Adolescent Sexual Health Research Articles

Predictors of condom use among system-involved youth: The importance of Sex Ed

Sexual health education has been proven effective in improving adolescent sexual reproductive health outcomes. System-involved youth, including those in child welfare or juvenile justice systems, experience disproportionately poor outcomes as compared to youth in the general population, especially concerning STIs and early or unplanned pregnancies. Using logistic regression, this cross-sectional study examined the odds of condom use in a sample (n = 318; 61.3% males; 79.9% African American) of system-involved youth with multiple high-risk sexual behaviors. Specifically, it examined the impact of sexual health education, attitudes and beliefs about condoms, and the moderating effect of gender. The logistic regression models showed that youth were more likely to use a condom when exposed to comprehensive sexual health education (p < .05). Beliefs about condom effectiveness increased the odds of condom use in the second model (p < .01). Gender was not found to have a moderating effect. This study examined whether receiving comprehensive sexual health education and adolescent attitudes and beliefs towards condoms were associated with non-condom use using logistic regression in a sample of system-involved youth. Results suggest that comprehensive sexual health education could improve condom use in this vulnerable population.

Brief Motivational Intervention to Improve Adolescent Sexual Health Service Uptake: A Pilot Randomized Controlled Trial in the Emergency Department

To test the hypothesis that our motivational sexual health intervention (SexHealth) would increase health service uptake when compared with control. In a randomized controlled trial at a pediatric emergency department, sexually active adolescents received either the SexHealth intervention or printed materials (control). SexHealth, delivered by a health educator, was a tablet-based, interactive intervention that included motivational techniques to promote sexual health, condom skills training, and tailored service recommendations. We assessed feasibility (eg, intervention completion, recommendations discussed, intervention duration), acceptability (ie, proportion enrolled and rating intervention as satisfactory), and efficacy; secondary outcomes were sexual and care-seeking behaviors at 6months. The efficacy outcome was completion of ≥1 service at the index visit (ie, counseling, condoms, emergency contraception for immediate or future use, pregnancy/sexually transmitted infection/HIV testing, sexually transmitted infection treatment, and clinic referral). We enrolled 91 participants (intervention=44; control=47). The intervention demonstrated high feasibility: 98% completed the intervention; 98% of recommendations were discussed; duration was 24.6minutes, and acceptability: 87% of eligible adolescents enrolled and 93% rated the intervention as fairly to very satisfactory. Compared with controls, intervention participants were more likely to complete ≥1 service (98% vs 70%, P<.001) including HIV testing (33% vs 6%, P=.02) and emergency contraception (80% vs 0%, P=.01). There were no meaningful differences between arms in behaviors at follow-up. SexHealth was feasible to implement, acceptable to youth, and resulted in increased uptake of health services during the emergency department visit. Additional strategies may be needed to extend intervention effects over time. ClinicalTrials.gov; NCT03341975.

Feasibility study of peer-led and school-based social network Intervention (STASH) to promote adolescent sexual health

BackgroundEffective sex education is the key to good sexual health. Peer-led approaches can augment teacher-delivered sex education, but many fail to capitalise on mechanisms of social influence. We assessed the feasibility of a novel intervention (STASH) in which students (aged 14–16) nominated as influential by their peers were recruited and trained as Peer Supporters (PS). Over a 5–10-week period, they spread positive sexual health messages to friends in their year group, both in-person and via social media, and were supported to do so via weekly trainer-facilitated meetings. The aims of the study were to assess the feasibility of STASH (acceptability, fidelity and reach), to test and refine the programme theory and to establish whether the study met pre-set progression criteria for continuation to larger-scale evaluation.MethodsThe overall design was a non-randomised feasibility study of the STASH intervention in 6 schools in Scotland. Baseline (n=680) and follow-up questionnaires (approx. 6 months later; n=603) were administered to the intervention year group. The control group (students in year above) completed the follow-up questionnaire only (n=696), 1 year before the intervention group. The PS (n=88) completed a brief web survey about their experience of the role; researchers interviewed participants in key roles (PS (n=20); PS friends (n=22); teachers (n=8); trainers (n=3)) and observed 20 intervention activities. Activity evaluation forms and project monitoring data also contributed information. We performed descriptive quantitative analysis and thematic qualitative analysis.ResultsThe PS role was acceptable; on average across schools >50% of students nominated as influential by their friends, signed up and were trained (n=104). This equated to 13% of the year group. Trained PS rarely dropped out (97% completion rate) and 85% said they liked the role. Fidelity was good (all bar one trainer-led activity carried out; PS were active). The intervention had good reach; PS were reasonably well connected and perceived as ‘a good mix’ and 58% of students reported exposure to STASH. Hypothesised pre-conditions, contextual influences and mechanisms of change for the intervention were largely confirmed. All bar one of the progression criteria was met.ConclusionThe weight of evidence supports continuation to full-scale evaluation.Trial registrationCurrent controlled trials ISRCTN97369178

