Associated Factors of Sexual Initiation among Male Vocational High School Students in Zhejiang Province, China: A Cross-sectional Study.

AIMS: This study aims to investigate the factors associated with sexual initiation among male vocational high school students (MVHSS) in Zhejiang Province, and provide a scientific basis for preventing unsafe sexual behavior and sexual health issues among adolescents. BACKGROUND: The prevalence of sexual behavior among young students has risen significantly in recent years. Contracting HIV poses a serious physical and psychological burden on young individuals and their families. Thus, it is imperative to promptly and effectively address the spread of HIV among young people. OBJECTIVE: The objectives of this study are to investigate the demographic characteristics of male vocational high school students (MVHSS) who have engaged in sexual activity and to identify associated factors, such as sexual attitudes and lifestyle, that may influence sexual initiation among this population, and to offer recommendations for interventions and policy development aimed at promoting healthy sexual behaviors among MVHSS. METHODS: A survey was conducted among vocational high school students in grades one and two in Zhejiang Province. Variables that were statistically significantly associated with sexual initiation in bivariate analyses were included in a multivariate logistic regression model, which adopted a backward elimination procedure with a p-value > 0.10 as the exclusion criterion. Odds ratios (ORs) and 95% confidence intervals (CIs) were used to describe the relationship between dependent and outcome variables. RESULTS: Of the 1032 male participants, 17.4% had initiated sexual behavior. The multivariate analysis results indicated thatThose who were frequent smokers (adjusted OR[AOR] =4.89, 95% CI: 2.36-10.13), those who reported having been in love (AOR=2.86, 95% CI: 1.84-4.44), those currently in love (AOR=4.47, 95% CI: 2.68-7.45), those willing to have sex with a high school student (AOR =2.63, 95% CI: 3.31-6.50), those willing to pay for sex (AOR =1.90, 95% CI: 1.10-3.27), and those who had received sex education and STDs/AIDS prevention education in school (AOR =2.21, 95% CI: 1.53-3.18) were more likely to initiate sexual behavior. CONCLUSION: Sexual attitudes among MVHSS are liberal, and the prevalence of sexual initiation is high. Interventions targeted at improving sexual safety education, reducing the rate of early initiation of sexual behavior, and promoting condom use among students must be implemented to reduce the risk of HIV infections and STDs among sexually active MVHSS.

Spatial distribution and determinants of Early sexual initiation in Ethiopia.

INTRODUCTION: Early sexual initiation has negative health, social, and economic consequences for both women and future generations. The trend of early sexual initiation is increasing globally, leading to higher rates of sexually transmitted diseases and unplanned pregnancies. Ethiopia has been challenged various disasters that makes women vulnerable and position them at heightened risk of early sexual initiation in the last four years. The spatial patterns and factors of early sexual initiation in the post-conflict-post pandemic settings is not well understood. Hence this research aimed at mapping Spatial Patterns and identifying determinant factors in the Post-COVID-Post-Conflict Settings. METHODS: The study was conducted on secondary data from the PMA 2021 cross-sectional survey which conducted nationally from November 2021 to January 2022 which is in the post pandemic and post-war period. Total weighted sample of 6,036 reproductive age women were included in the analysis. ArcGIS Pro and SaTScan software were used to handle spatial analysis. Multilevel logistic regression model was used to estimate the effects of independent variables on early sexual initiation at individual and community level factors. Adjusted odds ratio with the 95% confidence interval was reported to declare the strength and statistical significance of the association. RESULT: The spatial distribution of early sexual initiation was clustered in Ethiopia with a global Moran's I index value of 0.09 and Z-score 6.01 (p-value < 0.001).Significant hotspots were detected in East Gojjam zone of Amhara region, Bale, Arsi, West Hararge, East Wellega and Horo Gudru Wellega zones of Oromia region. The odds of having early sexual initiation was higher in women with primary education (AOR = 1.23, 95%CI: 1.03, 1.47), secondary or above education (AOR = 4.36, 95%CI: 3.49, 5.44), Women aged 26 to 25 (AOR = 1.91, 95%CI: 1.61, 2.26), women aged 36 to 49(AOR = 1.51, 95%CI: 1.24, 1.84). However, there was a significant lower likelihood of early sexual initiation in rural resident women (AOR = 0.53, 95%CI: 0.35, 0.81) and women living in 5 to 7 family size (AOR = 0.79, 95%CI: 0.68, 0.92), and more than 7 members (AOR = 0.63, 95%CI: 0.49, 0.81). CONCLUSIONS: The spatial distribution of early sexual initiation was clustered in Ethiopia. Interventions should be taken to eliminate the observed variation by mobilizing resources to high-risk areas. Policies and interventions targeted to this problem may also take the identified associated factors into account for better results.

