Delaying sexual onset: outcome of a comprehensive sexuality education initiative for adolescents in public schools.

BACKGROUND: A common risk behavior in adolescence is the early initiation of unprotected sex that exposes adolescents to an unplanned pregnancy or sexually transmitted infections. Schools are an ideal place to strengthen adolescents' sexual knowledge and modify their behavior, guiding them to exercise responsible sexuality. The purpose of this article was to evaluate the knowledge of public secondary school teachers who received training in comprehensive education in sexuality (CES) and estimate the counseling's effect on students' sexual behavior. METHODS: Seventy-five public school teachers were trained in participatory and innovative techniques for CES. The change in teacher knowledge (n = 75) was assessed before and after the training using t-tests, Wilcoxon ranks tests and a Generalized Estimate Equation model. The students' sexual and reproductive behavior was evaluated in intervention (n = 650) and comparison schools (n = 555). We fit a logistic regression model using the students' sexual debut as a dependent variable. RESULTS: Teachers increased their knowledge of sexuality after training from 5.3 to 6.1 (p < 0.01). 83.3% of students in the intervention school reported using a contraceptive method in their last sexual relation, while 58.3% did so in the comparison schools. The students in comparison schools were 4.7 (p < 0.01) times more likely to start sexual initiation than students in the intervention schools. CONCLUSION: Training in CES improved teachers' knowledge about sexual and reproductive health. Students who received counseling from teachers who were trained in participatory and innovative techniques for CES used more contraceptive protection and delayed sexual debut.

Factores asociados al inicio de vida sexual y al embarazo adolescente en Colombia. Estudio de corte transversal / Factors associated with the beginning of sexual life and adolescent pregnancy in Colombia. Cross-sectional study

RESUMEN Introducción: En Colombia, entre el año 2008 y 2014 el 23.4% de los nacimientos fueron producto de embarazos adolescentes, los cuales tienen graves consecuencias a nivel social, emocional y biológico tanto para la madre joven como para el bebé. Material y métodos: Estudio de corte transversal con componente analítico dónde se tomó una muestra representativa de 13.313 mujeres entre 13 y 19 años quienes respondieron la Encuesta Nacional de Demografía y Salud (ENDS) 2010. Se realizaron análisis bivariados y análisis de regresión logística multinomial con el fin de identificar factores individuales, del hogar y del comportamiento sexual asociados con el inicio de la vida sexual y con el embarazo en adolescentes colombianas. Resultados: A través del análisis multivariado se encontró que tener mayor edad, convivir en pareja, haber sufrido violencia parental y haber sufrido violencia sexual fueron factores de riesgo tanto para inicio de vida sexual como para embarazo adolescente. Se identificó que el hecho de estar asistiendo al colegio es un factor protector para ambos eventos. La pobreza, el hacinamiento y la falta de educación estuvieron asociados con el embarazo adolescente pero no con el inicio de la vida sexual. Conclusiones: Existen múltiples factores asociados con el inicio temprano de vida sexual y con el embarazo adolescente susceptibles de intervención. Este estudio presenta factores clave para generar programas de prevención para esta problemática.

ABSTRACT Introduction: In Colombia, between 2008 and 2014, 23.4% of births were product of adolescent pregnancies, which have serious social, emotional and biological consequences for both the young mother and the baby. Materials and methods: Cross-sectional study with analytical component, with a sample of 13,313 women between 13 and 19 years of age who answered the National Survey of Demography and Health (ENDS) 2010. Bivariate analyzes and multinomial logistic regression analysis were carried out in order to identify individual, home-related, and sexual behavior factors associated with sexual debut and adolescent pregnancy among Colombian adolescents in 2010. Results: Multivariate analysis shown that being older, living together as a couple, having suffered parental violence, and having suffered sexual violence, were risk factors for initiation of sexual life and teenage pregnancy. School attendance was found to be a protective factor for both events. Poverty, overcrowding and lack of education were associated with teen pregnancy but not with sexual debut. Conclusions: There are multiple factors associated with early sexual debut and adolescent pregnancy which are susceptible to intervention. This study presents key factors to generate prevention programs for these situations.

