The Health Communication Capacity Collaborative (HC3) conducted a review and program scan of peer-reviewed and grey literature on sexual and reproductive health (SRH) of adolescents and youth in urban areas to explore the behavioral drivers, barriers and contextual factors and identify SBCC interventions targeting the sexual health of urban youth.
The findings highlight promising practices and synthesize lessons learned, and offer insight into the elements that may yield more positive results for behavior change among urban youth.
Below is a table showing the peer-reviewed and grey literature articles from the review:
Urban Youth SBCC Research Synthesis
|Adedimeji AA, Hear NJ, Odutol 0, and Omulolo FO. (2008) Social factors, social support and condom use behavior among young urban slum inhabitants in southwest Nigeria. East African Journal of Public Health, 2(3):214-222
|Objectives: Despite widespread knowledge that condoms offer protection against STIs/HIV when used correctly and consistently, many young people do not regularly use condoms, thus leading to new sexually transmitted infections, including HIV and AIDS. This study explored condom use behaviour, specifically the extent to which beliefs, self efficacy, risk perception and perceived social support act as predictors of use or non-use of condoms among sexually active young people aged 15-24 years. Methods: Data was obtained from sexually active 448 boys and 338 girls, who were selected through multistage sampling techniques. Analysis of data, which was done with EPI Info and SPSS version 12, focused on predictors of condom use or non-use. Result: Generally, there is widespread knowledge and low levels of condoms use, despite high levels of risky sexual behaviour. Although, half of boys and one third of girls report ever using condoms, a considerably lower proportion of male and female adolescents regularly use condoms. Logistic regression models show that among girls, those who perceived social support from peers and non-parental figures were more likely to use condoms while among boys, earning an income, high risk perception and self efficacy were associated with higher odds of condom use. Conclusions: Programs aiming to increase condom use among young people need to address these factors through community-based strategies.
|Arora R Neogi S, and Misra M. (2011) Innovative ways to meet health challenges in urban India. White Paper, Public Health Foundation of India, September 2011
|In the year 2000, countries across the world agreed to work towards a set of ‘Millennium Development Goals’ (MDGs). For India, this meant reducing the maternal mortality ratio (MMR) to 109 per 100,000 live births and infant mortality rate (IMR) to 27 per 1000 live births (MDGs 4 & 5). At its current rate of progress, with an MMR of 254 (SRS 2006-09) and IMR of 50 (SRS, 2009), India is off-track towards achieving the targeted MDGs.
|Baker JL. (2008) Urban poverty: a global overview. The World Bank, Washington, D.C.,USA.
|This paper provides an overview on what has been learned about urban poverty over the past decade with a focus on what is new and what the implications are for the World Bank going forward in an increasingly urbanized world. Coverage includes current information on the scope of urban poverty, identification of the key issues for the urban poor, a summary of regional characteristics of urban poverty, what has been learned from programs and policies aimed at the urban poor, and finally, the paper identifies priorities for urban poverty reduction within the context of an overall urban strategy.
|Balaji M, Andrews T,Andrew G, Patel V.(2011) The acceptability, feasibility and effectiveness of a population-based intervention to promote youth health: an exploratory study in Goa, India. Journal of Adolescent Health, 48:453-460
|Purpose: To evaluate the acceptability, feasibility, and effectiveness of a population-based intervention to promote health of youth (age: 16–24 years) in Goa. Methods: Two pairs of urban and rural communities were selected; one of each was randomly assigned to receive a multi-component intervention and the other wait-listed. The intervention comprised educational institution-based peer education and teacher training (in the urban community), community peer education, and health information materials. Effectiveness was assessed through before–after population surveys at baseline and at 18 months. Outcomes were measured using a structured interview schedule with all eligible youth. Logistic regression compared each pair, adjusted for baseline differences, on prevalence of outcomes in the domains of reproductive and sexual health (RSH), violence, mental health, substance use, and help seeking for health concerns. Results: In both intervention communities, prevalence of violence perpetrated and probable depression was significantly lower and knowledge and attitudes about RSH significantly higher (p .05). The rural sample also reported fewer menstrual complaints and higher levels of help-seeking for RSH complaints by women, and knowledge and attitudes about emotional health and substance use; and, the urban sample reported significantly lower levels of substance use, suicidal behavior, sexual abuse, and RSH complaints. Although information materials were acceptable and feasible in both communities, community peer education was feasible only in the rural community. The institution-based interventions were generally acceptable and feasible. Conclusions: Multicomponent interventions comprising information materials, educational-institution interventions and, in rural contexts, community peer interventions are acceptable and feasible and likely to be effective for youth health promotion.
|Bankole A, Ahmed FH, Neema S, Ouedraogo C, and Konyani S. (2007)[i] Knowledge and correct condom use and consistency of use among adolescents in four countries in Sub saharan Africa. African Journal of Reproductive Health, No.3;Vol.1 1
|Using data from the 2004 National Adolescent Surveys, this paper undertook a detail analysis of knowledge of correct condom use and consistency of use, as well as their covariates, among adolescents in Burkina Faso, Ghana, Malawi and Uganda. The strongest predictor of knowledge of correct condom use among both male and female adolescents is exposure to a condom use demonstration. In Burkina Faso, Ghana and Uganda, adolescents who have seen a condom demonstration are 2 to 5 times as likely as those who have not to have good knowledge of correct condom use. Age, ever received sex education in school, ever attended school and exposure to the radio are also significant predictors of knowledge of correct use, particularly among men. As indicated by behavior among young men, the extent to which adolescents use the condom consistently varies across countries. Yet, it is nowhere near the required 100% level. The proportion reporting consistent use of the method in the 3 months preceding the survey is 38% in Burkina Faso, 47% in Ghana, 20% in Malawi and 36% in Uganda. Age difference between partners is a major determinant of consistent use of condoms: young men whose partner is 0–4 years younger are about two and a half times more likely to use condoms consistently than those who whose partner is 5–9 years younger. Other important predictors of consistent condom use are residence, education, living arrangement and exposure to mass media, specifically the radio and newspaper. Findings from this study point to areas that policy and program can address to provide adolescents access to the kinds of information and service they need to achieve healthy sexual and reproductive lives.
|Bankole A, Biddlecom A, Guiella G, Singh S, and Zulu A. (200)[ii] Sexual behavior, knowledge and information sources of very young adolescents in four Sub-Saharan African countries. African Journal of Reproductive Health, 11(3):28-43
|Adolescents are a key target group for HIV and pregnancy prevention efforts, yet very little is known about the youngest adolescents: those under age 15. New survey data from 12–14 year olds in Burkina Faso, Ghana, Malawi and Uganda are used to describe their sexual activity, knowledge about HIV, STIs and pregnancy prevention, and sources of sexual and reproductive health information, including sex education in schools. Results show that very young adolescents are already beginning to be sexually active and many believe their close friends are sexually active. They have high levels of awareness but little in-depth knowledge about pregnancy and HIV prevention. Multiple information sources are used and preferred by very young adolescents. Given their needs for HIV, STI and pregnancy prevention information that is specific and practical and considering that the large majority are attending school in most countries in Sub-Saharan Africa, school-based sex education is a particularly promising avenue for reaching adolescents under age 15.
|Belete S, Girgre A, Witte K. (2003) Summative evaluation of "Journey of Life": The Ethiopia Reproductive Health Communication Project. Addis Ababa, Ethiopia: Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs (CCPS) and Ethiopia National Office of Population.
|The Ethiopian Reproductive Health Communication Project (RHCP/E) is a four-year Information Education, and Communication (IEC0 initiative in Family Planning and HIV/AIDS Services. The RHCP/E is part of the USAID Supported Essential Services for Health in Ethiopia. The Ethiopia National Office of Population implements the project with technical assistance from the Johns Hopkins Bloomberg School of Public Health/Center for Communication Programs Population Communications Services Project (PCS). The purpose of the ESHE program and RHCP/E project is to improve the health status of Ethiopians and the help reduce the population growth rate. The ultimate goal of the RHCP/E project is to increase demand and use of Reproductive Health services.
|Bermudez MP, Castro A, Gude F, Buela-Casal G. (2010) Relationship power in the couple and sexual double standard as predictors of the risk of sexually transmitted infections and HIV: multi-cultural and gender differences. Current HIV Research, 8(32):172-1
|The goal of this work is to determine whether relationship power in couples and sexual double standard can predict the risk of sexually transmitted infections/human immunodeficiency virus (STI/HIV) as a function of cultural and gender differences. The sample was made up of 689 adolescents living in Spain, of both sexes, aged between 14 and 19 years, who were sexually active in the past six months and who had a stable partner. Of them, 58.9% were native Spaniards and 41.1% were immigrants of Latin American origin. The results show that origin, age, double standard and the control over decision-making in the couple can predict the risk of STI/HIV; thus, the immigrants, the older participants, those who scored higher in double standard, and those with less control over decision-making were at higher risk of STI/HIV. With regard to gender, the males displayed more double standard and more control over decisionmaking, and the females displayed higher control over the relationship. The need to adapt STI/HIV prevention programs to the cultural and gender inequality differences in the couple is commented on in the discussion.
|HIV and other STIs
|Biddlecom AE, Hessburg L, Singh S, Bankole A, and Darabi L.(2007) Protecting the next generation in Sub-Saharan Africa: learning from adolescents to prevent HIV and unintended pregnancy.
|Addressing the sexual and reproductive health needs of adolescents un Sub-Saharan Africa is vital, given the devastating impact of AIDS, the high rates of unintended pregnancy and the risk that those pregnancies may lead to unsafe abortions. Protecting the health of adolescents is clearly important for the adolescents themselves. In addition, it is critical public health priority. Increased investment in adolescent sexual and reproductive health can contribute to wider development goals, because it enables adolescents to become health, productive adults. This report presents key findings from nationally representative surveys conducted in 2004 among 12-19-year-olds in four African countries - Burkina Faso, Ghana, Malawi, and Uganda - with the goal of guiding programs, policies and investments aimed at improving adolescent sexual and reproductive health.
|Blum RW and Nelson-Mmari K. (2004) The health of young people in a global context. Journal of Adolescent Health.35:402-418
|Purpose: To examine the chief causes and influences of morbidity and mortality among young people throughout the world. Methods: A comprehensive literature search was conducted that included WHO's Global Burden of Disease, UNFPA's State of the Worlds' Population, Medline, Popline, Sociological Abstracts, as well as data collected from UNICEF, UNAIDS, Population Reference Bureau, and the United Nations Headquarters. Experts in the fields of substance use, suicide, and infectious diseases were also contacted for unpublished and published sources. Studies were restricted to those completed after 1985, had a sample size of at least 100, focused primarily on the age group of 10–24 years, and examined trends related to unintentional injuries, HIV/AIDS, suicide, homicide, war, maternal mortality, pregnancy, abortion, sexually transmitted diseases, substance abuse, and infectious diseases. Results: Trends in adolescent morbidity and mortality have shifted over the past decade from predominately infectious to social etiologies. Currently, unintentional injury is the leading killer of young people in nearly every region of the world, with homicide, war, and interpersonal violence following closely behind. Conclusions: The changes in population, migration, age of marriage, and education have had profound impact on the mortality and morbidity among adolescents. As we come to learn about the factors that influence adolescent morbidity and mortality, we begin to have a better understanding of how to improve the health of youth throughout the world.
|Blum RW, Bastos FIP, Kabiru CW, and Le LC. (2012) Adolescent health in the 21'1 century. Lancet, 379:1567-1568
|Several factors have contributed to the social construct of adolescence as a distinct period of life, including the rise in education (and with it age segregation), social media, and urbanisation.1 But adolescence also has a biological basis. Many of the behaviours we associate with the teenage years (eg, risk taking) are evident in other species,2 and we know that brain maturation in human beings is not complete until about age 25 years. As young people enter adolescence they bring with them resources and vulnerabilities, both biological (genetics, epigenetics, natural endowments) and environmental (national and local policies, as well ascommunity, school, workplace, peers, neighbourhood, and family infl uences). Consequently, an ecological or life-course framework is crucial to understanding adolescent trajectories (fi gure).3
|Blum RW. (2007) Youth in Sub-saharan Africa. Journal of Adolescent Health, 41 :230-238
|Sub-Saharan Africa is going through rapid social, political, and economic transformations that have a profound impact on youth. The present review explores trends and outcomes as they relate to education, family formation and sexual and reproductive health and the interrelationships among these areas. It is based on both published and unpublished reports. Over the past 20 years, school enrollment has increased for much of the subcontinent; although the gender gap has narrowed, females remain educationally disadvantaged. Likewise, marriage is occurring later today than a generation ago, posing new challenges of out-of-wedlock births, clandestine abortions, and an increased likelihood of engaging in premarital sex. So, too, although there has been a slowing of the population growth in much of the region, in many countries of sub-Saharan Africa, the population is doubling every 30 years. Although acquired immunodeficiency syndrome is the predominant cause of death among youth, maternal mortality remains a major risk of death for youth—in some countries 600 times greater than that of peers in the industrialized world.
|Boileau C, Rashed S, Sylla M,and Zunzunegui MV. (2008) Monitoring HIV risk and evaluating interventions among young people in urban West Africa: development and validation of an instrument. AIDS Education and Prevention, 20(3):203-219
|We developed an instrument for HIV/AIDS behavioral surveillance applicable to youth living in urban West Africa. The instrument includes a comprehensive set of constructs borrowed from the sociocognitive theory of planned behavior as well as measures of parental and peer communication An exploratory (n = 189) and validation sample (n = 342) of young men and women living in Bamako were interviewed. Scale construct validity was assessed via factor analysis and multiple linear regressions and internal consistency was assessed using Cronbach's coefficient. All constructs had high internal consistency, scales' structure was relatively stable, and associations between different components of the questionnaire were in the predicted directions. Gender, sexual experience and education were significantly associated with attitudes and perception of control. Furthermore, attitudes, perceived behavioral control, perceived norms, and peer communication significantly predicted condom use. This questionnaire offers a valid and reliable tool for assessing young people's sexual behavior in an urban West African setting.
|HIV and other STIs
|Boileau C,Zunzunegui MV, and Rashed S. (2009) Gender differences in unsafe sexual behavior among young people in urban Mali. AIDS Carem 21(8):1014-1024
|We developed gender-specific explanatory models for unsafe sexual behavior among unmarried young people living in urban West Africa using a culturally adapted instrument which addresses personal, relational and socio-cognitive factors. Data were collected on condom use and number of sexual partners, and on their potential determinants, using in-person interviews on a heterogeneous sample of in-school and out-of-school young women (n=185) and (n=214) men who reported ever having had sexual intercourse. Recruitment was done at various sites in 21 randomly selected neighborhoods in Bamako. Bivariate analysis and multivariate logistic regressions were conducted to identify determinants of lack of condom at last sex and having more than one partner in the last six months and to test for interactions with gender. Similar percentages of men (40%) and women (46%) reported not using a condom at last sex. However, more men (64%) reported multiple partnering in the last six months than women (32%). Our findings suggest that the context of sexual debut, social status, relation to peers and family as well as attitudinal, normative and behavioral control constructs may influence young men and womens’ sexual behavior, but that pathways leading to unsafe sex are different across genders. Our findings also show that factors associated with condom use and sexual partnering are distinct. Earlier sexual debut seems to be risk-inducing in women while risk-reducing in men. Poor communication with peers and receiving money from sexual partner were associated with lack of condom use in women. High behavioral control was associated with fewer sexual partners in men. Determinants of unsafe sexual behavior were found at the social, interpersonal and individual levels for both men and women, but notable gender differentials existed. These findings underscore the importance of addressing gender as a crucial factor shaping HIV-risk profiles.
|Bruce J. (2007) Reaching the girls left behind: targeting adolescent programming for equity, social inclusion, health and poverty alleviation. The Population Council
|Despite decades of investment in HIV prevention, a large and vulnerable population—that of adolescent girls—remains invisible, underserved, and at disproportionate risk of HIV. When the HIV epidemic was first recognized in the early 1980s, prevention messages reflected the context of the same-sex male relations in which the epidemic was first identified. As it became clear that the epidemic also included a large heterosexual component, messages expanded to promote negotiation and responsibility within presumptively voluntary partnerships. However, recommended protection measures assumed relative equality between girls and women and their sexual partners: presuming, for example, that girls and women possessed the ability to avoid pregnancy or choose abstinence, the agency to select a safe partner, and the power to use condoms consistently. In fact, these protection strategies were not feasible and some, such as avoiding pregnancy in child marriage, were virtually unachievable for the vast majority of sexually active adolescent girls.
|Campbell C, Foulis CA, Maimane S, and Sibya Z. (2005) The impact of social environments on the effectiveness of youth HIV prevention: a South African case study. AIDS Care, 17(5):471-478
|Few would disagree that ‘social context’ shapes the effectiveness of HIV-prevention programmes. However much work remains to be done in developing systematic conceptualisations of HIV/AIDS-relevant aspects of social environments in vulnerable communities. This paper contributes to this challenge through a case study (44 interviews, 11 focus groups with 55 people and fieldworker diaries) of the impact of social context on a participatory peer education programme involving young people in a peri-urban community in South Africa. Three interacting dimensions of context undermine the likelihood of effective HIV-prevention. Symbolic context includes stigma, the pathologisation of youth sexuality (especially that of girls) and negative images of young people. Organisational/network context includes patchy networking amongst NGOs, health, welfare and education representatives and local community leaders and groups. This is exacerbated by different understandings of the causes of HIV/AIDS and how to manage it. These challenges are exacerbated in a material-political context of poverty, unemployment and crime, coupled with the exclusion of young people from local and national decision-making and politics. HIV-prevention initiatives seeking to promote health-supporting social environments should work closely with social development programmes -- to promote young peoples’ social and political participation, increase opportunities for their economic empowerment, challenge negative social representations of youth, and fight for greater recognition of their sexuality and their right to protect their sexual health.
