School-age pregnancy: why hasn't prevention worked?
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Abortion, Induced↗
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Determinants of sexual habits in Italian females.
OBJECTIVE: To identify characteristics of women reporting multiple sexual partners and early age at first intercourse in Italy. METHOD: Information on 1139 control women (median age 54 years) interviewed as part of a case-control study of cervical neoplasia conducted in the greater Milan area, Northern Italy were analysed using stratified analysis and multiple logistic regression. RESULTS: Overall, 81% of the study sample reported no more than one sexual partner, 10% two and 9% three or more. The proportion reporting multiple sexual partners tended to be higher among younger and more educated women (4% vs 19% of women with respectively less than 7 and 12 or more years of education reported three or more partners). Ever smokers reported a higher number of sexual partners than never smokers. The proportion of nulliparae reporting three or more sexual partners was higher than that of parous women. These findings were confirmed after taking into account in a multivariate analysis the role of potential confounding factors. Furthermore similar findings emerged from an analysis restricted to women aged 40 years or less. Always considering number of sexual partners, no relationship emerged with marital status, spontaneous or induced abortions, lifetime number of reported Pap smears and contraceptive habits. With reference to age at first intercourse, 25% of the study population reported their first intercourse at age 18 or before, 34% between 19 and 22 years, and 41% at age 23 or later. Younger women (that is, more recent cohorts) more frequently reported earlier age at first intercourse and the proportion of never married women reporting early intercourse was higher (51% vs 22% of never married vs married women). No relationship emerged between education, smoking habits, parity, history of spontaneous or induced abortions, number of Pap smears, contraceptive habits, and age at first intercourse. CONCLUSION: This study documents conservative sexual habits in Northern Italian females (at least on the basis of self reporting) but indicates that any educational compaigns towards safe sex should be focused towards younger women, particularly smokers, unmarried and nulliparae.
Abortion, Induced↗
Using the theory of reasoned action (TRA) to understand the decision to use condoms in an STD clinic population.
The theory of reasoned action (TRA) provides useful information when designing health education interventions. In this study, 703 heterosexual STD clinic clients responded to a TRA-based survey. With steady partners, social norms and attitudes toward condom use were significant predictors of intention for both men and women. The interaction of attitude and norm increased prediction for men (R = .64, p < 0.001) and women (R = .70, p < 0.001). With casual partners, attitude was a predictor for men and social norm was a predictor for women. Prior use of condoms increased prediction for men (R = .38, p < 0.001) and women (R = .47, p < 0.001). Findings suggest that, in addition to traditional TRA model variables, the relationship between sexual partners and the individual's prior experience with condom use should be incorporated into attempts to understand this complex, dyadic behavior. Examining specific outcome and normative beliefs also provides important information for intervention design.
Adult↗
Barriers to condom use among women attending planned parenthood clinics.
Assessed condom use, barriers to condom use, oral contraceptive use, partnership status and STD history in 457 15-30 year-old women attending four family planning clinics. Subjects were classified into three condom use groups: Non Users (37%); Current Users (33%); and Past Users (30%). Factor analysis revealed five barriers to condom use: Partner's Perception, Peer's Perception, Pleasure/Intimacy, Communication, and Low Perceived Need. Multivariate analyses revealed significant group differences on only two barrier factors: Pleasure/Intimacy and Low Perceived Need. Low Perceived Need accounted for 13.5% of the variance in condom use. Women with low perceived need to use condoms were more likely to use oral contraceptives.
Adolescent↗
Determinants of intentions of Junior High School students to become sexually active and use condoms: implications for reduction and prevention of AIDS risk.
The purpose of this study was to examine factors associated with young adolescents' increased risk for AIDS. A multiethnic sample of 303 seventh-grade students in three schools in the greater New York area completed questionnaires assessing their basic demographic characteristics (gender and ethnicity), AIDS knowledge, substance use (cigarette smoking, alcohol use), and decision-making skills. AIDS knowledge, substance use, decision-making skills, gender, and ethnicity predicted intentions to engage in sexual behavior in the future. Relevant knowledge of AIDS was associated with lower intentions to engage in sexual behavior in the future. More frequent substance use, less frequent use of decision-making skills, and being male increased intentions to engage in sexual behavior in the future. Our findings are discussed in terms of their implications for education and prevention of adolescent sexual activity and AIDS-risk reduction.