Age at Sexual Initiation and Sexual and Health Risk Behaviors Among Jamaican Adolescents and Young Adults.

Current policies limit access to sexual and reproductive health services for adolescents younger than 16 years in Jamaica. Using data from a national survey, we explored the relationship between age at sexual initiation and subsequent sexual risk behaviors in a random sample of 837 Jamaican adolescents and young adults aged 15-24 years. In the sample overall, 21.0% had not yet had sex. Among the 661 sexually active participants, the mean age at first sex was 14.7 years. High percentages of sexually active youth reported engaging in risk behaviors such as inconsistent condom use (58.8%), multiple sex partners (44.5%), and transactional sex (43.0%). Age of sexual initiation for males was unrelated to subsequent sexual risk behaviors. However, earlier sexual debut for females was associated with their number of partners during the preceding year. Findings underscore the potential benefits of access to sexual and reproductive education and services at earlier ages than current policies allow. Interventions before and during the period of sexual debut may reduce sexual risk for Jamaican adolescents and young adults.

Community social capital on the timing of sexual debut and teen birth in Nicaragua: a multilevel approach.

BACKGROUND: Community attributes have been gradually recognized as critical determinants shaping sexual behaviors in young population; nevertheless, most of the published studies were conducted in high income countries. The study aims to examine the association between community social capital with the time to sexual onset and to first birth in Central America. METHODS: Building upon the 2011/12 Demographic and Health Survey conducted in Nicaragua, we identified a sample of 2766 community-dwelling female adolescents aged 15 to 19 years. Multilevel survival analyses were performed to estimate the risks linked with three domains of community social capital (i.e., norms, resource and social network). RESULTS: Higher prevalence of female sexual debut (norms) and higher proportion of secondary school or higher education (resource) in the community are associated with an earlier age of sexual debut by 47 % (p < 0.05) and 16 %, respectively (p < 0.001). Living in a community with a high proportion of females having a child increases the hazard of teen birth (p < 0.001) and resource is negatively associated with teen childbearing (p < 0.05). Residential stability and community religious composition (social network) were not linked with teen-onset sex and birth. CONCLUSIONS: The norm and resource aspects of social capital appeared differentially associated with adolescent sexual and reproductive behaviors. Interventions aiming to tackle unfavorable sexual and reproductive outcomes in young people should be devised and implemented with integration of social process.

Riesgo sexual en adolescentes según la edad de debut sexual / Sexual risk in adolescents depending on the age of sexual debut / Risco sexual em adolescentes de acordo com a idade de debute sexual

En España los jóvenes debutan sexualmente antes que en otros países; sin embargo, poco se sabe de la relación entre la edad de debut sexual y el comportamiento sexual en esta población. Se analizan las prácticas sexuales y el uso del preservativo según la edad de debut sexual en adolescentes españoles sexualmente experimentados (N = 351); la edad media fue 15.9 años (DT = .75, rango: 14-18). Se establecieron tres grupos a partir de la edad de debut sexual informada: debut sexual temprano (anterior a los 15 años), promedio (15 años) y tardío (posterior a los 15 años). El grupo con debut sexual temprano practicó en mayor medida masturbación mutua, coito vaginal y sexo oral, con un número de parejas sexuales superior al resto. El uso del preservativo en la primera relación sexual, el porcentaje de uso y el uso consistente del preservativo fue inferior en el grupo debut sexual temprano respecto a los otros dos. El debut sexual anterior a los 15 años se asoció con mayor riesgo de contraer infecciones sexuales por déficit en el uso del preservativo y mayor exposición sexual. Los hallazgos de este estudio sugieren que la edad de debut sexual tiene implicaciones en la salud sexual de los jóvenes.