|HIV and other STIs
|Chatterji M, Murray N, London D, and Angelwicz P. (2004) The factors influencing transactional sex among young men and women in 12Sub-Saharan African countries. USAID
|Anecdotal evidence and several qualitative studies suggest that transactional sex, which is defined as the exchange of gifts or money for sex, is common among adolescents throughout sub-Saharan Africa (Bledsoe, 1990; Castle and Konaté, 1999). In situations of transactional sex, young women may be less able to decide the timing and conditions of sex. Women who have little negotiating power with their partners to insist on use of condoms experience a higher risk of becoming pregnant and contracting sexually transmitted infections (STIs), including HIV/AIDS (Gregson et al., 2002; Longfield et al., 2002). Young men involved in transactional sex may also expose themselves to the risk of STIs. To begin to protect young men and young women from this heightened risk of HIV/AIDS, it is important that policymakers and program managers gain a better understanding of transactional sex among youth. Policymakers and program managers need answers to questions such as: Are youth at higher risk of engaging in transactional sex than other groups? What factors influence youth to engage in transactional sex? And, what subgroups of youth are particularly vulnerable to engaging in transactional sex? This study seeks to answer these questions by exploring whether adolescent boys and girls are at higher risk for engaging in transactional sex than older men and women by analyzing data from the Demographic and Health Surveys (DHS) from 12 sub-Saharan African countries including Benin, Burkina Faso, Central African Republic (CAR), Chad, Guinea, Kenya, Mali, Niger, Nigeria, Togo, Zambia, and Zimbabwe. We also examine the relationship between young men and young women’s individual socio-demographic characteristics and the probability that they will engage in the exchange of sex for money.
|Cherie A, Mitkie G, Ismail S, and Berhane Y. (2005) Perceived sufficiency and usefulness of IEC materials and methods related to HIV/AIDS among high-school youth in Addis Ababa, Ethiopia. African Journal of Reproductive Health, 9(1):66-77
|This study was conducted to assess the perceived sufficiency and usefulness of HIV/AIDS information, education and communication (IEC) messages and materials as well as to identify preferences for IEC sources and methods. Data were collected using a self-administered questionnaire and focus group discussions. A total of 901 students in Addis Ababa, Ethiopia, participated in the study. Over three quarters of the respondents believed in the usefulness of IEC. IEC materials were perceived to be useful in increasing knowledge about HIV/AIDS by 456 (51%), to influence attitude by 357 (40%) and to acquire safer sexual practices by 382 (42%) of the respondents. None of the information sources and messages available for high school students highly satisfied the sufficiency indicators. Even though no single information source was highly preferred, radio and television ranked top. Life skills training was the most desired intervention by the students. IEC on HIV/AIDS was able to acquaint students with the disease rather than equipping them with knowledge and skill needed in their daily life. Therefore, appropriate and mutually reinforcing IEC messages with emphasis on life skill training are recommended.
|HIV and other STIs
|Cho H and Witte K. (2005) Managing fear in public health campaigns: a theory-based formative evaluation process. Health Promotion Practice, 6:482
|The HIV/AIDS infection rate of Ethiopia is one of the world's highest. Prevention campaigns should systematically incorporate and respond to at-risk population's existing beliefs, emotions, and perceived barriers in the message design process to effectively promote behavior change. However, guidelines for conducting formative evaluation that are grounded in proven risk communication theory and empirical data analysis techniques are hard to find. This article provides a five-step formative evaluation process that translates theory and research for developing effective messages for behavior change. Guided by the extended parallel process model, the five-step process helps message designers manage public's fear surrounding issues such as HIV/AIDS. An entertainment education project that used the process to design HIV/AIDS prevention messages for Ethiopian urban youth is reported. Data were collected in five urban regions of Ethiopia and analyzed according to the process to develop key messages for a 26-week radio soap opera.
|HIV and other STIs
|Clark TS, Friedrich GK, Ndlovu M, Neilands TB, and McFarland W. (2006) An adolescent targeted HIV prevention project using African professional soccer players as role models and educators in Bulaywayo, Zimbabwe. AIDS Behavior, 10:S77-S81
|The calamitous effects of HIV in Africa demand novel approaches to prevention. Young people are an ideal target as early intervention may have long-term benefits. Given their high social status, professional soccer players may be effective in HIV education as role models and educators. In our study, professional soccer players provided HIV education in an interactive curriculum for 7th grade boys and girls in Bulawayo, Zimbabwe. Students in intervention classrooms demonstrated significant increases in knowledge and attitudes using pre-, immediately post- and fivemonth post-intervention surveys. There was a delayed increase in these factors among control students, suggesting a possible diffusion of information from their peers who received the intervention curriculum. Given these results and the magnitude of the HIV epidemic, this pilot program should be replicated in other communities in sub-Saharan Africa. Continual efforts should be made to rigorously evaluate the approach and improve its effectiveness.
|HIV and other STIs
|Crosby RA, Salazar LF, and DiClemente RJ. (2011) Ecological Approaches in the New Public Health. In DiClemente RJ, Salazar LF, and Crosby RA. Health Behavior Theory for Public Health: Principles, Foundations and Applications. Burlington MA, Jones & Bartle
|Darj E, Mirembe FM,and Rasjo EB. (201O) STI prevalence and differences in social background and sexual behavior among urban and rural young women in Uganda. Sexual and Reproductive Healthcare, (1):111-115
|Background: Adolescents in Uganda carry a heavy burden of reproductive health problems. Different environment creates different problems. Objectives: To study the prevalence of STI and to compare social and behavioral risk factors for Neisseria gonorrhoea (NG) and Chlamydia trachomatis (CT) among sexually experienced young women in one urban and one rural area in Uganda. Methods: Consenting, sexually experienced women, below 20 years, visiting two different youth clinics were asked about social background, genital symptoms and sexual experiences. Vaginal samples were taken for NG and CT and analyzed by PCR. Results: The prevalence of NG and/or CT was 20 (6.8%) in the urban and 23 (7.8%) in the rural study site, a non-significant difference. The rural women were often in marital union, 25.3% compared to 12.2% of the urban women (OR 2.4, 95% CI 1.6-3.8) and had experienced more pregnancies and had more children. Their partners were often more than 10 years older. More urban women (42.2%) knew their HIV status compared to rural women (16.2%), OR 2.1 (1.6–2.7), reported more condom use and more sexual partners. Conclusions: Marital status and few sexual partners does not appear to protect young rural women from sexually transmitted infections (STIs), implying that male sexual behavior may have an important impact on women’s risk to be infected.
|HIV and other STIs
|DiCenso A, Guyatt G, Willan A, and Griffith L. (2002) Interventions to reduce unintended pregnancies among adolescents: systematic review of randomized controlled trials. BMJ,324:1420-30
|Objective: To review the effectiveness of primary prevention strategies aimed at delaying sexual intercourse, improving use of birth control, and reducing incidence of unintended pregnancy in adolescents. Data sources: 12 electronic bibliographic databases, 10 key journals, citations of relevant articles, and contact with authors. Study selection: 26 trials described in 22 published and unpublished reports that randomised adolescents to an intervention or a control group (alternate intervention or nothing). Data extraction: Two independent reviewers assessed methodological quality and abstracted data. Data synthesis: The interventions did not delay initiation of sexual intercourse in young women (pooled odds ratio 1.12; 95% confidence interval 0.96 to 1.30) or young men (0.99; 0.84 to 1.16); did not improve use of birth control by young women at every intercourse (0.95; 0.69 to 1.30) or at last intercourse (1.05; 0.50 to 2.19) or by young men at every intercourse (0.90; 0.70 to 1.16) or at last intercourse (1.25; 0.99 to 1.59); and did not reduce pregnancy rates in young women (1.04; 0.78 to 1.40). Four abstinence programmes and one school based sex education programme were associated with an increase in number of pregnancies among partners of young male participants (1.54; 1.03 to 2.29). There were significantly fewer pregnancies in young women who received a multifaceted programme (0.41; 0.20 to 0.83), though baseline differences in this study favoured the intervention. Conclusions: Primary prevention strategies evaluated to date do not delay the initiation of sexual intercourse, improve use of birth control among young men and women, or reduce the number of pregnancies in young women.
|Diop-Sidbe N. (2005) Sibling's premarital childbearing and the timing offirst sex in three major cities in Cote d'Ivoire. International Family Planning Perspectives, Vol 31; No.2
|CONTEXT: The association between youths' sexual and reproductive attitudes and behaviors and those of their peers and parents has been documented; however, information on siblings' influence is scarce, especially for developing countries. METHODS: Data on 1,395 female and 1,242 male survey respondents aged 15–24 from three cities in Côte d'Ivoire were analyzed. Life-table analysis was conducted to examine respondents' probability of remaining sexually inexperienced according to siblings' history of premarital childbearing. Cox multivariate regressions were used to estimate respondents' relative risks of sexual debut by age 17 and by age 24. RESULTS: At any age between 15 and 24 years, the life-table probability of remaining sexually inexperienced was typically lower among persons who had at least one sibling with a premarital birth than among those who had no such sibling. In general, among those with at least one sibling who had had a premarital birth, the probability was lower if the sibling or siblings and the respondent were of the same gender rather than opposite genders, and the probability was lowest among those who had a brother and a sister with a history of premarital childbearing. In the multivariate analysis for males, having one or more brothers only, or having at least one brother and at least one sister, with a history of premarital childbearing was associated with increased relative risks of being sexually experienced by ages 17 and 24. No such association was found for females. CONCLUSION: Programs that seek to reduce premarital sexual activity among young people should develop strategies that take into account the potential influence of siblings.
|Educational Research Institute of Harbin Normal University and the Institute of Population and Labor Economics, Chinese Academy of Social Sciences on behalf of the China Youth Reproductive Health Project. (2005) Evaluation of the Impact of Life-Planning Skills Training in the Harbin City Education System. Beijing, China; CFPA and Path
|Engebretsen A. (2012) Baseline and endline findings of Filles Eveillees (Girls Awakened): a pilot program for migrant adolescent girls in domestic Service. Cohort 1 (2011-2012) Bobo Dioulasso.New York, Population Council.
|The pre- and post-test design was used to evaluate the Filles Éveillées program by assessing improvements in participating girls’ social capital as well as knowledge, attitudes, and behaviors in key program areas. This report explores the baseline and endline findings from adolescent girls ages 11–16 who participated in Cohort 1 of the Filles Éveillées program in Bobo Dioulasso from 2011–2012
|Ergene T, Cok F, Turner A, and Onal S. (2005) A controlled study of preventive effects of peer education and single session lectures on HIV/AIDS knowledge and attitudes among university students in Turkey.AIDS Education and Prevention, 17(3)268-278
|The goal of this study was to assess the impact of peer education and single-session educational lectures on HIV/AIDS knowledge and attitude change among university students (n = 157 male, n = 230 female; mean age = 20) on the campuses of two metropolitan state universities in Ankara, Turkey. The students were randomly selected to participate in peer education (n = 204), single-session lecture (n = 74) or wait-list control (n = 109) groups. Statistical analyses reveal significant differences in knowledge and attitudes, personal behavior, and awareness of HIV/AIDS. Both the peer education and HIV/AIDS lecture strategies were more effective in eliciting change in student's knowledge and attitudes than the control condition (p > .05). Male and female students in both experimental groups showed higher attitude scores compared with all students in the control group.
|HIV and other STIs
|Erulkar AS. (2004) The experience of sexual coercion among young people in Kenya. International Family Planning Perspectives, 30(4):182-189
|CONTEXT: Studies of sexual behavior among young people in the developing world have generally neglected the circumstances in which sex takes place, most often assuming that when young people have sex, it is wanted and consensual. The few published studies on nonconsensual sex have often used highly selective samples, ignoring the experience of males and of married young people. METHODS: A 2001 population-based survey of young people in Nyeri, Kenya, included a special module on sexual coercion. Descriptive data and multivariate analysis are used to explore the prevalence and patterns of sexual coercion among married and unmarried males and females aged 10-24. RESULTS: Among the sexually experienced respondents, 21% of females and 11% of males had experienced sex under coercive conditions. Most of the perpetrators were intimate partners, including boyfriends, girlfriends and husbands. In a multivariate logistic regression, females who had ever been married and those who did not live with a parent or spouse had a significantly elevated risk of sexual coercion (odds ratios, 2.6 and 3.1, respectively); sexual coercion was associated with having had multiple sexual partners and with having had a reproductive tract infection (2.2 and 2.5). Males who had been coerced into sex were significantly more likely than those who had not to have had a first partner who was older by at least five years (82.9). CONCLUSION: Reproductive health programs for young people need to address nonconsensual sex, including the special needs of males and of married females.
|Erulkar A, Bruce J, Dondo A, Sebstad J, Matheka J, Banu Khan A, and Gathuku A.(2006) Tap and Reposition Youth (TRY) Providing Social Support, Savings, and Microcredit Opportunities for Young Women in Areas of High HIV Prevalence. The Population Council. Number 23, Nairobi, Kenya.
|Adolescents represent a substantial and growing proportion of people living in informal settlements in Africa’s large cities. These urban slums typically lack basic infrastructure and government services, including water, adequate housing, sewage disposal, electricity, health services, and law enforcement. Young people migrate to urban areas in search of education and livelihood opportunities, yet many are unable to achieve these goals and instead find themselves in high-risk situations. Girls and young women in particular face a number of risks to their well-being, including HIV infection (due in part to poverty-driven commercial sex), coerced sex, domestic violence, unwanted pregnancy, and unsafe abortion.
|Erulkar AS, Ettyang LIA, Onaka C, Nyagah FK, and Muyonga A. (2004) Behavior change evaluation of a culturally consistent reproductive health program for young Kenyans. International Family Planning Perspectives, 30(2):58-67
|CONTEXT: Few rigorous evaluations have been conducted of locally designed, culturally consistent adolescent reproductive health programs. METHODS: A quasi-experimental research design was used to measure behavioral changes associated with a culturally consistent reproductive health program for young people in Kenya.Baseline and endline surveys were conducted in 1997 and 2001,respectively, in the project and control areas.Multivariate analysis was used to assess whether the project was associated with changes in young people’s sexual initiation, safer-sex behavior and discussion of reproductive health issues with adults. RESULTS: The 36-month project was associated with considerable changes in young people’s sexual and reproductive health–related behavior,but behavior change differed by gender. Females in the project site were significantly more likely than those in the control site to adopt secondary abstinence (odds ratio, 3.3) and less likely to have had three or more sex partners (0.1).Males in the project site were more likely to use condoms than those in the control site (3.7). Both males and females in the project site were more likely to discuss sexual and reproductive health issues with a nonparent adult than were young people in the control site (1.9 and 5.5,respectively). CONCLUSIONS: Interventions that adapt to indigenous traditions can be both acceptable to communities and associated with significant changes in young people’s behavior.
|Erulkar A and Ferede A. (2009) Social exclusion and early or unwanted sexual initiation among poor urban females in Ethiopia. International Perspectives on Sexual and Reproductive Health, 34(4):186-194
|CONTEXT: Numerous studies of adolescent sexual behavior have explored factors associated with early sexual debut. However, few studies have examined the role of social exclusion and marginalization in relation to early and unwanted sexual initiation. METHODS: A population-based study of 1,837 out-of-school females aged 10–19 was conducted in three low-income urban areas of Ethiopia in 2008. Descriptive and multivariate analyses were used to identify characteristics associated with having experienced coerced sexual initiation and sexual debut before age 15. RESULTS: Nearly half (48%) of the young women in the sample were domestic workers, and many reported significant social exclusion, including lack of friends, community support networks and group membership. Overall, 23% reported being sexually experienced and 27% of those had first had sex before age 15. Compared with other young women, domestic workers were significantly more likely to have had sex before age 15 (odds ratio, 3.3), and to have been coerced into having sex (1.8). Social exclusion was associated with significantly higher odds of coerced first sex (2.0). CONCLUSIONS: Programs for female adolescents should build their social capital and inclusion, as well as provide opportunities for them to stay in school and obtain positive and nonexploitive forms of work.
|Erulkar A, Ferede A, Girma W, and Ambelu W. (2012) Evaluation of 'Biruh Tesfa" (Bright Future) program for vulnerable girls in Ethiopia. Vulnerable Children and Youth Studies: An International Interdisciplinary Journal for Research, Policy and Care. 8(2)
|Adolescent girls in sub-Saharan Africa are disproportionately affected by HIV/AIDS compared to boys of the same age. Few programs on the continent have sought to address the social exclusion of most marginalized girls in the poorest communities, including child domestic workers and migrants, as well as their vulnerability to HIV. Moreover, few interventions have been rigorously evaluated. “Biruh Tesfa” (Bright Future) program is for poorest adolescent girls in urban Ethiopia and aims to build their social support and improve skills to prevent HIV infection. The project uses a combination of house-to-house recruitment, formation of girls' groups by female mentors, and education on HIV/AIDS, life skills, and basic literacy. A quasi-experimental research design involving pre- and post-intervention surveys in experimental and control areas was used to measure changes in social safety nets, HIV knowledge, and prevention capabilities. Descriptive and multivariate analyses were conducted. At endline, girls in the intervention sites were more than twice as likely to report social support (odds ratio (OR) = 2.0) compared to girls in the control site. They were also twice as likely (OR = 1.9) to score highly on HIV knowledge questions, to know where to obtain voluntary counseling and testing (OR = 2.0) and to want to be tested (OR = 1.9). “Biruh Tesfa” is one of a few rigorously evaluated support programs targeted at vulnerable girls in sub-Saharan Africa. The positive changes suggest that well-designed programs can reach and effectively support the most vulnerable girls in the poorest areas, such as child domestic workers and rural–urban migrants.