Acquired Immunodeficiency Syndrome↗
A study of the cognitive aspects of sexual decision making in adolescent females.
A comprehensive sexuality questionnaire was administered to 37 females, ages 13 through 16 years, who attended clinics for routine health care. Subjects completed standardized scales of self-concept, locus of control, and future orientation. They also were given a short battery of standardized cognitive tests. Three groups were identified: Group 1 was sexually active and using contraception reliably, Group 2 was not using contraception reliably, and Group 3 had not been sexually active. Group 1 adolescents had higher scores on the vocabulary subtest of the WISC-R (F = 3.4, p less than .05) than did Group 2 adolescents, over and above the effect of socioeconomic status (SES). Group 1 subjects had higher scores on knowledge of sex and contraception than did Group 2 (F = 3.3, p less than .05). Group 1 had more internal locus of control (F = 7.0, p less than .005) than did Group 2 over and above the effect of SES. Mean scores for Group 3 adolescents were intermediate and not significantly different. The findings suggest that cognitive factors may influence contraceptive behavior in adolescent females.
Adolescent↗
Women's status and fertility: successive cross-sectional evidence from Tamil Nadu, India, 1970-80.
This study explores linkages between the status of women and fertility over time in Tamil Nadu, India, using sample survey data for currently married women aged 35-44 in 1970 and 1980. The effects of individual indicators of the status of women on fertility are decomposed into effects through each of the proximate variables, notably those affecting marriage duration, marital fertility, and contraception. There is considerable variation in the direction and magnitude of the relationships between the status indicators and fertility behavior and in the relationship to the underlying mechanisms at the two points in time. On balance, the evidence suggests improvements in the status of women come to exert an increasingly negative effect on fertility over the course of demographic transition.
Adult↗
Alcohol use as a situational influence on young women's pregnancy risk-taking behaviors.
Recent studies have found that many young women just beginning their sexual lives use alcohol prior to intercourse. A large number appear to drink heavily enough prior to sex to compromise their ability to use contraceptives. The question emerges whether there is a relationship between drinking before intercourse, the nonuse of birth control methods, and unplanned pregnancies. The present research describes 43 instances of intercourse which resulted in unplanned pregnancies in 14- to 21-year-olds. Variables examined included alcohol use prior to sex, amount of alcohol consumed, the use of other drugs, the planning of intercourse, respondents' stated reasons for nonuse of contraceptives, and other general demographic data.
Adolescent↗
The determinants of sexuality among adolescent school girls in Kenya.
One thousand seven hundred and fifty one Secondary school girls aged 12 to 19 years were interviewed by means of a self-administered questionnaire. 416 (23.8%), of them reported to have been sexually experienced at the time of the study. 4.1% of the sexually experienced girls had started sex below the age of 10 years, some of whom had been raped. The low and middle class private schools in the city centre had higher incidence of sexually experienced girls. The same was observed in those girls staying away from their parents. Majority of the sexually experienced girls had started coitus within one to two years of attaining menarche or having a boyfriend. Some of these girls may have been forced to indulge in sex by the men/boys or circumstances. Lack of factual knowledge, parental guidance and lust for material gains are some of the factors the girls felt may be responsible for the upsurge in adolescent sexual behaviour. The role played by these factors in adolescent sexuality is discussed, and possible remedial measures are suggested.
Adolescent↗
Teenage pregnancy in the United States.