Geographically weighted regression analysis to assess hotspots of early sexual initiation and associated factors in Ethiopia.

Background: Early sexual initiation (ESI) causes unintended pregnancy, sexually transmitted infections (STI), high risk of depression and anxiety, developmental delays, lack of emotional maturity, and difficulty in pursuing education. This study aims to analyze the geographically weighted regression and associated factors of ESI of women in Ethiopia. Methods: The study utilized data from the Ethiopian Demographic and Health Survey, 2016. It included a weighted sample of 11,775 women. Spatial regression was carried out to determine which factors are related to hotspots of ESI of women. To identify the factors associated with ESI, a multilevel Poisson regression model with robust variance was conducted. An adjusted prevalence ratio (APR) with its 95 % confidence interval was presented. Results: The prevalence of ESI was 75.3 % (95%CI: 74.6 %, 76.1 %), showing notable spatial variation across different regions of Ethiopia. Areas of significant hotspots of ESI were identified in Western and Southern Tigray, most parts of Amhara, Southern, Central and Western Afar, Eastern Gambella, and North Western SNNPR. The significant variables for the spatial variation of ESI were; being single, rural residence, and having no formal education of the women. Factors including; wealth index, marital status, khat chewing, education level, residence, and region were associated significantly with ESI in the multilevel robust Poisson analysis. Conclusion: A higher proportion of ESI in women was found. Public health interventions must be made by targeting hotspot areas of ESI through increasing health care access and education (specifically among rural residents), developing a comprehensive sexual education, implementing policies and laws that outlaw early marriage, and mass community-based programs to increase awareness about the importance of delaying sexual activity.

Associations of Parents-Adolescent Relationship with Adolescent Sexual Risk Behaviors: A Global Analysis Based on 156,649 School-Going Adolescents from 50 Countries.

Our study, examining the Global School-Based Student Health Survey data from 50 countries across four WHO regions, found boys have higher sexual exposure (33.5 vs 17.7%) and risk behaviors - early sexual initiation (55.0 vs. 40.1%), multiple partners (45.2 vs. 26.2%), and condom nonuse (29.2 vs. 26.8%) - than girls. We found that adolescents with parents who understood their problems, monitored academic and leisure-time activities, and respected privacy were less likely to be engaged in sexual activities and risk behaviors. This study highlights the importance of parental involvement and advocates for gender-specific, family-focused interventions to mitigate adolescent sexual risks.

The sexual and reproductive health covariates of early menarche among adolescent girls.

INTRODUCTION: Research suggests that girls who reach menarche at an early age are at greater risk for negative sexual and reproductive health (SRH) outcomes than their later-maturing counterparts, but very little research has examined this issue in sub-Saharan Africa, especially in West Africa. The goal of the current study was to determine whether early menarche was associated with any SRH outcomes in a sample of Ghanaian girls. METHODS: The study data were drawn from the baseline assessment of a longitudinal study involving two age cohorts (13-14 and 18-19 years) of 700 adolescent girls from Ghana. Logistic regressions were used to assess the association between early menarche (before age 13) and seven SRH outcomes (adolescent sexual activity, early sexual initiation, inconsistent condom use, transactional sex, sexual violence, multiple sexual partners, and adolescent pregnancy). RESULTS: Early menarche was significantly associated with adolescent sexual activity (odds ratio [OR] = 6.4; 95% confidence interval [CI] 2.1-19.7), and sexual violence (OR = 3.2; 95% CI 1.6-6.2) in the younger cohort and early sexual initiation (OR = 3.2; 95% CI 1.19-8.61) and multiple sexual partners (OR = 3.7; 95% CI 1.39-9.87) in the older cohort. Early menarche was also associated with transactional sex and teen pregnancy in the full sample. CONCLUSIONS: These findings suggest the need for special attention to the needs of early-maturing girls in SRH programming. Interventions are needed to delay adolescent sexual activity in girls with early menarche. Efforts to prevent sexual violence among adolescent girls in Ghana may benefit from targeting and addressing the specific needs of early-maturing girls.