Exploring Parent-gender Differences in Parent and Adolescent Reports of the Frequency, Quality, and Content of Their Sexual Health Communication

ABSTRACT Parent-adolescent sexual health communication (SHC) is a protective factor that can reduce adverse adolescent sexual health outcomes, and the frequency, quality, and content of SHC predicts its effectiveness. However, research on this topic has been limited in scope, overwhelmingly focused on mothers; and often has only included the parent or adolescent perspective, not both members of the dyad. Using secondary cross-sectional data, this study used ANCOVA, logistic regression, correlational, and chi-square analyses to investigate parent-gender differences in parent-adolescent SHC. Participants included 341 parent-adolescent dyads. Compared to fathers, mothers rated parent-adolescent SHC as more important and more comfortable, and had greater self-efficacy for and fewer reservations about SHC than fathers. Mothers also reported talking more frequently and more broadly with their child about sexual health than fathers. Adolescent-reported frequency, quality, and content of parent-adolescent SHC did not differ significantly by parent gender, except for one sexual health topic. Dyadic analyses revealed that mothers and their children tended to agree more in their reports of parent-adolescent SHC than fathers and their children. These findings suggest that fathers may need additional resources to help them confidently engage in effective parent-adolescent SHC.

South African Fathers Involvement and Their Adolescents' Sexual Risk Behavior and Alcohol Consumption.

Although considerable research has examined the influence of parent-adolescent relationships on the sexual health of adolescents, there is a great need for research to understand the influence of fathers on their children's HIV sexual risk behavior, particularly in sub-Saharan Africa. We examined how the residence and the involvement of fathers are related to their children's HIV sexual risk and alcohol consumption behaviors. A cross-sectional survey was completed by 175 sixth-grade adolescents in the Eastern Cape Province, South Africa. Analyses showed that adolescents living with their fathers had fewer sexual partners (B = -0.606, SE = 0.299, p = .043) and consumed alcohol less frequently (B = -0.642, SE = 0.294, p = .029). Adolescents who spent more quality days with their fathers in the past 30days had fewer sexual partners (B = -0.103, SE = 0.039, p = .008) and had condomless sex less frequently (B = -0.097, SE = 0.047, p = 0.041). It was also found that there were significant father-residence × child-gender interactions on sexual debut (B = 1.132, SE = 0.564, p = .045) and on frequency of condomless sex (B = -2.140, SE = 0.924, p = .021). These interactions indicate that boys living with their fathers were less likely to have had vaginal intercourse than girls and that girls living with their fathers were less likely to have unprotected sex than boys. This study highlights the importance of South African fathers' roles in their adolescent children's HIV sexual risk and alcohol drinking behaviors and the need to promote father-child relationships for adolescent health. The results suggest that health programs aiming to reduce South African adolescents' HIV sexual risk behaviors and alcohol consumption consider strategies that target their fathers.

Multicultural Adaptation of Mighty Girls for Widespread Dissemination: Pilot Study, App Development and Usability Testing, and Gauging Parent Support With Focus Groups.

