Prevalence of adolescent mental disorders in Kenya, Indonesia, and Viet Nam measured by the National Adolescent Mental Health Surveys (NAMHS): a multi-national cross-sectional study.

BACKGROUND: Mental disorders are the leading global cause of health burden among adolescents. However, prevalence data for mental disorders among adolescents in low-income and middle-income countries are scarce with often limited generalisability. This study aimed to generate nationally representative prevalence estimates for mental disorders in adolescents in Kenya, Indonesia, and Viet Nam. METHODS: As part of the National Adolescent Mental Health Surveys (NAMHS), a multinational cross-sectional study, nationally representative household surveys were conducted in Kenya, Indonesia, and Viet Nam between March and December, 2021. Adolescents aged 10-17 years and their primary caregiver were interviewed from households selected randomly according to sampling frames specifically designed to elicit nationally representative results. Six mental disorders (social phobia, generalised anxiety disorder, major depressive disorder, post-traumatic stress disorder, conduct disorder, and attention-deficit hyperactivity disorder) were assessed with the Diagnostic Interview Schedule for Children, Version 5. Suicidal behaviours and self-harm in the past 12 months were also assessed. Prevalence in the past 12 months and past 4 weeks was calculated for each mental disorder and collectively for any mental disorder (ie, of the six mental disorders assessed). Prevalence of suicidal behaviours (ie, ideation, planning, and attempt) and self-harm in the past 12 months was calculated, along with adjusted odds ratios (aORs) to show the association with prevalence of any mental disorder in the past 12 months. Inverse probability weighting was applied to generate national estimates with corresponding 95% CIs. FINDINGS: Final samples consisted of 5155 households (ie, adolescent and primary caregiver pairs) from Kenya, 5664 households from Indonesia, and 5996 households from Viet Nam. In Kenya, 2416 (46·9%) adolescents were male and 2739 (53·1%) were female; in Indonesia, 2803 (49·5%) adolescents were male and 2861 (50·5%) were female; and in Viet Nam, 3151 (52·5%) were male and 2845 (47·4%) were female. Prevalence of any mental disorder in the past 12 months was 12·1% (95% CI 10·9-13·5) in Kenya, 5·5% (4·3-6·9) in Indonesia, and 3·3% (2·7-4·1) in Viet Nam. Prevalence in the past 4 weeks was 9·4% (8·3-10·6) in Kenya, 4·4% (3·4-5·6) in Indonesia, and 2·7% (2·2-3·3) in Viet Nam. The prevalence of suicidal behaviours in the past 12 months was low in all three countries, with suicide ideation ranging from 1·4% in Indonesia (1·0-2·0) and Viet Nam (1·0-1·9) to 4·6% (3·9-5·3) in Kenya, suicide planning ranging from 0·4% in Indonesia (0·3-0·8) and Viet Nam (0·2-0·6) to 2·4% (1·9-2·9) in Kenya, and suicide attempts ranging from 0·2% in Indonesia (0·1-0·4) and Viet Nam (0·1-0·3) to 1·0% (0·7-1·4) in Kenya. The prevalence of self-harm in the past 12 months was also low in all three countries, ranging from 0·9% (0·6-1·3) in Indonesia to 1·2% (0·9-1·7) in Kenya. However, the prevalence of suicidal behaviours and self-harm in the past 12 months was significantly higher among those with any mental disorder in the past 12 months than those without (eg, aORs for suicidal ideation ranged from 7·1 [3·1-15·9] in Indonesia to 14·7 [7·5-28·6] in Viet Nam). INTERPRETATION: NAMHS provides the first national adolescent mental disorders prevalence estimates for Kenya, Indonesia, and Viet Nam. These data can inform mental health and broader health policies in low-income and middle-income countries. FUNDING: The University of Queensland in America (TUQIA) through support from Pivotal Ventures, a Melinda French Gates company.

'Inexperienced'? Patterns in romantic and sexual experiences among urban poor early adolescents in Nairobi, Kenya.