The Association Between Sexual Initiation and Membership in Dyadic Profiles of Perceived Shared Power.

There is scarce empirical evidence examining whether sexual initiation and power are associated with each other. Utilizing latent profile analyses, we examined in a nationally representative sample of US newlywed heterosexual couples (N = 1,948 couples) whether wives' and husbands' sexual initiation patterns and satisfaction with these patterns were associated with membership in different profiles of wives' and husbands' perceptions of shared relational power while accounting for both partner's satisfaction with sexual frequency. We found four profiles of wives' and husbands' perceptions of power. The most common profile was when both wives and husbands perceived high levels of power compared to other profiles, but wives had significantly higher reports of perceived power than husbands (High Power, Wife Higher; 40.8%). Husbands' sexual initiation patterns were not associated with profile membership. Wives who reported equal sexual initiation patterns had a higher probability of being in the High Power, Wife Higher profile compared to the Wife Low Power, Husband Moderate Power profile. Both wives' and husbands' satisfaction with sexual initiation patterns were associated with profile membership. Wives and husbands that were satisfied with sexual initiation patterns had a higher probability of being in the High Power, Wife Higher profile compared to the profile where both wives and husbands had high perceptions of shared relational power compared to other profiles, but their scores were not significantly different from each other (High Power, Equal).

Exploring the effect of early menarche on sexual violence among adolescent girls and young women in southeastern Ghana: a longitudinal mediation analysis.

Research from several high-income countries links early menarche with an increased risk for sexual violence. However, the role of early menarche in adolescent girls' and young women's sexual violence risk in sub-Saharan Africa, where sexual violence rates are high, is not well understood. The current study explores the association between early menarche and sexual violence in Ghana with secondary analysis of data collected from 700 adolescent girls and young women followed over three years. Logistic regressions were used to assess the cross-sectional association between early menarche and sexual violence. Generalised estimating equations were used to assess whether the association between early menarche and sexual violence persisted over time. Inverse odds weighting was used to test potential mediators of the association between early menarche and sexual violence. Sexual violence was fairly common in the study sample, with 27% reporting having experienced sexual violence at baseline, and approximately 50% at year three. Early menarche was associated with 72% greater odds of having experienced sexual violence at baseline (95% confidence interval: 1.01-2.93). However, the odds ratio attenuated and lost significance over the three-year study period, with a lower risk of sexual violence among girls with early menarche at year three. Neither child marriage nor early sexual initiation significantly mediated the association between early menarche and sexual violence. The findings suggest that early-maturing girls may be particularly vulnerable to sexual violence in early adolescence, thus necessitating prevention interventions around the time of menarche to reduce the risk for sexual violence.

Determinants of early sexual initiation among female adolescents in Bangladesh: evidence from a countrywide cross-sectional survey.

