Personal and social factors influencing age at first sexual intercourse.

Early initiation of sexual activity is a concern, in part because of increased risk of sexually transmitted diseases, including HIV, and unwanted pregnancies among young people. In this study, 241 high schoolers were administered a questionnaire to establish the relationships between age at first sexual intercourse and personal qualities (sexual style, attractiveness, physical maturity, restraint, autonomy expectations, and attitudes to gender roles), smoking and drug use, and aspects of the social context (social activities, media impact, peer norms). There were few effects of sex of respondent and none in which respondents' sex impacted on age of initiation. Overall (and among the male sample), perceptions of greater physical maturity, greater use of uncommon (mostly illicit) drugs, and expectations of earlier autonomy significantly differentiated between early and later initiators. This group of factors tends to confirm the view that early experience of sexual intercourse is correlated with problem behaviors and a press toward "adult" behaviors. For girls, this pattern was even clearer, with use of uncommon drugs being replaced as a significant contributor to early sexual experience by relative lack of restraint. We conclude that the desire to achieve the transition to adulthood at an earlier age than their peers constitutes a powerful incentive for young people to become sexually active.

The importance of importance: adolescents' perceptions of parental communication about sexuality.

High-schoolers (n=298) completed surveys describing the frequency and importance of mother and father communication about 20 different sex-related topics. There were four domains of sex-related topics: Development and Societal Concerns, Sexual Safety, Experiencing Sex, and Solitary Sexual Activity. Adolescents reported infrequent communication which varied by domain and gender of parent and teen. When communication occurred, it was most frequently about the first two domains. Mothers were reported as more frequent communicators about sexuality than fathers and girls received more communication than boys. Young people rated parental communication about sexuality as unimportant, with findings that paralleled those for frequency. Examination of the match between frequency and perceived importance of parental communication revealed more matches than mismatches. Almost all matches resulted from responses indicating low frequency and little importance. Most mismatches reflected a perception of insufficient rather than excessive parental communication about sexuality. It is argued that we need to consider the relative importance given to parental communication, as well as its frequency, if parents are to be effective communicators.

Conflicting advice? Australian adolescents' use of condoms or the pill.

CONTEXT: Teenagers are exposed to two potentially conflicting sexual health messages, one emphasizing the prevention of sexually transmitted diseases (STDs) and the other stressing pregnancy prevention. To protect teenagers from both STDs and unwanted pregnancy, it is important to know what method choices they make and why. METHODS: Data from a 1997 national survey of 3,550 Australian secondary school students were used to examine teenagers' method choice and patterns of advice-seeking about contraception and STD prevention. Logistic regression analyses were conducted to identify factors associated with the exclusive use of condoms or the pill. RESULTS: Virtually all 961 currently sexually active students were using at least one contraceptive method--primarily condoms (78%) or the pill (45%). Some 31% were using condoms exclusively, and 10% were using the pill exclusively. Older students and those who had sought contraceptive advice had elevated odds of using the pill rather than condoms exclusively (odds ratios, 4.4 and 2.6, respectively), while those who had had only casual partners in the last year had a reduced likelihood of exclusive pill rather than condom use (0.1). Furthermore, the more students believed that their peers used condoms, the less likely they were to report exclusive pill use (0.4). Parents were the most frequent source of advice about contraception, followed by physicians and teachers. The most common sources of advice about HIV and other STDs were parents, teachers and then physicians. CONCLUSIONS: Young people must be educated about the distinction between safer sex and contraception, and about how to prevent both STDs and pregnancy. Providing parents with current sexual health information may help to improve young people's sexual health.

PIP: Data from a 1997 national survey of 3550 Australian secondary school students aged 15 and 17 years old were used to examine teenagers' method choices and patterns of advice-seeking about contraception and STD prevention. 94.8% of the 961 currently sexually active students were using at least 1 contraceptive method. The most often used method was the condom (78.0%), followed by the pill (44.7%) and withdrawal (13.5%). 31% and 10% were using condoms and the pill exclusively, respectively. Older students and those who had sought contraceptive advice were more likely to use the pill rather than condoms exclusively, while those who had had only casual partners in the past year were less likely to use the pill exclusively instead of condoms. The more students believed that their peers used condoms, the less likely they were to report exclusive pill use. Parents were the most frequent source of advice about contraception, followed by physicians and teachers. The most common sources of advice about HIV and other STDs were parents, teachers, and then physicians.

