Calidad de la educación sexual recibida en el contexto escolar y su asociación a conductas sexuales en adolescentes chilenos, según datos VIII Encuesta Nacional de la Juventud / Quality of sexual education received in the school context and its association with sexual behaviors in Chilean adolescents, according to data from the VIII National Youth Survey

OBJETIVO: Evaluar la calidad de la educación sexual recibida en el contexto escolar y su asociación a conductas sexuales en adolescentes chilenos. MÉTODOS: Estudio transversal y analítico. La muestra correspondió a adolescentes de ambos sexos de 15 a 19 años, se obtuvo de una base de datos con representación nacional. Se evaluó la calidad de la educación sexual recibida en el contexto escolar como buena, regular y mala. Se realizó análisis descriptivo y de asociación entre las variables. Se calculó OR (Odds ratio) y RRR (Relative-risk ratios) ajustado por sexo, edad en años cumplidos, grupo socioeconómico y zona. RESULTADOS: La muestra correspondió a 1.049 adolescentes sexualmente activos, de estos el 21,83% correspondió al grupo con evaluación mala, 44,16% con evaluación regular y 34,01% con evaluación buena. La razón entre adolescentes que no usaron condón en la última relación sexual versus usaron condón, es 1,64 veces mayor en los adolescentes con evaluación mala de la educación sexual recibida (OR: 1,64; IC95%: 1,01 - 2,68). La razón entre adolescentes que tuvieron dos o más parejas sexuales en el último año versus ninguna o una, es 2,15 veces mayor en los adolescentes con evaluación mala de la educación sexual recibida (OR: 2,15; IC95%: 1,30 - 3,56). CONCLUSIÓN: Los participantes de este estudio evalúan la educación sexual recibida mayoritariamente como regular, existiendo una asociación con las conductas sexuales. Es importante realizar estudios en profundidad que permitan conocer por qué los adolescentes evalúan sólo como regular la educación sexual recibida en el sistema escolar.

OBJECTIVE: To evaluate the quality of the sexual education received in the school context and its association with sexual behaviors in Chilean adolescents. METHODS: Cross-sectional and analytical study. The sample corresponded to adolescents of both sexes from 15 to 19 years old, it was obtained from a database with national representation. The quality of the sexual education received in the school context was evaluated as good, regular and bad. Descriptive and association analysis were performed between the variables. OR (Odds ratio) and RRR (Relative-risk ratios) adjusted for sex, age in completed years, socioeconomic group and area were calculated. RESULTS: The sample corresponded to 1,049 sexually active adolescents, of these, 21.83% corresponded to the group with bad "Evaluation", 44.16% with regular "Evaluation" and 34.01% with good "Evaluation". The ratio among adolescents who did not use a condom in the last sexual relationship versus those who used a condom is 1.64 times higher in adolescents with a poor evaluation of sexual education received (OR: 1.64; 95% CI: 1.01 - 2.68). The ratio among adolescents who had two or more sexual partners in the last year versus those who had neither or one, is 2.15 times higher in adolescents with poor evaluation of sexual education received (OR: 2.15; 95% CI: 1.30 - 3.56). CONCLUSION: The participants of this study evaluate the sexual education received mostly as regular, with an association with sexual behaviors. It is important to conduct in-depth studies that allow us to know why adolescents evaluate the sexual education received in the school system as regular only.

Inicio sexual en contexto de sexo casual y su asociación a comportamientos de riesgo en salud sexual y reproductiva en adolescents / Sexual initiation in the context of casual sex and its association with risk behaviors in sexual and reproductive health in adolescents

RESUMEN Antecedentes: Los adolescentes que se comprometen en actividad sexual en un contexto de sexo casual, pueden desarrollar patrones de actividad sexual que los llevarán a resultados en salud negativos tales como embarazo no planificado, infecciones de transmisión sexual, y mayor exposición a múltiples parejas sexuales. Objetivo: Analizar la asociación entre inicio sexual en contexto de sexo casual y comportamientos de riesgo en la salud sexual y reproductiva en adolescentes. Método: Estudio transversal y analítico en una población adolescente de ambos sexos. Se compararon adolescentes que iniciaron actividad sexual en un contexto de relaciones románticas y aquellos que lo hicieron en un contexto de sexo casual. Se analizó la asociación entre edad inicio relaciones sexuales, número de parejas sexuales, uso de método anticonceptivo y variables personales y familiares seleccionadas. Resultados: Se entrevistaron 3.565 adolescentes que habían iniciado relaciones sexuales. Las variables personales y familiares asociadas al inicio sexual en un contexto de sexo casual fueron: tener escolaridad básica, menor mediana de notas, antecedente de repitencia, proyectos académicos futuro solo terminar enseñanza media o secundaria, malas relaciones familiares, y disfunción familiar. Los comportamientos de riesgo en salud sexual en adolescentes de ambos sexos, que iniciaron actividad sexual en un contexto de relación de sexo casual fueron: inicio sexual más temprano, no uso de métodos anticonceptivos y mayor número de parejas sexuales. Conclusión: El inicio de la actividad sexual en un contexto de sexo casual expone a los adolescentes a mayores riesgos en sus comportamientos en su salud sexual y reproductiva cuando se comparan con aquellos que inician actividad sexual en un contexto más romantico.

