Source of Sex Information and Condom Use Intention Among Latino Adolescents.

Adolescence is a common time for sexual initiation and information seeking about sexual health, yet little is known about how adolescents' sources of information about sex influence their sexual beliefs and behaviors. This is particularly true for Latino adolescents, whose sources of sex information and sexual behaviors are vastly understudied. A survey of ninth-grade Latino adolescents ( N = 1,186) was employed to examine the relationship between adolescents' primary source of sex information and their intention to use condoms. The study also examined the potential influences of demographics (age, gender), sociodemographics (socioeconomic status, parent education, and linguistic acculturation), and sexual experience on condom use intention. Among Latino youth, the most commonly reported source of sex information was parents (37.8%), followed by another relative (17.1%), school (13.4%), and friends (11.4%). Hierarchical regression analyses showed that after controlling for other factors, primary source of sex information was significantly associated with condom use intention ( p = .042). Hierarchical regression results stratified by gender showed that this relationship remained significant for males ( p = .004) but not for females ( p = .242). Males who reported friends (odds ratio [ OR] = 0.44, p = .003) or the media/Internet ( OR = 0.44, p = .008) as their primary sources of sex information, as compared to parents as their primary source, reported significantly lower intention to use condoms. These findings suggest it may be important for Latino adolescents, particularly males, to have additional or other sources for sex information in order to promote healthy sexual behaviors. Alternatively, interventions targeting parents or other family members to improve sexual health communication with adolescent boys may prove essential.

Predisposing, enabling and need-for-care predictors of adolescents' intention to use sexual health services.

BACKGROUND: The study aimed to understand the influence of predisposing, enabling and need-for-care factors on adolescents' intention to use sexual health services, using Andersen's Behavioural Model of Health Service Utilisation to organise and test these factors. METHODS: A sample of predominantly Hispanic teens (n=600) in Los Angeles, California completed a self-report survey about their sexual health knowledge, beliefs, intentions, and behaviours. Hierarchical regression modelling was used to examine the incremental influences on adolescents' intention to use sexual health services of: 1) predisposing sociodemographic factors; 2) predisposing knowledge and beliefs about sexual health; 3) enabling factors regarding perceived access to sexual health services; and 4) a need-for-care factor (sexual experience). RESULTS: Adolescents reported high intentions to use sexual health services (3.25 on a 4-point scale), yet only 42% reported knowing where to access services. Sexual health knowledge and beliefs significantly predicted adolescents' intention to use services beyond the effect of sociodemographics (P<0.001). Enabling factors indicating awareness of and importance attributed to accessibility significantly predicted intention to use services incremental to predisposing factors (P<0.001). However, need for care - that is, sexual experience - was not statistically associated with intention to use services (P=0.402). CONCLUSIONS: Sexual health interventions are needed to provide sexual health information, promote positive beliefs about health care, and ensure adolescents' awareness of and access to sexual health services.

Readability of Educational Materials to Support Parent Sexual Communication With Their Children and Adolescents.

Sexual communication is a principal means of transmitting sexual values, expectations, and knowledge from parents to their children and adolescents. Many parents seek information and guidance to support talking with their children about sex and sexuality. Parent education materials can deliver this guidance but must use appropriate readability levels to facilitate comprehension and motivation. This study appraised the readability of educational materials to support parent sexual communication with their children. Fifty brochures, pamphlets, and booklets were analyzed using the Flesch-Kincaid, Gunning Fog, and Simple Measure of Gobbledygook (SMOG) index methods. Mean readability grade-level scores were 8.3 (range = 4.5-12.8), 9.7 (range = 5.5-14.9), and 10.1 (range = 6.7-13.9), respectively. Informed by National Institutes of Health-recommended 6th to 7th grade levels and American Medical Association-recommended 5th to 6th grade levels, percentages falling at or below the 7.0 grade level were calculated as 38%, 12%, and 2% and those falling at or below the 6.0 grade level were calculated as 12%, 2%, and 0% based on the Flesch-Kincaid, Gunning Fog, and SMOG methods, respectively. These analyses indicate that the majority of educational materials available online to support parents' communication with their children about sex and sexuality do not meet the needs of many or most parents. Efforts to improve the accessibility of these materials are warranted.