Uncertain knowledge: a national survey of high school students' knowledge and beliefs about hepatitis C.

OBJECTIVE: Hepatitis C (HCV) has recently emerged as an important public health issue. This study documents young people's hepatitis C (HCV) knowledge, risk perceptions and sources of information. METHOD: Australia, 1997; nationally representative survey; sample of students in Years 10 and 12 in government secondary schools (n = 3,550). RESULTS: Students' knowledge about HCV was found to be extremely poor. Of the seven questions on hepatitis, only one was answered correctly by more than half the students. Few could differentiate between hepatitis A, hepatitis B and hepatitis C. Only a small number (12%) perceived themselves to be at risk of hepatitis and fewer than half (41%) had sought advice about hepatitis. CONCLUSION: There is a need for more HCV education and health promotion for secondary school students. IMPLICATIONS: Some lessons from HIV education can be readily transferred to this new epidemic but others cannot. There is a danger that HIV and HCV will be conflated in education programs.

Same-sex attraction, drug injection and binge drinking among Australian adolescents.

OBJECTIVE: To document the prevalence of same-sex attraction among students in years 10 and 12 in Australian Government high schools and to assess the association between same-sex attraction, binge drinking and drug injection. METHOD: Cross-section survey by anonymous, self-administered questionnaire of 3,387 students in Years 10 and 12 of the Government school system in Australia. RESULTS: Approximately 6% of respondents reported being currently attracted to members of their own sex. Being attracted to members of the same-sex was associated with more frequent binge drinking among boys and girls, and a three- to four-fold increase in the likelihood of reporting injecting drug use both over the lifetime and within the previous 12 months. CONCLUSIONS: Adolescents attracted to members of the same-sex report engaging in elevated levels of health-limiting behaviours. There is an urgent need for further research to document the reasons for this. It is recommended that health promotion activities directed at moderating young people's drug and alcohol practices explicitly acknowledge the over-representation of same-sex attracted young people in their target audience.

Antiretroviral uptake in Australia: medical, attitudinal and cultural correlates.

The objective of this study was to describe the medical, attitudinal and cultural correlates of antiretroviral uptake amongst people living with HIV/AIDS (PLWHA) in Australia. Stratified purposive sampling produced a sample of 925 PLWHA, which represents 8.3% of the current population of PLWHA in Australia. Respondents completed a self-administered questionnaire which revealed that 78% of respondents were using antiretroviral drugs for HIV/AIDS. Logistic regression revealed that PLWHA were more likely to use antiretroviral drugs if they had more favourable attitudes toward antiretroviral drugs, if they had been diagnosed with an AIDS-defining illness, and if they had ever had a CD4/T-cell count below 400 copies/ml blood. Women were less likely than men to use antiretroviral drugs, and logistic regression revealed different predictors of antiretroviral drug use amongst men and women. Given the importance of attitudes toward antiretroviral drugs, it is likely that if the current confidence in antiretroviral drugs were to change, this would be reflected in an equally rapid cessation of treatment amongst many PLWHA.

Revisiting sexual styles: patterns of adolescents' self-perceptions.

Recently, Buzwell and Rosenthal proposed that sexual styles were a useful way of understanding young people's constructions of a sexual identity. In this work we replicated with a sample of 522 15- to 16-yr.-olds in broad terms, the five styles identified by Buzwell and Rosenthal.

Examining self-justifications for unsafe sex as a technique of AIDS education: the importance of personal relevance.

In an earlier study, we found that sexual risk-taking in gay men was reduced by getting them to evaluate the self-justifications for having unsafe sex which they had used on a specific occasion when they 'slipped up' (broke their safe sex rules by having unprotected anal intercourse). This study investigated whether the earlier finding occurred simply because recalling vividly a specific encounter in which a slip-up took place brought the men's risk-taking home to them very strongly and whether the intervention would still work if translated into posters suitable for the mass media. Gay men (n=92) who had slipped up kept diaries of their sexual behaviour for 16 weeks. After 4 weeks, they were allocated to one of 3 conditions: Specific Encounter (detailed reconstruction of a slip-up, but without any questions about self-justifications); Posters (examination of posters, specially designed for the study, that focused on self-justifications); and Control (no intervention). All 3 groups slipped up to the same extent in the post-intervention period. The results for the Specific Encounter group indicate that the earlier finding is not attributable to the alternative explanation above, while those for the Posters group suggest the importance of ensuring personal 'ownership' of the self-justifications presented. Implications for AIDS education are discussed.