ABSTRACT Background: Adolescents who engage in sexual activity in a non-romantic relationship may develop patterns of sexual activity that lead to negative health outcomes such as unplanned pregnancy, sexually transmitted infections, and increased exposure to multiple sexual partners. Objective: To analyze the association between sexual initiation in the context of non-romantic relationship and risk behaviors in sexual and reproductive health in adolescents. Method: Cross-sectional and analytical study in a teenage population of both sexes. We compared adolescents who initiated sexual activity in a context of romantic relationships and those who did it in a non-romantic context. The association between age at sexual initiation, number of sexual partners, use of contraceptive method and selected personal and family variables was analyzed. Results: 3,565 adolescents who had initiated sexual intercourse were interviewed. The personal and family variables associated with sexual initiation in a non-romantic context are: having a basic schooling, a lower grade point average and repeating background, and academic projects finishing secondary or high school, bad family relationships, and family dysfunction. The risk behaviors in sexual health in adolescents of both sexes who initiated sexual activity in a context of non-romantic relationship were: sexual debut earlier, no use of contraceptive methods and greater number of sexual partners. Conclusion: The beginning of sexual activity in a non-romantic context exposes adolescents to risk behaviors in their sexual and reproductive health.

Edad de inicio sexual y asociación a variables de salud sexual y violencia en la relación de pareja en adolescentes chilenos / Age of sexual initiation and association with variables of sexual health and violence in the couple relationship in Chilean adolescents

RESUMEN Objetivo Analizar la edad de inicio sexual y su asociación a variables de salud sexual y violencia en la relación de pareja (VRP) en adolescentes chilenos. Métodos Estudio transversal y analítico. La muestra se obtuvo de base de datos con representación nacional. Se realizó análisis de regresión logística múltiple controlando por edad y grupo socioeconómico y estratificando por sexo para determinar asociación entre las variables. Resultados En mujeres, el inicio sexual temprano (antes de los 15 años) aumenta en 0,85 veces el riesgo de embarazo no planificado (OR: 1,85; IC95%: 1,08 - 3,15). En hombres el inicio sexual temprano aumenta en 2.33 veces el riego de no usar anticonceptivo en la primera relación sexual (OR: 3,33; IC95%: 1,85 - 6,01) y 4.33 veces de tener 2 y más parejas sexuales durante los últimos 12 meses (OR: 5,33; IC95%: 3,25 - 8,75). La prevalencia de VRP fue 10%, siendo la violencia psicológica la más frecuente en hombres y en mujeres. En las mujeres, la edad de inicio sexual temprano aumenta 5,72 veces el riesgo de violencia física (OR: 6,72; IC95%: 2,52 - 17,87) y 7,82 veces violencia psicológica (OR: 8,82; IC95%: 4,10 - 19,0). Las adolescentes que presentan un inicio temprano de actividad sexual, muestran más frecuencia de prácticas de control y abuso hacia su pareja, en comparación con los hombres. Conclusiones El inicio sexual temprano y la VRP existen con una frecuencia preocupante, existiendo asociación entre ambas, en especial en mujeres, lo que aumenta el riesgo para la salud en general. Es necesaria la capacitación de los equipos de salud y educación e implementación de estrategias integrales que contribuyan a promover la salud y bienestar de los adolescentes.

ABSTRACT Objective To analyze the age of sexual debut, its association with variables of sexual health and intimate partner violence (PV) in Chilean adolescents. Methods Cross-sectional and analytical study. The sample was obtained from a database with national representation. Multiple logistic regression analysis was carried out controlling by age and socioeconomic group and stratifying by sex to determine association between the variables. Results In women, the age of early sexual initiation increases in 0.85 times the risk of unplanned pregnancy (OR: 1.85, 95% CI: 1.08 - 3.15). In men, the age of early sexual debut increases by 2.33 times the risk of not using contraception in the first sexual relationship (OR: 3.33, 95% CI: 1.85 - 6.01) and 4.33 times of having 2 and more sexual partners during the last 12 months (OR: 5.33, 95% CI: 3.25 - 8.75). The prevalence of PV was 10%, psychological violence was the most frequent in men and women. In women, the age of early sexual initiation increases 5.72 times the risk of physical violence (OR: 6.72, 95% CI: 2.52 17.87) and 7.82 times psychological violence (OR: 8.82; 95% CI: 4.10 - 19.0) Adolescents who have an early onset of sexual activity show more evidence of control practices and abuse toward their partner, compared to men. Conclusions Intimate partner violence exists with a worrisome frequency, having an association with early sexual initiation, especially in women, increasing the risk to health in general. It is necessary to train health and education teams and implement comprehensive strategies that contribute to promoting the health and well-being of adolescents.

Relaciones románticas tempranas y su asociación con comportamientos de riesgo en salud durante la adolescencia / Early romantic relationships and their association with health risk behaviors during adolescence

RESUMEN Antecedentes: La evidencia científica sugiere que el inicio de las relaciones románticas en la adolescencia temprana expone a los adolescentes a otros comportamientos no normativos, como inicio sexual más temprano, mayor número de parejas sexuales, inicio del consumo de alcohol y drogas, entre otros, lo que resultara en una desventaja persistente para su vida futura. Objetivo: Analizar la asociación entre relaciones románticas tempranas y comportamientos de riesgo en salud en adolescentes chilenas. Método: Estudio transversal y analítico en una población de 4.398 adolescentes mujeres quienes contestaron una encuesta al ingreso de su primera consulta. Se compararon adolescentes que iniciaron relaciones románticas en la adolescencia temprana (13 y menos años), adolescencia media (14 y 16 años) y adolescencia tardía (17 y 19 años). Se analizó la asociación entre edad inicio relaciones románticas y variables personales, familiares, y de comportamiento. Resultados: El 50,1% inició relaciones románticas en la adolescencia temprana; el 48,3% en la adolescencia media y el 1,7% en la adolescencia tardía. El 84,17% del total de la muestra había iniciado actividad sexual y un 26,6% de ellas lo hizo antes de los 15 años. Se observó que las adolescentes que habían iniciado relaciones románticas en la adolescencia temprana con mayor frecuencia habían iniciado actividad sexual a edad más temprana, tenían más parejas cuando se comparan con los otros grupos. La menor edad de inicio de relaciones románticas también se asoció al consumo de marihuana. Conclusión: El inicio de las relaciones románticas en la adolescencia temprana se asoció a inicio sexual más temprano, tener más parejas sexuales, consumo de marihuana en adolescentes mujeres.