The need for early prevention approaches to improve young people's sexual and reproductive health is gaining attention, yet little is known about the sexual experiences of early adolescents aged 10-14 years. Drawing on cross-sectional survey data collected from 365 early adolescents in a Nairobi slum, we used latent class analysis to identify subgroups based on self-reported awareness about sex and involvement in romantic and sexual activities. Multivariate regression models were fitted to examine the characteristics of each subgroup. Results revealed three subgroups: Involved (12%, high probability of being aware of sex and to have engaged in romantic/sexual activities); Observant (48%, high awareness but little own experience); and Naïve (40%, little awareness or personal experience). Being in the Involved group was associated with older age, having commenced puberty/orphanhood, and living in the least poor households. Findings suggest that while most early adolescents in this setting have not initiated romantic and sexual activities, there are distinct subgroups of who would not be captured by looking only at the prevalence of sexual intercourse. Understanding the characteristics and needs of specific subgroups may help to strengthen efforts to improve young people's sexual and reproductive health in urban poor environments.

Who Adolescents Trust May Impact Their Health: Findings from Baltimore.

This study is one of the first to explore the relevance of trust to the health of adolescents living in a disadvantaged urban setting. The primary objectives were to determine the differences in the sociodemographic characteristics between adolescents who do and do not trust and to examine the associations between trust and health. Data were drawn from the Well-Being of Adolescents in Vulnerable Environments (WAVE) study, which is a cross-sectional global study of adolescents in very low-income urban settings conducted in 2011-2013. This paper focused on 446 adolescents in Baltimore as it was the primary site where trust was explicitly measured. For the main analyses, six health outcomes were examined: (1) self-rated health; (2) violence victimization; (3) binge drinking; (4) marijuana use; (5) post-traumatic stress disorder (PTSD); and (6) condom use at last sex. Independent variables included sociodemographic variables (age, gender, current school enrolment, perceived relative wealth, and family structure) and two dimensions of trust: community trust (trust in individuals/groups within neighborhood) and institutional trust (trust in authorities). The results show that more than half the sample had no trust in police, and a high proportion had no trust in other types of authority. Among girls, those with higher levels of community trust were less likely to be victimized and involved in binge drinking. Meanwhile, girls with higher levels of institutional trust were more likely to use a condom and less likely to have used marijuana. Among boys, those with higher levels of community trust were more likely to use a condom, while those with higher levels of institutional trust were less likely to use marijuana, but more likely binge drink. Overall, this study highlights the importance of trust for adolescent health. Most surprising were the differences in the associations between boys and girls with regard to the type of trust and specific health outcome that was significant.

Sexual dysfunction among youth: an overlooked sexual health concern.

BACKGROUND: There is growing recognition that youth sexual health entails a broad range of physical, emotional and psychosocial responses to sexual interactions, yet little is known about sexual dysfunctions and well being in youth populations. This study explored sexual dysfunctions among youth and its associations with other domains of sexual health. Sexual dysfunctions were defined as: problems related to orgasm, pain during intercourse, lack of sexual desire or sexual pleasure. METHODS: Data were drawn from the 2010 French national sexual and reproductive health survey comprising a random sample of 2309 respondents aged 15-24 years. The current analysis included 842 females and 642 males who had sexual intercourse in the last 12 months. Chi square tests were used to test for differences in sexual dysfunctions by sex and explore associations with other domains of sexual health. RESULTS: Half of females (48%) reported at least one sexual dysfunction versus 23% of males. However, over half (57%) of youth reporting at least one dysfunction did not consider this to hinder their sexuality. Altogether, 31% of females cited at least one sexual dysfunction hindering their sexuality-more than three times the 9% of males. Sexual dysfunction was strongly and inversely related to sexual satisfaction for both males and females and additionally to a recent diagnosis of STI or unintended pregnancy for females. Sexual dysfunctions hindering sexuality were also correlated with a history of unintended pregnancy among males. CONCLUSION: While most youth in France enjoy a satisfying sexual life, sexual dysfunction is common, especially among females. Public health programs and clinicians should screen for and address sexual dysfunction, which substantially reduce youth sexual wellbeing.

Characteristics of youth who report early sexual experiences in Sweden.

Early timing of first sex is a common risk factor for adverse sexual and reproductive health (SRH) outcomes. This study explored characteristics and circumstances associated with early sexual experience (at or below age 14) among Swedish youth. Data were drawn from UngKAB09, a national study of youth SRH in Sweden. 24,000 youth 16-28 years were randomly selected for a web-based survey with a response rate of 24%. Post-stratification weights were used to correct for over- and underrepresentation in response. Adjusted logistic regression was used to model associations with early sexual experience, by gender. In the final sample (N = 5,321, 49% girls), 9 in 10 were sexually experienced, of whom 21% reported early first sex. In multivariate analysis, early sex was significantly associated with 7 of the 9 predictor variables selected for the model among boys and 14 of 15 selected factors among girls. Early sex was positively associated with low educational attainment, early pubertal onset, bisexual identity and (girls only) rural residence. For girls, first generation immigrant status, greater religiosity, conservative sexual attitudes and low Chlamydia knowledge decreased the odds of early sex. Early experience was more common if youth had older partners and, among girls, felt that sex was expected. Being in love, feelings of intimacy, alcohol use at first sex, and (girls only) causal sexual partner and wantedness of first sex were inversely associated with early first sex. The findings and implications are discussed in relation to the European and global literature on early sexual experiences.