In Spain young people have their first sexual intercourse at an earlier age than in other countries; however, little is known about the relationship between age of sexual debut and sexual behavior in this population. Sexual practices and methods of protection are analyzed depending on the age of sexual debut among Spanish adolescents who are sexually experienced (N = 351). The mean age was 15.9 years (SD = .75, range: 14-18). Three groups were formed according to the age of sexual debut reported: early sexual debut (earlier than 15 years), average (15 years) and late (later than 15 years). The early sexual debut group reported further mutual masturbation, vaginal intercourse and oral sex with a higher number of sexual partners than the rest. Condom use at first intercourse, percentage of use and consistent condom use was significantly lower in the early sexual debut group compared to the others. Sexual debut before 15 years old was associated with increased risk of sexual infections, deficit in condom use and increased sexual exposure. The findings of this study suggest that the age of sexual debut has implications for the sexual health in young people.

Na Espanha os jovens debutam sexualmente antes que em outros países; porém pouco se sabe com respeito à relação entre idade de debute sexual e o comportamento sexual nesta população. Analisam-se as práticas sexuais e o uso do preservativo segundo a idade de debute sexual em adolescentes espanhóis sexualmente experimentados (N = 351); a idade média foi 15.9 anos (DT = .75, faixa: 14-18). Estabeleceram-se três grupos a partir da idade de debute sexual informada: debute sexual precoce (anterior aos 15 anos), média (15 anos) e tardio (posterior aos 15 anos). O grupo com debute sexual precoce praticou em maior medida masturbação mútua, coito vaginal e sexo oral, com um número de parceiros sexuais superior ao resto. O uso do preservativo na primeira relação sexual, a porcentagem de uso e o uso consistente do preservativo foi inferior no grupo de debute sexual precoce com respeito aos outros dois. O debute sexual anterior aos 15 anos foi associado com maior risco de contrair infecções sexuais por déficit no uso do preservativo e maior exposição sexual. Os descobrimentos deste estudo sugerem que a idade de debute sexual tem implicações na saúde sexual dos jovens.

Factores asociados al inicio sexual en adolescentes de ambos sexos de nivel socioeconómico medio-bajo de la Región Metropolitana / Factors associated to the sexual debut in adolescent populations in precarious economic settings of Metropolitan Region

Antecedentes: escasa evidencia está disponible en Chile acerca del inicio de la actividad sexual adolescente. Objetivo: examinar cuales variables identificadas previamente están asociadas al inicio de la actividad sexual en una población adolescente de nivel socioeconómico medio-bajo de la Región Metropolitana. Método: los datos corresponden a adolescentes consultantes en CEMERA. Se compararon con adolescentes que habían iniciado actividad sexual y aquellos que no. La información fue recolectada en la primera consulta a 5.854 adolescentes de ambos sexos entre 12 y 19 años. Se usó regresión logística para identificar los factores asociados al inicio sexual. Resultados: 92,6 por ciento mujeres y 7,4 por ciento hombres. El 84,2 por ciento había iniciado actividad sexual y no el 15,8 por ciento. Las variables asociadas al inicio sexual fueron: ser hombre; mayor edad; mayor escolaridad; aspiraciones académicas básicas; desempeño escolar bajo; repitencia escolar; no afiliación religiosa; no asistencia a servicios religiosos; tener un trabajo; tener pareja mayor; tener una pareja que trabaje; conversar temas de sexualidad solo con la pareja; más parejas románticas; no participación social; historia de abuso sexual; mayor número de hijos; mala relación padre-hijo; mala comunicación familiar; supervisión parental limitada; historia de paternidad y/o maternidad adolescente en los padres; padres con baja educación; menor supervisión parental. Conclusión: se necesitan programas que motiven a retardar el inicio sexual. Los programas de educación sexual deberían animar a la conversación de los temas de sexualidad con los padres y capacitar a los educandos a demorar el inicio sexual y/o obtener anticonceptivos, en forma expedita, amigable y confidencial.