SUMMARY Background: Scientific evidence suggests that starting romantic relationships in early adolescence exposes people to other non-normative behaviors such as earlier sexual initiation, a larger number of sexual partners, and the start of alcohol and drug use, among others, leading to persistent disadvantages later in life. Objective: To analyze the association between early romantic relationships and health-risk behaviors in female Chilean adolescents. Method: Cross-sectional and analytic study in a population of 4.398 female adolescents who answered a survey during first medical appointment. The study compared adolescents who started romantic relationships in early adolescence (13 years and under), middle adolescence (14 and 16 years), and late adolescence (17 and 19 years). The association between the starting age of romantic relationships and personal, family and behavioral variables was analyzed. Results: 50.1% of the participants engaged in romantic relationships in early adolescence; 48.3% in middle adolescence, and 1.7% in late adolescence. 84.17% of sample had initiated sexual activity and 26.6% had done so before the age of 15. It was observed that adolescents who had had their first romantic relationships in early adolescence were more at risk of starting sexual activity at an earlier age, and having more sexual partners compared to the other groups. An earlier starting age of romantic relationships was also associated with marijuana use. Conclusion: The start of romantic relationships in early adolescence was associated with earlier sexual initiation, more sexual partners, and marijuana use in female adolescents.

Religiosidad juvenil y su asociación a comportamientos sexuales en adolescentes consultantes en un centro de salud sexual y reproductiva en la Región Metropolitana / Youth religiosity and its association to sexual behaviors in adolescent consultants in a sexual and reproductive health center in the Metropolitan Region

ANTECEDENTES: La evidencia muestra que uno de los factores fuertemente asociado con la postergación de la actividad sexual, es la afiliación o membrecía a religiones judeo-cristianas, con códigos estrictos de conductas. OBJETIVO: analizar la asociación entre religiosidad y comportamientos sexuales en adolescentes. MÉTODO: Estudio transversal analítico en una población adolescente. Se compararon adolescentes católicas, evangélicas y sin religión. Se analizó la asociación entre afiliación y asistencia a servicios religiosos y edad de inicio de la actividad sexual, uso de condón y número de parejas sexuales. RESULTADOS: Se entrevistaron 5.231 adolescentes (mediana de edad 16 años, 91,6% mujeres, 97,3% estudiantes). Las adolescentes que se declaran evangélicas, dejan de asistir a los servicios religiosos en mayor proporción que las adolescentes católicas al iniciar actividad sexual. La afiliación religiosa, sea católica o evangélica, retarda el inicio de la actividad sexual y disminuye el riesgo de tener más de una pareja sexual, comparadas con aquellas sin religión. Pero la afiliación religiosa, sea católica o evangélica, aumenta la posibilidad del no uso de condón, en comparación con aquellas sin religión. CONCLUSIÓN: La afiliación religiosa influye en los comportamientos sexuales en adolescentes, disminuyendo el riesgo en el inicio sexual y en el número de parejas sexuales, aumenta la posibilidad del no uso de condón pero no influye en el uso de anticonceptivos orales.

BACKGROUND: Evidence shows that one of the factors associated with the postponement of sexual activity is membership or affiliation to Judeo-Christian religions, with strict codes of behavior. OBJECTIVE: To analyze the association between religiosity and sexual behaviors in adolescents. METHOD: Analytical cross-sectional study conducted in a population of adolescents. Were compared catholic, evangelical and without religion. Association between affiliation and assistance religious services and age sexual initiation, condom use and number of sexual partners were analyzed. RESULTS: In total, 5.231 adolescents (median age 16 years, 91.6% female, 97.3% students,), were interviewed. Adolescents who declare to be evangelicals cease to attend religious services in greater proportion than Catholic adolescents when initiating sexual activity. Religious affiliation, whether Catholic or evangelical, delay the onset of sexual activity and decreases the risk of having more than one sexual partner, compared with those without religion, but religious affiliation, whether Catholic or evangelical, increases the risk of non-use of condoms, compared to those without religion. CONCLUSION: Religious affiliation influences sexual behaviors in adolescents, decreasing the risk in the age of sexual debut and in the number of sexual partners but increasing the risk in the non-use of the condom but does not influence the pill use.

[Gender differences in health-related quality of life of Chilean adolescent students]. / Diferencias de género en la calidad de vida relacionada con la salud en adolescentes escolarizados chilenos.