|HIV and other STIs
|Erulkar AS, Semunegus B, and Mekonnen G. (2011) Biruh Tesfa provides domestic workers, orphans, and migrants in urban Ethiopia with social support, HIV education, and skills. Transitions to Adulthood. Brief 27. Population Council
|HIV and other STIs
|FHI 360. (March 2013) Mobile for reproductive health project: Rwanda. FHI, Kigali,Rwanda.
|The Rwanda Ministry of Health (MOH), with technical assistance from FHI 360’s Program Research for Strengthening Services (PROGRESS) project, is adapting the Mobile for Reproductive Health (m4RH) program for young people in Rwanda in an effort to improve young people’s access to sexual and reproductive health information. In 2010, m4RH was launched as a pilot project in Kenya and Tanzania. In the pilot, adolescents and young adults up to age 29 were the most frequent users of m4RH among those reporting their age. Among participants in this younger age group, the method most frequently queried was condoms. Also, condom use was the most frequently cited contraceptive behavior change among this group in response to a text message-based survey. Younger users were also interested in a variety of short- and long-term methods.
|Fongkaew WRN, Cupp PK, Miller AB, Atwood KA, Chamratrithirong A, Rhucharoenpronpanich 0,Rosati MF, Chookhare W, and Byrnes HF. (2012) Do Thai parents really know a bout the sexual risk taking of their children? a qualitative study in Bangkok. Nursing & Health Sciences, 14(3):391-397
|This qualitative study explores the perceptions of parents and adolescents toward sexual risk-taking behaviors. In-depth interviews were conducted with 30 parents and 30 adolescents (aged 13–14 years) in Bangkok, and were analyzed by using coding and thematic analysis. The results showed that although parents generally believed that Thai teens begin to have sex at an early age and engage in sexual risk-taking behaviors, they trusted that their teens would follow parental guidance and rules and not engage in sexual activity at this age. Most of the Thai teens in the present study reported that their parents were not really aware of their sexual behaviors because of their tendency to keep their sexual stories secret for fear of being scolded, blamed, and punished. The teens also reported that they wanted their parents to listen, give them warmth and more freedom, and be more in touch with their activities. Parents expressed their need for knowledge and skills so that they could help guide their adolescent children to avoid sexual risk-taking behaviors. A family intervention specifically aimed at empowering Thai urban parents is needed.
|Foulger L, Page RM, Hall C, Cookstone BT, and West JH. (2013) Health risk behavior in urban and rural Guatemalan adolescents. International Journal of Adolescent Medicine and Health, 25(1):97-105
|Adolescence is an important stage of life when health behaviors and attitudes are established. The purpose of this research was to assess health risk behaviors among Guatemalan students in both an urban and rural school. Items were adapted from the Global School-based Student Health Survey and were used to measure and compare the prevalence of risk behaviors between these two demographically and culturally distant school-based samples. In general, the prevalence of adolescent health risk behaviors in both schools was lower than other Latin American countries. Many health risk behaviors were associated with location (urban vs. rural settings) and/or gender. Tobacco use, alcohol use, and sexual activity were higher among urban students. Boys were more likely than girls to use alcohol, use tobacco, and be sexually active. In addition, the prevalence of mental health problems was higher among girls and rural students. These findings imply that measures should be taken to design effective and appropriate health strategies for adolescents attending these schools. Health promotion programs in schools and communities should assist the youth in developing positive health behaviors and cultivating healthy lifestyles in an effort to reduce risk behaviors among adolescent populations. Further research is needed to extend our understanding of risk factors of health behavior in these adolescent populations and to identify effective preventative approaches and strategies that specifically cater to the location and culture of the students.
|Geary CW, McClain Burke H, Castelnau L,Neupane S, Ba Sall Y, Wong E, and Toms Tucker H (2007) MTV's "Staying Alive' global campaign promoted interpersonal communication about HIV and positive beliefs about HIV prevention. AIDS Education and Prevention, 19(1):51-67
|In 2002 MTV launched a global multicomponent HIV prevention campaign, “Staying Alive,” reaching over 166 countries worldwide. An evaluation of this campaign focused on three diverse sites: Kathmandu, Nepal; São Paulo, Brazil; and Dakar, Senegal. Data were collected before and after campaign implementation through population–based household surveys. Using linear regression techniques, our evaluation examined the effects of campaign exposure on interpersonal communication about HIV and the effects of campaign exposure and interpersonal communication on beliefs about HIV prevention. We found a consistent positive effect of exposure on interpersonal communication across all sites, though there were differences among sites with regard to whom the respondent talked about HIV. We also found a consistent positive effect of exposure on HIV prevention beliefs across sites when interpersonal communication was simultaneously entered into the model. Finally, in two sites we found a relationship between interpersonal communication and HIV prevention beliefs, controlling for exposure, though again, the effects differed by the type of person the communication was with. These similar findings in three diverse sites provide ecological validity of the findings that “Staying Alive” promoted interpersonal communication and influenced young people's beliefs about HIV prevention in a positive way, evidence for the potential of a global media campaign to have an impact on social norms.
|HIV and other STIs
|Givaudan M, Leenen I,Van De Vijver FJR, Poorting YH, and Picks 5. (2008) Longitudinal study of a school-based HIV/AIDS early prevention program of Mexican adolescents. Psychology,Health & Medicine, 13(1):98-11O
|A quasi-experimental study is reported with four measurement occasions to evaluate longer-term effects of a life-skills and HIV/AIDS school-based prevention program. Trained teachers administered the program promoting precursors of safer sex behavior to 2064 Mexican high-school students at an age before most were sexually active. The variables included in the study (knowledge about HIV/AIDS prevention, attitudes towards use of condoms, subjective norms, intentions to use condoms and life skills as decision-making skills, partner communication and individual responsibility) have been reported as precursors of protective sexual behavior. The results demonstrate the stability of training effects and a positive impact on these precursors over 1 year of follow-up.
|HIV and other STIs
|Glover EK,Bannerman A, Pence BW, Jones H, Miller R, Weiss E, and Nerquaye-Tetteh J. (2003) Sexual Experiences of adolescents in three Ghanaian towns. International Family Perspectives, 29(1):32-40
|CONTEXT: Ghanaian youth are greatly affected by widespread social change, and their reproductive health needs may differ by social group, age and gender. METHODS: In-person interviews on sexual health issues were conducted with 704 never-married youth aged 12-24 in three Ghanaian towns. The sample included youth who were in school, in apprenticeship programs or in neither school nor apprenticeship programs (unaffiliated). RESULTS: More than half of the respondents had ever had sexual intercourse (52%), with the adjusted odds for females being 1.6 times those for males and the odds for unaffiliated and apprenticed youth being 2.5-3.2 times those for in-school youth. The odds of having had sex in the previous month were elevated for females (2.0) and apprentices (2.7). Both sexes tended to accept violence towards women, with unaffiliated youth showing the highest level of acceptance and in-school youth the lowest. Nearly all respondents (99%) knew of condoms, but fewer than half (48%) could identify any of four elements of correct use; females and sexually inexperienced youth were the least informed. Two-thirds of respondents considered it unacceptable for males to carry condoms, and three-quarters considered it unacceptable for females. Twenty-five percent of males and 8% of females reported having had a sexually transmitted infection. One-third of sexually experienced females reported having ever been pregnant; of those, 70% reported having had or having attempted to have an abortion. CONCLUSIONS: Adolescent reproductive health programs should be targeted to the needs of specific groups.
|Gore F, Bloem P, Patton GC, Ferguson, J, Joseph V, Coffey C, Swayer SM, and Mathers CD (2011) Global burden of disease in young people aged 10-24 years: a systematic analysis. Lancet. 2011;377:2093-102
|Background: Young people aged 10–24 years represent 27% of the world’s population. Although important health problems and risk factors for disease in later life emerge in these years, the contribution to the global burden of disease is unknown. We describe the global burden of disease arising in young people and the contribution of risk factors to that burden. Methods: We used data from WHO’s 2004 Global Burden of Disease study. Cause-specifi c disability-adjusted life-years (DALYs) for young people aged 10–24 years were estimated by WHO region on the basis of available data for incidence, prevalence, severity, and mortality. WHO member states were classifi ed into low-income, middle-income, and highincome countries, and into WHO regions. We estimated DALYs attributable to specifi c global health risk factors using the comparative risk assessment method. DALYs were divided into years of life lost because of premature mortality (YLLs) and years lost because of disability (YLDs), and are presented for regions by sex and by 5-year age groups. Findings: The total number of incident DALYs in those aged 10–24 years was about 236 million, representing 15·5% of total DALYs for all age groups. Africa had the highest rate of DALYs for this age group, which was 2·5 times greater than in high-income countries (208 vs 82 DALYs per 1000 population). Across regions, DALY rates were 12% higher in girls than in boys between 15 and 19 years (137 vs 153). Worldwide, the three main causes of YLDs for 10–24-year-olds were neuropsychiatric disorders (45%), unintentional injuries (12%), and infectious and parasitic diseases (10%). The main risk factors for incident DALYs in 10–24-year-olds were alcohol (7% of DALYs), unsafe sex (4%), iron defi ciency (3%), lack of contraception (2%), and illicit drug use (2%). Interpretation: The health of young people has been largely neglected in global public health because this age group is perceived as healthy. However, opportunities for prevention of disease and injury in this age group are not fully exploited. The fi ndings from this study suggest that adolescent health would benefi t from increased public health attention.
|Gutierrez JP, Bertozzi SM, Conde-Glez CJ, and Sanchez-Aleman MA. (2006) Risk behaviors of 15 to 21 year olds in Mexico lead to a high prevalence of sexually transmitted infections: result of a survey in disadvantaged urban areas. BMC Public Health. 6:49
|Background: Due to the fact that adolescents are more likely to participate in high-risk behaviors, this sector of the population is particularly vulnerable to contracting sexually transmitted infections (STIs) and resultant health problems. Methods: A survey was carried out among adolescents from poor homes in 204 small-urban areas of Mexico. Information was collected in relation to risk behaviors and socio-economic environment. A sub-group of the participants also provided blood and urine samples which were analyzed to detect sexually transmitted infections. Results: The presence of Chlamydia was detected in nearly 8% of participants who had stated that they were sexually active (18%) and approximately 12% were positive for herpes type 2-specific antibodies. For both, a greater proportion of girls resulted positive compared to boys. The presence of these biological outcomes of sexual risk behavior was associated with other risk behaviors (smoking), but not with self-reported indicators of protected sex (reported use of condom during most recent sexual activity). Conclusion: The results presented in this study show a startlingly high prevalence of HSV-2 among sexually active Mexican adolescents in poor urban areas, suggesting that this group has participated to a great extent in risky sexual practices. The relationships between socioeconomic environment and adolescent risk behavior need to be better understood if we are to design preventive interventions that modify the determinants of risk behaviors.
|HIV and other STIs
|Gupta N, Katende C, and Bessinger R. (2003) Association of mass media exposure with family planning attitudes and practices in Uganda. Studies in Family Planning, 34(1):19-31
|This paper examined the influences of multi-media Behavior Change Communication campaigns on women's and men's use of and intentions to use contraception in target areas of Uganda. Data were primarily drawn from the 1997 and 1999 Delivery of Improved Services for Health evaluation surveys, which collected information from representative samples of women and men of reproductive age in the districts served by the DISH project. Additional time-trend analyses relied on data from the 1995 Demographic and Health Survey. Logistic regressions were used to assess the associations between BCC exposure and family planning attitudes and practices, controlling for individuals' background characteristics. To minimize the biases of self-reported exposure, the analyses also considered cluster-level indices of the penetration of BCC messages in the community. Results indicated that exposure to BCC messages was associated with higher contraceptive intentions and use. While there was some evidence of bias of self-report, the pathways to behavior change appeared different for women and men.
|Hallman K. (2004). Socio-economic disadvantage and unsafe sexual behaviors in young women and men in South Africa. Policy Research Division Working Paper, No, 190 ,Population Council
|Recent evidence suggests that the burden of new HIV infections in developing countries is concentrated among young people and females. Even with knowledge of how to protect oneself from infection, such information may not always be usable in daily situations of economic and social disadvantage that characterize the lives of many young people and women in poor countries. Using household survey data collected in 2001, this study investigates how relative socioeconomic status influences the sexual behaviors of young women and men aged 14-24 years in KwaZulu-Natal Province, South Africa -- an environment characterized by high HIV prevalence and high rates of poverty and inequality. Relative economic disadvantage is found to significantly increase the likelihood of a variety of unsafe sexual behaviors and experiences. Low socioeconomic status not only increases female odds of exchanging sex for money or goods, it also raises female chances of experiencing coerced sex, and male and female odds of having multiple sexual partners in the year before the survey; it lowers female chances of secondary abstinence in the year before the survey, female and male age at sexual debut, condom use at last sex, and communication with most recent sexual partner about sensitive topics. Low socioeconomic status has more consistent negative effects on female than on male sexual behaviors; it also raises female risk of early pregnancy. Controlling for wealth and other factors, orphanhood confers added risk for unsafe sexual behaviors. Poorer young people, especially females, also have access to significantly fewer media sources for family planning information. Without sufficient attention in the design and placement of HIV prevention programs to the economic and social conditions in which individuals live, the potential effectiveness of the global response to HIV/AIDS is sacrificed
|Halpern TC, Mitchel I EM, Farhat T, and Bradsley P. (2008) Effectiveness of web-based education on Kenyan and Brazilian adolescents' knowledge about HIV/AIDS, abortion law and emergency contraception. Social Science & Medicine, 67:628-637
|Little evidence is available about the utility of web-based health education for students in low resource settings. This paper reports results from an evaluation of the TeenWeb project, a multi-year, web-based health education intervention implemented in two urban settings: Nairobi, Kenya (N = 1178 school students) and Rio de Janeiro, Brazil (N = 714 school students). A quasi-experimental, school-based pre-test/post-test design was implemented at each study site to determine if easy access to web-based reproductive health information, combined with intellectual “priming” about reproductive health topics, would result in improved knowledge and attitudes about topics such as condom use, access to HIV testing, emergency contraception and abortion laws. Students in web-access schools completed one web-based module approximately every 6–8 weeks, and in return, had access to the Internet for at least 30 min after completing each module. Although students were encouraged to access project-supplied web-based health information, freedom of web navigation was an incentive, so they could choose to access other Internet content instead. Most measures showed statistically significant differences between students in “web” and “comparison” conditions at post-test, but only about half of the differences were in the hypothesized direction. Results of an embedded experiment employing more directed feedback tripled the likelihood of correctly reporting the duration of emergency contraception effectiveness. Review of URL logs suggests that the modest results were due to inadequate exposure to educational materials. Future intervention should focus on teen's purposeful searching for health information when they are in personal circumstances of unmet health needs.
|House DL,Bates J, Markham CM,Lesesn C. (2010) Competence as a predictor of sexual and reproductive health outcomes for youth: a systematic review. Journal of Adolescent Health, (46): S7-S22
|To examine the association between ‘‘competence’’ and adolescent sexual and reproductive health (ASRH) outcomes. Competence refers to the development of skills to perform tasks successfully in four areas including social and behavioral, cognitive, emotional, and moral competence. We conducted a systematic review of research published from 1985 through 2007. Inclusion criteria included use of multivariate analyses, a sample size of 100, publication in a peer-reviewed journal, and measurement of an ASRH outcome. We coded findings as protective, risk, or no association and as longitudinal or cross-sectional. We considered the presence of two longitudinal studies with consistent findings for at least one outcome to be sufficient evidence for a risk or protective association. We identified 77 studies that examined cognitive competence, 27 studies that examined social and behavioral competence, 12 studies that examined emotional competence, and no studies that met inclusion criteria for moral competence. The evidence indicated that cognitive competence and social and behavioral competence can be protective factors for ASRH, with findings from at least two longitudinal studies demonstrating a protective association with an ASRH outcome. Findings across cognitive, social and behavioral subconstructs and ASRH outcomes were more mixed. There was insufficient evidence to draw conclusions about emotional and moral competence and ASRH. Helping adolescents to achieve cognitive, social, and behavioral competence may reduce the likelihood of sexual activity and teen pregnancy, and increase contraceptive use. Additional research is needed to examine other outcomes and the generalizability of findings.
|Hutchinson K, Kahwa E, Waldron N, Hepburn Brown C, Hamilton Pl,Hewit HH,Aiken J, Cederbaum J, Alter E, and Jemmott LS. (2012) Jamaican mothers' influence of adolescent girls' sexual beliefs and behaviors. Journal of Nursing Scholarship, 44(1):27-35
|Purpose: The purpose of this study was to identify the ways in which urban Jamaican mothers influence their adolescent daughters’ sexual beliefs and behaviors in order to incorporate them into the design of a family-based human immunodeficiency virus (HIV) risk reduction intervention program. Design: Focus groups were conducted with 46 14- to 18-year-old adolescent girls and 30 mothers or female guardians of adolescent girls recruited from community-based organizations in and around Kingston and St. Andrew, Jamaica. Separate focus groups were held with mothers and daughters; each included 6 to 10 participants. Focus group sessions were scripted, led by teams that included trained Jamaican and American facilitators and note-takers, and audio-taped to ensure data accuracy. Data were analyzed using qualitative content analysis. Findings: Four major maternal influences were identified: mother-daughter relationship quality, mother-daughter sexual communication, monitoring or supervision, and maternal sexual role modeling. Mothers’ and daughters’ reports were consistent; both groups identified positive and negative influences within each category. Conclusions: Some maternal influences were positive and health promoting; others were negative and promoted unsafe sexual activity and risk for HIV and other sexually transmitted infections. These influences were incorporated into the design of a culture-specific family-based HIV risk reduction intervention tailored to the needs of urban Jamaican adolescent girls and their mothers. Clinical Relevance: In order to be effective, family-based HIV risk reduction interventions should be theory based and tailored to the target audience. The four maternal influences identified in this formative study were incorporated into the subsequent intervention design.