A Rights-Based Sexuality Education Curriculum for Adolescents: 1-Year Outcomes From a Cluster-Randomized Trial.

PURPOSE: The purpose of this study was to evaluate the impact of a rights-based sexuality education curriculum on adolescents' sexual health behaviors and psychosocial outcomes 1 year after participation. METHODS: Within 10 urban high schools, ninth-grade classrooms were randomized to receive a rights-based curriculum or a basic sex education (control) curriculum. The intervention was delivered across two school years (2011-2012, 2012-2013). Surveys were completed by 1,447 students at pretest and 1-year follow-up. Multilevel analyses examined curriculum effects on behavioral and psychosocial outcomes, including four primary outcomes: pregnancy risk, sexually transmitted infection risk, multiple sexual partners, and use of sexual health services. RESULTS: Students receiving the rights-based curriculum had higher scores than control curriculum students on six of nine psychosocial outcomes, including sexual health knowledge, attitudes about relationship rights, partner communication, protection self-efficacy, access to health information, and awareness of sexual health services. These students also were more likely to report use of sexual health services (odds ratio, 1.37; 95% confidence interval, 1.05-1.78) and more likely to be carrying a condom (odds ratio, 1.97; 95% confidence interval, 1.39-2.80) relative to those receiving the control curriculum. No effects were found for other sexual health behaviors, possibly because of low prevalence of sexual activity in the sample. CONCLUSIONS: The curriculum had significant, positive effects on psychosocial and some behavioral outcomes 1 year later, but it might not be sufficient to change future sexual behaviors among younger adolescents, most of whom are not yet sexually active. Booster education sessions might be required throughout adolescence as youth initiate sexual relationships.

Sexuality Education Websites for Adolescents: A Framework-Based Content Analysis.

The web has unique potential for adolescents seeking comprehensive sexual health information. As such, it is important to understand the nature, scope, and readability of the content and messaging provided by sexuality educational websites. We conducted a content analysis of 14 sexuality education websites for adolescents, based on the 7 essential components (sexual and reproductive health and HIV, relationships, sexual rights and sexual citizenship, pleasure, violence, diversity, and gender) of the International Planned Parenthood Framework for Comprehensive Sexuality Education. A majority of content across all sites focused on sexual and reproductive health and HIV, particularly pregnancy and STI prevention, and other information about STIs and HIV. No other topic comprised more than 10% of content coverage across a majority of sites. The authors found little discussion of gender issues, sexual rights, sexual diversity, or sexual violence. Most sites provided brief references to sexual pleasure, generally moderated with cautionary words. Language used implied a heterosexual female audience. Reading levels for most sites were above the 9th-grade level, with several at the college level. These findings have implications for enhancing online sexuality education and broadening the coverage of essential topics.

Short-term effects of a rights-based sexuality education curriculum for high-school students: a cluster-randomized trial.

BACKGROUND: An emerging model for sexuality education is the rights-based approach, which unifies discussions of sexuality, gender norms, and sexual rights to promote the healthy sexual development of adolescents. A rigorous evaluation of a rights-based intervention for a broad population of adolescents in the U.S. has not previously been published. This paper evaluates the immediate effects of the Sexuality Education Initiative (SEI) on hypothesized psychosocial determinants of sexual behavior. METHODS: A cluster-randomized trial was conducted with ninth-grade students at 10 high schools in Los Angeles. Classrooms at each school were randomized to receive either a rights-based curriculum or basic sex education (control) curriculum. Surveys were completed by 1,750 students (N = 934 intervention, N = 816 control) at pretest and immediate posttest. Multilevel regression models examined the short-term effects of the intervention on nine psychosocial outcomes, which were hypothesized to be mediators of students' sexual behaviors. RESULTS: Compared with students who received the control curriculum, students receiving the rights-based curriculum demonstrated significantly greater knowledge about sexual health and sexual health services, more positive attitudes about sexual relationship rights, greater communication about sex and relationships with parents, and greater self-efficacy to manage risky situations at immediate posttest. There were no significant differences between the two groups for two outcomes, communication with sexual partners and intentions to use condoms. CONCLUSIONS: Participation in the rights-based classroom curriculum resulted in positive, statistically significant effects on seven of nine psychosocial outcomes, relative to a basic sex education curriculum. Longer-term effects on students' sexual behaviors will be tested in subsequent analyses. TRIAL REGISTRATION: ClinicalTrials.gov NCT02009046.