BACKGROUND: Health-related quality of life (HRQOL) refers to individuals' perception of their subjective well-being, considering various aspects of their life and the impact on their health. AIM: To analyze gender differences in the HRQOL of adolescent students in Chile, by age, type of school attended, and area of residence. MATERIAL AND METHODS: Analytical cross-sectional study conducted in a population of 5th and 12th grade students attending municipal, subsidized and private schools in 11 regions of the country. HRQOL was assessed with the KIDSCREEN-52, an instrument that has been previously adapted and validated in Chile. The database obtained from that adaption and validation process was analyzed. RESULTS: In total, 7,910 students (median age 14 years, 53% female) completed the questionnaire. Compared to males, females had lower HRQOL scores in most of the KIDSCREEN-52 dimensions. However, males were more likely to have lower scores in the “Peers and Social Support” and “School Environment” dimensions. These differences remained valid when the sample was stratified by age, type of school, and area of residence were analyzed. CONCLUSIONS: This study supports the existence of inequalities in the self-perceived HRQOL of Chilean adolescent students. The existing differences are not only related to gender but are also evident when stratifying by type of school attended.

Comportamientos sexuales y características personales según orientación sexual en adolescentes chilenos / Sexual behaviors and personal characteristics according to sexual orientation in Chilean adolescents

ANTECEDENTES: Los adolescentes y jóvenes lesbianas, gays y bisexuales (LGB) presentan desafíos adicionales en su desarrollo comparados con sus pares heterosexuales, lo cual los expone a altos niveles de estrés y angustia que pueden llevarlos a comportamientos sexuales de riesgo. OBJETIVO: Analizar los comportamientos sexuales y características personales según la orientación sexual en adolescentes consultantes en un centro de salud sexual y reproductiva. MÉTODO: Estudio transversal y analítico en una población adolescente. Los datos fueron recolectados entre 2000-2012. Se utilizó regresión logística múltiple para comparar variables personales, comportamientos sexuales y la orientación sexual. RESULTADOS: En total, 5.143 adolescentes (mediana de edad 16 años, 91,5% mujeres y 97,5% estudiantes) fueron estudiados; 127 reportaron orientación LGB. Los adolescentes LGB presentaron riesgo de tener más parejas sexuales en el grupo de adolescentes católicos, y en el grupo total inicio de la actividad sexual más temprana que sus pares heterosexuales, además los adolescentes LGB en el uso de métodos anticonceptivos no mostró ser un factor de riesgo en los adolescentes católicos pero si en los adolescentes con otra o sin religión. CONCLUSIONES: Los resultados de este estudio muestran que los adolescentes LGB y heterosexual no son idénticos en términos de riesgo sexual. La población LGB se compromete en comportamientos sexuales de más riesgo que su contraparte heterosexual. Los proveedores de salud como el sector educación necesitan estar más sensibilizados a estas diferencias y sus implicancias para la salud y consejería de los y las adolescentes.

BACKGROUND: Adolescents and young lesbian, gay and bisexual (LGB) present additional challenges in their development compared to their heterosexual peers which exposes them to high levels of stress and distress that can lead to sexual risk behaviors. AIM: To analyze the sexual behavior, personal characteristics and sexual orientation in adolescents that attended in a center of sexual and reproductive health. METHODS: Analytical cross-sectional study conducted in an adolescent population. Data were collected in 2000-2012. Multiple logistic regression was used to quantify comparisons of sexual behaviors and personal variables between LGB and heterosexual adolescents. RESULTS: In total, 5,143 adolescents (median age 16 years, 91.5% women and 97.5% students) were studied, 127 were LGB teenagers. LGB adolescents reported risk having more sexual partners and sexual debut earlier than their heterosexual peers. This risk increased by catholic teenagers. Using contraception methods showed no risk in catholic teenagers but adolescents as-signed to another religion or no religion which was a risk factor. CONCLUSIONS: The results of this study show that the LGB and heterosexual adolescents are not identical in terms of sexual risk. LGB engages in riskier sexual behaviors than heterosexual counterparts. Healthcare providers and the education sector need to be sensitive to these differences and their implications for health and counseling of adolescents.

Diferencias de género en la calidad de vida relacionada con la salud en adolescentes escolarizados chilenos / Gender differences in health-related quality of life of Chilean adolescent students

Background: Health-related quality of life (HRQOL) refers to individuals' perception of their subjective well-being, considering various aspects of their life and the impact on their health. Aim: To analyze gender differences in the HRQOL of adolescent students in Chile, by age, type of school attended, and area of residence. Material and Methods: Analytical cross-sectional study conducted in a population of 5th and 12th grade students attending municipal, subsidized and private schools in 11 regions of the country. HRQOL was assessed with the KIDSCREEN-52, an instrument that has been previously adapted and validated in Chile. The database obtained from that adaption and validation process was analyzed. Results: In total, 7,910 students (median age 14 years, 53% female) completed the questionnaire. Compared to males, females had lower HRQOL scores in most of the KIDSCREEN-52 dimensions. However, males were more likely to have lower scores in the “Peers and Social Support” and “School Environment” dimensions. These differences remained valid when the sample was stratified by age, type of school, and area of residence were analyzed. Conclusions: This study supports the existence of inequalities in the self-perceived HRQOL of Chilean adolescent students. The existing differences are not only related to gender but are also evident when stratifying by type of school attended.