|In Focus. Emergency Contraceptive Pills: An Important Option for Young Adults. Pathfinder International. http://www2.pathfinder.org/pf/pubs/focus/IN%20FOCUS/emcon%20final.htmlI. accessed 22 February 2014
|Because emergency contraception (EC) used within 72 hours of unprotected sexual intercourse (USI) can prevent unintended pregnancy, it is an important option for women under age 24 who are most likely to have an unplanned pregnancy. EC is a special regimen that involves ingestion of increased doses of regular oral contraceptive pills. EC reduces the risk of pregnancy by 75% and causes only temporary side effects, such as nausea and vomiting. EC can stop or delay ovulation, may prevent fertilization, or may prevent implantation, but it cannot cause abortion and will have no harmful effect on a pregnant woman or fetus. EC provides youth with an important safety net and an introduction to sustained reproductive health care. However, EC does not protect against sexually transmitted diseases and is only effective if initiated within 72 hours of USI. Experience with EC has been limited in some countries, but others market specially packaged oral contraceptives. The barriers to increased provision of EC include lack of awareness about the method on the part of clients and service providers, confusion between EC and abortion, and hesitancy to promote EC in lieu of condom use. Family planning programs in Nigeria, Kenya, and Mexico are working to increase availability through pilot projects involving information and service provision.
|Jaya J and Hindin MJ. (2009). Premarital romantic partnerships: attitudes and sexual experiences of youth in Delhi, India. International Perspectives on Sexual and Reproductive Health, 35(2):97-104
|CONTEXT: Despite restrictive social norms, there is increasing evidence that youth in India engage in premarital romantic and sexual partnerships. However, information on how they initiate and build these relationships is scarce, even though it is vital for addressing the needs of young people. METHODS: Attitudes toward and behavior within romantic partnerships were examined using data collected in 2004 from unmarried youth (583 males and 475 females, aged 15–19) living in economically disadvantaged neighborhoods in Delhi, India. Associations between specific attitudes or behaviors and age, gender and sexual experience were determined using Fisher's exact tests. RESULTS: Sixty-two percent of males and 53% of females reported that someone of the opposite sex had expressed an interest in them; 86% of males and 63% of females reported feeling good about it. In addition, 67% of males and 47% of females reported that they liked someone from the opposite sex. Compared with females, males were more likely to seek information about the person they were interested in (76% vs. 61%), and to engage in heterosexual premarital sex (32% vs. 6%). Females were less likely than males to report that it is okay to engage in premarital sex if the male and female love one another (14% vs. 33%). For both males and females, television and films were the most popular source of information on issues related to sexual health. CONCLUSIONS: Gender disparities in premarital romantic partnership formation and the experience of sexual relations make a strong case for sexuality education programs tailored to the different experiences and circumstances of young men and women.
|Jemmott JB3rd, Jemmott LS, O'Leary A, Ngwane Z, Icard LD, Bellamy SL, Jones SF, Landis JR, Heeren GA,Tyler JC, and Makiwane MB. (2010) School-based randomized controlled trial of an HIV/STD intervention for South African adolescents. Archives of Pediatric and Adolescent Medicine, 164(10)923-929
|HIV and other STIs
|Jewkes R, Nduna M, Levin J,Jama N, Dunkle K,Khuzwayo N,Koss M, Puren A, Wood K, and Duvury N.(2006) A cluster randomized-controlled trial to determine the effectiveness of Stepping Stones in preventing HIV infections and promoting safer sexual health behavior amongst youth in the rural Eastern Cape, South Africa: trial design, methods and baseline findings. Tropical Medicine and International Health, Vol. 11, No. 1:3-16
|Objective: To describe the study design, methods and baseline findings of a behavioural intervention trial aimed at reducing HIV incidence. Method: A cluster randomized-controlled trial (RCT) conducted in 70 villages in rural South Africa. A behavioural intervention, Stepping Stones, was implemented in 35 communities in two workshops of 20 men and 20 women in each community who met for 17 sessions (50 h) over a period of 3–12 weeks. Individuals in the control arm communities attended a single session of about 3 h on HIV and safer sex. Impact assessment was conducted through two questionnaire and serological surveys at 12-month intervals. The primary outcome was HIV incidence and secondary measures included changes in knowledge, attitude and sexual behaviours. Qualitative research was also undertaken with 10 men and 10 women from two sites receiving the intervention (one rural and one urban) and five men and five women from one village in the control arm. They were interviewed individually three times prior to the workshops and then 9–12 months later. Results: A total of 2776 participants (1409 intervention and 1367 control) were enrolled at baseline and had an interview, and HIV sero-status was established. HIV baseline prevalence rates in women were 9.8% in the intervention arm and 12.8% in the control arm. In men the prevalence was 1.7% in the intervention arm and 2.1% in the control arm. Demographic and behavioural characteristics were similar in the two arms. In the intervention groups 59.9% of participants attended more than 75% of the sessions. In the control group 66.3% attended the control session. Conclusion: This is the third RCT to be conducted in sub-Saharan Africa evaluating a behavioural intervention using HIV incidence as a primary outcome. It is of particular interest as the intervention in question is used in many developing countries. There is good baseline comparability between the study arms and the process data on the workshops suggested that the interventions were feasible and adequately implemented.
|HIV and other STIs
|Jones RK and Biddlecom RA. (2011) The more things change: the relative importance of the Internet as a source of contraceptive information for teen. Sexuality Research and Social Policy, 8:27-37
|Most teens have regular access to the internet, and there is some expectation that the internet is helping to fill the sexual health information gap. We conducted in-depth interviews with a racially and ethnically diverse sample of 58 high school students to find out where they obtained information about contraception. A substantial minority had been exposed to online contraceptive information, but most did not consider it a main source. A majority had been exposed to this information from school, family, friends, and traditional media. Most teens were wary, or even distrustful, of online sexual health information, whereas school, family and, to a lesser extent, friends, were generally trusted. Our findings suggest that the internet is not filling the sexual health information gap for a number of teens, but we identify strategies that could increase teens awareness of, and trust in, information from this source.
|Juarez F and Castro Martin T. (2006) Safe sex versus save love? Relationship context and condom use among male adolescents in the favelas of Recife, Brazil. Archives of Sexual Behavior, 35(1):25-35
|This study examined the influence of the relationship context where adolescent sexual activity takes place on contraceptive decisions. The data were collected in a specially designed survey carried out in May 2000 on 1,438 adolescent males aged 13–19 residing in favelas (urban slum areas) of Recife, Brazil. A logistic regression analysis of condom use at last sexual intercourse and a multinomial logit analysis of contraceptive method choice were performed for 678 sexually active adolescents. Educational attainment, degree of knowledge of HIV transmission and prevention, and condom use at first sexual intercourse were found to be significantly associated with current condom use. Regarding the relationship context, the analysis revealed that adolescent males in steady relationships were less likely to use condoms, less likely to regard themselves at risk of HIV infection, and more concerned about pregnancy prevention than adolescents in casual relationships. Differentials in condom use by type of relationship, however, did not result from a higher rejection of contraception by steady partners but from their higher likelihood to rely on other contraceptive methods. Results suggest that prevention campaigns need to take into account the intimate context where adolescents assess potential health risks, and to address the divergent symbolic meanings condoms may have in different types of relationships. If an increase of condom use among stable sexual partners is pursued, public health campaigns might need to romanticize condom use as a sign of love and trust and place more emphasis on the benefits of dual protection.
|Juarez F and LeGrand T. (2005) Factors influencing boys' age and first intercourse and condom use in the shanty towns of Recife, Brazil. Studies in Family Planning, 36(1):57-70
|Despite the general recognition that the sexual practices of adolescent boys place them at high risk of acquiring sexually transmitted infections (STIs), including HIV, and of causing unwanted pregnancies, advances in mapping their sexual behaviors have been slow. This study uses data recently collected from low-income areas of the city of Recife, Brazil, to study boys’ age at first sexual intercourse and factors that hinder their use of condoms. These boys become sexually active at early ages, and despite their general awareness of HIV, they rarely use condoms, especially at ages younger than 15. Sustained family involvement in guiding boys is associated with later first intercourse and an increased use of condoms. Boys who describe themselves as shy with girls have later first intercourse, although the probability of their using condoms does not differ from that of other boys of their age. Higher socioeconomic tatus leads to earlier sexual activity for boys (in contrast with girls), but also to a greater likelihood of using condoms during first intercourse.
|Kabiru CW, Beguy D, Crichton J, and Zulu EM. (2011) HIV/AIDS among youth in urban informal (slum) settlements in Kenya: what are the correlates of and motivations for HIV testing. BMC Public Health, 11:685
|Background: Although HIV counseling and testing (HCT) is widely considered an integral component of HIV prevention and treatment strategies, few studies have examined HCT behavior among youth in sub-Saharan Africa-a group at substantial risk for HIV infection. In this paper we examine: the correlates of HIV testing, including whether associations differ based on the context under which a person gets tested; and the motivations for getting (or not getting) an HIV test. Methods: Drawing on data collected in 2007 from 4028 (51% male) youth (12-22 years) living in Korogocho and Viwandani slum settlements in Nairobi (Kenya), we explored the correlates of and motivations for HIV testing using the Health Belief Model (HBM) as a theoretical framework. Multinomial and binary logistic regression analyses were employed to examine correlates of HIV testing. Bivariate analyses were employed to assess reasons for or against testing. Results: Nineteen percent of males and 35% of females had been tested. Among tested youth, 74% of males and 43% of females had requested for their most recent HIV test while 7% of males and 32% of females reported that they were required to take their most recent HIV test (i.e., the test was mandatory). About 60% of females who had ever had sex received an HIV test because they were pregnant. We found modest support for the HBM in explaining variation in testing behavior. In particular, we found that perceived risk for HIV infection may drive HIV testing among youth. For example, about half of youth who had ever had sex but had never been tested reported that they had not been tested because they were not at risk. Conclusions: Targeted interventions to help young people correctly assess their level of risk and to increase awareness of the potential value of HIV testing may help enhance uptake of testing services. Given the relative success of Prevention of Mother-to-Child Transmission (PMTCT) services in increasing HIV testing rates among females, routine provider-initiated testing and counseling among all clients visiting medical facilities may provide an important avenue to increase HIV status awareness among the general population and especially among males.
|HIV and other STIs
|Katz I.(2007) Explaining the Increase of Condom Use Among South African Young Females. Journal of Health Communication, 11(8):737-753
|Since 1998 South Africa has experienced stability in HIV prevalence among its 15 to 19 year olds, and to a lesser extent among its 20 to 24 year olds. While a few studies point to behavioural change, mainly an increase in condom use, none has established the reasons. This article explores the influence of various information sources about AIDS upon the use of condoms among rural and urban South African young females, using the South Africa Demographic Health Survey of 1998 (1998 SADHS), while controlling for various socioeconomic and cultural parameters.The results show that condom use among urban residents was positively correlated with mass media exposure, television as a source of information about AIDS, and the number of mass media sources from which the respondent received information about AIDS. Condom use among rural residents was associated with the number of sources of information about AIDS, exposure to mass media, and the language and education of the respondent. Among urban residents condom use was almost twice as high as among rural residents. The results from the article indicate that three elements influenced the increase in condom use among females: the threat of AIDS, mass media, and receptiveness to condom use. The receptiveness was culturally dependent.
|Karim AM, Magnani RJ, Morgan GT, and Bond KC. (2003) Reproductive health risk and protective factors among unmarried youth in Ghana. International Family Planning Perspectives, 29(1): 14-24
|CONTEXT: In Ghana, as in many other Sub-Saharan African countries, the behaviors of the current cohort of adolescents will strongly influence the course of the HIV/AIDS epidemic. This study sought to identify factors associated with elevated risks of pregnancy and sexually transmitted infection among unmarried Ghanaian youth. METHODS: A nationally representative sample of 3,739 unmarried 12–24-year-olds were surveyed. Various regression techniques were used to assess the effects of individual and contextual factors on sexual behavior and condom use. RESULTS: Forty-one percent of female and 36% of male youth reported being sexually experienced. On average, sexually experienced youth had had fewer than two partners; only 4% of these females and 11% of males had had more than one sexual partner in the three months before the survey. Although Ghanaian youth are knowledgeable about condoms, only 24% of sexually experienced males and 20% of females reported consistent condom use with their current or most recent partner. A sizable number of contextual factors and attributes of youth themselves were associated with sexual behaviors, while individual characteristics were stronger predictors of condom use. CONCLUSIONS: The findings provide further justification for interventions targeting key contextual factors that influence youth behaviors in addition to providing youth with necessary communication, negotiation and other life skills.
|Kaufman CE, Clark S, Manzini N, May J. (2004) Communities, opportunities and adolescents' sexual behavior in KwaZulu-Natal, South Africa. Studies in Family Planning, 35(4):261-274
|In 2002, the prevalence of HIV among South African clinic attendees under the age of 20 was 15 percent, suggesting a correspondingly high level of unprotected sex and risky sexual behavior. Past research focused on the dynamics of individuals’ and partners’ sexual decisionmaking without accounting for the larger context in which such decisions are made. Do adolescents’ opportunities for schooling, work, and other community activities make a difference? This study uses data collected from a representative sample of young people living in KwaZulu-Natal, South Africa, to explore these questions. Logit analyses show that for girls, higher levels of education reduced the probability of having had sex in the 12 months prior to the survey, and average wages were positively associated with condom use. Greater participation in community sports increased risk-taking behaviors among boys but decreased them among girls. Within the household, education of adults had a positive effect on condom use for both boys and girls.
|Khan M,Brown L, Nagot N, Salouka S, and Weir SS. (2006) HIV-related sexual behavior in urban, rural and border areas of Burkina Faso. AIDS Behavior, 10:607-617
|The article discuses the differences in HIV-related sexual behavior among urban, rural and border areas of Burkina Faso, depicting the Priorities for Local AIDS Control Efforts (PLACE) method implemented by the Burkina Faso National AIDS Control Program (CNLS). Detailed notes on the PLACE method, implemented in the Banfora and the Tenkodogo health districts, and the results are presented to highlight the sexual partnerships and condom usage in the community.
|HIV and other STIs
|Kim CR and Free C. (2008) Recent evaluations of peer-led approach in adolescent sexual health education: a systematic review. International Family Planning Perspectives, 34(2):89- 96
|CONTEXT: Peer-led interventions have become a popular method of providing sexua lhealth education to adolescents, but the efficacy of this approach and the methodological quality of recent trials have not been systematically reviewed. METHODS: Electronic and hand searches were conducted to identify quasi-randomized and randomized controlled trials of peer-led adolescent sexual health education published from 1998 to 2005. Studies were eligible if they had an appropriate comparison group, provided preintervention and postintervention data, and reported all outcomes. Study results were summarized and, where appropriate, pooled; in addition, I0 aspects of studies' methodological quality were assessed RESULTS: Thirteen articles met the inclusion criteria. Pooled, adjusted results from seven trials that examined the effects of peer-led interventions on condom use at last sex found no overall benefit (odds ratio, 1.0). None of the three trials that assessed consistent condom use found a benefit. One study reported a reduced risk of chlamydia (0.2), but another found no impacton STD incidence. One study found that young women (but not young men) who received peer-led education were more likely than nonrecipients to have never had sex. Most interventions produced improvements in knowledge, attitudes and intentions. Only three studies fulfilled all 10 of the assessed quality criteria; two others metnine criteria. CONCLUSIONS: Despite promising results in some trials, overall findings do not provide convincing evidence that peer-led education improves sexual outcomes among adolescents. Future trials should build on the successful trials conducted to date and should strive to fulfill existing quality criteria.
|Kinsler J, Sneed CD,Morisky DE, and Ang A. (2004) Evaluation of a school-based intervention for HIV/AIDS prevention among Belizean adolescents .Health Research Education, 19(6):730-738
|The purpose of this study was to evaluate the impact of a cognitive-behavioral peer-facilitated school-based HIV/AIDS education program on knowledge, attitudes and behavior among primary and secondary students in Belize. Students (N = 150) were recruited from six schools in Belize City. A quasi-experimental research design was used to assess the impact of a 3-month intervention. Seventy-five students received the intervention and 75 students served as controls. The intervention was guided by constructs from the Theory of Reasoned Action and Social Cognitive Theory. At the follow-up assessment, the intervention group showed higher HIV knowledge, were more likely to report condom use, had more positive attitudes toward condoms and were more likely to report future intentions to use condoms than the students in the control group. Overall, the findings indicate that the intervention had a positive impact on participants. Given the increasing rate of HIV/AIDS in Belize, especially among adolescents, this study has important implications for the country of Belize.
|HIV and other STIs
|Kumi-Kyereme A, Awusabo-Asare K,Biddlecom AE, Tanle A. (2007) Influence of social connectedness, communication and monitoring on adolescent sexual activity in Ghana. African Journal of Reproductive Health, 11(3):133-149
|This paper examines connectedness to, communication with and monitoring of unmarried adolescents in Ghana by parents, other adults, friends and key social institutions and the roles these groups play with respect to adolescent sexual activity. The paper draws on 2004 nationally-representative survey data and qualitative evidence from focus group discussions and in-depth interviews with adolescents in 2003. Adolescents show high levels of connectedness to family, adults, friends, school and religious groups. High levels of adult monitoring are also observed, but communication with family about sex-related matters was not as high as with non-family members. The qualitative data highlight gender differences in communication. Multivariate analysis of survey data shows a strong negative relationship between parental monitoring and recent sexual activity for males and females, and limited effects of communication. Creating a supportive environment and showing interest in the welfare of adolescents appear to promote positive sexual and reproductive health outcomes.