BackgroundTaking evidence-based interventions to scale is a challenge for prevention science. Mighty Girls is an evidence-based sexual health intervention program that combines classroom sessions with novel, cutting-edge technology (digital puppetry). The program was developed for 7th grade Latinas, but US school and community demographics rarely allow interventions targeting a single ethnic group. Additionally, digital puppetry is costly to scale up, and parent disapproval often prevents successful dissemination of adolescent sexual health programs. Intervening steps along the scaling-up pathway are needed to adapt the program prior to scaling up for dissemination.ObjectiveThe aims of this study were to create a multicultural adaptation of the Mighty Girls program using a mobile app that is less costly to disseminate and is acceptable to parents of 7th grade girls.MethodsThis study used a three-phase process to adapt Mighty Girls into Mighty Teens. All phases used purposive (nonprobability) sampling of low-income, multicultural, urban metropolitan groups (7th grade girls and their parents) within central Florida. Phase 1 involved two videotaped implementations of a multicultural adaptation of the classroom sessions, one involving focus groups (N=14) and the other serving as a single-group pretest-posttest pilot study (N=23). Phase 2 involved development of a narrative cell phone app prototype, which was subjected to usability testing (N=25). App usability and engagement were assessed qualitatively (observation, focus group, open-ended questions) and quantitatively. Phase 3 used focus groups to assess parent support for the program (N=6). Qualitative data were analyzed using descriptive content analysis. Quantitative data were analyzed using descriptive statistics and paired t tests.ResultsQualitative findings supported classroom sessions being multicultural, and identified simple changes to improve engagement and learning. Quantitative findings from the second classroom session implementation pilot study indicated a significant pre-post difference in intention to delay sexual intercourse (P=.04). App usability and appeal were supported by a System Usability Scale score of 76 (exceeding 68 per the industry standard) and 83% (20/24) of participants agreeing they would recommend the app to friends. Parents (mothers) expressed only positive regard for program goals, and classroom session and app activities.ConclusionsThis study adapted Mighty Girls into an engaging, easier-to-disseminate, multicultural program, termed Mighty Teens, that uses a narrative-generating app to support behavior change, and is likely to be accepted by parents of 7th grade girls. This study also provides evidence of the preliminary effectiveness of Mighty Teens classroom sessions. The sampling method and sample size were appropriate for adaptation, but research involving a more representative US sample is needed to confirm multicultural fit, parent receptivity, and program effectiveness. Study implications include integrating app use throughout the classroom sessions to build narrative-generating skills across the program and increasing the number of narratives produced, which should in turn increase the program’s behavior change potency.

Examining the recent trends in adolescent sexual and reproductive health in five countries of sub\u2010Saharan Africa based on PMA and DHS household surveys

BackgroundThe annual collection of fertility, marriage, sexual behaviour, and contraceptive use data in the nationally representative rounds of Performance Monitoring and Accountability (PMA) surveys in sub-Saharan Africa may contribute to the periodic monitoring of adolescent sexual and reproductive health (ASRH). However, we need to understand the reliability of these data in monitoring the ASRH indicators. We assessed the internal and external consistencies in ASRH indicators in five countries.MethodsWe included countries with at least three nationally representative rounds of PMA surveys and two recent DHS: Ethiopia, Ghana, Kenya, Nigeria, and Uganda. Our analysis focused on four current status indicators of ASRH among girls 15–19 years: ever had sex, currently married, has given birth or currently pregnant, and currently using modern contraceptives among sexually active unmarried girls. We compared the PMA survey and DHS data and tested for statistical significance and assessed trends over time using Jonckheere-Terpstra test statistic.ResultsPMA and DHS survey methodologies were similar and, where there were differences, these were shown to have minimal impact on the indicator values. The comparison of the data points from PMA and DHS for the same years showed statistically significant differences in 12 of the 20 comparisons, which was most common for sexual behaviour (4/5) and least for contraceptive use (2/5). This is partly due to larger confidence intervals in both surveys. The time trends were consistent between the annual PMA surveys in most instances in Ethiopia, Kenya, and Nigeria but less so for Ghana and Uganda. However, both surveys highlight slow progress in adolescent and reproductive health indicators with major disparities between the countries.ConclusionsDespite the differences between PMA 2020 surveys and DHS surveys conducted in the same year, and inconsistencies of the PMA survey time series for several indicators in some countries, we found no systematic issues with PMA surveys and consider PMA surveys a valuable data source for the assessment of levels and trends of ASRH beyond contraceptive use and family planning for indicators of fertility, marriage, and sex among adolescent girls in sub-Saharan Africa.

Multilevel Barriers to Sexual Health Behavior Among Vulnerable Adolescent Girls in the USA.