One out of every 10 women aged 15-19 becomes pregnant each year in the United States. Of these pregnancies, five out of every six are unintended--92 percent of those conceived premaritally, and half of those conceived in marriage. The teenage pregnancy rate is high because only a minority (one in three) of sexually active young women always use contraceptives, and only one in two of these women rely on the most effective methods. The two most common reasons given by adolescents for not using contraceptives are believing that the risk of pregnancy is small, and failing to anticipate intercourse. Experience in other developed countries clearly shows that the incidence of adolescent pregnancy can be reduced if effective contraceptives are made widely available. Although high quality sex education programs that include information about contraception, reproductive biology and responsible sexual behavior can enhance the effectiveness of contraceptive delivery systems, they are not a substitute for the actual provision of services and supplies. However, there is formidable political opposition to the provision of such services by a vocal minority who believe that the crux of the problem is premarital sexual activity, and that lowering the cost of such behavior by reducing the risk of pregnancy will both legitimize adolescent sex and increase its prevalence. Consequently, there is a political impasse that guarantees a continuing large number of adolescent pregnancies. Further, even if contraceptives and sex education were readily available to all adolescents, there would still be a pool of teenagers who would see little benefit in postponing parenthood. This pool would be composed overwhelmingly of the poor and of blacks and Hispanics. Increasing the demand for pregnancy prevention among young women and men in this hard-core, high-risk group will be extremely hard to achieve without a fundamental restructuring of society.
Adolescent↗
Birth interval and pregnancy outcome.
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Adult↗
Parents' behavioral norms as predictors of adolescent sexual activity and contraceptive use.
The influence of parental factors on adolescent sexual behavior and contraceptive use has been examined previously, and findings have been contradictory. Previous studies, which found little relationship between parental norms and adolescent sexual activity, have been limited by their failure to recognize developmental differences in the relative weight of parent and peer influences between younger and older teens and by use of selected samples, resulting in a restriction of range. The current study differs in that it utilizes a clustered sample household survey of 329 males and females, aged 14 to 17, and 470 of their parents. Using multiple regression analysis, it was found that parents' reported behavioral norms account for 5% of the variance in whether adolescents have had intercourse, and for 33% of the variance in use of contraception at last intercourse. The study suggests that while parents' normative beliefs have limited effect in the decision to become sexually active, they have considerable impact on later contraceptive use.
Adolescent↗
The relational determinants of condom use with commercial sex partners in Thailand.
OBJECTIVE: To analyze the extent and determinants of condom use with commercial sex partners among lower socioeconomic status groups in the Thai population. DESIGN: Respondents were sampled in Udon Thani, Saraburi and Bangkok in 1992. Completed sample size was 678 women in brothels, 330 male truck drivers and 1,075 men aged 17-45 years. Behavioral data and local sexual network information were collected using structured questionnaires (face-to-face interviews), focus groups and in-depth unstructured interviews. METHODS: Data were analyzed using univariate and multivariate logistic regression. RESULTS: Condom use with commercial partners remains inconsistent. Consistent use was reported by 61% of women in brothels, 25% of truck drivers, and 29% of men in the low-income population. The single strongest predictor of consistent condom use for all groups is type of partnership. Consistent use drops significantly with regular (multivisit) commercial sex partners compared with casual (single visit) commercial partners; adjusted odds of consistent use are 0.22 for women and 0.25 for men. Brothel women report that one in five of their commercial partners is a 'regular', and 20% of the young men who report a commercial partner report a 'regular'. DISCUSSION: The strongest determinant of consistent condom use is the nature of the relational bond between the partners, rather than their individual characteristics, knowledge or attitudes. To raise condom use further, programs will have to move beyond the standard knowledge-attitudes-practices paradigm focus on individual attributes to address the contextual determinants of behavior.
Adolescent↗
HIV-infected women and sexual risk reduction: the relevance of existing models of behavior change.
This article utilizes constructs of the AIDS Risk Reduction Model (ARRM) to examine condom use in a sample of 215 HIV-infected women in New Jersey. We find evidence that processes affecting condom use in HIV-infected individuals are similar to those found in HIV-negative individuals. Results suggest that partner-related factors are important to consistent condom use in HIV-infected women. Women are more likely to use condoms consistently if they have high perceived power to influence their partner's condom use, have partners who are HIV seronegative, and have partners who do not want more children. Conflicts with the partner decrease the probability of consistent condom use. Also negatively associated with condom use are the woman's use of drugs and/or alcohol and her belief that condoms reduce sexual enjoyment. Implications of these findings for designing interventions for HIV-infected women are considered.
Adult↗
Prevalence and correlates of AIDS-related behavioral intentions among urban minority high school students.