|Lou C,Zhao Q, Gao ES,and Shah I. (2006) Can the Internet be an effective way to conduct sex education for young People in China? Journal of Adolescent Health, 39:720-728
|Objective: To promote adolescents and young people to learn sex related knowledge on Internet, and evaluate the effectiveness of sex education conducted. Methods: This was an Internet-based intervention study of sex and reproductive health education. Two high schools and four colleges of a university in Shanghai were selected as the research sites. One high school and two colleges were chosen as the intervention group, the other school and two colleges as the control group. The intervention lasted 10 months (March 2003 through December 2003) and the education was provided through the website (www.youthhood.com.cn) on Internet, with web pages, online educational videos, Bulletin Board System (BBS) and expert mailbox. The website offered sexual and reproductive health knowledge/information (including sexual physiology and psychology, sexual morals, interpersonal relationship, love and marriage, STDs/HIV/AIDS, reproduction and contraception, premarital sex and pregnancy, induced abortion, sexual harassment, smoking and drug use etc.), service information, counseling and discussion on sex-related issues for all grade one students in the intervention group. Only subjects in the intervention group, who were provided private usernames and passwords, could browse the website. No special sexual education was given to the students in the control group. Baseline survey was conducted in both groups prior to the implementation of the intervention, then similar survey was conducted in both groups after the intervention. Totally, 624 students from the intervention school/colleges, and 713 from the control school/colleges enrolled, and about 97.2% of these were re-interviewed at follow-up. The impact of the intervention was evaluated by comparing the changes of students’ sex and reproductive health knowledge, attitudes and behaviors between the baseline and post-intervention surveys and between the intervention and control groups. Survey data were entered with EpiInfo 6.04 and analyzed with SAS 8.01. Findings: Baseline survey showed that 90.0% of subjects ever surfed Internet and two thirds (67.8%) thought it was a good way to carry out sex education on Internet. More than 80% of subjects reported that they benefited from the web site and about half reported the website promoted them to pay attention to reproductive health knowledge or learn the knowledge from other sources at post-intervention survey. At baseline, the median scores of reproductive health knowledge in the intervention and control groups were about 50.0 and no significant differences were found between two groups (p>0.05). After intervention, the score in the intervention group increased to 63.4, and it was significantly higher than that in the control group (55.1). In terms of each type of knowledge (reproduction, contraception, condom, STDs and HIV/AIDS), all of 5 types’ scores in the intervention group were significantly higher than those in the control group at post-intervention (p<0.0001) while no significant differences were observed between them at baseline p>0.05). Group×time interaction effects were found in ordinal logistic regression analysis on knowledge scores (p<0.001),indicating the intervention increased subjects’ knowledge significantly. After classified by type of subjects, group×time interaction effect on attitude towards sex-related issues was found among high school students (OR=0.628, 95%CI:0.398-0.991), suggesting the intervention might change the attitude of high school students and make their attitude towards sex more conservative. Results also showed that the intervention had positive influence on young people’s attitude towards providing contraceptive service for the unmarried. However, no differences of sex-related behaviors were observed between two groups both at baseline and post-intervention surveys in this study. Conclusions: Providing sex education through Internet was highly feasible. Internet –based sex education program increased students’ reproductive health knowledge effectively, and made high school students’ attitude towards sex more positive.
|Lou C, Cheng Y, Gao E, Zuo X, Emerson M, and Zabin LS. (2012) Media's contribution to sexual knowledge, attitudes and behaviors for adolescents and young adults in three Asian cities. Journal of Adolescent Health, SO:S26-S36
|Purpose: Evidence in western countries indicates that the media have associations with adolescents' and young people's sexual behavior that may be as important as family, school, and peers. In this new study of Asian adolescents and young adults in the three cities of Hanoi, Shanghai, and Taipei, the associations between exposure to sexual content in the media and adolescents' and young adults' sex-related knowledge, attitudes, and behaviors are explored in societies with traditional Confucian culture, but at different stages in the process of modernization. Methods: The data are from a questionnaire-based cross-sectional study conducted from 2006 to 2007, where a sample of 17,016 adolescents and young adults aged 15–24 years from Shanghai, Hanoi, and Taipei completed face-to-face interviews coupled with computer-assisted self-interviews for sensitive questions. For the objectives of this article, analysis was restricted to the 16,554 unmarried respondents. Exposure to sexual content in the mass media (including the Internet and traditional media), pornographic videos, and a preference for western/Asian movies/videos were the main media influence measures. Sex-related knowledge, premarital sexual permissiveness (PSP), and sex-related behaviors were the main outcome measures. The impact of each of four contexts including family, peer, school, and media on sex-related knowledge, attitudes, and behaviors were assessed using multiple linear regression stratified by gender and city, controlling for age, urban/rural residence, education, and economic status. The change in adjusted R2 from the multiple linear regression analysis was adopted to indicate the contribution of family, peer, school, and media variables to respondents' sex-related knowledge, attitudes, and behaviors. Results: The contextual factors, including family, peer, school, and media, explained 30%–50% of the variance in sex-related knowledge, 8%–22% of the variance in PSP, and 32%–41% of the variance in sex-related behaviors. Media variables explained 13%–24% of the variance in sexual knowledge, 3%–13% in PSP, and 3%–13% in sex-related behaviors, which was comparable with that of family, peer, and school variables. These associations differed by city and gender. Conclusions: Access to and use of mass media and the messages they present are influential factors on sex-related knowledge, attitudes, and behaviors of unmarried Asian adolescents and young adults, and should be considered in future research and intervention programs attempting to improve reproductive health outcomes.
|Loyd C. (2009) New lessons: the power of educating adolescent girls. The Population Council.
|This report offers new evidence of the dramatic, immediate returns that girls reap when they remain in school during adolescence. It is a compendium of promising, girl-friendly educational initiatives with key features of hundreds of programs, sorted by region and country. The report includes a ten-step plan to count, invest in, and advocate for adolescent girls' education.
|Mmari K and Sabherwal S. (2013) A review of risk and protective factors for adolescent sexual and reproductive health in developing countries: an update. Journal of Adolescent Health, 1-11
|Purpose: To conduct a literature review of studies that examined risk and protective factors related to adolescent sexual and reproductive health in developing countries. Methods: A literature search was conducted using multiple databases, including PubMed, PsycINFO, Scopus, JSTOR, and the Interagency Youth Working Group. Review criteria included publications that: were conducted in a low- or middle-income country; had a sample size of at least 100 young people aged 10–24 years, and used multivariate analysis. All studies that were identified were also conducted between 1990 and 2010, a 20-year time frame. The literature search and initial review yielded a total of 244 studies that met the criteria and analyzed risk and protective factors related to the following outcomes: sexual initiation, number of sexual partners, condom use, contraceptive use, pregnancy and early childbearing, human immunodeficiency virus, sexually transmitted infections, and sexual coercion. Results: Most studies that were conducted on adolescent sexual and reproductive health in developing countries were largely focused in Sub-Saharan African contexts, and primarily examined factors related to sexual initiation and condom use. Most factors that examined an adolescent sexual and reproductive health outcome were also focused on the individual level, although an increasing number of studies within the past 10 years have focused on family-level factors. Few studies examined factors at the community or neighborhood level, which, to date, has largely been ignored in developing country contexts. Conclusions: The review not only summarizes what is currently known in terms of risk and protective factors that relate to adolescent sexual and reproductive health in developing countries, but also highlights the gaps. Implications for future research are discussed.
|Mohammad K, Farahani FKA, Mohammadi RM,Alikhani S, Zare M, Tehrani FM, Ramezankhani A, Hassanzadeh A, and Ghanbari H.(2007) Sexual risk-taking behaviors among boys aged 15 to 18 in Tehran. Journal of Adolescent Health, 41:407-414
|Purpose: The purpose of this study is to evaluate the extent and potential correlates of sexual risk-taking behaviors among adolescent boys aged 15–18 in metropolitan Tehran. Methods: Data were collected from a population-based, cross-sectional survey of adolescent males (ages 15–18) residing in Tehran, Iran. Of 1385 subjects, 382 reported sexual experience (27.7%). The article is mainly considering sexually experienced subjects. Two factors were considered as sexual risk-taking behavior (“not using condom or inconsistent condom use in sexual contacts” and “ever had multiple sexual partners in lifetime.” Several other factors were considered as independent variables and their relations were assessed using t test, χ2 test, and logistic regression models. Results: Having no access to Internet, feeling regretful at sexual debut, having one sexual partner in lifetime and lower knowledge of condoms are predictors of condom non-use. Older age, using alcoholic drinks, early sexual debut, and poor knowledge of reproductive physiology are predictors of multiple sexual partners among adolescent boys aged 15–18 years. Conclusion: Appropriate interventional programs should be implemented for adolescents in Iran to encourage and enable them to delay first sex and abstain unwanted and unplanned penetrative sex, to stress the health risks of alcohol use in terms of sexual health and finally to enhance their knowledge on different aspects of reproductive health particularly prevention against STI/HIV.
|Mohammadi MR, Mohammad K, Farahani FK, Alikhani S, Zare M, Tehrani FR, Ramezankhani A, and Alaeddini F. (2006) Reproductive knowledge attitude and behavior among adolescent males in Tehran, Iran. International Family Planning Perspectives, 32(1):35-44
|Montgomery MR and Hewett PC. (2005) Urban poverty and health in developing countries: household and neighborhood effects. Demography, 42(3):397-425
|In the United States and other high-income countries, there is intense scholarly and programmatic interest in the effects of household and neighborhood living standards on health. Yet few studies of developing-country cities have explored these issues. We investigated whether the health of urban women and children in poor countries is influenced by both household and neighborhood standards of living. Using data from the urban samples of 85 Demographic and Health Surveys and modeling living standards using factor-analytic MIMIC methods, we found that the neighborhoods of relatively poor households are more heterogeneous than is often asserted. Our results indicated that poor urban households do not tend to live in uniformly poor neighborhoods: about 1 in 10 of a poor household's neighbors is relatively ajJluent, belonging to the upper quartile of the urban distribution of living standards. Do household and neighborhood living standards influence health? Using multivariate models, we found that household living standards are closely associated with three health measures: unmet need for modern contraception, attendance of a trained health care provider at childbirth, and young children's height for age. Neighborhood living standards exert a significant additional influence in many of the surveys we examined, especially for birth attendance.
|Ndugwa RP, Kabiru CW, Cleland J, Beguy D,Egondi T, Zulu EM, and Jessor R. (2010) Adolescent problem behavior in Nairobi's informal settlements: applying problem behavior theory in Sub-saharan Africa.Journal of Urban Health. 88(2):5298-5317
|Adolescent involvement in problem behaviors can compromise health, development, and successful transition to adulthood. The present study explores the appropriateness of a particular theoretical framework, Problem Behavior Theory, to account for variation in problem behavior among adolescents in informal settlements around a large, rapidly urbanizing city in sub-Saharan Africa. Data were collected from samples of never married adolescents of both sexes, aged 12–19, living in two Nairobi slum settlements (N = 1,722). Measures of the theoretical psychosocial protective and risk factor concepts provided a substantial, multi-variate, and explanatory account of adolescent problem behavior variation and demonstrated that protection can also moderate the impact of exposure to risk. Key protective and risk factors constitute targets for policies and programs to enhance the health and well-being of poor urban adolescents in sub-Saharan Africa.
|Ngo AD, Ross MW, and Ratliff EA. (2008) Internet influences in sexual practices among young people in Hanoi, Vietnam. Culture, Sex & Sexuality, 10,Suppl:S201-213
|While the influences of the Internet on adult sexuality are well recognized, research on the potential connection between the Internet and young people's sexuality is still limited. We conducted a qualitative study to examine how young people (aged 15–19 years) in Hanoi, Vietnam used the Internet to develop sexual practices and identities. Our analysis of texts from focus groups, in‐depth interviews, chat scripts and field notes reveals how the Internet is used to assemble sexual information that was not available from other sources such as the family and school. Young people's narratives also show how they use the Internet as a medium for expressing sexual identities and desires. In the light of these findings, we suggest expanding sex education to include issues that are important to young people such as emotions and relationships, rather than simply focusing more narrowly on reproduction, public health and other interests of the state.
|Ngom P, Magadi MA, and Owor T. (2003) Parental presence and adolescent reproductive health among the Nairobi urban poor. Journal of Adolescent Health, 33:369-377
|Purpose: To investigate whether the presence of parents constitute a protective factor against adverse reproductive health outcomes for adolescents living in slums of Nairobi, Kenya. Methods: The data come from a cross-sectional survey that canvassed a random sample of 4564 households representative of all Nairobi slums in February–June 2000. Structured questionnaires on household census, reproduction and adolescent health were verbally administered to household heads, women of reproductive ages, and adolescents, respectively. We restrict the analysis to a sub-sample of 788 never-married adolescent girls aged 12–19 years. We compare reproductive health outcomes of adolescents who live with neither parent, father only, mother only, and both parents. Data were analyzed using simple descriptive analysis and logistic regression models of three outcome variables: ever sexually active, ever experienced an unplanned pregnancy, and sexually active within the past 4 weeks. For each of the outcome variables, two models, one with and one without a proxy for adolescents' disorderly behavior are presented to establish whether parental presence affects adolescents' reproductive health. Results: When the father is present in the household (i.e., father only or both parents present), adolescent girls are 42% less likely to have ever had sex (p < .05), 45% less likely to have been sexually active in the most recent 4-week period (p < 0.1), and 59% less likely to have ever experienced an unwanted pregnancy (p < .05) than when neither parent, or only the mother, is present in the household. Conclusions: In the slums of Nairobi, father's presence, unlike that of the mother, is associated with stronger resilience among adolescents. When programming for adolescents in these resource-constrained settings, it is important, therefore, to involve parents.
|Nutbeam D and Harris E (2002) Theory in a nutshell: a guide to health promotion theory. Roseville,Australia: McGraw-Hill Book Company
|The use of theory in the planning and implementation of health promotion programs will more reliably produce positive outcomes. Following on from the success of the second edition, 'Theory in a Nutshell 3' explores the main theoretical concepts and models in health promotion and explains the significance, practical application and impact of different theories on the individual, community and organisation. This edition includes concise reviews of established theories, such as social cognitive theory and health belief model, as well as expanding on new developments in the field including evidence-based policy making and health impact assessment. Thoroughly revised and updated, the book maintains the accessible style suitable for public health practitioners, health promotion and health education specialists, epidemiologists and social policy makers, as well as students of public health and health promotion.
|O'Higgins N. (2001) Youth unemployment and employment policy: a global perspective. Geneva, ILO
|This study discusses in depth the youth unemployment "problem" and examines the various policy responses to it, including education and training, and active labour market policy. It emphasizes the need for adequate labour market information, policy monitoring and programme evaluation to help provide more and better-quality jobs for young people - while also offering specific recommendations and guidelines for this age group in industrialized, transition and developing countries, While analysing the characteristics, causes and consequences of youth unemployment, the study explores the nature of the youth labour market and how it differs from the labour market for other workers. It looks at minimum wages, as well as the pivotal role of education and training systems. It also identifies vital ILO instruments concerned with young people and examines the broader international policy challenges faced by many countries around the world. In particular, it discusses the failure of many countries to integrate young people into good, quality employment. Active labour market policies, both successful and unsuccessful, are evaluated, and the book looks closely at policies promoting wage employment, self-employment and programmes aimed at disadvantaged young people. The book reveals how youth unemployment is first and foremost a consequence of poor macroeconomic performance and suggests ways in which countries can formulate coordinated youth employment policies according to the state of their economies. In contrast to prevalent approaches in the literature, it emphasizes the need to go beyond a purely supply-side response. The study includes strategies for involving governments, as well as employers' and workers' organizations, in tackling youth unemployment and providing alternatives.
|Prastertsawat P and Petchum S. (2004) Sexual behavior of secondary school students in Bangkok metropolis. Journal of the Medical Association of Thailand. 87(7):755-89
|Objective : To explore sexual behavior in terms of masturbation, homosexual contact and coitus in secondary school students in Bangkok. Material and Method : This was a cross-sectional survey research from December, 2002 to January, 2003. 362 students were selected by the multistages simple random sampling technique. A self administered questionnaire was used to collect data on baseline characteristics and sexual behavior of the students. Results : 197 male and 165 female students were enrolled in the present study. The mean age was 16.5 years, and 65.7 percent of the students were exposed to sexually explicit contents via the internet. 58.0 percent of the students used the internet for pornographic viewing. According to the sexual behavior of the students, 79.2 percent of the males and 9.1 percent of the females had experience in masturbation (p < 0.05). The male had a slightly higher in homosexual contact than the females (10.2% vs 9.1%) but coital experience of the males was markedly significance higher than the females (25.4% vs 7.9%) (P < 0.05). Conclusion : It was concluded that sexual behavior in the internet era; males had more experience in all these categories than females. Sexual education via the internet should be improved in order to make adolescents understand appropriate sexual behavior and practice safer sex.
|Ozumba BC, Obi SN, and ljioma NN. (2005) Knowledge, attitude and practice of modern contraception among single women in a rural and urban community in southeast Nigeria. Journal of Obstetrics and Gynecology, 25(3):292-295
|The contraceptive information and services offered to single women in most developing countries is compromised by stigma attached to premarital sex. This study was to ascertain the knowledge, attitude and practice of contraception among single women in a rural and urban community in southeast Nigeria, using a cross-sectional survey of 279 and 295 single women in Ngwo (rural) and Enugu (urban) community. The mean age of the population was 21.3 years. Contraceptive awareness was more among the urban than rural respondents (90.2% vs 34.1%). The major sources of contraceptive knowledge were mass media (68%) and peer groups (86.3%) for the urban and rural respondents, respectively. Most respondents in both groups had positive attitude towards contraception. More urban than rural respondents (68.3% vs 12.5%) began sexual activity during adolescence and the level of contraceptive use during first coitus were 48.4% and 13.7%, respectively. Of the currently sexually active respondents, 32.5% (rural) and 59.7% (urban) were using a form of modern contraception. Condoms, followed by oral pills were the most popular contraceptive method because they can easily procure them over the counter. Poor contraceptive information, highly critical behavior of family planning providers towards unmarried women seeking contraception and attitude of male partners militate against contraceptive practice. There is need to promote information and education on contraception among single women, their male partners and family planning providers.