Embarazo repetido en la adolescencia: la realidad chilena / Repeat pregnancy in adolescence: the Chilean reality

Antecedentes: El embarazo repetido durante la adolescencia aumenta el riesgo para las madres de no completar sus estudios, tener más baja tasa de participación laboral y menores ingresos. Objetivo: Describir la magnitud del embarazo repetido en adolescentes y analizar los principales factores que se asocian a la reincidencia del embarazo adolescente en la Región Metropolitana. Método: Estudio descriptivo, analítico y transversal. La población del estudio fueron adolescentes embarazadas que se controlaron en el período Enero a Diciembre de 2007 en 8 consultorios de la Región Metropolitana. Los datos obtenidos desde las fichas clínicas. Variables estudiadas: edad, nivel educacional, relación de pareja, período intergenésico (PIG), paridad, edad gestacional al ingreso a control, uso de método anticonceptivo (MAC) y número de embarazos previos. Resultados: Del total de embarazadas del período en estudio, 852 (30%) eran embarazadas adolescentes. De éstas el 15,6% (133) correspondió a adolescentes reincidentes. El 5,2% de las reincidentes tenían 15 años y menos. El 67,7% sólo cursó escolaridad básica. El 64,7% estaban casadas o convivían. El 36,6% presentó PIG de 11 meses y menos. El 6,8% había tenido 2 o más gestaciones previas. El 59,4% inició control prenatal después de las 12 semanas de gestación. El 73,5% no usó MAC. Al relacionar PIG con escolaridad se observó que el 59,4% de las adolescentes que tenían PIG de 11 meses y menos se concentraron en el nivel de menor escolaridad. Conclusiones: Las adolescentes estudiadas mostraron factores de alto riesgo los cuales deberían haber sido detectados previamente para fortalecer una estrategia de apoyo.

Background: Repeat pregnancy during adolescence increases the risk for mothers not to complete their studies, have lower labor participation rate and less income. Objective: To describe the magnitude of recurrent pregnancy among adolescent females and analyze the main factors associated with recidivism of adolescent pregnancy in the Metropolitan Region. Method: A descriptive, analytical, cross-sectional study. The study population consisted of pregnant adolescents who were attended during January to December 2007 in eight primary care clinics in the northern sector of the metropolitan area. Data were collected from the medical records. The following variables, age, schooling level, relationship, interpregnancy period (IPP), parity, gestational age at admission control, contraceptive use and number of previous pregnancies, were studied. Results: Of all pregnant women in the study period, 852 (30%) were pregnant teenagers. Of these 15.6% (133) corresponded to repeat adolescents. 5.2% of these women have 15 years and under. 67.7% attended only primary school. 64.7% are married or live together. 36.6% had IPP interval of 11 months and less. 6.8% had 2 or more previous pregnancies. 59.4% began prenatal care after 12 weeks gestation. 73.5% of these teenagers did not use birth control though that all of them were cited for their indication. When the IPP was related with schooling was observed that 59.4% of adolescents with IPP 11 months were concentrated in the lower level of education. Conclusions: The adolescents studied showed high risk factors which should have been previously identified to strengthen a support strategy.

Características de la educación sexual escolar recibida y su asociación con la edad de inicio sexual y uso de anticonceptivos en adolescentes chilenas sexualmente activas / Characteristics of the school sexual education received and its association with the age of sexual initiation and use of contraceptives in sexually active Chilean adolescents

ANTECEDENTES: La educación sexual integral en el contexto escolar es uno de los pilares fundamentales para prevenir embarazos e infecciones de transmisión sexual en adolescentes. OBJETIVO: Analizar las características de la educación sexual escolar recibida y su asociación con la edad de inicio sexual y uso de anticonceptivo en adolescentes consultantes en un centro de salud sexual y reproductiva. MÉTODO: Estudio analítico de corte transversal realizado en 1.232 adolescentes mujeres de nivel socioeconómico medio y bajo atendidas en un centro de salud sexual y reproductiva durante 2007-2011. La información fue obtenida desde una entrevista estructurada aplicada al ingreso. RESULTADOS: El 92,8% reportó haber recibido alguna forma de educación sexual en el colegio, un 51,6% reconoció el colegio como principal fuente de información en métodos anticonceptivos. Tener como fuente principal de conocimiento en métodos anticonceptivos el colegio fue asociado a inicio sexual más tardío y uso de método anticonceptivo. CONCLUSIÓN: Los resultados del estudio muestran que dada la prevalencia de conocimientos anticonceptivos (92,8%) y que solo el 1% de las adolescentes que había recibido educación sexual en sus respectivos colegios se había embarazado podemos afirmar que la educación sexual recibida por las adolescentes del estudio fue al menos adecuada.

BACJGROUND: Comprehensive sex education in the school context is one of fundamental pillars to prevent pregnancy and sexually transmitted infections in adolescents. AIM: to analyze the characteristics of the sexuality information received in school and its association with age of sexual initiation and contraceptive use in adolescents consulting a center for sexual and reproductive health. METHODS: Analytical cross-sectional study performed in 1,232 adolescent women of medium and low socio-economic status attending to a sexual and reproductive health center during 2007-2011. Information was obtained from a structured interview applied at first visit. RESULTS: 92.8% reported receiving some form of sex education at school, 51.6% recognized the school as the main source of information on contraception. Having as a main source of knowledge in school contraceptives was associated with later sexual initiation and contraceptive use. CONCLUSION: The study results show that given the contraceptive prevalence (92.8%) knowledge and that only 1% of adolescents who had received sex education in their schools had been pregnant can say that sex education received by adolescents study was at least adequate.