Background: little evidence is available from Chile concerning adolescent people's sexual debut. Objective: to examine which variables previously identified were associated to the sexual activity in adolescent populations in precarious economic settings of Metropolitan Region. Method: data from a population of adolescents attending at CEMERA were used to compare those who had sexual debut and those who had not. Analysis used data collected at the adolescent's first visit of 5,854 adolescents, both sexes, aged 12-19. Logistic regression was used to identify factors associated with sexual debut. Results: 92.6 percent were females and 7.4 percent males. 84.2 percent adolescents had sexual debut and 15.8 percent did not. Variables associated with sexual debut were: gender (male); age (older); education (higher): low academic aspirations (finishing high school only); low academic performance; repeating an academic year; no religious affiliation; no attendance at religious services; having a job; having an older partner; having a partner who works; discussing topics related to sexuality only with partner; more lifetime romantic partners; no social participation; history of sexual abuse; higher number of siblings; poor parent-child relationship; poor family communications; limited parental supervision; history of adolescent parenthood in parents; low parental education; low family involvement in the adolescent's life. Conclusion: programs that encourage the delay of sexual debut are needed. Sexual health education programs should encourage the discussion of sexuality with parents and enable girls and boys to delay sexual debut or to obtain contraceptives easily and privately.

Variables psicosociales que median en el debut sexual de adolescentes en España / Psychosocial variables related to sexual debut in adolescents in Spain

El objetivo de esta investigación es analizar las variables sociodemográficas y psicosociales que median en el debut sexual de los adolescentes en España. Participaron 2.153 adolescentes residentes en España, entre 14 y 19 años de edad, y de distinto origen cultural. De ellos, el 67.7% eran autóctonos españoles y el 32.3% inmigrantes latinoamericanos. El 19.2% de los participantes no había tenido contacto sexual, el 47.3% lo había tenido sin penetración y el 33.5% restante manifestó haber tenido relaciones sexuales con penetración. Se llevó a cabo una regresión logística multinomial para comparar a los adolescentes de los tres grupos, a través de la cual se concluye que las relaciones sexuales sin penetración pueden ser predichas por las actitudes positivas hacia el preservativo y que las relaciones sexuales con penetración pueden serlo por la adaptación personal, la adaptación escolar y las actitudes positivas hacia el preservativo. Posteriormente, a través de un análisis de regresión logística binaria, se obtuvo que los adolescentes latinoamericanos, las mujeres, los que están más adaptados en el ámbito personal y los que presentan menos autoeficacia en el uso del preservativo tienen más probabilidades de tener relaciones sexuales con penetración. En la discusión se resalta la importancia de la edad de inicio en las relaciones sexuales como factor clave para la emisión de conductas sexuales de riesgo.

The aim of this study was to analyze variables that are related to sexual debut in adolescents in Spain. Participants were 2.153 adolescents who lived in Spain. Ages ranged from 14 to 19 years old. Of them, 67.7% were native Spanish and 32.3% were Latin American immigrants. 19.2% of adolescents had never had any sexual contact; 47.3% had had sexual activities without penetration and 33.5% reported sexual intercourse experience. A multinomial logistic regression analysis was performed to compare these three groups of adolescents. According to that analysis, positive attitudes towards condom use predicted sexual activities without penetration. Likewise, personal and scholar adaptation and positive attitudes towards condom use predicted sexual intercourse experience. Subsequently, a binomial logistic regression analysis was performed. This analysis showed that Latin American adolescents, females, those adolescents who were more adapted in the personal area as well as those who had less self-efficacy towards condom use, had a higher likelihood of having had sexual intercourse experience. In the discussion section, relevance of age at first sexual intercourse as a key factor for sexual risk behaviour engagement is highlighted.