OBJECTIVES: Early sexual initiation (ESI), defined as sexual activity that begins before 15 or 18 years of age, is one of the risky sexual behaviours that has been linked to increased likelihood of adverse consequences, such as sexually transmitted diseases, unintended pregnancies and unsafe abortions. However, to date, there are no studies investigating the prevalence and factors influencing ESI among adolescent females (aged 10-19 years) in Bangladesh. Thus, this study aimed to identify the potential determinants of ESI among adolescent females in Bangladesh based on data that are representative of the country. STUDY DESIGN: This was a cross-sectional study. METHODS: Based on the availability of the data, the analysis included a weighted sample of 2051 adolescent females aged 15-19 years from the Bangladesh Demographic and Health Survey 2017/18. Initial selection of predictor variables was based on the bivariate analysis using the Chi-squared test. Univariate and multivariable logistic regression modelling were performed to measure the crude and adjusted effect of the selected predictor variables on ESI using the odds ratio (OR). The elasticity of the effects was calculated by their 95% confidence intervals (CIs). RESULTS: Approximately 22% and 85% of female adolescents experienced ESI before the age of 15 and 18 years, respectively. Findings revealed that illiteracy (adjusted OR [AOR]: 3.61, 95% CI: 1.82-7.18), primary education (AOR: 2.08, 95% CI: 1.60-2.69), working status (AOR: 1.25, 95% CI: 0.98-1.60), living in Chittagong (AOR: 0.46, 95% CI: 0.27-0.79), living in Sylhet (AOR: 0.21, 95% CI: 0.08-0.56), reading newspapers (AOR: 0.63, 95% CI: 0.40-1.01), earlier marriage preference (AOR: 3.30, 95% CI: 2.31-4.71) and later marriage preference (AOR: 4.10, 95% CI: 3.01-5.59) were significantly linked with ESI before the age of 15 years. ESI before the age of 18 years was significantly association with primary education (AOR: 1.47, 95% CI: 1.01-2.13), religion (AOR: 0.55, 95% CI: 0.32-0.94), female household head (AOR: 1.93, 95% CI: 1.17-3.19), living in Rajshahi (AOR: 1.97, 95% CI: 0.95-4.08), being in the 'poorest' wealth category (AOR: 2.43, 95% CI: 1.45-4.07), being in the 'poorer' wealth category (AOR: 1.70, 95% CI: 1.06-2.72), being in the 'middle' wealth category (AOR: 1.76, 95% CI: 1.12-2.77), being in the 'richer' wealth category (AOR: 1.58, 95% CI: 1.02-2.44), earlier marriage preference (AOR: 15.71, 95% CI: 9.09-27.14), later marriage preference (AOR: 12.62, 95% CI: 8.82-18.06) and heard about family planning (AOR: 0.70, 95% CI: 0.47-1.04). CONCLUSIONS: In Bangladesh, the prevalence of ESI among female adolescents is a public health concern. Due to the detrimental impact of ESI on the well-being of adolescents, it is crucial that policymakers consider the factors influencing ESI that have been identified in this study when designing health strategies. The findings from this study will help the development of evidence-based effective initiatives by policymakers in collaboration with governmental and non-governmental organisations.

Socioeconomic inequality in early sexual initiation among female youths in sub-Saharan African countries: a decomposition analysis.

INTRODUCTION: Youths are defined as individuals within the age group 15-24 years. It is the transitional stage from childhood to adulthood with biological, social, and psychological change, so it is a time of risk and opportunity for their future life. Early sexual initiation exposes young people to various social, economic, sexual, and reproductive health issues, such as unwanted adolescent pregnancies, sexually transmitted infections, unsafe abortion, cervical cancer, and early marriages. Therefore, this study aimed to assess the presence of socioeconomic inequality in early sexual initiation and contributing factors in sub-Saharan African countries. METHODS: A total of 118,932 weighted female youths from SSA countries' DHS data were included in the study. Socioeconomic inequality of Early sexual initiation was evaluated using the Erreygers znormalized concentration index and associated concentration curve. Decomposition analysis was performed to determine those factors causing socioeconomic-related inequality. RESULTS: The weighted Erreygers normalized concentration index of wealth-related inequality of early sexual initiation was - 0.157 with a Standard error = 0.0046 (P value < 0.0001); this indicated that early sexual initiation was disproportionately concentrated among the poor (pro-poor). Moreover, the weighted Erreygers normalized concentration index (ECI) of educational status-related inequality of early sexual initiation was - 0.205 with a Standard error = 0.0043 (P value < 0.0001). This indicated that early sexual initiation was disproportionately concentrated among youths with no formal education. The decomposition analysis revealed that mass media exposure, wealth index, place of residency, religion, marital status, educational status, and age were significant contributors to the pro-poor socioeconomic inequalities in early sexual initiation. CONCLUSION AND RECOMMENDATION: This study has revealed pro-poor inequality in early sexual initiation. Therefore, priority must be given to modifiable factors such as promoting the accessibility of media exposure in the household, improving the educational opportunity of female youths, and improving their country's economy to a higher economic level to improve the wealth status of the population.

It Takes Two to Tango: Links Between Traditional Beliefs About both Men's and Women's Gender Roles and Comfort Initiating Sex and Comfort Refusing Sex.