|Peres CA, Rutherford G, Borges G, Galano E, Hudes ES, Hearst N. (2008) Family structure and adolescent sexual behavior in a poor area of Sao Paulo, Brazil. Journal of Adolescent Health, 42:177-183
|Purpose: In Brazil, as elsewhere, behavior during adolescence can place young people at risk for serious medical and social problems, including sexually transmitted infections, unintended pregnancy, drugs, crime, and violence. Few studies internationally have examined the influence of family structure on risk behavior among low-income youths. Methods: This cross-sectional study included 296 young people in one of the poorest areas of São Paulo who were recruited through a vocational school and completed an anonymous, self-administered questionnaire. We examined associations between family structure and various risk behaviors. Results: Ages ranged from 13–24 years (82%, 15–18); 67% were of Afro-Brazilian ancestry, and 56% were female. Median family monthly income was about US$200. Less than half lived with both parents, and 14% lived with neither parent. Rates of many risk behaviors, including involvement in crime and violence, drug and alcohol use, and sexual risk, were lowest among those living with both parents, higher among those living with one parent, and highest among those living with neither parent. For example, 26% of females living with both parents, 37% with one parent, and 71% with neither parent were sexually active (p = .003). Family structure and a personal or parental history of drug or alcohol problems were significant independent predictors of sexual activity. Conclusions: The presence of both parents is an important protective factor for Brazilian youth vulnerable to multiple risks. Prevention programs should explore ways to support parents to be present and involved in the lives of their adolescent children.
|Perez F and Dabis F. (2003) HIV prevention in Latin America: reaching youth in Colombia. AIDS Care, Vol. 5; No. 1:77-87
|The aim of this paper is to describe and evaluate a school-based peer education programme on HIV primary prevention implemented in urban marginal districts of three cities of Colombia from 1997 to 1999. Its main objective was to promote risk awareness and safe sexual behaviours among urban youth populations. Methodology included the collection of baseline information through qualitative methods (focus groups and in-depth interviews), a knowledge, attitudes and practices (KAP) survey, a health education intervention, and post-intervention data collection. Direct beneficiaries were adolescents 10 to 19 years of age, and secondary school teachers of 6th to 9th grades. Main strategies used were peer education and classroom sessions conducted by trained teachers. Short-term results suggest that the programme had a positive effect on knowledge and attitudes related to HIV/AIDS (as the mean knowledge summary indicator among adolescents and secondary school teachers increased 24% and 21%, respectively). The main outcome has been the development of a sex education programme, emphasizing the role of schools in the promotion of sexual and reproductive health. Mass education by a combination of interventions and events at school level, backed up by effective interpersonal communication such as peer education, classroom teaching and community actions are effective primary prevention strategies for HIV sexual transmission and should be more extensively considered.
|HIV and other STIs
|Pettifor AE, Measham DM, Rees HV,and Padian NS. (2004) Sexual power and HIV risk, South Africa. Emerging Infectious Disease, 10(11):1996-2004
|Gender power inequities are believed to play a key role in the HIV epidemic through their effects on women’s power in sexual relationships. We hypothesized that lack of sexual power, measured with a four-point relationship control scale and by a woman’s experience of forced sex with her most recent partner, would decrease the likelihood of consistent condom use and increase the risk for HIV infection among sexually experienced, 15- to 24-year-old women in South Africa. While limited sexual power was not directly associated with HIV, it was associated with inconsistent condom use: women with low relationship control were 2.10 times more likely to use condoms inconsistently (95% confidence interval [CI] 1.17–3.78), and women experiencing forced sex were 5.77 times more likely to inconsistently use condoms (95% CI 1.86–17.91). Inconsistent condom use was, in turn, significantly associated with HIV infection (adjusted odds ratio 1.58, 95% CI 1.10–2.27).
|HIV and other STIs
|Pittman KJ, Irby M,Tolman J, Yohalem N, and Ferber T. (2003) Preventing problems, promoting development, encouraging engagement: competing priorities or inseparable goals? Washington, D.C.:Forum for Youth Investment. PSI Liberia. http:www.psi.org/liberia. accessed 18th October 2013
|Over the last 15 to 20 years, there have been several major shifts in what researchers, policy makers and practitioners think about what young people need, what they get and where they get it. There have also been shifts in thinking about what young people do, should do and can do and when it is reasonable to expect to see results. These shifts have not been universal — there are still differences among the various theories and strategies proposed and the populations addressed. But shifts have occurred.
|PSI Research & Metrics.Mexico (2011). Programa de Promocion de la Salud Sexual y Reproductiva. Estudio TRaC Evaluando niveles de comportamientos de riesgo, factores asociados e impacto del programa entre Jovenes de 15-24 anos en Chetumal, Quintana Roo. Segunda Ronda. Population Services International (PSI); TRac Summary Report, 2011.
|CONTEXTO & OBEJTIVOS DE LA INVESTIGACIÓN: El propósito de este estudio es proveer una medición de los niveles de comportamientos meta, determinantes asociados y exposición a las estrategias de comunicación implementadas por PSI/México durante 2010-2011, entre jóvenes de 15-24 años residentes en la ciudad de Chetumal, Quintana Roo, en donde PSI/México está implementando un programa financiado por The Summit Foundation. DESCRIPCIÓN DE LA INTERVENCIÓN: Desde 2007 PSI/México implementa actividades de comunicación para el cambio de comportamiento dirigidos a promover la salud sexual y reproductiva en jóvenes de 15-24 años en Chetumal. El eje central de la estrategia es la capacitación de promotores pares quienes diseñan e implementan –con el apoyo de personal de PSI/México- un programa semanal de radio denominado “Hoy Toka”, a través del cual se brinda información sobre salud sexual y reproductiva y se promueven normas sociales relacionadas con la toma informada de decisiones referidas a abstinencia sexual, uso de condón y uso de anticoncepción moderna. Así mismo, los promotores pares realizan abordajes cara-a-cara en lugares públicos de encuentro de jóvenes y actividades de promoción de la salud sexual y reproductiva en escuelas de la ciudad apoyándose con materiales de comunicación de la campaña “asunto sexo”. El programa cuenta con una oficina donde se brinda información sobre anticoncepción moderna y consejería para la toma de decisiones informadas sobre sexualidad.
|Regmi P, Simkhada P, Van Teijlingen ER. (2008) Sexual and reproductive health status among young peoples in Nepal: opportunities and barriers to sexual health education and services utilization. Kathmandu University Medical Journal, Vol 6, No 2,Issue 22:1-5
|This article attempts to summarise the situation of sexual and reproductive health among young people in Nepal. Modernisation and social transformation are occurring rapidly in Nepalese society. Growing expansion of communication and transportation networks, urbanisation and in-migration of population to urban areas is creating a different sociocultural environment, which is conducive to more social interactions between young girls and boys in Nepal. Rising age at marriage has now opened a window of opportunity for pre-marital and unsafe sexual activity among young people in Nepal which creates risks of unwanted pregnancy, STIs/HIV and AIDS. Several socio-economic, demographic and cultural factors have been identifi ed as encouraging factors for risk taking behaviours among young people. Improving access to youth friendly services, implementing peer education programmes for school and out of school going adolescents, developing effective Information, Communication and Education (IEC) materials and curricula have been highly suggested to improve the existing young people’s sexual and reproductive health status.
|Robinson AL and Seiber EE. (2008) Does community clustering mitigate the effect of poverty on adolescent condom use in South Africa? International Family Planning Perspectives, 34:3
|CONTEXT: It is important to examine whether youth from disadvantaged households are less likely than others to use a condom at first sex, even after correcting for shared characteristics within communities. METHODS: Baseline survey data from the Transitions to Adulthood in the Context of AIDS in South Africa study in KwaZulu-Natal were used. Random effects logistic regression assessed the relationship between poverty and 14-22-year-olds' use of condoms at first sex, correcting for shared characteristics of adolescents within each community. RESULTS: Twenty-three percent of young people had used a condom at first sex. Poor and extremely poor females had about one-third the odds of nonpoor females of using a condom at first sex, even after adjusting for community clustering; among males; however, there was no association between poverty and condom use, after adjusting for background factors and community clustering. CONCLUSIONS: The importance of community clustering of neighborhood-level characteristics differs by gender in South Africa. Poverty remains a central risk factor for HIV among young women, regardless of the surrounding context, but not among men.
|Sanchez N,Grogan-Kaylor A, Castillo M,Ca baller G, and Dela J. (2010) Sexual intercourse among adolescents in Santiago, Chile: a study of individual and parenting factors.Revista Panamericana de Salud Pub!ica, 28(4):267-274
|OBJECTIVE: To examine a range of individual, parenting, and family factors associated with sexual intercourse among a community sample of youth and their families in Santiago, Chile. METHODS: Data were taken from the Santiago Longitudinal Study conducted in January 2008-November 2009. Participants were 766 youth (mean age = 14.03 years, 51% male) from municipalities of low- to mid-socioeconomic status. Variables included emotional and behavioral subscales from the Child Behavior Checklist's Youth Self Report, parental monitoring, family involvement, parental control and autonomy, relationship with each parent, and sexual activity. Bivariate and multivariate logistic regression models were used to examine the odds of sexual intercourse initiation. RESULTS: Seventy (9.14%) youth reported having had sex in their lifetime; the average age of first sexual intercourse among this group was 13.5 years (Standard Deviation [SD] = 1.74) for males and 14.08 (SD = 1.40) for females. Having sex was inversely associated with withdrawn-depressed symptoms (Odds Ratio [OR] = 0.84, Confidence Interval [CI] = 0.72-0.97), but positively associated with somatic complaints (OR = 1.20, CI = 1.04-1.38) and rule breaking behavior (OR = 1.21, CI = 1.08-1.36), after adjusting for demographic and other individual and parenting variables. The majority (80%) of the youth who had had sex reported using protection at the time of last intercourse. CONCLUSIONS: Findings highlight the role that mental health problems-some of them not commonly associated with onset of sexual activity-may play in a youth's decision to have sex. The potential protective effects of several parenting and family characteristics disappeared with youth age and youth behavioral problems.
|Sawyer SM,Afifi RA, Bearigner LH, Blakemore SJ, Dick B, Ezech AC, and Patton GC. (2012) Adolescence: a foundation for future health.Lancet, 379:1630-1640
|Adolescence is a life phase in which the opportunities for health are great and future patterns of adult health are established. Health in adolescence is the result of interactions between prenatal and early childhood development and the specific biological and social-role changes that accompany puberty, shaped by social determinants and risk and protective factors that affect the uptake of health-related behaviours. The shape of adolescence is rapidly changing—the age of onset of puberty is decreasing and the age at which mature social roles are achieved is rising. New understandings of the diverse and dynamic effects on adolescent health include insights into the effects of puberty and brain development, together with social media. A focus on adolescence is central to the success of many public health agendas, including the Millennium Development Goals aiming to reduce child and maternal mortality and HIV/AIDS, and the more recent emphases on mental health, injuries, and non-communicable diseases. Greater attention to adolescence is needed within each of these public health domains if global health targets are to be met. Strategies that place the adolescent years centre stage—rather than focusing only on specific health agendas—provide important opportunities to improve health, both in adolescence and later in life.
|Schwandt HM and Underwood C. (2013) Making a difference in adult-child relationships: evidence from and adult child communication intervention in Botswana, Malawi,and Mozambique. Journal of Adolescence, 36:1177-1186
|Girls are vulnerable to HIV in part because the social systems in which they live have failed to protect them. This study evaluates a program aimed at strengthening adult–child relationships to reduce girls' vulnerability to HIV in Botswana, Malawi, and Mozambique. In addition to an extensive process evaluation, a cross-sectional post-intervention survey was conducted in the three countries. The total sample size was 1418 adolescent girls (ages 11–18). Bivariate and multilevel, multivariate analyses were conducted to assess the association between adult program exposure and adult–child relationship improvement. In Botswana, Malawi, and Mozambique, girls whose mothers and fathers participated in the program, as compared to those whose parents did not participate in the program, were significantly more likely to report that their relationships with their parents had improved. Research has shown the important role that adults can play in the mitigation of youth risk taking behavior.
|Sebastian MP, Grant M, and Mensch B. (2005) Integrating Adolescent Livelihood Activities within a Reproductive Health Programme for Urban Slum Dwellers in India. New Delhi: Population Council.
|While adolescents in India are facing a rapidly changing economic environment, the life choices of adolescent girls are different from those of adolescent boys. Nearly half of 20-24-year-old women in India are married by age 18. Moreover, most young women have little say in the timing of their marriage or the choice of spouse, and after marriage most have limited power within their marital household. Adolescent girls are much less likely to be engaged in economic activities than adolescent boys; by ages 15-19 over 40 per cent of boys are economically active compared to about one-quarter of girls. When adolescent girls do participate in income-generating activities, it is often in home-based work for which they may or may not be remunerated. Even in instances when girls are paid for their labour, they may not retain control over their income. Adolescent girl’s lack of opportunities for generating income is coupled with restricted physical mobility within the community and limited decision-making power within the household. Given this situation, programmes are needed that increase the ability of unmarried girls to have a say in their own lives and enhance the skills that expand life choices. By building social networks and developing critical financial and income generating capacities, livelihoods programmes have the potential to increase the agency and decision-making power of adolescent girls. As broadly conceived, the “livelihoods approach” to adolescent programming not only attempts to deliver technical and life skills but also seeks to transform the ways in which girls view themselves and the ways in which they are perceived by the community. However, although a wide variety of livelihood programmes for adult women exist in India, few focus on adolescent girls. Of those that do, few employ rigorous scientific methods to evaluate the impact of the intervention.
|Seifu A, Fantahun M, and Worku A .(2006) Reproductive health needs of out-of-school adolescents: a cross-sectional comparative study of rural and urban areas in northwest Ethiopia. Ethiopian Journal of Development, 20(10): 10-17
|Background: It is a globally acknowledged that adolescents, in general, and out-of-school adolescents, in particular often lack access to health information, counseling, legal protection, as well as health care and other social services. Objective: This study is intended to assess and compare reproductive health needs of rural and urban out-of-school adolescents. Methods: A cross-sectional, comparative study was conducted in East Gojjam zone, northwest Ethiopia, in May 2001. Twelve kebeles (smallest social administrative units) were randomly selected from four districts (one urban and three rural). A modified, random walk method was used to identify households in ach cluster. Trained 12th grade students collected data using pretested questionnaires. The 2 - test, the t- test, and the Odds Ratio (OR) with 95% Confidence Interval (CI) were used in data analysis. A multiple logistic regression analysis was performed using the SPSS version 10 statistical program to assess the relative impact of variables on sexual activity and contraceptive use. Results: Overall, 1001 adolescents responded to the interview. Knowledge on reproductive issues appeared good but several misconceptions were observed. Only 53% of the study participants knew that a healthy looking person can have HIV while 40% said that a person can get HIV the first time he/ she has sex. About 10% of the participants believed that they were at risk of getting HIV in the next 12 months, whereas more than 45% reported that they had sexual experience. The mean age at first sexual onset was found to be 13.6 years. Significantly higher proportions of rural adolescents were also found to be sexually active (OR =3.0; 95%CI = 1.9, 6.2). About 46% of the sexually active rural adolescents had 2-5 lifetime sexual partners compared to 35.4% of their urban counterparts. However, contraceptive use including condoms was ten times lower among rural adolescents (OR = 0.10; 95%CI =0.04 - 0.3). Only 2% of the rural compared to 35% of the urban sexually active adolescents had ever used condoms. A high divorce rate of 32% in rural and 27% in the urban adolescents was noted. Conclusions: Early and unprotected sexual activity and misconceptions about HIV/AIDS were found to be prevalent in the study population and rural out-of-school adolescents are at the greatest risk of sexual and reproductive health problems. In this era of the rapid spread of HIV/AIDS, high mobility and the ever increasing interaction between rural and urban populations, appropriate programs to prevent HIV/AIDS and promote reproductive health should be designed for out of school adolescents and rural out of school adolescents need the utmost attention.
|Senderowitz J, Hainsworth G, and Salter C (2003) A rapid assessment of youth friendly reproductive health services. Pathfinder International. Technical Guidance Series, Number 4
|Young people face greater reproductive health (RH) risks than adults, yet they are less willing and able to access RH services. Lack of awareness, inadequate information, and significant barriers posed by the current state of most RH services are perceived as unwelcoming to young clients. Given that the consequences of poor reproductive health in adolescence, such as those stemming from a too-early pregnancy or acquiring a STI or HIV, have serious implications for the future as well as the present, clinical programs need to find practical ways to assess their current operations and take steps to ensure that they are "youth friendly. The "Clinic Assessment of Youth Friendly Services: A Tool for Rapid Assessment and Improving Reproductive Health for Youth" was developed to facilitate the rapid assessment of youth friendly characteristics, providing the basis for developing and implementing a comprehensive action plan. Among the key issues assessed are provider attitudes, privacy and confidentiality, access to service, supportive policies and administrative procedures. The Tool is implemented through a variety of methods (including provider and client interviews, observation, and review of clinic statistics and policies) and can be used to establish a baseline, prepare a plan for training and service quality improvement, and measure changes in youth-friendliness by conducting periodic reassessments. It also allows for management and staff to become more involved in program operations and provides a means to get input from adolescent clients.
|Senderowitz J, Salter C,and Hainsworth G. (2002) Module 16: Reproductive Health Services for Adolescents. Pathfinder International.