Percepciones y experiencias del inicio sexual desde una perspectiva de género, en adolescentes consultantes en un centro universitario de salud sexual y reproductiva / Perceptions and experiences of sexual debut from a gender perspective in adolescents consulting in a university centre for sexual and reproductive health care

Antecedentes: El contexto en que se inicia la actividad sexual en adolescentes tiene importantes signifca-dos para las personas e implicancias en salud pública. Objetivo: Conocer con un enfoque exploratorio, los factores que infuyen en el inicio de la actividad sexual en adolescentes y explorar el contexto en el cual ocurre. Método: Muestra de adolescentes, hombres y mujeres, sexualmente activos entre 14 y 19 años, re-clutados en el CEMERA, durante 2007. Se realizaron 117 entrevistas semiestructuradas. Se utilizó el análisis temático de los datos. Los signifcados e interpretaciones fueron constantemente verifcados a través de sucesivos análisis. Resultados: El grado de control personal que tuvieron sobre los factores que condujeron a su primera experiencia sexual, determinó como ellos/as se sintieron con esta experiencia. Aquellos/as que dijeron que había sido una buena experiencia, demoraron el inicio sexual hasta que se sintieron cómodos/as con el momento y con quien debutaron sexualmente. Sin embargo, sentimientos de culpa marcaron el evento, porque ellos/as habían transgredido las normas sociales. En contraste, la coerción de sus parejas y los efectos del alcohol, fueron razones que llevaron a una experiencia sexual prematura y no deseada. Conclusiones: El rol de la interacción con sus pares, el abuso de alcohol y la presión de la pareja, en el caso de las niñas, infuyen en la actividad sexual prematura y no deseada. Las intervenciones educacionales debieran considerar estos aspectos para que tengan relevancia personal y el impacto pueda ser mayor en la postergación del inicio de la actividad sexual o que esta sea protegida.

Background: It is important to understand that the timing and context in which sexual intercourse is initiated, has signifcant personal and public health implications. Objective: To explore the factors that infuence the initiation of frst intercourse among adolescent females and males and the context in which this event occurs. Methods: A sample of sexually active teenagers both female and male, aged between 14 and 19 years, were recruited from a University Centre for Sexual and Reproductive Health Care (CEMERA), during 2007. One hundred and seventeen semi structural interviews were conducted. Thematic analysis was used to analyze the data. Meanings and interpretations that emerged were constantly verifed through subsequent inquiry. Results: The degree of personal control over the factors that led to their frst experience of intercourse determined how adolescents refected upon the experience. Those who were ready and felt well were more likely to have delayed intercourse until they were comfortable with when and with whom the sexual debut occurred. However, feelings of blame because the social norms were transgressed marked the event. In contrast, coercion from sexual partners and being under effect of alcohol were reasons for premature and unwanted frst experience of sexual intercourse. Conclusions: The role of peer interaction and abuse of alcohol, and the pressure from sexual partner to infuence in premature and unwanted sexual activity, may to generate educational interventions of greater personal relevance and impact to prevent risky sexual behaviors.

Iniciação sexual de homens adolescentes / Sexual initiation in male adolescents

Trata-se de pesquisa quantitativa que teve como objetivo investigar a iniciação sexual de adolescentes do sexo masculino em Concórdia, Santa Catarina. Participaram da mesma 340 adolescentes do sexo masculino, com idades entre 14 e 19 anos, que frequentavam o ensino médio em seis instituições de ensino do município de Concórdia, que aceitaram participar e que trouxeram o termo de consentimento livre e esclarecido assinado pelos pais ou responsáveis. Destes, 69,7 por cento afirmaram ter relações sexuais, sendo que a média de idade da primeira relação foi de 14,4 anos, menor que a média nacional de 15 anos. A primeira relação sexual ocorreu com uma ficante para 45,1 por cento e 64,2 por cento afirmaram que o principal motivo para a mesma foi vontade/tesão. A maioria (74,2 por cento) qualificou a experiência como boa ou muito boa. O uso da camisinha foi apontado como método utilizado na primeira relação sexual por 73,8 por cento dos adolescentes e como método usado em todas as relações por 72,5 por cento. Alguns adolescentes relataram não conversar sobre sexualidade, mas a maioðria aponta os amigos como principal fonte de informações sobre sexo. Frente ao exposto, fica claro que, apesar de terem sua primeira relação sexual cada vez mais precocemente, o diálogo sobre prevenção tem surtido efeito, o que é reforçado pelo uso expressivo do preservativo entre os adolescentes.

