Risky sexual behavior and associated factors among sexually-experienced adolescents in Bangkok, Thailand: findings from a school web-based survey.

BACKGROUND: The risk of sexually transmitted infections (STI) arises when there is unsafe sexual activity. Unsafe sex often begins in the teenage years, and it will persist as long as there is the opportunity for risky sexual activity. The purpose of this study was to assess the sexual risk behaviors and related factors of sexually-active adolescents in educational institutions in Thailand. METHODS: This was cross-sectional survey using an Internet-based application in schools in Bangkok from November 2020 to February 2021 with a total of 6,167 high school and vocational students. The schools were selected by simple random sampling among institutions, and the students were systematically randomly selected, with an equal number of males and females. We used multivariable logistic regression to analyze associations and control confounding variables. Indicators of risky sex include: (1) Not using a condom; (2) Having more than one sex partner; (3) Having sex in exchange for cash or in-kind compensation; and (4) Having sex without consent. RESULTS: Of a total of 872 sexually-active participants, the mean age was 15.6 years, 66.9% were vocational students, 42.1% were male, 57.9% were female, and 69.5% had sex risk behavior. The multivariate logistic regression analysis identified the following statistically-significant factors related to risky sex: smokes cigarettes (AOR = 1.79; 95% CI 1.12-2.88); uses cannabis (AOR = 2.84; 95% CI 1.23-6.56); gambles (AOR = 1.81; 95% CI 1.28-2.55); has sex without contraception (AOR = 2.74; 95% CI 2.91-3.93); has a history of childhood sex abuse (AOR = 1.60; 95% CI 1.03-2.56). CONCLUSIONS: Our findings suggest that, in designing and implementing sexual risk prevention programs for adolescents in educational settings, there is a need to highlight the role of substance abuse in relation to sexual risk behaviors. Programs should target both male and female students. Teenagers who use marijuana are more likely to be sexually active than those who have never used marijuana. These potential risks should be taken into account with respect to legalization of marijuana and recreational use of this drug.

Risky sexual behavior (RSB) is engaging in sexual practices that may increase vulnerability to a reproductive health problem. This study was conducted to assess the sexual risk behaviors of students living in Bangkok, which has the highest rates of STIs among regions in Thailand. Previous studies of RSB have focused on the general population age 18 years or older. By contrast, there is a dearth of studies on sex behavior among Thais under age 18 years. In addition, the present study aimed to explore the association of substance abuse and adverse childhood experiences (ACEs) with adolescent RSB. In this study, 14.1% of all students in the participating schools had ever had sex before. Using the study criteria, two out of three students in the sample had experienced RSB. The findings from this study may help inform programs and interventions aimed at reducing the negative health impacts associated with RSB, specifically STIs. The findings of the study should be relevant for health program managers, socio-behavioral researchers, and other stakeholders who design reproductive health intervention strategies for in-school adolescents.

HIV risk behavior and testing among MS M in Bangkok 2015-2019: a short report.

Men who have sex with men (MSM) in Thailand have high HIV prevalence. This analysis used three years of data from the Behavioral Surveillance Survey (BSS) to examine the behaviors and biomedical interventions among MSM in Bangkok. Percent MSM with an HIV or STI test in the past 12 months decreased from 50.8% to 29.8%, and 42.2% to 33.0%, respectively. The frequency of HIV/STI testing was higher among those who had university-level education, as well as among those who reported higher AIDS knowledge, and had utilized prevention services. Additionally, awareness of PrEP peaked in 2017 (74.1%). The study found an increasing trend of men who had sex without a condom the last time they had anal sex with a man, and/or with multiple partners. Nearly two-thirds of the sample were reached by HIV prevention interventions. One-third had correct AIDS knowledge. These findings suggest that, after an increase of sex behavior risk, a decrease in PrEP awareness, and unknown HIV status, HIV prevalence among MSM in Bangkok may have begun to increase again. Intensified prevention interventions are urgently needed to reduce HIV behavioral risk for MSM since that is a major driver of the HIV epidemic in Thailand.

An analysis of e-cigarette and polysubstance use patterns of adolescents in Bangkok, Thailand.

INTRODUCTION: The prevalence of adolescent e-cigarette use has increased markedly in recent years. Specifically, the prevalence of e-cigarette use over the past 30 days was higher than the prevalence of use of other tobacco products. However, there is no definitive data on e-cigarette use among adolescents, including a description of how e-cigarette use is part of a more widespread pattern of substance abuse. The objective of this study was to assess the prevalence of e-cigarette use in combination with tobacco, alcohol, or marijuana, and the risk of polysubstance use among a sample of Thai adolescents, analyzed by sociodemographic characteristics. METHODS: Data were extracted from the Bangkok Behavioral Surveillance Survey (BBSS) cross-sectional survey conducted in 2019. The survey used self-reports from a sample of adolescents aged 14-17 years in Bangkok (n=6167). Multinomial logistic regression was used to determine the status of poly drug use in combination with e-cigarettes. RESULTS: In all, 6.8% of adolescents in this sample reported having used e-cigarettes in the last 30 days. Among the students who used e-cigarettes, the majority (72.0%) reported using other substances along with e-cigarettes, and alcohol was the most common addictive substance used in combination with e-cigarette use. The use of e-cigarettes only and e-cigarettes in combination with other addictive substances (compared to the non-e-cigarette group) tended to be higher among male students, having low academic achievement, having a friend who smokes, being persuaded by a close friend, having ever had sex (OR: 1.48-3.70), and having close friends who drink alcohol (vs none) (OR=3.26). CONCLUSIONS: Polysubstance use is highly prevalent among adolescents who use e-cigarettes. There should be extensive screening for e-cigarette consumption, including use of other addictive substances, especially alcohol. Early and comprehensive prevention efforts to reduce the use of e-cigarettes and other addictive substances can have a huge impact on the health of the adolescent population.