Traditional gender roles dictate rigid rules and standards prescribing which behaviors, thoughts, and feelings are considered masculine and feminine within sexual contexts, and thus internalizing these beliefs (higher traditional gender ideology) may influence sexual attitudes. Prior theorizing has primarily focused on how women's traditional beliefs about women's gender roles (traditional femininity ideology) and men's traditional beliefs about men's gender roles (traditional masculinity ideology) influence their sexual assertiveness. Yet, men can hold traditional beliefs about women, and women can hold traditional beliefs about men, and these beliefs should have important implications for sexual assertiveness. We addressed this gap by testing how both heterosexual women's (n = 389) and men's (n = 393) traditional masculinity and femininity ideologies associate with their reported comfort initiating sex and comfort refusing sex in their relationships. When accounting for both sets of beliefs, women's traditional beliefs about men's and women's roles interacted to predict comfort initiating sex, but not comfort refusing sex. Men's traditional beliefs about men's roles predicted less comfort refusing sex, and their traditional beliefs about women's roles predicted less comfort initiating sex. This novel research underscores the importance of considering beliefs about both sets of traditional gender roles for understanding people's sexual attitudes. Supplementary Information: The online version contains supplementary material available at 10.1007/s11199-023-01366-w.

Early Sexual Debut and Its Associated Factors Among Young Women Aged 15-24 in Mali: A Multilevel Analysis.

Early sexual debut is associated with increased risk of several sexual and reproductive health problems, including unwanted pregnancies and sexually transmitted infections. Hence, determining factors that promote early sexual initiation is significant to guide policy and inform interventions aimed to promote the health of young people through to adulthood. This study examined the prevalence of early sexual debut and its associated factors among young women in Mali. Using cross-sectional nationally representative data from the 2018 Mali Demographic and Health Survey, a total of 4063 young women aged 15-24 were included in the study. Multilevel binary logistic regression analysis was done to determine the factors associated with early sexual debut. The results were presented using adjusted odds ratios (aOR) and 95% confidence intervals (CIs). The prevalence of early sexual debut in Mali was 17.8% (95% CI; 16-19.7%). Young women who attended higher school had lower odds of early sexual debut (aOR = 0.10, 95% CI; 0.01-0.82) compared to young women who had no formal education. Young women from richest households had lower odds of early sexual debut compared to those from the poorest households (aOR = 0.48, 95% CI; 0.27-0.82). Young women from households with large family size also had lower odds of experiencing early sexual debut compared to those in small family size (aOR = 0.81, 95% CI; 0.66-0.99). Furthermore, the odds of early sexual debut were lower among young women in Koulikoro (aOR = 0.59, 95% CI; 0.39-0.90), Sikasso (aOR = 0.35, 95% CI; 0.21-0.56), Segou (aOR = 0.40, 95% CI; 0.25-0.64), and Mopti (aOR = 0.44, 95% CI; 0.23-0.82) regions compared to young women in Kayes region. Higher odds of early sexual debut were found among currently employed compared to not currently employed young women (aOR = 1.74, 95% CI; 1.42-2.12) and currently married compared to not currently married young women (aOR = 4.64, 95% CI; 3.64-5.92). Young women from the Peulh ethnic groups compared to those from the Bambara ethnic groups were at a higher odds of early sexual debut (aOR = 1.43, 95% CI; 1.03-1.99). The findings suggest the need for interventions aimed at addressing early sexual debut among young women. These can include emphasizing the promotion and importance of female education, addressing the cultural practices that promote negative sexual norms/practices such as child marriages, and ensuring social change through efforts such as creating employment or economic opportunities for families.

Prevalence and associated factors of early sexual initiation among youth female in sub-Saharan Africa: a multilevel analysis of recent demographic and health surveys.