This quantitative study aimed to investigate the sexual initiation of male adolescents in the city of Concordia, Santa Catarina State. A total of 340 male adolescents aging from 14-19 years, from secondary education in six urban schools, that accepted to answer the questionnaire and whose parents signed the authorization. From the total, 69.7 percent had already had sexual relations, with average age of 14.4 years old, lower than national average of 15 years old. The first sexual relation occurred with a date to 45.1 percent and 64.2 percent affirmed that the main reason to have it was desire/excitation. Most of adolescents (74.2 percent) valued the experience as good or very good. Condoms were the contraceptive method used at first sexual relation by 73.8 percent and in all others relations by 72.5 percent. Some adolescents do not talk about sexuality, but the main source of information about sex was their friends. The data shows the importance of the work on prevention of STD/AIDS and pregnancy developed in the last decades, what is showed by the expressive condom use among the participants.

Iniciação sexual de homens adolescentes / The onset of sexual activity in male adolescents

Trata-se de pesquisa quantitativa que teve como objetivo investigar a iniciação sexual de adolescentes do sexo masculino em Concórdia, Santa Catarina. Participaram da mesma 340 adolescentes do sexo masculino, com idades entre 14 e 19 anos, que freqüentavam o ensino médio em seis instituições de ensino do município de Concórdia, que aceitaram participar e que trouxeram o Termo de Consentimento Livre e Esclarecido assinado pelos pais ou responsáveis. Destes, 69,7 por cento afirmaram ter relações sexuais, sendo que a média de idade da primeira relação foi de 14,4 anos, menor que a média nacional de 15 anos. A primeira relação sexual ocorreu com uma ficante para 45,1 por cento e 64,2 por cento afirmaram que o principal motivo para a mesma foi vontade/tesão. A maioria (74,2 por cento) qualificou a experiência como boa ou muito boa. O uso da camisinha foi apontado como método utilizado na primeira relação sexual por 73,8 por cento dos adolescentes e como método usado em todas as relações por 72,5 por cento. Alguns adolescentes relataram não conversar sobre sexualidade, mas a maioria aponta os amigos como principal fonte de informações sobre sexo. Frente ao exposto, fica claro que apesar de terem sua primeira relação sexual cada vez mais precocemente, o diálogo sobre prevenção tem surtido efeito, o que é reforçado pelo uso expressivo do preservativo entre os adolescentes.

This quantitative study aimed to investigate the onset of sexual activity in male adolescents from Concordia, Santa Catarina, Brazil. The studied sample consisted of a total of 340 14-19-year-old male adolescents attending secondary school in six local educational institutions, who accepted to answer the questionnaire and whose parents signed the Free and Informed Consent. From these, 69,7 percent affirmed that they already had sexual relations; the mean age at the first relation was 14,4, lower than national average of 15 years. The first sexual relation occurred with a date in the case of 45,1 percent and 64,2 percent affirmed that the main reason was sexual desire/excitation. Most of adolescents (74,2 percent) qualified the experience as good or very good. The condom was used in the first sexual relation by 73,8 percent and in all relations by 72,5 percent. Some adolescents do not talk about sexuality, but most of them indicate friends as the main source of information about sex. These data show the effectiveness of the dialogue about STD/AIDS prevention and contraception developed over the last decades, expressed by the considerable condom use among the adolescents.