Trends in Adolescent Health: Successes and Challenges From 2010 to the Present.

PURPOSE: This review considers trends in some of the major adolescent health outcomes and contextual influences since 2010, and explores the relevance of recent cultural, societal, and public health developments on adolescent well-being. METHODS: Based on a review of major reports published since 2010, we identified key topics of impact on adolescent health and development across several domains (education, economic opportunity, sexual and reproductive health, nutrition, and mental health) and ecological levels (from individual- to macro-level influences). Within these areas, we synthesized findings to describe recent trends, noting variation across countries/regions, gender/sex, and other social stratifications when possible. RESULTS: Since 2010, progress in several areas of sexual and reproductive health has been most striking, with notable global declines in female genital mutilation/cutting, child marriage, HIV transmission, and adolescent childbearing. Participation and retention in school has increased, although the COVID-19 pandemic interrupted positive progress for many adolescents and contributed to social isolation and economic insecurity. The mental health and nutrition domains have clear challenges. Increased internalizing mental health issues have been observed cross-culturally, especially among girls. The prevalence of anemia has remained stagnant, while overweight and obesity rates are rising. Within domains, we highlight uneven progress across and within countries. DISCUSSION: Based on recent successes and emerging challenges in adolescent well-being, we find that more and better research is needed that consistently takes an intersectional perspective, and critically, action must be taken to consolidate the gains in sexual and reproductive health and extend them to other areas of adolescent health.

Risk and Protective Factors for the Sexual and Reproductive Health of Young Adolescents: Lessons Learnt in the Past Decade and Research Priorities Moving Forward.

PURPOSE: To review the published literature on what has been reported on risk and protective factors for early adolescent sexual and reproductive health (SRH) in the recent decade. METHODS: A scoping review of English language, peer-reviewed literature on risk and protective factors for early adolescent (aged 10-14 years) SRH published between January 2010 and January 2023 using Medline, Web of Science, PsycInfo, CINAHL, and Google Scholar. Articles reporting only on nonmodifiable demographic factors, or on the effect of interventions, were beyond the scope of this review. RESULTS: Of 11,956 screened records, 118 were included of which half (49.2%) were published since 2018. Most articles (44.9%) presented research conducted in North America, followed by sub-Saharan Africa (20.3%) and East Asia and Pacific (16.1%). Five percent were based on multicountry studies or reported on pooled global data. Two-thirds (61.0%) reported on quantitative cross-sectional research designs, and 78.8% included both females and males. The most common SRH outcomes were sexual behaviors (34.7%); sexual and dating violence (28.8%); and sexual attitudes, beliefs, and intentions (19.5%). Most (83.0%) articles reported on risk/protective factors at the individual level, followed by interpersonal (family 58.5%, peers 33.0%, partners 11.9%), school (21.2%), and community (15.2%) factors. None of the included articles reported on macro/structural-level factors. DISCUSSION: While there has been growing attention to risk/protective factors for early adolescent SRH, gaps remain with regards to study contexts (mainly North America), focus (mostly individual factors), and conceptualizations (generally risk-oriented). We offer recommendations for research priorities over the coming decade.

Adolescent-Parent Relationships and Communication: Consequences for Pregnancy Knowledge and Family Planning Service Awareness.