|This training manual is part of the Comprehensive Reproductive Health and Family Planning Training Curriculum for service providers. It is designed to prepare participants to provide quality reproductive health services to adolescents. It is to be used to train physicians, nurses, counselors, and midwives. Parts of the module may be adapted for use with community-based workers or auxiliary workers. All of the modules in the curriculum are designed to actively involve participants in the learning process. Sessions include simulation skills practice; discussions; case studies; role plays; and using objective knowledge, attitude, and skills checklists.
|Speizer IS,Magnani RJ, Colvin CE. (2003) The effectiveness of adolescent reproductive health interventions in developing countries: a review of the evidence. Journal of Adolescent Health, 33(5):324-348
|Speizer IS, Fotso JC, Davis JT, Saad A, and Otai J. (2013) Timing and circumstances offirst sex among female and male youth from select urban areas of Nigeria, Kenya and Senegal. Journal of Adolescent Health: 1-8
|Purpose: To examine the timing and circumstances of first sex among urban female and male youth in Kenya, Nigeria, and Senegal. Methods: Recently collected data are used to examine youth sexual behaviors in Kenya, Nigeria, and Senegal. In each country, a large, representative sample of women (ages 15–49) and men (ages 15–59) was collected from multiple cities. Data from youth (ages 15–24) are used for the analyses of age at sexual initiation, whether first sex was premarital, and modern family planning use at first sex. Cox proportional hazard models and logistic regression analyses are performed to determine factors associated with these outcomes. Results: Across all three countries, a greater percentage of male youth than female youth report initiating sex with a nonmarital partner. More educated youth are less likely to have initiated sex at each age. In Nigeria and Senegal, poor female youth report earlier first sex than wealthier female youth. In Kenya, richer female youth are more likely to have premarital first sex and to use contraception/condom at first sex than their poorer counterparts. Older age at first sex and youth who report that first sex was premarital are significantly more likely to use a method of contraception (including condom) at first sex. City-specific distinctions are found and discussed for each outcome. Conclusions: Programs seeking to reduce HIV and unintended pregnancy risk among urban youth need to undertake needs assessments to understand the local context that influences the timing and circumstances of first sex in each city/country-specific context.
|Springer AE, Selwyn BJ, and Kelder SH. (2006) A Descriptive Study of Youth Risk Behavior in Urban and Rural Secondary School Students in El Salvador. BMC International Health and Human Rights. 6:3
|Background: Adolescence is an important stage of life for establishing healthy behaviors, attitudes, and lifestyles that contribute to current and future health. Health risk behavior is one indicator of health of young people that may serve both as a measure of health over time as well as a target for health policies and programs. This study examined the prevalence and distribution of youth health risk behaviors from five risk behavior domains–aggression, victimization, depression and suicidal ideation, substance use, and sexual behaviors–among public secondary school students in central El Salvador. Methods: We employed a multi-stage sampling design in which school districts, schools, and classrooms were randomly selected. Data were collected using a self-administered questionnaire based on the United States Center for Disease Control and Prevention's Youth Risk Behavior Survey. Sixteen schools and 982 students aged 12–20 years participated in the study. Results: Health risk behaviors with highest prevalence rates included: engagement in physical fight (32.1%); threatened/injured with a weapon (19.9%); feelings of sadness/hopelessness (32.2%); current cigarette use (13.6%); and no condom use at last sexual intercourse (69.1%). Urban and male students reported statistically significant higher prevalence of most youth risk behaviors; female students reported statistically significant higher prevalence of feelings of sadness/hopelessness (35.6%), suicidal ideation (17.9%) and, among the sexually experienced, forced sexual intercourse (20.6%).Conclusion: A high percentage of Salvadoran adolescents in this sample engaged in health risk behaviors, warranting enhanced adolescent health promotion strategies. Future health promotion efforts should target: the young age of sexual intercourse as well as low condom use among students, the higher prevalence of risk behaviors among urban students, and the important gender differences in risk behaviors, including the higher prevalence of reported feelings of sadness, suicidal ideation and forced sexual intercourse among females and higher sexual intercourse and substance use among males. Relevance of findings within the Salvadoran and the cross-national context and implications for health promotion efforts are discussed.
|Strasburger VC, Wilson BJ and Jordan AB. (2009) Children, adolescents and the media. Thousand Oaks, CA: Sage
|Sverdlik A (2011) Ill-health and poverty: a literature review on health in informal settlements. Environment and Urbanization, 23(1):126
|This paper reviews the literature on health in the informal settlements (and “slums”) that now house a substantial proportion of the urban population in Africa, Asia and Latin America. Although this highlights some important gaps in research, available studies do suggest that urban health inequalities usually begin at birth, are reproduced over a lifetime (often reinforced by undernutrition), and may be recreated through vulnerabilities to climate change and a “double burden” of communicable and non-communicable diseases. The review begins with a discussion of papers with a life-course perspective on health, poverty and housing, before considering recent literature on chronic poverty and ill-health over time. It then discusses the literature on the cost, quality and access to care among low-income groups, and the under-recognized threat of unintentional injuries. This includes recent literature that discusses where low-income residents may suffer an “urban penalty” rather than benefiting from urban bias – although there are also studies that show the effectiveness of accessible, pro-poor health care. The concluding section examines emerging risks such as non-communicable diseases and those associated with climate change. It notes how more gender- and age-sensitive strategies can help address the large inequalities in health between those in informal settlements and other urban residents. With greater attention to the multi-faceted needs of low-income communities, governments can create interventions to ensure that urban centres fulfil their enormous potential for health.
|Temin M, Montgomery MR, Engebretsen S, and Baker KM.(2013) Girls on the move: adolescent girls & migration in the developing world. Population Council
|Adolescent girls are on the move. Throughout the developing world, natural disasters, political emergencies, child marriage, and violence force a migration journey many girls do not choose. But for most girls, migration is a choice made in a quest for social and economic advancement. Migration offers adolescent girls the possibility and promise of opportunity. Absent from their parents and the limits of their natal homes, migrant girls can seize new opportunities and fully enjoy their human rights as they enter adulthood.
|Tu X, Lou C, Gao E, and Shah IH. (2008) Long-term effects of community-based program of contraceptive use among sexually active youth in Shanghai, China. Journal of Adolescent Health, 42:249-258
|Purpose: To evaluate the long-term (48-month) sustainable effect of a set of community-based interventions to promote contraceptive use among sexually active unmarried youth in suburban Shanghai, China. Methods: A nonrandomized community trial with one intervention and one control group was conducted in two comparable towns of a suburban area of Shanghai. The intervention program was developed and implemented to increase knowledge and access to sexual and reproductive health services among unmarried youth aged 15–24 years. Baseline surveys were conducted in both sites before implementation of the intervention, and similar surveys were conducted in both sites 20 months after the launch of the intervention and 28 months after the end of the intervention. Results: Statistically significant differences between the respondents surveyed at baseline in 2000 and at the long-term follow up in 2004 were observed in some age categories and in some educational groups. In the postproject period, there was a major improvement in all indicators in the control group. Among the sub-set of respondents interviewed both in 2000 and 2004 who were exposed to the intervention program, the interventions were associated with a significant increase in the frequency of contraceptive use among participants initiating sexual relations over the period of the intervention (odds ratio [OR] = 6.91), as well as with significant reduction in use ever of the withdrawal method of contraception among all sexually active respondents (OR = .37) compared with the control group during long-term follow-up period. No long-term effects on contraceptive practice were observed among new respondents who were not exposed to the intervention program. Conclusions: Comprehensive community-based interventions appear to have limited long-term effects on contraceptive use among unmarried youth in suburban Shanghai. It is necessary to provide sex and reproductive health education and services to all unmarried young people on a regular basis.
|Twa-Twa JM, Oketcho S, Sizyia S, and Muula A.(2008) Prevalence and correlates of condom use at last sexual intercourse among in-school adolescents in urban areas of Uganda. East African Journal of Public Health, 5(1):22-25
|Objectives: Correct and consistent condom use remains an important public health intervention against the spread of Human Immunodeficiency Virus and other sexually transmitted infections. There is paucity of information on sexual behaviour of in-school adolescents in Uganda. We, therefore, used secondary data of the Uganda Global School-based Health Survey (UGSHS) conducted in 2003 to determine the prevalence and correlates of condom use at last sexual intercourse in urban areas of Uganda. Methods: A two-stage cluster sampling technique was used to obtain a representative sample. Altogether 1709 students participated in the survey in urban areas of whom 179 (14.9% of males, and 7.9% of females) had sexual intercourse within 12 months before the survey. Results: Overall 77.3% (79.7% of male, and 72.3% of female) adolescents used a condom at last sexual intercourse. Adolescents who drank alcohol and used drugs were 64% (OR=1.64, 95%CI 1.54, 1.75) and 68% (OR=1.68, 95%CI 1.56, 1.81) more likely to have used a condom, respectively. Meanwhile, adolescents who ever got drunk, and who reported to ever had 2 or more sex partners were 55% (OR=0.45, 95%CI 0.42, 0.48) and 35% (OR=0.65, 95%CI 0.62, 0.68) less likely to have used a condom compared to those who had never got drunk, and who ever had 1 sex partner, respectively. Finally, adolescents who reported receiving no parental supervision were 45% (OR=0.55, 95%CI 0.53, 0.58) less likely to have used a condom compared to those who reported receiving parental supervision. Conclusions: Parental supervision may be effective in promoting condom use among adolescents. Furthermore, drinking alcohol wasassociated with condom use probably due to peer pressure and easy access of condoms in drinking places as condoms are not actively promoted in schools. There is need for further research on how in-school adolescents could access condoms.
|UN-HABITAT. (2006) The state of the world's cities 2006/2007. The millennium development goals and sustainability: 30 years of shaping the habitat agenda. Nairobi,Kenya.United Nationals Human Settlements Program
|The 2006/2007 edition of the State of the World’s Cities marks two important milestones: the dawn of the urban millennium in 2007 and the 30th anniversary of the first Habitat Conference held in Vancouver in June 1976, which placed “urbanisation” on the global development agenda. This publication also marks a less triumphal moment in history. Thirty years after the world’s governments first pledged to do more for cities, almost one-third of the world’s urban population lives in slums, most of them without access to decent housing or basic services and where disease, illiteracy and crime are rampant.
|UNAIDS (2004) 2004 Report on the Global AIDS Epidemic. 4th global report. Geneva, Switzerland. UNAIDS
|Every two years, on the occasion of the International Conference on AIDS, this Global Report sets out our current knowledge on the state of the epidemic based on the experiences of the Joint United Nations Programme on HIV/AIDS (UNAIDS), which comprises nine United Nations system agencies. It makes for sobering reading. Far from levelling off, rates of infection are still on the rise in many countries in Sub- Saharan Africa. Indeed, in 2003 alone, an estimated 3 million people in the region became newly infected. Most alarmingly, new epidemics appear to be advancing unchecked in other regions, notably Eastern Europe and Asia.
|HIV and other STIs
|UNAIDS (2011) HIV in Asia and the Pacific: getting to zero. UNAIDS
|This report, HIV in Asia and the Pacific: Getting to Zero, comes at a decisive point in the international and regional response to the HIV epidemic. In June 2011, 192 Member States of the United Nations agreed to bold new targets and commitments that can make AIDS a thing of the past, including: • reducing sexual transmission of HIV by 50%; • halving HIV infection among people who inject drugs; • eliminating new HIV infections among children;• increasing in the number of people on lifesaving treatment to 15 million; and • closing the US$ 6 billion global AIDS resource gap. World leaders pledged to achieve these goals by 2015, which will move us closer towards the vision of Zero new HIV infections, Zero discrimination and Zero AIDS-related deaths. ‘Getting to Zero’ in Asia and the Pacific demands evidence-based responses that solidly focus on and involve key populations most at risk, are adequately resourced and grounded in human rights. Increasingly, countries are acting on this knowledge – and reaping the rewards. Tremendous progress has already been made, proving that the epidemic can be reversed, and that HIV treatment and care can be brought to those who need it.
|HIV and other STIs
|Underwood C, Hachonda H, Serlemitsos E, and Bharath-Kumar U. (2006) Reducing the risk of HIV transmission among adolescents in Zambia: psychosocial and behavioral correlates of viewing a risk-reduction campaign. Journal of Adolescent Health, 38:55.el-55.el 3
|Purpose: The purpose of this study was to evaluate phase I of a theoretically informed media campaign designed by youth in Zambia to encourage their peers to adopt risk-reduction practices to protect themselves from sexually transmitted infections and human immunodeficiency virus (HIV). The Helping Each other Act Responsibly Together (HEART) campaign conveys information for young people ages 13 to 19 years about sexually transmitted infections, HIV, and acquired immune deficiency syndrome transmission and prevention, and promotes abstinence, a return to abstinence, or consistent condom use as viable risk-reduction practices. Methods: Separate sample baseline and follow-up designs were used to evaluate phase I of the HEART campaign among adolescents aged 13 to 19 years. The 1999 baseline survey had a sample of 368 male and 533 female adolescents; the 2000 follow-up survey comprised 496 male and 660 female adolescents. Results: Controlling for age, sex, educational attainment, and urban or rural residence, logistic regression analyses demonstrated that, compared with nonviewers, campaign viewers were 1.61 times more likely to report primary or secondary abstinence and 2.38 times more likely to have ever used a condom. The odds ratio of condom use during last sex was 2.1 for respondents who recalled at least 3 television spot advertisements compared with other respondents. Conclusions: The positive correlations between HEART campaign viewership and HIV risk-reduction practices demonstrate that mediated messages can influence adolescents. The HEART campaign is among a range of programs in Zambia designed to enable young people to protect their reproductive health. Future research should capture the independent as well as the synergistic effects of multiple campaigns and interventions.
|HIV and other STIs
|UNFPA. (2007) Growing Up Urban.State of the World Population,Youth Supplement. New York, NY, USA UNFPA website: http: //web.unfpa.org/ adolescents/youthfriendly.htm accessed 22nd February 2014
|This is the second edition of the Youth Supplement to UNFPA’s State of World Population. The 2007 report focuses on urbanization; the Youth Supplement addresses the challenges and promises of urbanization as they affect young people. In 2008, for the first time, more than half of the world’s population will live in urban areas, and the number and proportion of urban young people is increasing dramatically. Most will be born into poor families, where fertility tends to be higher. Growing Up Urban profiles the lives of young men and women from seven cities – Tianjin, China; San Salvador, El Salvador; Mumbai, India; Dhaka, Bangladesh; Cairo, Egypt; Rufisque, Senegal; and Rio de Janeiro, Brazil. Their stories give a sense of the lives of young women and men and the opportunities, pressures, and risks of modern urban living: as migrants who have left the countryside to work and make their home in the cities; as community organizers fighting for better housing and services in the margins of cities; as victims of sexual abuse and violence; sometimes even as perpetrators of violence themselves; as young women freed from traditional gender roles and discrimination; and as urbanites involved in music and culture to escape from urban poverty and insecurity, and to celebrate their lives.
|UNICEF. (1999) The state of the world's children: education. New York,USA. United Nations Children Fund
|Nearly a billion people will enter the 21st century unable to read a book or sign their names and two thirds of them are women. And they will live, as now, in more desperate poverty and poorer health than those who can. They are the world’s functional illiterates—and their numbers are growing. The total includes more than 130 million school age children, 73 million of them girls, who are growing up in the developing world without access to basic education. Millions of others languish in substandard schools where little learning takes place. The State of the World’s Children 1999 report tells the stories of a world community unwilling to accept the consequences of illiteracy or to be denied the human right to a quality education. With the Convention on the Rights of the Child as a guiding framework, governments, policy makers, educators, community leaders, parents and children themselves are advancing an education revolution. Their goal—Education For All. Theirs is a broad vision of education: as a human right and a force for social change; as the single most vital element in combating poverty, empowering women, safe-guarding children from exploitative and hazardous labour and sexual exploitation, promoting human rights and democracy, protecting the environment and controlling population growth. And as a path towards international peace and security. This report is on their efforts and their progress. The Convention on the Rights of the Child is clear: Education is the foundation of a free and fulfilled life. It is the right of all children and the obligation of all governments.
|UNICEF. (2005) Early marriage. A harmful traditional practice. New York, USA. The United Nations Children Fund
|Child marriage is a violation of human rights, compromising the development of girls and often resulting in early pregnancy and social isolation. Young married girls face onerous domestic burdens, constrained decision-making and reduced life choices. Using data from the Demographic and Household Surveys, this publication estimates the prevalence of child marriage and seeks to identify and understand the factors associated with child marriage and cohabitation. The statistical linkages identified can help programmeers promote delayed marriage and use advocacy and behaviour-change campaigns to prevent child marriage.
|UNICEF. (2011) The state of the world's children. Adolescence: an age of opportunity. New York, USA. United Nations Children Fund
|The world is home to 1.2 billion individuals aged 10–19 years. These adolescents have lived most or all of their lives under the Millennium Declaration, the unprecedented global compact that since 2000 has sought a better world for all. Many of their number have benefited from the gains in child survival, education, access to safe water, and other areas of development that stand as concrete successes of the drive to meet the Millennium Development Goals, the human development targets at the core of the Declaration. But now they have arrived at a pivotal moment in their lives – just as the world as a whole is facing a critical moment in this new millennium.
|UNICEF. (2012) The state of the world's children: children in an urban world. New York,USA. The United Nations Children Fund
|The day is coming when the majority of the world’s children will grow up in cities and towns. Already, half of all people live in urban areas. By mid-century, over two thirds of the global population will call these places home. This report focuses on the children – more than one billion and counting – who live in urban settings around the world. Urban areas offer great potential to secure children’s rights and accelerate progress towards the Millennium Development Goals (MDGs). Cities attract and generate wealth, jobs and investment, and are therefore associated with economic development. The more urban a country, the more likely it is to have higher incomes and stronger institutions.1 Children in urban areas are often better off than their rural counterparts thanks to higher standards of health, protection, education and sanitation. But urban advances have been uneven, and millions of children in marginalized urban settings confront daily challenges and deprivations of their rights.