Menarquia temprana y su asociación con conductas de riesgo en adolescentes / Early menarche and its association with risk behaviors in adolescents

ANTECEDENTES: La pubertad no está necesariamente asociada a un desarrollo psicosocial equivalente. La falta de madurez y las características de la adolescencia podrían favorecer la aparición de conductas de riesgo. OBJETIVO: Determinar la asociación entre la edad de la menarquia y presencia de conductas de riesgo en adolescentes. MÉTODO: Diseño de corte transversal. La muestra incluyó adolescentes postmenárquicas. El instrumento fue una encuesta semiestructurada. Se realizó análisis descriptivo bivariado y multivariado. RESULTADOS: La muestra correspondió a 1844 adolescentes, la mediana de edad fue de 16 años y 12 años para la menarquia. El 57% provino de nivel socioeconómico medio, el 98% estaba escolarizada y 52% vivía con ambos padres. El 35,1% presentó menarquia temprana. El abuso sexual se presentó en 26,0% en el grupo de menarquia temprana y en 21,4% en el de menarquia no temprana. El inicio de actividad sexual antes de los 15 años se presentó en un 39,4% y en 22,3% de adolescentes con menarquia temprana y no temprana respectivamente (OR: 1,88; IC95%: 1,46-2,43), asociándose con disfuncionalidad familiar (OR: 2,08; IC95%: 1,45-2,99) y ausencia de los padres (OR: 1,74; IC95%: 1,09-2,76). La frecuencia de consumo de alcohol se asoció a disfuncionalidad familiar severa (OR: 2,00; IC95%: 1,34-3,00). CONCLUSIÓN: La menarquia temprana se asoció al inicio precoz de actividad sexual. Es importante promover comportamientos seguros desde edades tempranas y acompañar a las niñas en su proceso de maduración.

BACKGROUND: Puberty is not necessarily associated with an equivalent psychosocial development. The lack of maturity and characteristics of adolescence may promote the emergence of risk behaviors. OBJECTIVE: To determine the association between age at menarche and presence of risk behaviors in adolescents. METHOD: Cross-sectional design study. The sample included postmenarchal adolescents. The instrument was a semistructured survey. Bivariate and multivariate descriptive analysis. RESULTS: The sample consisted of 1844 adolescents, the median age was 16 years and 12 years for menarche. 57% came from middle socioeconomic level, 98% attended school and 52% lived with both parents. 35.1% had early menarche. Sexual abuse occurred in 26.0% in the group of early menarche and 21.4% for no early menarche. The onset of sexual activity before age 15 occurred in 39.4% and 22.3% of adolescents with early and no early menarche respectively (OR: 1.88; 95%CI: 1.46-2.43), associated with family dysfunction (OR: 2.08; 95%CI: 1.45-2.99) and absence of parents (OR: 1.74; 95%CI: 1.09-2.76). The frequency of alcohol consumption was associated with severe family dysfunction (OR: 2.00; 95%CI: 1.34-3.00). CONCLUSION: Early menarche was associated with early onset of sexual activity. It is important to promote safe behavior from an early age and escort girls in their maturation process.

Propiedades psicométricas del cuestionario de calidad de vida relacionada con la salud KIDSCREEN-27 en adolescentes chilenos / Psychometric properties of the quality of life questionnaire health related KIDSCREEN-27 in Chilean adolescents

Background: KIDSCREEN-52, which assesses health related quality of life in adolescents, has been adapted and validated in Chile showing excellent psychometric properties. There is a shorter version of the instrument, whose psychometric properties must be assessed. Aim: To evaluate the psychometric properties of the instrument KIDSCREEN-27 in Chilean adolescents. Material and Methods: A secondary analysis of the database obtained for the adaptation and validation of KIDSCREEN-52. Results: The reliability, calculated through Cronbach’s alpha, for the entire instrument (five dimensions) was 0.89. For physical well-being, psychological well-being, autonomy and relationship with parents and peer social support dimensions, scores were higher than 0.75 while for school environment, the score was 0.69. The confirmatory factor analysis showed that the indices obtained to assess the goodness of fit in this study were a χ2 (314) = 10521.4, a Root Mean Square Error of Approximation = 0.064 and a Comparative Fit index = 0.96. KIDSCREEN-27 scores were higher among men in the physical well-being, psychological well-being, autonomy and relationship with parents dimensions and among women in social support and peers and school environment dimensions. Scores were higher in younger age groups. Conclusions: The Chilean version of KIDSCREEN-27 instrument has adequate reliability and validity.

[Psychometric properties of the quality of life questionnaire health related KIDSCREEN-27 in Chilean adolescents]. / Propiedades psicométricas del cuestionario de calidad de vida relacionada con la salud KIDSCREEN-27 en adolescentes chilenos.

BACKGROUND: KIDSCREEN-52, which assesses health related quality of life in adolescents, has been adapted and validated in Chile showing excellent psychometric properties. There is a shorter version of the instrument, whose psychometric properties must be assessed. AIM: To evaluate the psychometric properties of the instrument KIDSCREEN-27 in Chilean adolescents. MATERIAL AND METHODS: A secondary analysis of the database obtained for the adaptation and validation of KIDSCREEN-52. RESULTS: The reliability, calculated through Cronbach’s alpha, for the entire instrument (five dimensions) was 0.89. For physical well-being, psychological well-being, autonomy and relationship with parents and peer social support dimensions, scores were higher than 0.75 while for school environment, the score was 0.69. The confirmatory factor analysis showed that the indices obtained to assess the goodness of fit in this study were a χ2 (314) = 10521.4, a Root Mean Square Error of Approximation = 0.064 and a Comparative Fit index = 0.96. KIDSCREEN-27 scores were higher among men in the physical well-being, psychological well-being, autonomy and relationship with parents dimensions and among women in social support and peers and school environment dimensions. Scores were higher in younger age groups. CONCLUSIONS: The Chilean version of KIDSCREEN-27 instrument has adequate reliability and validity.