PURPOSE: We explore three dimensions of parent-adolescent relationships (sexual and reproductive health (SRH) communications, connectedness, and parental monitoring) from the perspective of young adolescents as they relate to pregnancy knowledge and family planning service awareness in four diverse geographic areas ranging from low to high income settings and stratified by sex. METHODS: Analyses utilized baseline data from four Global Early Adolescent Study sites (Shanghai, China; Kinshasa, Democratic Republic of the Congo; Denpasar and Semarang, Indonesia; and New Orleans, United States). Multiple linear regressions were conducted to assess the relationships between key characteristics of parent-adolescent relationships and pregnancy knowledge. Multiple logistic regressions were also conducted to assess relationships between key characteristics of parent-adolescent relationships and family planning service awareness. RESULTS: Across all four sites, communication with a parent about SRH matters was significantly associated with increased pregnancy knowledge among female respondents. Further, girls in Shanghai and New Orleans and boys in Kinshasa who had ever communicated with a parent about SRH matters were significantly more likely to know where to get condoms. Finally, girls who communicated with a parent about any SRH matter were significantly more likely to know where to get other forms of contraception across all four study sites. DISCUSSION: Findings strongly support the importance of SRH communications between young adolescents and their parents. Our findings also suggest that while parental connectedness and monitoring are beneficial they are not replacements for quality parent-adolescent communications about SRH issues that begin early in adolescence before sexual intercourse is initiated.

Sexual attitudes, behaviours and acculturation among young migrants in Shanghai.

China's rates of internal migration increased to an all-time high of over 200 million individuals at the beginning of the twenty-first century. Yet, there is a dearth of information on the lives of young migrant populations. The aim of this study was to explore how migration influences the sexual attitudes and behaviours of 18-24-year-old migrant men and women in Shanghai, China. A total of 64 migrants participated in 10 focus-group discussions and 20 in-depth interviews. Guided by acculturation theory, coded data were organised into analytic matrices to compare themes across participants. Factors associated with increased sexual-risk behaviours include acculturative stress, discrimination leading to social isolation, conflicts between traditional and modern city values and increased sexual opportunities. Premarital sex, cohabitation, unprotected sex and visiting sex workers are common among this population. Reasons for not using condoms included being unprepared, lack of knowledge and barriers in accessing reproductive services due to not having urban documentation. Local family planning programmes should help migrants negotiate traditional and modern values and partner with work-sites to provide comprehensive sexual education and services and train health professionals in the specific healthcare needs of young migrant populations.

Violence Perpetration in Early Adolescence: A Study of Four Urban Communities Worldwide.

PURPOSE: Violence perpetration is common among adolescents worldwide but existing research largely focuses on boys, older adolescents, and partner violence. Our study sought to identify individual, family, and neighborhood/peer factors associated with violence perpetration in a multinational sample of male and female young adolescents. METHODS: We used cross-sectional data from 5,762 adolescents in four sites in the Global Early Adolescent Study: Flanders, Belgium; Kinshasa, Democratic Republic of the Congo; Shanghai, China; and Semarang, Indonesia. Adolescents resided in high-poverty urban areas and were aged 10 to 14 years. Logistic regression examined pooled and stratified associations between independent variables with peer violence perpetration in the past six months. Factors included media viewing habits, gender norms, victimization, agency/empowerment, adversity, depression, familial relationships, neighborhood cohesion, and peer behaviors. RESULTS: Restricted-model analyses found increased odds of violence perpetration associated with high media consumption, pornography viewing, violence or bullying victimization, having drank alcohol, depressive symptoms, adverse childhood experiences, greater behavioral control, greater decision-making, feeling unsafe in the neighborhood/school, peer alcohol/tobacco use, and witnessing peers start a fight. Decreased odds of violence perpetration were associated with more egalitarian views on two gender norms scales, closer parental relationships, neighbors looking out for one another, and greater availability of adult help. DISCUSSION: Among young adolescents, increased odds of violence perpetration were related to a perceived lack of safety and risky peer behaviors. Parental and neighborhood connections were often associated with decreased perpetration. Further research examining the interplay of such factors among young adolescents is needed to inform effective intervention and policy.

Body Satisfaction in Early Adolescence: A Multisite Comparison.

PURPOSE: This study assesses the relationship between unequal gender perceptions, socioecological factors, and body satisfaction among early adolescents in six urban poor settings in four countries. METHODS: A cross-sectional study, part of the Global Early Adolescent Study, was conducted in Shanghai, China; Cuenca, Ecuador; Kinshasa, DRC; and three cities in Indonesia: Denpasar, Semarang, and Bandar Lampung. Bivariate and multiple linear regressions were conducted to assess the relationships between body satisfaction, perceptions of gender norms, and socioecological factors. A final sample of 7840 respondents aged between 10 and 14 years were included in the analysis. RESULTS: Adolescents who endorsed more traditional sex roles and traits were more likely to be satisfied with their bodies in Kinshasa and Indonesia, while only endorsement of GST was associated with body satisfaction in Shanghai. Individual factors related to body satisfaction varied by site and included perceived health status, perception of body weight, height, and growth rate. Family and neighborhood factors related to increased body satisfaction varied by site and sex and included closeness to parents, parental communication, discussing bodily changes with anyone, parental awareness, and perception of neighborhood. CONCLUSION: The results highlight the association between gender norms and social factors at individual, family, and neighborhood levels with body satisfaction. While associations differ significantly by site and sex, namely in perception of body weight and height, there exists commonalities that suggest body satisfaction, gender norms, and social context are intertwined.