Prevalence and Factors Associated with Postpartum Depression in Primary Healthcare Centres in Yangon, Myanmar.

BACKGROUND: Postpartum depression (PPD) can have serious consequences on both the mother and infant. Despite the higher prevalence, there are limited numbers of studies on PPD in low-and middle-income countries, like Myanmar. This study aimed to explore the prevalence and associated factors of PPD in primary healthcare settings in Myanmar. METHODS: This cross-sectional online study was conducted with 220 mothers under 6 months postpartum in April-May 2020 and who registered in public health centres in Kungyangone Township, Yangon, Myanmar. The postpartum depression was measured with the Edinburgh postpartum depression scale (EPDS, ≥ 13 scores). Independent variables included sociodemographic factors, obstetric and infant factors, psychosocial factors (social support and social media usage), health services utilisation and accessibility factors. Chi-square tests and multiple logistic regression were performed. RESULTS: Overall prevalence of depressive symptoms in 220 women under 6 months postpartum was 31.8% (95% confidence interval [CI]: 25.9, 37.3). In multiple logistic regression, unplanned pregnancy (adjusted odds ratio [AOR]: 2.946), less than four times antenatal care (ANC) visits (AOR: 2.518), travel time more than 1 h to reach health centres (AOR: 3.068) and birth interval more than 5 years (AOR: 4.594) were more likely to be associated with PPD, while preterm delivery (AOR: 0.091) was inversely associated. CONCLUSION: This study showed the relatively high prevalence of PPD and the strong association with preterm delivery, pregnancy intention, breastfeeding status, birth interval as well as frequency of ANC received and travel time to health centre. It may suggest that maternal mental health services should be integrated with existing maternal and child health (MCH) services for early detection and prevention of depression symptoms with promotion of MCH services utilisation and improved accessibility among mothers in primary healthcare setting.

Clinical audit of adherence to hypertension treatment guideline and control rates in hospitals of different sizes in Thailand.

A clinical audit of hospitals in Thailand was conducted to assess compliance with the national hypertension treatment guidelines and determine hypertension control rates across facilities of different sizes. Stratified random sampling was used to select sixteen hospitals of different sizes from four provinces. These included community (<90 beds), large (90-120 beds), and provincial (>120 beds) hospitals. Among new cases, the audit determined whether (i) the recommended baseline laboratory assessment was completed, (ii) the initial choice of medication was appropriate based on the patient's cardiovascular risk, and (iii) patients received medication adjustments when indicated. The hypertension control rates at six months and at the last visit were recorded. Among the 1406 patients, about 75% had their baseline glucose and kidney function assessed. Nearly 30% (n = 425/1406) of patients were indicated for dual therapy but only 43% of them (n = 182/425) received this. During treatment, 28% (198/1406) required adjustments in medication but this was not done. The control of hypertension at six months after treatment initiation was 53% varying between 51% in community and 56% in large hospitals (p < .01). The hypertension control rate at last visit was 64% but varied between 59% in community hospitals and 71% in large hospitals (p < .01). Failure to adjust medication when required was associated with 30% decrease in the odds of hypertension control (OR 0.69, 95% CI 0. 50 to 0.90). Failure to comply with the treatment guidelines regarding adjustment of medication and lost to follow-up are possible target areas to improve hypertension control in Thailand.

Adverse Childhood Experiences and Prevalence of Cigarette and E-Cigarette Use Among Adolescents in Bangkok, Thailand.

Currently, e-cigarettes are the most popular tobacco product among adolescents. The purpose of this study was to explore the relationship between exposure to adverse childhood experiences (ACEs) and use of cigarettes, e-cigarettes, and dual use in a sample of adolescents in Bangkok, Thailand. The sample comprises 6167 students from 48 schools (grades 9, 11, and vocational year 2) who participated in the 2019 round of the Behavior Surveillance Survey. History of 11 ACEs was used to calculate a cumulative ACE score (range 0-11). Multinomial logistic regression was used to assess the relationship between history of ACEs and smoking. In the sample, 7.0% reported using e-cigarettes only and 9.5% used e-cigarettes and cigarettes (dual use). After controlling for sociodemographic characteristics, history of ACEs was associated with increased odds of dual use. The odds of cigarette, e-cigarette, and dual use was significantly greater if the adolescent had a history of ≥4 ACEs. Special attention is needed to prevent smoking of different types among those with a history of ACEs.

Factors Enabling Access to HIV Voluntary Counseling and Testing for Key Affected Populations in Thailand.

The objective was to study the factors that enabled persons at risk of HIV to obtain voluntary counseling and testing (VCT) in Thailand. This research was a cross-sectional study and data were collected during May to July 2013 in 8, purposively selected provinces. The method for selecting respondents used time-location quota sampling to achieve a total sample of 751 persons. The proportion who had VCT in the year prior to the survey was 56%.The significant enabling factors associated with VCT were having someone encourage them to go for testing and receiving information about VCT In addition, other significant factors for female sex workers were self-assessed risk for HIV and having had risk behavior, and for men who have sex with men the factors were awareness of eligibility for VCT. Thus, in order to achieve the VCT target for higher risk populations by 2016, there should be special mechanisms to inform the different groups, along with improvements in outreach services to make VCT more convenient for key affected populations.