BACKGROUND: Early sexual initiation is a major public health concern globally, specifically in Sub-Saharan African (SSA) countries where reproductive health care services are limited. It is strongly related to increased risk of HIV/AIDS, sexually transmitted diseases, unwanted pregnancy, adverse birth outcomes, and psychosocial problems. However, there is limited evidence on the prevalence and associated factors of early sexual initiation among youth females in SSA. METHODS: A secondary data analysis was employed based on the recent DHSs of sub-Saharan African countries. A total weighted sample of 184,942 youth females was considered for analysis. Given the hierarchical nature of DHS data, a multilevel binary logistic regression model was fitted. The Intra-class Correlation Coefficient (ICC), Median Odds Ratio (MOR), and Likelihood Ratio (LR) test were used to assess the presence of clustering. Four nested models were fitted and the model with the lowest deviance (-2LLR0 was selected as the best-fitted model. Variables with p-value < 0.2 in the bivariable multilevel binary logistic regression analysis were considered for the multivariable analysis. In the multivariable multilevel binary logistic regression analysis, the Adjusted Odds Ratio (AOR) with the 95% Confidence Interval (CI) was reported to declare the strength and statistical significance of the association. RESULTS: The prevalence of early sexual initiation among youth females in sub-Saharan Africa was 46.39% [95%CI: 41.23%, 51.5%] ranging from 16.66% in Rwanda to 71.70% in Liberia. In the final model, having primary level education [AOR = 0.82, 95% CI; 0.79, 0.85], and [AOR = 0.50, 95%CI; 0.48, 0.52], being rural [AOR = 1.05, 95%CI: 1.03, 1.07], having media exposure [AOR = 0.91, 95%CI: 0.89, 0.94], and belonged to a community with high media exposure [AOR = 0.92, 95%CI: 0.89,0.96] were found significantly associated with early sexual initiation. CONCLUSION: The prevalence of early sexual initiation among youth females in SSA was high. Educational status, wealth index, residence, media exposure, and community media exposure have a significant association with early sexual initiation. These findings highlight those policymakers and other stakeholders had better give prior attention to empowering women, enhancing household wealth status, and media exposure to increase early sexual in the region.

Influence of Selected Sociodemographic and Cultural Factors on the Age of Sexual Initiation of Students from Polish Universities.

Sexuality is the one of the most important parts of human life. The aim of our study was to identify the factors influencing the onset and age of sexual initiation in students and drawing attention to the need to improve access to sexual education in Polish schools at a sufficiently high level. An original questionnaire with 31 questions was used for the study. Data were collected using the Google Forms tool. A total of 7528 students participated in the study and 5824 underwent sexual initiation. The mean age at sexual initiation was 18.1 years. Logistic regression analysis was performed to show factors influencing the onset of sexual activity, while linear regression analysis was used for factors influencing the age of sexual initiation. Religion, drug use, smoking, alcohol consumption, type of housing, and conversations with parents about contraception or sex affect the onset of sexual activity. The age of sexual initiation is affected by religion, the age of the first viewing of pornography, quality of life, the size of the city of residence, smoking and drug use.

Who Benefits from School-Based Teen Pregnancy Prevention Programs? Examining Multidimensional Moderators of Program Effectiveness Across Four Studies.

Recent research has suggested the importance of understanding for whom programs are most effective (Supplee et al., 2013) and that multidimensional profiles of risk and protective factors may moderate the effectiveness of programs (Lanza & Rhoades, 2012). For school-based prevention programs, moderators of program effectiveness may occur at both the individual and school levels. However, due to the relatively small number of schools in most individual trials, integrative data analysis across multiple studies may be necessary to fully understand the multidimensional individual and school factors that may influence program effectiveness. In this study, we applied multilevel latent class analysis to integrated data across four studies of a middle school pregnancy prevention program to examine moderators of program effectiveness on initiation of vaginal sex. Findings suggest that the program may be particularly effective for schools with USA-born students who speak another language at home. In addition, findings suggest potential positive outcomes of the program for individuals who are lower risk and engaging in normative dating or individuals with family risk. Findings suggest potential mechanisms by which teen pregnancy prevention programs may be effective.

Unequal Transitions to Adulthood: Widening Disparities in Age at First Union, Sex, and Birth in Many Low- and Middle-Income Countries.

Research on the timing of events during the transition to adulthood, such as first union, sex, and birth in low- and middle-income countries (LMICs), focused predominantly on measures of central tendency, notably median or mean ages. In this report, we adopt a different perspective on this topic by examining disparities in the timing of these events in 46 LMICs spanning four decades. Using Demographic and Health Surveys, we estimate ages at which 25 percent, 50 percent, and 75 percent of women have first union, birth, and sex. We compute interquartile ranges to measure within-country variation and disparities in the timing of sexual initiation and family formation. Variation in the timing of first union, birth, and sex generally increases as the median ages at these events increase. Disparities in the timing of first union and birth grew in West Africa and Latin America, and women who experience these events relatively early increasingly lag behind women who experience them relatively late. Documenting trends in measures of central tendency is insufficient to capture the complexity of ongoing changes because they mask growing disparities in the timing of family formation across many LMICs. These results are important for assessing progress toward the achievement of sustainable development goals related to the reduction of early marriages and pregnancies and highlight a need for more holistic approaches to measure the timing of family formation.