Unequal Gender Norms Are Related to Symptoms of Depression Among Young Adolescents: A Cross-Sectional, Cross-Cultural Study.

PURPOSE: This study was undertaken among 10- to 14-year-old girls and boys in disadvantaged areas of Shanghai, China; Cuenca, Ecuador; Flanders, Belgium; and Denpasar and Semarang, Indonesia. It aimed to assess whether gender norms are related to depressive symptomatology, and to examine whether sex differences in depressive symptoms can be explained by differences in gender norm perceptions. METHODS: We examined the distributions of depressive symptoms and two gender norms scales, gender stereotypical traits (GST), and sexual double standard (SDS), across sites and by sex. We next assessed crude and adjusted associations between each of the gender norms scales and depressive symptoms. Finally, we conducted path analysis to examine the mediating role of gender perceptions in sex differences in depressive symptoms. RESULTS: Girls reported more depressive symptoms than boys in all sites except Denpasar. SDS perceptions were more unequal among girls in most sites, while GST perceptions were more unequal among boys in all sites except Semarang. Gender-equal SDS and GST perceptions were associated with fewer depressive symptoms, while unequal perceptions were related to more symptoms. Gendered perceptions about traits and relationships appeared to partially mediate relationships between sex and depressive symptoms in Shanghai, Cuenca, and Semarang. CONCLUSIONS: Unequal gender norm perceptions were linked to poor mental health among boys and girls, suggesting that gender norms may play a role in psychological wellbeing for adolescents of both sexes. Gender norm perceptions appear to play a role in mental health sex disparities we observed across sites.

Understanding the Relationship Between Adverse Childhood Experiences, Peer-Violence Perpetration, and Gender Norms Among Very Young Adolescents in Indonesia: A Cross-Sectional Study.

PURPOSE: This study assesses the role of gender norms on the relationship between adverse childhood experiences (ACEs) and peer-violence perpetration among very young adolescents in three urban poor cities of Indonesia. METHODS: A cross-sectional study was conducted in Bandar Lampung, Denpasar, and Semarang in Indonesia. A total of 2,974 participants (boys: 44.79%, girls: 55.21%) between 10 and 14 years were included in the analysis. Logistic regression, mediation, and moderation analyses were conducted stratified by sex. RESULTS: Risk factors of peer-violence perpetration among boys and girls included three (boys: adjusted odds ratio [aOR] 2.51, 95% confidence interval [CI] 1.32-4.75; girls: aOR 1.82, 95% CI .95-3.52) and four or more (boys: aOR 6.75, 95% CI 3.86-11.80; girls: aOR 5.37, 95% CI 3.07-9.37) history of ACE. Risk factors of peer-violence perpetration among boys included having inequitable sexual double standard (SDS) indices (aOR 1.46, 95% CI 1.09-1.95). SDS measures the perception boys are rewarded for romantic relationship engagement, whereas girls are stigmatized or disadvantaged for the experience. Other risk factors included lifetime tobacco use among boys and girls and lifetime alcohol use among boys. Protective factors included parental closeness among girls. CONCLUSIONS: Based on the research in three Indonesian communities, this study demonstrates that boys are disproportionately exposed to adversities including history of ACE, inequitable SDS, lifetime alcohol use and tobacco use in comparison to girls. Programs targeting ACE and gender norms which engage boys, girls, and families are more likely to be successful in reducing peer-violence perpetration and promoting gender equitable norms.

The Social Context of Early Adolescents in the Global Early Adolescent Study.