Parent-adolescent sexual communication and its association with adolescent sexual behaviors: a nationally representative analysis in the Netherlands.

Sexual communication is a principal means of transmitting sexual values, beliefs, expectations, and knowledge from parents to children. Although this area has received considerable research attention, more studies with representative samples are needed to assure that findings are reflective of populations of interest. A nationally representative sample of parent-adolescent dyads (N = 2,965; mean adolescent age = 13.8 years) in the Netherlands was employed to examine the frequency of parent-adolescent sexual communication and its association with adolescent sexual behaviors (defined as sexual initiation, condom use, and contraceptive pill use). Nine communication topics in the areas of anatomy, relationships and rights, and protection and contraception were examined. In all, 75%of parents reported having discussed at least one topic multiple times with their adolescents. Romantic relationships were discussed most frequently. Hierarchical logistic regression analyses indicated that parent-adolescent sexual communication on protection and contraception was positively associated with adolescent sexual initiation and contraceptive pill use but not condom use. This may reflect that adolescents, when they become sexually active, are more likely to discuss sexuality with their parents. Findings are interpreted within the context of Dutch culture, which is generally accepting of adolescent sexuality and characterized by open sexual communication.

A rights-based approach to sexuality education: conceptualization, clarification and challenges.

CONTEXT: Although a rights-based approach to sexuality education has been increasingly discussed in the past decade, documented consensus regarding the goals, concepts and underlying assumptions of this approach is lacking. Differences in the assumed meaning of a rights-based approach can limit discussions of its implementation and evaluation, and impede opportunities to explore and critique a new model for sexuality education. METHODS: In-depth interviews were conducted in 2012 with 21 U.S. and international sexuality education experts. Data were thematically coded and analyzed using an iterative approach. Responses were compared according to respondents' professional discipline and geographic focus. RESULTS: A rights-based approach can be defined as the intersection of four elements: an underlying principle that youth have sexual rights; an expansion of programmatic goals beyond reducing unintended pregnancy and STDs; a broadening of curricula content to include such issues as gender norms, sexual orientation, sexual expression and pleasure, violence, and individual rights and responsibilities in relationships; and a participatory teaching strategy that engages youth in critical thinking about their sexuality and sexual choices. These elements were consistently identified by respondents across professional disciplines and geographic foci. In addition, all respondents raised questions about the feasibility of implementing a rights-based approach, particularly in the United States. CONCLUSIONS: While questions remain to be answered regarding the implementation and impact of rights-based sexuality education, the proposed conceptual definition suggests multiple avenues for advocates, researchers, program developers and funders to enhance adolescent sexual health.

Smoking cessation, maintenance, and relapse experiences among pregnant and postpartum adolescents: a qualitative analysis.

PURPOSE: To understand the experiences and processes of smoking cessation, maintenance, and relapse for pregnant and postpartum adolescents, whose perspectives and needs might be different from other age groups. METHODS: We conducted in-depth semistructured interviews with 52 pregnant and postpartum adolescents using tools of grounded theory analysis. RESULTS: Spontaneous smoking cessation during pregnancy was reported by most participants. This was generally explained as resulting from knowledge about the harmful effects of tobacco on the fetus, intense emotional reactions to this knowledge, or unpleasant tobacco- and pregnancy-related physical symptoms. Relapses were common, however. Most participants experienced guilt when they relapsed during pregnancy. Postpartum relapse was less fraught, as many participants no longer considered their smoking to negatively affect their infants. This was found even among adolescents who were breastfeeding. Participants who did maintain cessation postpartum typically reported support from smoke-free families and environments. CONCLUSIONS: The results of this study suggest a constellation of protective factors that contribute to smoking cessation and maintenance during and after pregnancy, as well as risk factors that contribute to temporary or permanent relapses. These results can inform future research and interventions on tobacco prevention among pregnant and postpartum adolescents. Several promising strategies for intervention development are discussed.