Youth Assets and Initiation of Sexual Intercourse by Family Structure: A Longitudinal Cohort Study.

BACKGROUND: The purpose of this study was to assess the protective influence of individual, family, and community assets from the initiation of sexual intercourse (ISI) for adolescents living in one-parent households compared with adolescents living in two-parent households. METHODS: Five waves of data were collected annually over a 4-year period (N = 591, 52.5% female, mean age = 14.0 years) from a racially/ethnically diverse sample of adolescents. Extended Cox models were used to assess the relationship between assets and time of ISI while controlling for demographic variables. Potential interactions between adolescent's household structure and assets were examined. RESULTS: Five of 17 assets were prospectively and significantly associated with a reduced risk of ISI among adolescents living in one-parent households compared with 11 of 17 assets for adolescents living in two-parent households. Adolescents living in one-parent households who possessed any one of five assets (e.g., general aspirations for the future, relationship with mother, positive peer role models) had between a 27% and 57% lower risk of ISI, whereas adolescents living in two-parent households who possessed any of one of 11 assets (e.g., responsible choices, family communication, community involvement) had between a 20% and 42% lower risk of ISI. CONCLUSION: The results suggest that strengthening specific youth assets across multiple dimensions of behavioral influence may decrease the risk of ISI for adolescents living in both one-parent and two-parent households. Public health efforts focused on developing programs to promote asset building tailored to adolescent's family structure are warranted.

Prevalence and associated factors of early sexual initiation among female youth in East Africa: further analysis of recent demographic and health survey.

BACKGROUND: Early sexual initiation is one of the risky sexual practices. Early sexual beginning is associated with an increased risk of HIV/AIDS, sexually transmitted infections (STIs), unexpected pregnancies, unsafe abortion, premature deliveries, and psychosocial issues. However, there is still a lack of evidence, particularly in East Africa, where community-level factors are not investigated. Therefore, this study aimed to estimate the pooled prevalence and to identify associated factors of early sexual initiation among female youth in Eastern Africa. METHODS: A total weighted sample of 49,716 female youth was included in this analysis. STATA version 14 software was used for data extraction, recoding, and analysis. A multilevel binary logistic regression model was fitted to identify determinants of early sexual initiation in the region. Finally, Adjusted Odds Ratio (AOR) with a 95% Confidence Interval (CI) was reported to declare the factors that are significantly associated with early sexual initiation. RESULT: The prevalence of early sexual initiation in East Africa was 21.14% [95% CI: 20.00%, 21.50%]. In the multivariable multilevel analysis; being age 20-24 years [AOR = 0.65: 95% CI; 0.61, 0.69], primary [AOR = 0.73: 95% CI; 0.67, 0.78], secondary &above education [AOR = 0.30: 95% CI; 0.27,0.33], married [AOR = 1.85: 95% CI; 1.73,1.97], middle wealth [AOR = 0.78: 95% CI; 0.72,0.84], richest [AOR = 0.74: 95% CI; 0.68,0.80], and reading newspaper [AOR 0.77: 95% CI;0.71,0.83] were significantly associated with early sexual initiation. CONCLUSION: The study revealed that early sexual initiation among female youth was high in East Africa. Educational status, respondent age, marital status, wealth index, age at first cohabitation, contraceptive use, reading newspaper, and place of residence were associated with early sexual initiation. Therefore, the survey findings will help policymakers, as well as governmental and non-governmental organizations, design the most effective interventions. Moreover, strengthening information, education, and wealth status are important intervention areas to delay the age of early sexual debut.

Geographical hotspots and correlates of early sexual debut among women in Ghana.

OBJECTIVES: Generalisation of sexual behaviour, including early sexual initiation, does not provide comprehensive knowledge of young people's sexual attitudes, behaviours and challenges, given the high sociocultural diversity and economic inequalities within countries. This study examines geographical hotspots of early sexual initiation, at the district level in Ghana and the factors associated with the observed spatial patterns. METHODS: Data was derived from the 2017 Ghana Maternal Health Survey, covering 21,392 women aged 15-49 years. Early sexual debut denotes first sexual intercourse before attaining the legal age of sexual consent, which in Ghana, is 16 years. The Bayesian geoadditive semiparametric regression technique was used to examine geographical hotspots and correlates of the observed spatial patterns, classified into demographic, socioeconomic and pregnancy outcome factors. RESULTS: The results show that 26.7% (95% CI = 26.1-27.3) of women had their first sexual intercourse before attaining the age of 16 years. Hotspots of early sexual debut was observed predominantly among districts along the mainstream of the Volta Lake, which are also reported hotspots of child trafficking, labour and slavery. Demographic, socioeconomic and pregnancy related factors were identified to be correlated with the observed spatial clustering. CONCLUSION: Policies and interventions such as sexual and reproductive health education should target at-risk population, simultaneously addressing other child abuses perpetuating the practice.