|Urban Reproductive HeaIth. Spotlight on Kenya, June 2013. http://www. urbanreproductive hea lth. org/reso urce/spotl i ght-kenya- ju ne-201 3 accessed 18th October 2013
|Jongo Love is an educational radio drama series produced by Well Told Story. The series takes place in a fictitious slum in Nairobi called Jongo. It is the story of a young ambitious girl named Amani whose dreams of getting ahead are thwarted by an unwanted pregnancy. Life in Nairobi is difficult and challenging for a young person with no skills, but through sheer determination and hard work, Amani, with the help of some good friends and sound advice, manages to get her life back on track. To date 24 15-minute episodes have been aired on 7 community radio stations in the three Tupange target cities- Nairobi, Mombasa and Kisumu.
|Van de GIind H. (2010) Migration and child labour. Exploring child migrant vulnerabilities and those of children left behind. Geneva. International Labour Office,International Programme on the Elimination of Child Labour (IPEC).
|The working paper attempts to describe the correlation between migration and child labour by reviewing secondary data of migrant children with or without their families, and children left behind by their migrant parents. Following the review, the paper offers a range of policy considerations, including in the world of work, and points at knowledge gaps.
|Veinot TC, Campbell TR, Kruger D, Grodzinski A, and Franzen S. (2011) Drama and danger: the opportunities and challenges of promoting youth sexual health through online social Networks. AM/A Annu Symp Proc,1436-1445
|Social networks affect both exposure to sexually transmitted infections (STIs) and associated risk behavior. Networks may also play a role in disparities in STI/HIV rates among African American youth. Accordingly, there is growing interest in the potential of social network-based interventions to reduce STI/HIV incidence in this group. However, any youth-focused network intervention must grapple with the role of technologies in the social lives of young people. We report results of 12 focus groups with 94 youth from one economically depressed city with a high STI/HIV prevalence. We examined how youth use information and communication technologies (ICTs) in order to socialize with others, and how this aligns with their communication about sexuality and HIV/STIs. The study resulted in the generation of five themes: distraction, diversification, dramatization, danger management and dialogue. We consider implications of these findings for future development of online, social network-based HIV/STI prevention interventions for youth.
|HIV and other STIs
|Viner RM,Ozer EM, Denny 5, Marmot M, Resnick M,Fatusi A, and Curri C. (2012) Adolescence and the social determinants of health.Lancet, 379: 1641-52
|The health of adolescents is strongly affected by social factors at personal, family, community, and national levels. Nations present young people with structures of opportunity as they grow up. Since health and health behaviours correspond strongly from adolescence into adult life, the way that these social determinants affect adolescent health are crucial to the health of the whole population and the economic development of nations. During adolescence, developmental effects related to puberty and brain development lead to new sets of behaviours and capacities that enable transitions in family, peer, and educational domains, and in health behaviours. These transitions modify childhood trajectories towards health and wellbeing and are modified by economic and social factors within countries, leading to inequalities. We review existing data on the effects of social determinants on health in adolescence, and present findings from country-level ecological analyses on the health of young people aged 10–24 years. The strongest determinants of adolescent health worldwide are structural factors such as national wealth, income inequality, and access to education. Furthermore, safe and supportive families, safe and supportive schools, together with positive and supportive peers are crucial to helping young people develop to their full potential and attain the best health in the transition to adulthood. Improving adolescent health worldwide requires improving young people's daily life with families and peers and in schools, addressing risk and protective factors in the social environment at a population level, and focusing on factors that are protective across various health outcomes. The most effective interventions are probably structural changes to improve access to education and employment for young people and to reduce the risk of transport-related injury.
|Vinh DTN, Raguin GL, Thebaut Y, Semaille C, and Tri LD. (2003) Knowledge,attitudes, belief and practice related to HIV/AIDS among young people in Ho Chi Minh City,Vietnam. European Journal of Epidemiology, 18(8):835-836
|The HIV infection rate has shown a rapid increase among the young people in Vietnam. In order to inform an HIV education prevention program, we have conducted a knowledge, attitudes, beliefs and practices (KABP) survey among 902 young vietnamese people in Ho Chi Minh City (HCMC) in 1999. Results show that overall knowledge about HIV, sexually transmitted diseases and safe sex is good. A minority of them (11%) declare having sexual activity. Eighty percent of those sexually active use condoms. This rather optimistic picture needs to be confirmed by qualitative measures of sexual behavioramong the youth of HCMC. Gender specific interventions should be developed since there appearto be significant differences of knowledge, beliefs and practices between males and females. Othergr oups of young people should be investigated in order to have a better picture of the Vietnamese context at a time of expansion of the Aids epidemic.
|HIV and other STIs
|Voeten CM,Egasah OB, and Habbema JDF. (2004) Sexual behavior is more risky in rural than urban areas among young women in Nyanza province, Kenya. Sexually Transmitted Diseases, Vol. 31(8):481-487
|Background: HIV/sexually transmitted disease interventions in sub-Saharan Africa have largely been focused on urban areas, where sexual behavior is supposed to be more risky than in rural areas. Goal: The goal of this study was to measure sexual risk behavior among young adults in Nyanza province in Kenya and to compare rural and urban areas. Study: In a cross-sectional study, 584 household members aged 15 to 29 years in Kisumu town and the rural districts Siaya and Bondo were selected by multistage random sampling and were administered a face-to-face questionnaire. Results: For women, sexual behavior was more risky in rural than in urban areas, also after adjusting for sociodemographic differences. Rural women reported less frequently being a virgin at marriage, a higher number of lifetime partners, and less consistent condom use with nonspousal partners. For men, sexual risk behavior was equally high in urban and rural areas. Conclusions: The potential for further HIV spread in rural Nyanza is large. HIV/sexually transmitted disease interventions should be expanded from urban to rural areas in Nyanza.
|Walker D, Gutierrez JP, Torres P, Bertozzi SM. (2006) HIV prevention in Mexican schools: prospective randomised evaluation of intervention. BMJ onfine. Doi: 10.1136/bmj.38796.457407 .80 (published 8 May 2006)
|Objective: To assess effects on condom use and other sexual behaviour of an HIV prevention programme at school that promotes the use of condoms with and without emergency contraception. Intervention: Schools were randomised to one of three arms: an HIV prevention course that promoted condom use, the same course with emergency contraception as back-up, or the existing sex education course. Self administered anonymous questionnaires were completed at baseline, four months, and 16 months. Students at intervention schools received a 30 hour course (over 15 weeks) on HIV prevention and life skills, designed in accordance with guidelines of the joint United Nations programme on HIV/AIDS. Two extra hours of education on emergency contraception were given to students in the condom promotion with contraception arm. Results: Intervention did not affect reported condom use. Knowledge of HIV improved in both intervention arms and knowledge of emergency contraception improved in the condom promotion with contraception arm. Reported sexual behaviour was similar in the intervention arms and the control group. Conclusion: A rigorously designed, implemented, and evaluated HIV education course based in public high schools did not reduce risk behaviour, so such courses need to be redesigned and evaluated. Addition of emergency contraception did not decrease reported condom use or increase risky sexual behaviour but did increase reported use of emergency contraception.
|HIV and other STIs
|Wang B, Hertog S, Meier A, Lou C, and Gao E. (2005) The potential of comprehensive sex education in China: findings from suburban Shanghai. International Family Planning Perspectives, 31(2):63-72
|Wight D and Fullerton D. (2013) A review with interventions with parents to promote the sexual health of their children.Journal of Adolescent Health, 52:4-27
|Purpose: To assess the effectiveness of interventions involving parents or carers intended to improve the sexual health of their children. Methods: Eleven databases were searched for evaluations of interventions with some parental involvement and with outcomes related to the sexual health of the parents' children. Studies had to be experimental, quasi-experimental, or of the before-and-after type. Results were analyzed in a narrative systematic review, taking account of methodological quality. Results: We identified adequately robust evaluations of 44 programs, delivered in diverse settings. In nearly all cases, the parenting component focused on improving parent–child communication about sex. In general, where measured, parent–child interaction and adolescents' knowledge and attitudes improved, but sexual behavior outcomes only improved in approximately half the studies. Three programs in which the parenting component made up at least one-fourth of the overall program were found, through randomized controlled trials, to modify some aspect of adolescents' sexual behavior. All programs involved parents for at least 14 hours, were community-based, and encouraged delayed sex. Conclusions: Targeted programs with intensive parental involvement can modify adolescents' sexual behavior, although the review was limited by the lack of rigorous evaluations. Few programs addressed behavioral control, parent–child connectedness, or parental modeling, all suggested by observational research.
|World Bank. (1997) Confronting AIDS: public priorities in a global epidemic. Oxford University Press. World Health Organization (1997). Factsheet N. 186. http:// collections.infocollections.org/ukedu/en/d/js0465e/ accessed 6th November 2013
|This book argues that the global epidemic of HIV/AIDS can be overcome. It draws from three bodies of knowledge: the epidemiology of HIV, public health insights into disease control, and public economics. The report argues that AIDS is a large and growing problem and that governments can and should confront the epidemic by preventing new infections and by mitigating the impact of infections that occur. It finds that some policies will be much more effective than others in reducing the spread of HIV and mitigating its impact, and it provides the framework to help distinguish among activities that can be undertaken by household and the private sector, including nongovernmental organizations (NGOs), those that should be initiated by developing country governments, and those that should be most strongly supported by the international development community.
|HIV and other STIs
|World Health Organization (1999). Programming for Adolescent Hea Ith and Development. WHO Technical Report,Series 886. http://www.who.int/maternal child adolescent/documents/trs 886/en/ accessed 3rd October 2013
|This report is a synthesis of the material and expert opinion presented to the 1995 WHO/UNFPA/UNICEF Study Group on Programming for Adolescent Health. It is organized according to the components of the 'Framework for country action'. Part 2 provides information on the challenges of programming for adolescent health and development as well as the recommendations of the Study Group, references and acknowledgements.
|World Health Organization (2008). 10 Facts About Adolescent Health. http://www.who.int/features/factfiles/adolescentheaIth/facts/en/indexl.html accessed 18th October 2013
|World Health Organization. (2012) Preventing Early Pregnancy and Poor Reproductive Outcomes among Adolescents in Developing Countries: What the Evidence Says. Geneva, Switzerland: World Health Organization
|WHO guidelines on preventing early pregnancy and poor reproductive outcomes among adolescents in developing countries provides a robust evidence base to help develop or reshape national policies and strategies. The guidelines help to ensure that available resources are spent on optimal approaches to prevent early pregnancies among adolescents, and on reducing morbidity and mortality associated with pregnancy and childbirth. ADOLESCENT PREGNANCY contributes to maternal, perinatal and infant mortality, and to a vicious cycle of poverty and ill-health. Reducing adolescent pregnancy is vital for achieving the Millennium Development Goals that relate to childhood and maternal mortality, and to the overall goal of poverty reduction. National reproductive health policies of a growing number of countries have identified tackling adolescent pregnancy as a priority. However, the approaches adopted are — in many cases — not as comprehensive as they should be and often not based on sound evidence.
|Ybarra ML, Kiwanuka J, EmnyonuN, and Bangsberg DR. (2006) Internet use among Ugandan adolescents: implications for HIV interventions. PLoS Medicine, Nov 3(11): e433
|Background: The Internet is fast gaining recognition as a powerful, low-cost method to deliver health intervention and prevention programs to large numbers of young people across diverse geographic regions. The feasibility and accessibility of Internet-based health interventions in resource-limited settings, where cost-effective interventions are most needed, is unknown. To determine the utility of developing technology-based interventions in resource-limited settings, availability and patterns of usage of the Internet first need to be assessed. Methods and Findings: The Uganda Media and You Survey was a cross-sectional survey of Internet use among adolescents (ages 12–18 years) in Mbarara, Uganda, a municipality mainly serving a rural population in sub-Saharan Africa. Participants were randomly selected among eligible students attending one of five participating secondary day and boarding schools in Mbarara, Uganda. Of a total of 538 students selected, 93% (500) participated. Of the total respondents, 45% (223) reported ever having used the Internet, 78% (175) of whom reported going online in the previous week. As maternal education increased, so too did the odds of adolescent Internet use. Almost two in five respondents (38% ) reported already having used a computer or the Internet to search for health information. Over one-third (35% ) had used the computer or Internet to find information about HIV/AIDS, and 20% (102) had looked for sexual health information. Among Internet users, searching for HIV/AIDS information on a computer or online was significantly related to using the Internet weekly, emailing, visiting chat rooms, and playing online games. In contrast, going online at school was inversely related to looking for HIV/AIDS information via technology. If Internet access were free, 66% (330) reported that they would search for information about HIV/AIDS prevention online. Conclusions: Both the desire to use, and the actual use of, the Internet to seek sexual health and HIV/AIDS information is high among secondary school students in Mbarara. The Internet may be a promising strategy to deliver low-cost HIV/AIDS risk reduction interventions in resource-limited settings with expanding Internet access.
|Ya manis TJ, Maman S, Mbwambo JK, Earp JA, and Kajula L. (2010) Social venues that protect against and promote HIV risk for urban young men in Dar es Salaam, Tanzania. Social Science & Medicine, 71 (9):1601-1609
|Developing effective place-based health interventions requires understanding of the dynamic between place and health. The therapeutic landscape framework explains how place-based social processes and physical geography interact and influence health behavior. This study applied this framework to examine how venues, or social gathering places, influenced HIV risk behavior among young, urban men in Tanzania. Eighty-three public venues where men aged 15–19 met new sexual partners were identified by community informants in one city ward. The majority (86%) of the venues were called ‘camps’, social gathering places that had formal leaders and members. observations were conducted at 23 camps and in-depth interviews were conducted with 36 camp members and 10 camp leaders in 15 purposively selected camps. Geographic and social features of camps were examined to understand their contributions to men’s behaviors. Camps were characterized by a geographic space claimed by members, a unique name and a democratic system of leadership and governance. Members were mostly men and socialized daily at their camp. They reported strong social bonds and engaging in health-promoting activities such as playing sports and generating income. Members also engaged in HIV risk behaviors, such as meeting new sexual partners and having sex in or around the camp at night. Some members promoted concurrent sexual partnerships with their friends and resisted camp leaders’ efforts to change their sexual risk behavior. We conclude that camps are strategic venues for HIV prevention programs for young Tanzanian men. They served as both protective and risk landscapes, illustrating three domains of the therapeutic landscape framework: the built environment; identities of landscape occupants; and sites for collective efficacy. The framework and data suggest HIV intervention components might augment the protective features of the camps, while changing environmental features to reduce risk.
|HIV and other STIs
|Zabin LS, Emerson MR, Nan, L, Chaohua L, Ersheng G, Minh NH, Chuang YL,Hurng BS, Bishai D, and Blum RW. (2009) Levels of change of adolescent sexual behavior in three Asian cities. Studies in Family Planning, 49(1 ):1-12
|Considerable change in the romantic and sexual behaviors of Asian young people may be occur ring as traditionally Confucian societies modernize and increase outside contacts. This study explores the dimensions and context of this change in three sites at different stages in the process of modernization: Hanoi (early), Shanghai (intermediate), and Taipei (later stage). A survey was conducted of17,016 males and females aged 15-24 in urban and rural settings in three large metropolitan areas. Survival analysis and Cox regressions were performed to explore ages of respondents at key transitions and the significance of differences between two age cohorts: 15-19 and 20-24. Significant differences are found in levels of sexual and other transitions, even within the narrow time span reflected by the age cohorts. The findings highlight the differential impact of modernization on adolescent sexual behavior as traditional societies undergo social change, and they underline the importance of context in exploring youthful transitions. Adolescence and young adulthood have long been rec ognized as a fluid period in the life span, as individuals move at their own rates through a series of developmen tal changes and transitional events. In many parts of the world today, that process is taking place on a shifting stage amid social and economic change, where young people are experiencing the transient realities of adoles cence at many levels, from the intimate context of their families to their exposure through the media to the larger world. In such societies, concomitant changes in youthful sexual behavior are often greeted with considerable con cern by older generations, especially when accompanied by activities that place adolescents at some risk to them selves and to their futures. This concern appears to exist in many Asian societies. Appropriate intervention, how ever, requires an understanding of the means by which these environmental changes and departures from tradi tional values are related to behavioral change?and it be gins with an understanding of the changes themselves. This study explores the relationships between these environmental changes and young people's sexual be haviors in three Asian settings?three cultures with a heritage of Confucian values?in which broad changes in context and in contact with the outside world have taken place but have occurred in different measure on different timetables. In this first analysis of data from the Three-City Study of Asian Adolescents and Youth: Hanoi, Shanghai, and Taipei, we describe the samples and meth ods employed and test the project's basic premise: that clear differences exist across these sites and that, despite these differences, significant variations between adjacent age cohorts within each site can be measured, confirming a hypothesis of ongoing behavioral change.
|Zellner JA, Martinez-Donate A P, Hovell MF, Sipan CL,Blumberg EJ,Carrizosa CM,Rovinak L. (2006) Feasibility and use of school-based condom availability programs in Tijuana, Mexico.AIDS Behavior.10"649-657
|Condom availability programs (CAPs) may increase access to condoms and contribute to increased condom use among youth. This study describes the characteristics, degree of satisfaction, and gender differences among users of a CAP implemented in two high schools in Tijuana (Baja California, Mexico). A kiosk distributing free male condoms was set up in two high schools in Tijuana. Kiosk users (N=570) were more likely to be male, young, and/or enrolled in a lower SES school. Most kiosk users were either sexually active or planning to have sex. Females were less likely to request condoms and to continue using the kiosk, but more likely to request information on other contraceptive methods. Results demonstrate the feasibility of implementing CAPs in Mexican schools and suggest that these programs can improve adolescents’ condom access.