Factors associated with parent support for condom education and availability.

Expanding condom-related knowledge and skills and reducing barriers to condom use have the potential to help reduce pregnancies and sexually transmitted infections among youth. These goals are sometimes addressed through condom education and availability (CEA) programs as part of sexuality education in school. Parents are a key constituency in efforts to implement such programs. A representative statewide sample of households with children (N = 1,093) in California was employed to examine parent support for CEA and the potential influences of demographics (gender, age, and Hispanic ethnicity), sociodemographics (education, religious affiliation, religious service attendance, and political ideology), and condom-related beliefs (belief in condom effectiveness and belief that teens who use condoms during sex are being responsible) on parent support for CEA. The parents in our sample reported a high level of support for CEA (M = 3.23 on a 4-point scale) and believing in a high level of condom effectiveness (M = 3.36 on a 4-point scale). In addition, 84% of the parents agreed that teens who use condoms during sex are being responsible. Hierarchical regression analyses showed that parents who were younger, Hispanic, with a lower educational attainment, without a religious affiliation, less religiously observant, and politically liberal were more supportive of CEA. After controlling for these demographic and sociodemographic factors, condom effectiveness and responsibility beliefs each added independently to the predictability of parent support for CEA. These findings suggest that parent education related to condom effectiveness could help increase support for school-based CEA programs.

Factors associated with contraceptive use in Angola.

After emerging from decades of civil war, Angola's economy has rapidly grown, yet its reproductive health outcomes have not improved at a commensurate level. At the time of this study, Angola had one of the highest rates of maternal mortality and fertility in the world. Only 6 percent of women aged 15-49 used contraception, with substantial differences in use and access across the different provinces of the country. This study uses a mixed-methods approach, combining analyses of a nationwide cross-sectional survey to assess which factors are associated with contraceptive use, with data from qualitative, semi-structured interviews of health care providers and internally displaced women to better understand and illuminate the survey data. High educational level and living in the capital region were strongly associated with contraceptive use, while age below 20 years was negatively associated with use. During qualitative interviews, health professionals commonly mentioned rural living, young age, cultural beliefs, and power imbalances as reasons for not using contraception. Internally displaced women often described difficulty paying for services, lack of nearby services, and limited knowledge of methods as barriers to use.

Demographic and psychological predictors of parent-adolescent communication about sex: a representative statewide analysis.

Sexual communication is a principal means of transmitting sexual values, beliefs, expectations, and knowledge between parents and children. Although this area has received considerable research attention, more studies with representative samples are needed to assure that findings are reflective of populations of interest. A representative statewide sample of households with adolescents (N = 907) from a large and diverse state in the United States was employed to examine the content and extent of sexual communication between parents and their adolescents, and the influence of selected primary demographic (age and gender), socio-demographic (Hispanic ethnicity, education, and religious attendance), and psychological (self-reported comfort, knowledge, and sexual communication difficulties) factors on the number of topics discussed. More than two-thirds of the parents reported experiencing some type of sexual communication difficulty, such as developmental concerns and embarrassment. Hierarchical regression results indicated that self-reported comfort, knowledge, and sexual communication difficulties strongly predicted the number of topics discussed, beyond the effect of demographic variables. These findings reinforce the notion that sexual communication between parents and adolescents can be universally challenging, and parents of both genders, all ages, and all socio-demographic characteristics might benefit from education and support.

California parents' preferences and beliefs regarding school-based sex education policy.