Using data from a cross-sectional survey of 926 predominantly black and Hispanic ninth through twelfth graders in three New York City public high schools, the explanatory power of theoretically and empirically derived predictors (i.e., demographic, contextual, and cognitive) of intentions to engage in sexual intercourse, to be sexually monogamous, to use condoms during intercourse, and to ascertain intercourse partners' sexual and drug-use histories was compared. One-third of sampled students "definitely" intended to have sexual intercourse in the next year, one-half "definitely" intended to be sexually monogamous, two-thirds "definitely" intended to use condoms during intercourse, and three-quarters "definitely" intended to ascertain intercourse partners' sexual and drug-use histories. In a predictive model including all investigated variables, those variables derived from the cognitive set (i.e., beliefs about susceptibility to getting AIDS, and beliefs about barriers, self-efficacy, norms, and values pertaining to AIDS-preventive actions) were most strongly associated with the four investigated behavioral intentions. However, certain variables derived from the demographic set (i.e., age, gender, race/ethnicity) and contextual set (i.e., previous behavioral involvement, cues, academic failure, substance use) also contributed explained variance to all four intentions.
Acquired Immunodeficiency Syndrome↗
Condom knowledge, attitudes and use among patients attending the public STD clinic in Singapore.
Three hundred patients (255 males and 45 females) attending the public STD clinic in Singapore were interviewed regarding their frequency of condom use, attitudes towards condoms, problems related to condom use and places of purchase of the condoms. Among respondents with regular partners, 55.2% of males and 48.8% of females never used condoms, only 12.4% of males and 16.3% of females used condoms consistently. Among respondents with non-regular partners, only 2.2% of males used condoms consistently. The commonest reasons why male respondents did not use condoms consistently were that condoms decreased sensation, condoms made sex mechanical, the use of other forms of contraception, no condoms were available, and the perception that there was no risk of contracting STD/AIDS. Condoms were most commonly obtained from sex partners, supermarkets, roadside sundry shops and the Maternal & Child Health Clinics (MCHCs). About 8% of both males and females had experienced some problems with condoms before. Greater efforts to promote the practice of protected intercourse among the STD patient population as well as in the general population are required in order to control the spread of STD and AIDS in Singapore.
Adult↗
Parent and peer communication effects on AIDS-related behavior among U.S. high school students.
Data from a 1989 national probability sample of 8,098 high school students in the United States indicate that young people's discussions about the human immunodeficiency virus (HIV) with parents and with peers are highly correlated and have opposite effects on behavior. Students who discussed HIV with their parents were less likely than those who did not to have had multiple sex partners, to have had unprotected sexual intercourse and to have ever injected drugs; on the other hand, students who discussed HIV with their peers were more likely than those who did not to have had multiple partners and to have had unprotected sexual intercourse. Subgroup analyses show that young women were influenced more by HIV discussions with parents, while young men were influenced more by discussions with peers; some communication effects differed by race and ethnicity. Students who received HIV instruction in school were more likely to have talked about HIV with both parents and peers.
Adolescent↗
Condom awareness and use in the Arusha and Kilimanjaro regions, Tanzania: a population-based study.
A cross-sectional study of condom awareness, perceived availability, and use was conducted using a questionnaire in the Arusha and Kilimanjaro regions in northern Tanzania. The questionnaire was administered to a random sample (n = 1,081) of males and females (15-54 years of age) from four localities in the Arusha, Babati, Moshi, and Same districts. Of the 1,081 respondents, 69.9% knew what condoms are and, of these, 31.7% reported having ever used a condom, while 20.7% stated that they used condoms regularly. Furthermore, of the 756 respondents who knew what condoms are, 62.2% stated that condoms were available in their localities and, of these, 44.1% reported having used condoms regularly. The results suggested that, while the majority of the respondents knew about condoms and stated that condoms were available in their localities, reported regular condom use was low. Age, gender, marital status, occupation, and place of residence appeared to be significant determinants of condom awareness and use, while educational status was not. Although barmaids and professional drivers have been shown to practice high-risk sexual behavior, reported condom use among them was low.
Adolescent↗