PURPOSE: This paper used data from the Global Early Adolescent Study (GEAS) to provide a descriptive analysis of how early adolescents' social environments vary by sex across diverse cultural settings. METHODS: The analyses were based on baseline data among 10-14-year old adolescents living in disadvantaged urban areas in seven sites: Kinshasa (DRC), Shanghai (China), Cuenca (Ecuador), Lampung, Semarang and Denpasar (Indonesia), and Flanders (Belgium). Except in Kinshasa where face-to face interviews were used, data were collected using self-administered surveys on mobile tablets. Social environments were measured by examining factors within five main domains, including the household and family, school, peers, neighborhoods, and the media. Site-specific descriptive analyses were performed, using Chi square tests and Student T-tests to identify sex-differences in each site. RESULTS: The majority of early adolescents lived in two-parent households, perceived their parents/guardians cared and monitored them, had at least one friend, reported high educational aspirations, and perceived their neighborhoods as safe, socially cohesive, with a high level of social control. Yet, large gender and site differences were also observed. More girls reported same-sex friends and high levels of parental monitoring, while boys were more likely to have mixed-sex friends and spend greater amounts of time with friends. Adolescents in Kinshasa and Semarang watched the most TV per day, while higher proportions of adolescents in Flanders used social media on a daily basis. Significant gender differences in media use were also observed but varied according to site. CONCLUSIONS: Understanding how social contexts differ between boys and girls across sites has relevance for how we might examine gender attitude formations and subsequent health behaviors. Given the increased attention on the importance of early adolescence for shaping gender attitudes and norms, implementing approaches that consider the differences in boys' and girls' lives may hold the most promise for creating sustained and improve change.

Measuring Adverse Child Experiences Among Young Adolescents Globally: Relationships With Depressive Symptoms and Violence Perpetration.

PURPOSE: The purpose of the study was to develop a measure of ACEs applicable for young adolescents in low- and middle-income countries (ACEs) and to analyze the relationships of ACEs against two outcomes: depressive symptoms and violence perpetration. There is a paucity of research on the consequences of adverse child experiences (ACEs) on adolescent health and behavior from low- and middle-income countries and virtually no multinational studies. METHODS: As part of the Global Early Adolescent Study, an 11-item measure of ACEs was developed and piloted with 1,284 adolescents aged 10-14 years in 14 urban communities in an equal number of countries. With one exception where interviewers were used, data were self-reported anonymously using tablets. Results compared a summative ACEs index score and latent class analysis. RESULTS: Findings show high rates of ACEs exposure experienced by young adolescents in resource-poor neighborhoods in low- and middle-income countries; disproportionate exposures of boys and strong associations between ACEs and both depressive symptoms and violence perpetration. Latent class analysis provided modest refinement over a summed ACEs score. CONCLUSION: While interventions tend to focus on behavioral outcomes, evidence suggests that ACEs exposure is a strong antecedent related to both depressive symptoms and violence perpetration.

Coming of Age in the Shadow of the Taliban: Education, Child Marriage, and the Future of Afghanistan From the Perspectives of Adolescents and Their Parents.

OBJECTIVE: To understand adolescent and parental attitudes toward education, child marriage, and the changes in matriculation for boys and girls over one generation. METHODS: Two-staged household sampling method was used in six provinces with low educational enrollment in Afghanistan during 2016. Final sample included 910 adolescents aged 12-15 years and 454 parents. Data analysis included k-Nearest Neighbour imputation for missing values. Response percentages were compared by two-tail proportional z-test for two-sample comparison or Chi-squared test for multiple groups comparison with adjusted p values. RESULTS: Adolescents reported highly valuing education but considered boys to be greater beneficiaries than girls. Over 90% of parents concur expecting their children to complete at least secondary education independent of the child's sex with more than a third (37.89%) indicating that marriage should be postponed until at least high school completion. Likewise, both boys and girls believe marriage of girls under age 18-years limits future educational opportunities as well as increases risks of domestic violence and loss of freedom. Whereas a generation ago four-out-of-five parents of today's adolescents were not in school, today that has reversed; and among 12-15 year olds in the provinces studied, 75% were in school at the time of the survey. CONCLUSIONS: In the most disadvantaged provinces of Afghanistan, almost all young adolescents surveyed (98.8%) were not married and the majority were in school while an equal percent of their parents had no formal education. Additionally, both parents report that education of their sons and daughters is highly valued; and, for two-fifths, they believe marriage should occur after completion of secondary school.

Core competencies and the prevention of high-risk sexual behavior.

Adolescent sexual risk-taking behavior has numerous individual, family, community, and societal consequences. In an effort to contribute to the research and propose new directions, this chapter applies the core competencies framework to the prevention of high-risk sexual behavior. It describes the magnitude of the problem, summarizes explanatory theories of high-risk sexual behavior, and highlights the association between high-risk sexual behaviors and the five core competencies. We conclude the chapter by providing an overview of selected evidence-based prevention strategies and identifying future directions for research and intervention.