were early starters. Five girls were mothers. STD was reported by 19% and induced abortion by 14%. Sexual abuse was alleged by 28%. CONCLUSION: Coitarche before age 15 is related to early menarche and high perceived social age. High number of partners and first date intercourse make early starters at increased risk for STD and unintended pregnancy. Sexual abuse is alleged more often by early starters.

Adolescent↗
PubMed2000

Sexual behaviour and negotiation of the male condom by female students of the University of Ibadan, Nigeria.

This study explored the sexual behaviour of unmarried female students of the University of Ibadan, Nigeria, and assessed the extent to which those who were sexually active negotiated and used the male condom. Four focus group discussions were conducted followed by a survey of 354 students. The results show that the mean age of the students was 22.5 years 55.1% had had sexual intercourse; the mean age at first intercourse was 16.5 years. The number of lifetime sexual partners ranged from 1 to 20 with a mean of 3.4; 75% of those who had had sex reported ever using condom; 16.9% and 39% used it during their first and last sexual episodes respectively; only 34.3% used it consistently. Seventy-three per cent had ever negotiated condom use with a partner, but only 41% did so during their last sexual encounter. A significant association was found between condom negotiation and number of sexual partners: Students with fewer life time partners (3.2) had less frequently negotiated condom use than those with more partners (4.3) (P<0.05). Condom negotiators also scored significantly higher (4.6) on a 6-point AIDS Knowledge Score than those who had never done so (4.0) (P<0.05). About a quarter (26.7%) had ever bought a condom, while 38.5% had ever carried it. We conclude that although many female students had sometimes used a condom only a few used it consistently and are therefore at risk of the unintended outcomes of unprotected sex. We propose appropriate interventions to address the problem.

Journal Article↗