Most sexual health interventions focus on individual-level predictors of sexual behavior. Given the considerable influence of environmental factors on adolescent girls' sexual health, current interventions may be insufficient to promote safer sex. In this study, we aimed to understand adolescent girls' anticipated barriers to engaging in safer sex behavior after completing a brief, web-based sexual health intervention called HEART. This study used qualitative interviews with 50 adolescent girls who were recruited from community-based organizations that serve vulnerable youth. All participants were 12 to 19 years old (mean age=15.62, SD=1.83), and identified with a marginalized racial/ethnic group (58% Black; 18% Latinx; 24% Asian, biracial, or multiracial). Further, 24% identified as LGBTQ+, and 58% were sexually active. Guided by the social ecological model, we delineate six unique barriers to safer sex discussed by adolescents: partner manipulation, slut shaming, unclear sexual values, present time orientation, embarrassment, and access to sexual and reproductive health services. We conclude with recommendations for addressing these barriers to optimize adolescent girls' sexual health.

Are rhetorical commitments to adolescents reflected in planning documents? An exploratory content analysis of adolescent sexual and reproductive health in Global Financing Facility country plans

BackgroundThe Global Financing Facility (GFF) offers an opportunity to close the financing gap that holds back gains in women, children’s and adolescent health. However, very little work exists examining GFF practice, particularly for adolescent health. As momentum builds for the GFF, we examine initial GFF planning documents to inform future national and multi-lateral efforts to advance adolescent sexual and reproductive health.MethodsWe undertook a content analysis of the first 11 GFF Investment Cases and Project Appraisal Documents available on the GFF website. The countries involved include Bangladesh, Cameroon, Democratic Republic of Congo, Ethiopia, Guatemala, Kenya, Liberia, Mozambique, Nigeria, Tanzania and Uganda.ResultsWhile several country documents signal understanding and investment in adolescents as a strategic area, this is not consistent across all countries, nor between Investment Cases and Project Appraisal Documents. In both types of documents commitments weaken as one moves from programming content to indicators to investment. Important contributions include how teenage pregnancy is a universal concern, how adolescent and youth friendly health services and school-based programs are supported in several country documents, how gender is noted as a key social determinant critical for mainstreaming across the health system, alongside the importance of multi-sectoral collaboration, and the acknowledgement of adolescent rights. Weaknesses include the lack of comprehensive analysis of adolescent health needs, inconsistent investments in adolescent friendly health services and school based programs, missed opportunities in not supporting multi-component and multi-level initiatives to change gender norms involving adolescent boys in addition to adolescent girls, and neglect of governance approaches to broker effective multi-sectoral collaboration, community engagement and adolescent involvement.ConclusionThere are important examples of how the GFF supports adolescents and their sexual and reproductive health. However, more can be done. While building on service delivery approaches more consistently, it must also fund initiatives that address the main social and systems drivers of adolescent health. This requires capacity building for the technical aspects of adolescent health, but also engaging politically to ensure that the right actors are convened to prioritize adolescent health in country plans and to ensure accountability in the GFF process itself.

Socio-demographic and economic determinants of awareness and use of contraceptives among adolescents in Ebonyi State, South-east, Nigeria.

Understanding factors that explain levels of awareness and use of contraceptives among adolescents is a critical entry point for improving their sexual and reproductive health. This study assessed the demographic and socioeconomic determinants of awareness and use of contraceptives among adolescents in rural and urban communities in Ebonyi State, Nigeria. A cross-sectional household survey was conducted in three rural and urban communities in August, 2018. Modified cluster sampling technique was used to select eligible households. A total of 1045 adolescents (598 females and 447 males) were randomly selected from the households and interviewed using a pre-tested structured questionnaire. The mean age is 15.4years (15.3 - 15.5) and the median age is 15.5years. Univariate, bivariate and multivariate analysis were undertaken. Statistical significance was set at p-value of <0.05. Majority of respondents, 723 (68.9%), were aware of male condom. Place of residence predicts awareness of contraceptive pills (AOR 0.66, CI 0.48-0.91); schooling predicts awareness of male condoms (AOR 0.57; CI 0.32-0.99). Predictors of awareness of female condoms are place of residence (AOR 0.66, CI 0.47-0.93), gender (AOR 0.57, CI 0.32-0.99) and wealth index (AOR 1.16, CI 1.03-1.30). Demographic and socioeconomic characteristics of respondents did not predict contraceptive use in the last sex. Although awareness of contraceptives is high, utilization is low among sexually active adolescents. Hence, the need to promote access to and utilization of contraceptives through comprehensive contraceptive education to improve adolescents sexual and reproductive health.