CONTEXT: Policy debates over the merits of abstinence-only versus comprehensive approaches to sex education are ongoing, despite well-documented public support for comprehensive sex education. Although parents are key stakeholders in the outcomes of these debates, their views have been less thoroughly considered. METHODS: A random digit dial survey of 1,284 California parents was conducted in 2006. Parents were asked about their sex education policy preferences, the importance of teaching selected topics at different grade levels and reasons for their preferences. Cross-tabulations and odds ratios were used to assess regional and other subgroup differences. RESULTS: Overall, 89% of parents reported a preference for comprehensive sex education, and 11% for abstinence-only education. Support for comprehensive sex education was high in all regions (87-93%) and across all subgroup characteristics: race or ethnicity (79-92%), age (86-94%), education (84-93%), household income (87-92%), religious affiliation (86-91%), religious service attendance (69-96%) and ideological leaning (71-96%). Four types of reasons for preferences emerged: those focused on the consequences of actions, on the importance of providing complete information, on the inevitability of adolescents' engaging in sex and on religious or purity-based morality concerns. While 64% of abstinence-only supporters cited the last type (absolutist reasons), 94% of comprehensive sex education supporters cited one of the first three (pragmatic reasons). CONCLUSIONS: The high levels of support for comprehensive sex education across California's diverse regions and demographic subgroups suggest that such support may be generalizable to communities and school districts both in California and around the country. Furthermore, ideological differences might be less important to the sex education debates than the distinction between pragmatic and absolutist perspectives.

Promoting prenatal and early childhood health: evaluation of a statewide materials-based intervention for parents.

OBJECTIVES: There is a critical need for effective, large-scale health communication programs to support parents of children aged 0-5 years. We evaluated the effectiveness of the Kit for New Parents, a multimedia health and parenting resource now distributed annually to 500000 parents in California. METHODS: In this quasi-experimental study, 462 mothers in the intervention group and 1011 mothers in the comparison group, recruited from prenatal and postnatal programs, completed a baseline interview about health-relevant parenting knowledge, and mothers in the intervention group received the kit. Both groups were reinterviewed 2 months later. At 14-months postbaseline, 350 mothers in the intervention group and a sample of 414 mothers who had equivalent demographic characteristics (comparison group) were interviewed about parenting knowledge and practices. RESULTS: Of the mothers in the intervention group, 87% reported using the kit within 2 months after receiving it, and 53% had shared it with their partner. At both follow-ups, mothers in the intervention group showed greater gains in knowledge and reported better practices at 14 months than did mothers in the comparison group. Gains were greater for prenatal recipients and for Spanish speakers. Providers considered the kit a valuable resource for their parenting programs. CONCLUSIONS: The kit is an effective, low-cost, statewide health intervention for parents.

Acceptance of human papillomavirus vaccination among Californian parents of daughters: a representative statewide analysis.

PURPOSE: To examine likelihood of parental acceptance of human papillomavirus (HPV) vaccination for young adolescent girls, together with reasons for acceptance and nonacceptance. The ultimate goal of this research is to inform policy decisions and educational planning in this area. METHODS: A random-digit-dial telephone survey of parents in California households was conducted, yielding 522 parents with an eligible daughter. Cross tabulations and odds ratios were employed to analyze likelihood of vaccination acceptability. Reasons provided for acceptance or nonacceptance were analyzed qualitatively. RESULTS: Overall, 75% of the sample reported that they would be likely to vaccinate a daughter before age 13 years. Hispanic parents were more likely to accept vaccination than were non-Hispanic parents, whereas African-American and Asian-American parents were less likely. Other subgroups less likely to accept vaccination were identified. Five clusters of reasons by nonaccepting parents emerged: pragmatic concerns about effects on sexual behavior, specific HPV vaccine concerns, moral concerns about sexual behavior, general vaccine concerns, and denial of need. A sixth group of interest comprised those who would vaccinate before age 16 years, but not age 13. CONCLUSIONS: Consistent with previous studies on this topic, a large majority of California parents endorsed HPV vaccination for daughters by the recommended age. Although important subgroup disparities were found, majorities of all subgroups supported vaccination. This information, together with the identified clusters of cognitive decision factors for nonacceptance, has implications for policy decisions and educational planning in this area. Suggestions for further research on subgroup disparities and on cognitive factors involved in parents' decisions arise from these findings.