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.

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.

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.

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.

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.

Factores psicosociales y culturales que influyen en el evento de la menarquia en adolescentes posmanárquicas / Psychosocial and cultural factors in post-menarcheal adolescents

Introducción: La menarquia es un evento de vida significativo con importantes implicaciones culturales, sociales y personales. Objetivo: Conocer y entender mejor el contexto psicosocial en que ocurre la menarquia considerando la edad de ocurrencia, fuentes y calidad de la información o preparación recibida, y las reacciones emocionales experimentadas. Método: Se entrevistaron adolescentes entre 11 y 19 años que consultaron en CEMERA entre 2005 y 2006. Se aplicó un cuestionario especialmente diseñado y se aseguró confidencialidad y anonimato de sus respuestas. Resultados: Participaron 826 adolescentes. 34,6 por ciento de ellas tuvieron la menarquia entre los 9 y 11 años, 53,1 por ciento entre 12 y 13 años y 12,3 por ciento entre los 14 y 16 años. 88,6 por ciento recibieron información sobre el tema previo a la menarquia. 81,3 por ciento de las madres fueron quienes informaron a sus hijas, seguidas por familiares mujeres en 6,8 por ciento, colegio en 4,6 por ciento; 78 por ciento de las adolescentes que recibieron información indicaron no sentirse preparadas al momento del evento. 23,6 por ciento reportó sentirse muy mal, 21 por ciento asustada, 20,5 por ciento extraña, 4 por ciento indiferente y 30,8 por ciento indicó sentirse feliz con la menarquia. Conclusión: Si bien en la actualidad las niñas tienen acceso a una serie de fuentes de información acerca de la menstruación es principalmente la madre, el colegio y los profesionales de salud quienes juegan un rol primordial en su preparación en este aspecto. Pero esta información tiende a estar focalizada solo en aspectos higiénicos y biológicos inmediatos y obvios pero desconectados de la experiencia del propio cuerpo de las niñas como de su emocionalidad.

Background: Menarche is a significant life event with important cultural, social and personal implications. Objectives: To know and to understand in a better way, the psychosocial context in which menarche takes place, considering age occurrence, sources and quality of information, training received and the emotional reactions experienced. Methods: In 2005 and 2006, adolescents from 12 to 19 years old, who consulted at an Adolescents Clinic, took a specially designed questionnaire and they were guaranteed confidentiality and anonymity in their answers. Results: 826 adolescents took part in this study; 34.6 percent of them had the menarche between 9-12 years old, 53.1 percent between 12-13 years old and 12.3 percent between 12-14 years old; 88.6 percent got information previously to menarche; 81.3 percent mothers were who gave the corresponding information to their daughters, followed by their female relatives in a 6.8 percent, school in a 4.6 percent; 78 percent of the total number of adolescents who got adequate information, pointed out that they did not feel prepared enough at the moment of the event; 23.6 percent reported they felt very bad, 21 percent were frightened, 20.5 percent awkward, 4 percent unconcerned and only 30.8 percent reported they felt happy when they experienced menarche. Conclusion: Although, nowadays girls have a major access to a various sources of information about menarche, it is mainly mother, school and health professionals who participate in their training on this area. But this information tends to be focused on hygienically and biological aspects that are immediate and obvious, but it is disconnected from the experience of the girl bodies as of their emotionality.

Comportamientos sexuales y diferencias de género en adolescentes usuarios de un sistema público de salud universitario / Sexual behavior and gender differencesamong adolescents consultingat a university public health system

Background: The predetermined gender roles and the emphasis on reproductive responsibility on women, excluding men, have negative consequences on their sexual reproductive health and satisfactory sexual practices. Aim: To describe and analyze changes in sexual practices and gender differences in adolescents of the lower-middle socioeconomic level, users of public health system who started their sexual activity. Material and methods: We studied 4,971 adolescents of both sexes aged between 12 and 19 years, who consulted in a clinic for adolescents between the years 1990 and 2005. Several variables related to adolescent sexuality were considered. Uni and bivariate analysis were carried out and a model of stratified lineal regression per sex was fixed to explain the following variables: age at which sexual activity is initiated, number of sexual partners, time period between start of dating and the start of sexual activity along time. Results: The average age when men and women start their sexual activity was 15.7 and 15.5years, respectively. Along years and among women but not men, there was a reduction in the age of start of sexual activity and an increase in the number of sexual partners. The mean íapse between start of dating and the start of sexual activity in men and women was 6.2 and 7.5 months, respectively. This figure had an 11.696 and 13.9 percent reduction per year of study in females and males, respectively. Conclusions: There is an increasing expansion of sexual roles in adolescents, but certain patterns of contradictory conservative reasoning are maintained.