Ghana operates a decentralised health system, where health policies and interventions, including those for sexual and reproductive health are implemented at the district level. Yet, there are no studies that systematically identify districts where sexual behaviours, such as early sexual debut, require attention. This study uses spatial models and data from the 2017 Ghana Maternal Health Survey to identify areas (districts) with high concentration of women who initiated sex before the legal age of consent. Early sexual debut refers to first sexual intercourse before attainment of the legal age (16 years) of sexual consent. Early sexual initiation has been associated with adverse sexual and reproductive health outcomes such as unwanted pregnancies and STIs. The results show that about one in four women reported having early sexual intercourse. High early sexual intercourse was observed to be particularly concentrated among districts along the mainstream of the Volta Lake. With regards to the spatial correlates, for the districts in the Oti region, high early sexual debut was associated with low educational attainment and inability to read. For those in the Bono East and Eastern regions, women who had early sexual debut were more likely to have had a miscarriage, abortion or stillbirth. Younger women, those in co-habiting relationships and those not in union were more likely to have had early sexual debut in the districts in the Ashanti, Central and Northern regions. The findings call for intensification of sexual and reproductive health education in districts along the mainstream of the Volta Lake.

Early Sexual Initiation Is Associated with Suicide Attempts among Chinese Young People.

This study aimed to investigate the association between early sexual initiation and suicide attempts (SAs) among Chinese young people. Our analysis included 9131 college students who had sexual experience from a national sample of 31 provincial administrative regions. Self-reported age at first intercourse was categorized as ≤15, 15-18, and ≥18 years, and the experience of SAs was recorded and analyzed. Compared with females whose sexual debut age was ≥18 years, those ≤15 years (defined as early sexual initiation) had higher odds of SAs in both the forced debut group (odds ratio (OR) 17.04, 95% confidence interval (CI) 4.87-59.66) and the voluntary debut group (OR 37.63, 95% CI 14.96-94.66). Early sexual initiators who lived in rural areas were more inclined to have SAs (female: OR 65.76, 95% CI 19.80-218.42; male: OR 15.39, 95% CI 1.64-144.19). Early sexual initiators who never had parent-child communication about sex were more likely to report having SAs (female: OR 37.81, 95% CI 12.28-116.46). Sexual debut during adolescence, particularly early sexual initiation, was a crucial risk factor for SAs among both sexes. Comprehensive sexuality education and smooth parental communication about sex will provide a supportive environment for young people and hence reduce the potential risks of SAs.

Sexual behavior of Lithuanian high school students.

OBJECTIVE: To evaluate the sexual behavior of Lithuanian high school students. STUDY DESIGN: School-based anonymous self-administered survey of high school students, conducted from February to June 2017. RESULTS: Of 167 invited schools, 113 (67.7%) agreed to participate in the survey with a response rate of 75% among invited students (8143/10,811). Respondents' median age was 18 (range 16-20) years. Nearly one-third of students (31.3%) reported sexual intercourse with a median age at coitarche of 17 years. Most (82.9%) used contraception at coitarche. Contraception at coitarche was more common among those who were sober at coitarche (aOR 2.2, 95% CI 1.5-3.2). Students whose parents had discussed sex with them were more likely to plan coitarche (aOR 1.3, 95% CI 1.1-1.5). Students searching for information about sexual life more often had their coitarche sober than those not searching for information (29.7% (n = 60) vs 21.1% (n = 497, p = 0.006). CONCLUSIONS: Every fifth high school student reported contraceptive nonuse; however, only 6% indicated the use of reliable dual contraception during the first sexual intercourse. IMPLICATIONS: Efforts are needed to improve the sexual education offered to Lithuanian adolescents to ensure the many sexually active adolescents are aware of how to protect themselves from infection and undesired pregnancy.