Childhood behavior problems and age at first sexual intercourse: a prospective birth cohort study.

BACKGROUND AND OBJECTIVES: Early first sexual intercourse (FSI) is a risk factor for unplanned teenage pregnancy, sexually transmitted infection, and adverse social, emotional, and physical health outcomes in adolescence and into adulthood. The aim of this study was to examine relationships between internalizing (eg, anxious/depressed, withdrawn) and externalizing (eg, delinquent, aggressive) behavior problems in childhood and age at FSI. METHODS: We used a large, population-based birth cohort (The Western Australian Pregnancy Cohort [Raine] Study) to address this question. Child behavior was measured by using the Child Behavior Checklist collected from parents at ages 2, 5, 8, 10, and 14 and scores calculated for total, internalizing, and externalizing behavior problems. At age 17, 1200 participants reported sexual behavior. RESULTS: Participants with clinically significant Child Behavior Checklist scores (T ≥ 60) were at increased risk for earlier first sexual intercourse (FSI) (<16 years). Adjusted odds ratios revealed that total and externalizing behavior problems from age 5 years onward significantly increased the risk of earlier FSI for boys. In girls, externalizing problems from age 10 years increased the risk for earlier FSI. Internalizing problems at ages 8 and 10 were significantly associated with early FSI for boys but not girls. CONCLUSIONS: Externalizing behavior from as early as 5 in boys and 10 in girls is a significant risk factor for earlier age at FSI. Adolescent sexual health promotion should consider early intervention in children with behavior problems, particularly boys.

Australian newspaper coverage of human papillomavirus vaccination, October 2006-December 2009.

Vaccination against human papillomavirus (HPV) is now routine practice for adolescent females in Australia. Media information about HPV vaccination is likely to affect girls' and parents' decisions about vaccination. This article reports a content analysis of 131 Australian print media news stories published between October 2006 and December 2009. Each story was coded for main themes of the article; completeness and accuracy of information presented; potential issues and concerns related to HPV vaccination; phrasing, emphasis, and language used; and representation of experts. Resulting themes were as follows: Australian pride in vaccine development; details and progress of the National Vaccination Program; vaccine safety; HPV vaccination's future; whether or not males could and/or should get the vaccine; issues related to sexual activity and the vaccine; and issues about decision making for acceptance of HPV vaccine. To fill gaps that are created by media representations of HPV vaccination, educational interventions should include information about HPV transmission and male vaccination and should promote adolescent involvement in decision making.

Midwife attitudes: an important determinant of maternal postpartum pertussis booster vaccination.

BACKGROUND: The study was designed to determine the feasibility of implementing routine dTpa vaccination in the maternity ward to new mothers and to assess midwives' attitudes toward pertussis booster vaccination, their perceived susceptibility and severity of pertussis in their patients' communities, the perceived barriers and benefits of their patients' vaccinations, and their cues to action and self-efficacy in delivering the vaccine. METHOD: A self-completed questionnaire was developed to evaluate constructs of the Health Belief Model as well as to measure midwife demographic information. Questionnaires were completed by midwives during in-services at both a public hospital and a private hospital in New South Wales, Australia. RESULTS: Midwives who perceived ease in integrating booster vaccination into their workload were more likely to have high self-efficacy in delivering booster vaccination, measured through perceived importance of the role as part of their job (r = .449, p<.01), perceived confidence in delivering vaccination as part of their role (r = .608, p<.01), and perceived sufficient level of skills to deliver booster vaccination (r = .528, p<.01). CONCLUSIONS: These results suggest that, of the factors measured, the most important to midwives in terms of providing pertussis booster vaccination to mothers was their own perceived self-efficacy of providing the vaccination. To increase midwives' desire and confidence to provide pertussis booster to mothers, educational materials and skills workshops could be offered.

"I just signed": Factors influencing decision-making for school-based HPV vaccination of adolescent girls.

OBJECTIVES: Australia was one of the first countries to implement a nationwide program providing HPV vaccination to girls at school. To date, there are no published studies describing decision-making processes and behavior postimplementation of HPV vaccination of adolescents participating in a school-based program. DESIGN: A purposive sample of nine schools was selected to reflect a range of vaccination coverage and school types. Semistructured focus groups with girls and interviews with parents, teachers, and immunization nurses (n = 185) were conducted until saturation was reached. Transcripts were analyzed inductively and emergent themes were subject to constant comparison. MAIN OUTCOME MEASURES: Explanatory model of decision-making in HPV vaccination. RESULTS: An explanatory model of decision-making and behavior was constructed from the data. Five decision-making states emerged across a continuum of vaccination behavior: active decision-vaccinated, passive decision- vaccinated, passive decision- not vaccinated, active decision- not vaccinated, and antivaccination. A range of factors influenced participants in each decision-behavior state. Adolescents were often part of the decision-making process. Where adolescents were not involved, nonagreement sometimes occurred. CONCLUSION: We have presented a variety of paths girls and their parents experience regarding decision-making and behavior in HPV vaccination. Attitudes, past experiences, and worldviews contributed to this process.

'It's a logistical nightmare!' Recommendations for optimising human papillomavirus school-based vaccination experience.

INTRODUCTION: To date, no published studies examine procedural factors of the school-based human papillomavirus (HPV) vaccination program from the perspective of those involved. This study examines the factors that were perceived to impact optimal vaccination experience. METHODS: Schools across Sydney were selected to reflect a range of vaccination coverage at the school level and different school types to ensure a range of experiences. Semi-structured focus groups were conducted with girls; and one-on-one interviews were undertaken with parents, teachers and nurses until saturation of data in all emergent themes was reached. Focus groups and interviews explored participants' experiences in school-based HPV vaccination. Transcripts were analysed, letting themes emerge. RESULTS: Themes related to participants' experience of the organisational, logistical and procedural aspects of the vaccination program and their perceptions of an optimal process were organised into two categories: (1) preparation for the vaccination program and (2) vaccination day strategies. In (1), themes emerged regarding commitment to the process from those involved, planning time and space for vaccinations, communication within and between agencies, and flexibility. In (2), themes included vaccinating the most anxious girls first, facilitating peer support, use of distraction techniques, minimising waiting time girls, and support staff. DISCUSSION: A range of views exists on what constitutes an optimal school-based program. Several findings were identified that should be considered in the development of guidelines for implementing school-based programs. Future research should evaluate how different approaches to acquiring parental consent, and the use of anxiety and fear reduction strategies impact experience and uptake in the school-based setting.