Antecedente de agresión sexual y su asociación con conductas de riesgo en adolescentes consultantes en un centro de atención en salud sexual y reproductiva / History of sexual aggression and its association with risk behavior in adolescents consulting a focus on sexual and reproductive health

Antecedentes: La mayoría de los programas de salud reproductiva en Chile operan bajo la premisa de que todas las mujeres y en especial las adolescentes están o han estado comprometidas en relaciones sexuales consensuales, y no consideran que muchas de ellas pueden ser sobrevivientes de agresión sexual y pueden presentar necesidades diferentes en salud sexual y reproductiva. Objetivo: Examinar cuáles conductas de riesgo y variables sociodemográficas y familiares están asociadas al antecedente de agresión sexual en adolescentes consultantes en un centro de atención en salud sexual y reproductiva. Método: Estudio analítico de corte transversal. La información fue recolectada en la primera consulta a 3.064 adolescentes mujeres entre 12 y 19 años, atendidas en un centro de salud sexual y reproductiva en el período 2003-2010. Se usó regresión logística para identificar los factores asociados a la agresión sexual. Resultados: Un 22,7 por ciento reportó antecedente de agresión sexual. Las conductas de riesgo asociadas al antecedente de agresión sexual fueron: inicio de la actividad sexual bajo coerción o bajo efectos del alcohol, mayor número de relaciones afectivas y parejas sexuales, menor edad al inicio de la actividad sexual, menor promedio de notas, mayor consumo de cigarrillo, de alcohol y drogas, y menor edad al inicio del consumo de drogas. Conclusión: El antecedente de agresión sexual deja a las mujeres expuestas a riesgos en la salud sexual y reproductiva, por lo que los equipos de salud debieran ser capaces de detectar estas problemáticas para poder intervenir en forma adecuada y eficaz.

Background: Most of reproductive health programs in Chile operate under the premise that women and adolescent girls in particular, are or have been engaged in consensual sex and do not consider that many of them may be survivors of sexual abuse, and may have different needs in sexual and reproductive health. Objective: Determine which risk behaviors and familial variables are associated with sexual aggression history in adolescents consulting at sexual and reproductive health center. Method: Cross-sectional analytical study. The information was gathered from a structured interview applied in the first consultation to 3,064 adolescent girls between 12 and 19 years, who attended a sexual and reproductive health centre for the period 2003-2010. Logistic regression was used to identify factors associated with sexual assault. Results: A 22.7 percent reported sexual assault history. Risk behaviors associated with sexual aggression were: onset of sexual activity forced or under influence of alcohol, as many relationships and sexual partners, younger age at onset of sexual activity, lower grade point average, cigarette smoking, alcohol and drug use and younger age at onset of drug use. Conclusion: A history of sexual aggression leaves women at risk for sexual and reproductive health, so health teams should be able to detect these problems in order to intervene appropriately and effectively.

Adaptación transcultural y validación de un instrumento de calidad de vida relacionada con la salud en adolescentes chilenos / Validation of an instrument to measure health-related quality of life in Chilean children and adolescents

Background: KIDSCREEN-52 is an instrument to assess health related quality of life in children and adolescents. Aim: To culturally adapt and validate the KIDSCREEN-52 questionnaire in Chileans. Material and Methods: Two independent translations from the English Spanish language were conciliated and retranslated to English. The conciliated version was tested during a cognitive interview to adolescents of different socioeconomic levels. The final version was validated in 7,910 school attending adolescents. Results: In the cross-cultural adaptation, 50 of the 52 items presented low or medium levels of difficulty and a high semantic equivalence. Distribution according to gender, grades and types of schools was similar to the sample. Single ages were not affected by sex distribution. The Confirmatory Factor Analyses were: X² (1229) = 20996.7, Root Mean Square Error of Approximation = .045 and Comparative Fit Index = .96. The instrument had a Cronbach’s alpha of .93. The domains had scores over 0.70 points, with the exception of the "Selfperception" domain, with a score of 0.62. Conclusions: The Chilean version of KIDSCREEN-52 is culturally appropriate and semantically equivalent in its English and Spanish versions (from Spain). Its reliability and validity were adequate.

[Factors associated with early sexual activity among Chilean adolescents]. / Factores familiares asociados al inicio sexual temprano en adolescentes consultantes en un centro de salud sexual y reproductiva en Santiago de Chile.

BACKGROUND: Nowadays, adolescent population begins sexual activity earlier, a behavior with negative psychological ana social consequences. AIM: To determine the association between family factors and early sexual activity in adolescents of low and middle socioeconomic level. MATERIAL AND METHODS: A sample of 3,210 adolescents, who confidentially requested care in a sexual and reproductive health university center, between 2000 and 2007, was analyzed. Adolescents who started sexual activity before 15 years of age, and those who started sexual activity after 15 years of age, were compared. Data was collected from structured interviews conducted at the adolescente first visit. Logistic regression was used to identify family factors associated with early sexual initiating in both, men and women. RESULTS: Family factors associated with early sexual activity start were not being raised by both parents, a poor parent-child relationship, a poor family communication, mothers with a history of adolescent motherhood, mothers employed outside the home and family dysfunction. Among women, the variables associated with a higher risk of early sexual debut were not married parents and history of adolescent fatherhood record among parents. Among men, these variables were permissions without restriction during the week and punishment when family rules were broken. CONCLUSIONS: Family factors must be considered in the design of strategies to prevent early sexual activity.