PIP: Previous research indicated that sexual risk-taking in homosexual Australian men was reduced by having them evaluate through a questionnaire the self-justifications used on occasions when they broke their safe sex rules and had unprotected anal intercourse. The present study sought to determine whether the earlier finding occurred simply because the process of recalling vividly a specific encounter in which a "slip-up" took place was sobering in and of itself and whether the process of examining one's self-justifications would remain effective when translated into posters suitable for the mass media. 92 gay men who reported unprotected anal intercourse were enrolled and instructed to keep diaries of their sexual encounters for 16 weeks. After 4 weeks, they were allocated to one of the following conditions: 1) specific encounter--detailed reconstruction of an unprotected sexual encounter, but without any questioning on self-justifications; 2) posters--examination of posters focused on the self-justification process; or 3) control--no intervention. The posters emphasized the discrepancy between rationalizing in the immediate pre-intercourse period and thinking after unprotected intercourse. The proportion of men who slipped up at least once in the postintervention period was 56% among controls, 58% in the specific encounter group, and 66% in the posters group. It was concluded that the posters employed in the present study were not as good as the questionnaire used in the previous study at inducing the participants to see their self-justifications as personally relevant. To the extent that the men did not perceive the information on the posters as personally salient, they may have attended instead to the pornographic depictions of intercourse on the posters.

Mum's the word: mothers' perspectives on communication about sexuality with adolescents.

Mothers' perceptions of the style, content and frequency of their communications with their adolescents about sex and sexuality were examined. We administered semi-structured interviews to 30 mothers of 16-year-olds (16 mothers of sons, 14 mothers of daughters). Despite a uniform assessment that they were effective sexual communicators, mothers varied greatly in their style of sexual communication. Qualitative analyses revealed five communication styles: avoidant, reactive, opportunistic, child-initiated and mutually interactive. These styles differed in who initiated and maintained sexual communication, the comfort level of mother and of teenager, the frequency of sexual communications, the context in which communications took place and the topics discussed and avoided.

Understanding sexual coercion among young adolescents: communicative clarity, pressure, and acceptance.

Young people's understanding of sexual coercion was studied. Boys and girls (N = 191) were asked to rate scenarios depicting sexual situations according to their perceptions of communicative clarity, the extent of pressure being applied to one partner, and the acceptability of the behaviors. Judgments of communicative clarity were given more readily when there was consent rather than dissent to sex. Clear communication was readily inferred even when there were no cues that this was the case. Boundaries of behaviors that were defined as constituting "pressure" were influenced by the outcome, that is whether sex did or did not occur, as well as the behavior itself. Ratings of acceptability closely followed those of pressure, although the relationships between perceptions of pressure and acceptability were stronger for girls than for boys. In general, there were few gender differences in perceptions of pressure and communicative clarity. Of concern was the finding that, for some respondents, pressure and acceptability were unrelated to the use of either physical or emotional force.

Rural and urban female secondary school students' attitudes towards and use of primary care services.

In light of the current and ongoing threats to young women's health of unplanned pregnancy and sexually transmissible diseases (including HIV/AIDS), assured access to appropriate and sensitive health services is of paramount importance. In this article, the results of a recent Victorian study involving rural and urban female secondary school students on issues relating to sexual health are reported. Drawing upon the findings of an extensive self-report questionnaire, young women's attitudes towards and use of health services are presented with a particular focus upon the variations that exist between the rural and urban populations. Apart from issues associated with privacy, which were found to be more crucial to rural young women's decisions to seek medical care, this study found young women's concern about the attitudes of medical and non-medical staff alike, the atmosphere of surgery or clinic, and gender of doctor all to be important factors in their general use of health services, regardless of location.

High schoolers masturbatory practices: their relationship to sexual intercourse and personal characteristics.

This study examined the self-reported masturbatory experiences of high schooler and the relationships between masturbation and sexual intercourse and personal characteristics of these young people. A total of 436 suburban Australian adolescents between 15 and 18 years of age participated. Boys were more likely to report ever having masturbated (58.5%, versus 42.7%) and to have done so more frequently than girls (38.2% versus 8.7% reporting masturbating three or more times a week). While there was no significant sex difference in the age of initiation of masturbation there was some evidence that girls began masturbation earlier than boys. Whether sexual intercourse replaced or supplemented masturbation as a sexual practice could not be resolved, but there was evidence that masturbation was positively correlated with sexual self esteem. Young people whose parents provided a more open environment for the discussion of sexuality were more likely to report having masturbated, although the environment had a complex relationship with masturbatory practices as did young people's self rated physical maturity compared to their peers. A range of social and contextual factors must be explored to understand more fully this important component of young people's sexual experience.