Características de la maternidad adolescente de madres a hijas / Characteristics of pregnant adolescents and their mothers

Antecedentes: En la investigación de la maternidad adolescente un aspecto importante a considerar es el rol de la familia, especialmente el de la madre en el embarazo de las hijas. Objetivo: Investigar las características y ocurrencia de maternidad adolescente en las madres de adolescentes embarazadas. Método: Se estudiaron 255 mujeres y sus hijas adolescentes embarazadas. Se seleccionaron variables maternas y de las hijas. Se realizó análisis uni y bivariado y se ajustaron modelos de regresión múltiple. Resultados: Las mujeres que fueron madres adolescentes eran más jóvenes, menor escolaridad, mayor número de hijos, menor edad ideal en que hubieran preferido ser madres, ejercían labores de casa y estaban solteras al primer embarazo en mayor proporción que las madres que no presentaron este antecedente. El promedio de la edad al parto de las madres fue 19,7 años y de las hijas 16,2 años. Estaban solteras al parto 27,1 por ciento de las madres y 90,2 por ciento de las hijas. Promedio de escolaridad de las madres fue 7,3 años y las hijas 9,1 años. Las hijas de madres adolescentes tenían menos aspiraciones de estudios superiores, menor escolaridad y ejercían labores de casa cuando se comparó con las hijas de madres no adolescentes. Conclusión: El diseño de políticas públicas para reducir los resultados adversos en las hijas de madres adolescentes deben ser considerados los factores negativos previos y posteriores al embarazo adolescente.

Background: The research on adolescent pregnancy has been focused on medical difficulties, psychological and consequences on adolescent life, besides, it is also necessary to call the attention to the role family, especially, mother during her daughter's pregnancy. Objective: Characteristics of pregnant adolescent's mothers and happening of adolescent pregnancy in these women's life. Methods: The study was carried out on 225 women and their pregnant adolescent daughters. A uni and bivariate analyses were carried out. Results: Mothers who had adolescent maternity background were younger, had low schooling, a great number of children, under ideal age they would have preferred to become mothers. They usually did housework and they were single at the first pregnancy in larger proportion than mothers who had not this previous background; 58.4 percent of mothers were single at the moment of pregnancy and daughters 100 percent; 27.1 percent of mothers were single when they gave birth and 90.2 percent of daughters. The age average at the beginning of mothers maternity was 19.7 percent years old and daughters 16.2 years old. The schooling average of mothers was 7.7 years, 9.1 years for daughters. 26.2 percent of adolescent mother's daughters did housework versus 8.5 percent adult mother's daughters. 43 percent of adolescent mother's daughters did not aspire to have higher education compared to 26.4 percent no adolescent mother's daughters. Adolescent mother's daughters showed lower schooling average than no adolescent mother's daughters. Conclusion: When designing public policies to diminish adverse results on sons and daughters of adolescent mothers, pre and post adolescent pregnancy negative factors should be considered.

Sexualidad en alumnos universitarios / Sexuallity in university students

El objetivo de este trabajo fue determinar conocimiento, actitudes y prácticas sexuales en alumnos universitarios. Se aplicó un cuestionario anónimo, previamente probado, a 328 alumnos ingresados en 1997 al primer año de las 8 carreras de la Facultad de Medicina de la Universidad de Chile. Se encontró que 26,5 por ciento de jóvenes provenientes de colegios subvencionados aceptan tener relaciones sexuales cuando se da la ocasión. El 46,8 por ciento de los jóvenes menores de 20 años considera que las relaciones prematrimoniales ayudan al mejor conocimiento de la pareja. 57,6 por ciento estima que el orgasmo simultáneo es el objetivo central en la relación sexual

Paternidad adolescente I: variables personales del padre adolescente / Adolescent fatherhood I: personal characteristics of the adolescent father

Se estudiaron 182 varones, parejas de adolescentes embarazadas. Se compararon 2 grupos de varones: adolescentes y adultos jóvenes en relación a variables personales. A todos se les aplicó una entrevista y un cuestionario a la primera vista al centro. Alrededor de 20 variables personales y relacionadas con la sexualidad fueron seleccionadas para este análisis. Los resultados de este estudio muestran que las variables asociadas al padre adolescente son: estado civil (soltero), actividad (estudiante), deserción escolar más temprana, ingreso al campo laboral a menor edad, tipo de trabajo, edad inicio actividad sexual más temprana