Factores familiares asociados al inicio sexual temprano en adolescentes consultantes en un centro de salud sexual y reproductiva en Santiago de Chile / Factors associated with early sexual activity among Chilean adolescents

Background: Nowadays, adolescent population begins sexual activity earlier, a behavior with negativepsychological ana social consequences. Aim: To determine the association between family factors and early sexual activity in adolescents oflow and middle socioeconomic level. Material and Methods: A sample of 3,210 adolescents, who confidentially requested care in a sexual and reproductive health university center, between 2000 and 2007, was analyzed. Adolescents who started sexual activity before 15years ofage, and those who started sexual activity after 15years ofage, were compared. Data was collectedfrom structured interviews conducted at the adolescente firstvisit. Logistic regression was used to identify family factors associated with early sexual initiatingin both, men and women. Results: Family factors associated with early sexual activity startwere not being raised by both parents, apoor parent-child relationship, a poor family communication, mothers with a history of adolescent motherhood, mothers employed outside the home and family dysfunction. Among women, the variables associated with a higher risk of early sexual debut were not married parents and history of adolescent fatherhood record among parents. Among men, these variables were permissions without restriction during the week and punishment when family rules were broken. Conclusions: Family factors must be considered in the design ofstrategies to prevent early sexual activity.

[Validation of an instrument to measure health-related quality of life in Chilean children and adolescents]. / Adaptación transcultural y validación de un instrumento de calidad de vida relacionada con la salud en adolescentes chilenos.

BACKGROUND: KIDSCREEN-52 is an instrument to assess health related quality of life in children and adolescents. AIM: To culturally adapt and validate the KIDSCREEN-52 questionnaire in Chileans. MATERIAL AND METHODS: Two independent translations from the English Spanish language were conciliated and retranslated to English. The conciliated version was tested during a cognitive interview to adolescents of different socioeconomic levels. The final version was validated in 7,910 school attending adolescents. RESULTS: In the cross-cultural adaptation, 50 of the 52 items presented low or medium levels of difficulty and a high semantic equivalence. Distribution according to gender, grades and types of schools was similar to the sample. Single ages were not affected by sex distribution. The Confirmatory Factor Analyses were: X² (1229) = 20996.7, Root Mean Square Error of Approximation = .045 and Comparative Fit Index = .96. The instrument had a Cronbach's alpha of .93. The domains had scores over 0.70 points, with the exception of the "Selfperception" domain, with a score of 0.62. CONCLUSIONS: The Chilean version of KIDSCREEN-52 is culturally appropriate and semantically equivalent in its English and Spanish versions (from Spain). Its reliability and validity were adequate.

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

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

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

Patrón intergeneracional del embarazo adolescente en las hijas de una cohorte de mujeres que controlaron su primer embarazo en un centro integral para adolescentes embarazadas / Intergenerational pattern of adolescent pregnancy in daughters of a cohort of women who were teenage mothers

Antecedentes: Las circunstancia desventajosas de las madres adolescentes tienden a repetirse, con consecuencias aún más graves en la vida de sus hijas, que suelen tener dificultades escolares y se embarazan a una edad incluso más temprana que sus propias madres. Objetivo: Examinar el patrón intergeneracional del embarazo adolescente en las hijas de una cohorte de mujeres que fueron madres adolescentes. Método: Estudio transversal medido en dos momentos, de una cohorte histórica de mujeres que controlaron su primer embarazo en un centro especializado en la atención de adolescentes embarazadas. La información de las madres se obtuvo en la primera entrevista que se aplicó al ingreso prenatal y la de las hijas fue obtenida cuando éstas eran adolescentes. Se analizaron las características de las madres y de las hijas que se embarazaron. Posteriormente se compararon las características entre las hijas que se embarazaron y aquellas que no. Resultados: En el 21 por ciento las hijas se embarazaron, aunque menor a lo que reporta la literatura, es igualmente preocupante porque un embarazo en la adolescencia altera en general la trayectoria estudiantil y el proyecto de vida de la adolescente. Las hijas repitieron consecuencias adversas, pero lograron tener éxito en la permanencia escolar y sus madres tuvieron menos hijos que las abuelas, como resultado positivo del programa. Conclusión: Programas de atención integral con profesionales entrenados en la atención de adolescentes embarazadas pueden tener un impacto positivo importante en la reducción de los patrones reproductivos intergeneracionales del embarazo adolescente...

Background: Disadvantaged circumstances of adolescent mothers tend to repeat, with even worse consequences in the lives of their daughters, who often have schooling difficulties and become pregnant at an even earlier age than their own mothers. Objective: To examine the intergenerational pattern of adolescent pregnancy in daughters of a cohort of women who were teenage mothers. Method: Cross-sectional study measured at two points in a historical cohort of women who attended their first pregnancy in a specialized center of pregnant adolescents. Mothers information was obtained in the first interview that was applied to the prenatal admission and daughters information was obtained when they were teenagers. The characteristics of the mothers and daughters who got pregnant are analyzed. We then compared the characteristics of the daughters who became pregnant and those not. Results: In 21 percent the daughters became pregnant, though lower then reported by literature, is also worrisome because a teenage pregnancy alters the overall student experience and life projects teenager. The daughters repeated adverse consequences, but managed to succeed in school retention and mothers had fewer children than their grandmothers, as a positive result of the program. Conclusion: Comprehensive care programs with trained professionals in the care of pregnant adolescents can have significant positive impact on reducing intergenerational reproductive patterns of teenage pregnancy...