Changes in heterosexual university undergraduates' HIV-related knowledge, attitudes and behaviour: Melbourne, 1989-1994.

OBJECTIVE: To examine differences in the AIDS-related knowledge, attitudes and behaviours of first year university undergraduates in 1989 and 1994. DESIGN: Comparisons were made between cross-sectional surveys, conducted in 1989 and 1994, of first year undergraduates at three Melbourne universities. RESULTS: The 1994 cohort reported more positive attitudes toward, and better knowledge of, safe sex practices and less discrimination against perceived risk groups than did the 1989 cohort; however, this was due primarily to improvement among female undergraduates. Male undergraduates either demonstrated no improvement or a decline in pro-safe sex attitudes. A general increase was found in the proportion of respondents always using condoms for vaginal sex with casual and regular partners and for oral sex with casual and regular partners. CONCLUSIONS: While the extent of sexual behaviour among these young people has remained essentially unchanged over the past five years, the extent of self-reported condom use has increased markedly. The general decline in attitudinal measures among young men contrasts with a marked improvement among young women and suggests the need for education programs targeted specifically at this group.

Preventing unprotected anal intercourse in gay men: a comparison of two intervention techniques.

This study compared the effectiveness of getting gay men to evaluate the self-justifications they use when breaking their safe sex rules to that of a standard approach to AIDS education. Men (n = 109) who had 'slipped up' (broken their safe sex rules by having unprotected anal intercourse) kept diaries of their sexual behaviour for 16 weeks. After 4 weeks they were allocated to one of 3 conditions, 2 involving brief interventions--Self-justifications (evaluation of self-justifications) and Standard (examination of posters used in AIDS education)--and a Control (diary only). At the time of the intervention, more members of the Self-justifications than the Standard group thought that it would help them not to slip up. In the post-intervention period, the 3 groups did not differ in the incidence of sexual activity or in the proportion who slipped up at least once, but the Self-justifications group were less likely to have had multiple slip-ups. Three possible explanations are offered for the effectiveness of the Self-justifications intervention. This approach may provide a useful alternative to standard techniques of AIDS education.

Validity of a single-item index of acculturation in Vietnamese immigrant youth.

A single-item index of acculturation towards a host culture is described. The index appears to have good construct validity as assessed in a sample of 177 young Vietnamese immigrants in Australia.

Condoms and coitus: adolescents attitudes to AIDS and safe sex behavior.

This study investigated the relationship between sexual risk taking and attitudes to AIDS precautions among a sample of approximately 1000 non-virgin adolescents attending 15 colleges and universities in Victoria, Australia. Four attitudinal dimensions were isolated: Antiprecautions, Risk Denial, Abrogation of Responsibility and Fatalism. These attitudes showed meaningful relationships with different types of sexual risk: risk with a casual partner, risk with a regular partner, and multiple partnering. Different patterns of association emerged for males and females, with female risk behavior being more strongly related to antiprecautions attitudes. These differences were discussed in the light of gender-stereotypic responses to sexual situations, and their implications for educational interventions were explored.

The acculturation of Chinese immigrants: perceived effects on family functioning of length of residence in two cultural contexts.

In two studies, conducted in Australia and the United States, first- and second-generation adolescents of Chinese descent, together with adolescents from the host culture (Anglo-Australian or Euro-American) and from Hong Kong, were asked about their family environment. In both studies, an autonomy-promoting family style differentiated the host culture from the Hong Kong Chinese, with the Chinese immigrants occupying an intermediate position. Chinese immigrants of both generations reported more structured, controlling family environments than did the nonimmigrant groups. First-generation Chinese-Australians reported a more organized family pattern than that of their second-generation peers, whereas second-generation Chinese-Americans perceived more family regulation of adolescents than did the first-generation respondents. The two studies yielded remarkably similar results in spite of differences in the Chinese communities' positions in the host culture. There was evidence of somewhat rapid change in the first-generation families toward individualistic norms but little shift in family environment as a function of length of residence.