Associations between Parent-Child Communication on Sexual Health and Drug Use and Use of Drugs during Sex among Urban Black Youth.

Black youth and their families living in urban settings may experience unique stressors that contribute to underlying issues due to the environmental context. Such factors may exacerbate and promote drug use and engagement in risky sexual behaviors, unknowingly. Little is known about how family factors, peer pressure, condom use, and other related factors are associated with substance use and engaging in sexual behaviors while on drugs among urban African American youth aged 12–22 (N = 638). We used regression models to examine associations between parental bonding, parent–adolescent sexual health communication, condom use, peer pressure on substance use, and having sex while on drugs. Multivariate results indicated that parental bonding was statistically significant and associated with drug use (OR: 1.36, 95%CI: 1.36). Our study highlights that parental bonding plays a critical role in youth using drugs while living in urban environments.

Which factors contribute to sexual well-being? A comparative study among 17 to 20 year old boys and girls in Belgium and Ecuador

Despite recognition that sexual well-being is an important part of adolescent sexual and reproductive health, a clear description of adolescent sexual well-being does not yet exist. Through six in-depth interviews and four focus group discussions with 56 young people in two distinct contexts (Belgium and Ecuador), we used the social-ecological framework to identify factors influencing adolescent sexual well-being. According to respondents, the main factors that influence adolescent sexual well-being are not only situated at the individual (having knowledge and skills and being physically, sexually and mental mature and healthy) and interpersonal levels (positive attraction towards others and communication about sexuality), but at a broader societal level, including social acceptance of sex, gender and sexual diversity and its (legal) translation into comprehensive sexuality education and the ready availability of contraceptives. Our results go well beyond two existing definitions of (adolescent) sexual well-being to contribute to understanding and measurement from the perspective of young people themselves, adding substantively to ongoing discussion about the definition of the concept.

An Exploratory Study of Current Sources of Adolescent Sexual and Reproductive Health Information in Kenya and Their Limitations: Are Mobile Phone Technologies the Answer?

Purpose The prevalence of pregnancy and sexually transmitted infections among adolescents in low and middle-income countries leads us to believe that sexual and reproductive health (SRH) information needs are still unmet. This paper investigates current sources and their limitations and then explores the role technology could play. Methods: In an exploratory qualitative study themes identified; (1) preferred sources of SRH information; (2) their limitations; (3) the role of technology in meeting their needs. Results: Mobile phone-based apps could improve awareness and provide information in a confidential way. Conclusions: Adolescents have an unmet need that vary by age and gender. Mobile phones could offer accessible, user-friendly platform.

Impact of family law reform on adolescent reproductive health in Ethiopia: A quasi-experimental study

• Ethiopia passed the Revised Family Code in 2000, which set the minimum age of marriage for girls at 18 and strengthened women’s rights within marriage. • Analysis using synthetic control method and difference-in-differences helps to overcome empirical challenges of identifying impact of the law. • Implementation of the law was associated with large reductions in rates of adolescent birth, child marriage, and early sexual initiation. • Reductions were similar in rural and urban areas. • Findings indicate that strong legal frameworks for gender equality may be effective catalysts in facilitating social change on child marriage. In sub-Saharan Africa, nearly 2 in 5 girls are married before the age of 18. Child marriage has adverse consequences for women’s physical, emotional, and social wellbeing and development. Emerging evidence has identified the importance of gender equality as a social context for shaping adolescent sexual and reproductive health norms. In 2000, Ethiopia’s government passed the Revised Family Code, increasing the minimum age of marriage from 15 to 18 for girls without exceptions, and strengthening women’s rights within marriage regarding marital property, divorce, and employment. I evaluated the impact of the law on adolescent reproductive health indicators and newborn mortality rates. I used difference-in-differences (DID) and synthetic control methods (SCM) to compare cohort trends in Ethiopia to those in comparison countries. I show that implementation of the law was associated with a 9-percentage-point reduction in risk of adolescent birth for exposed cohorts, an 8-percentage-point reduction in child marriage, and a 10-percentage-point reduction in sexual initiation before age 18 in SCM models. There was no association of the law with changes in risk of termination of pregnancy, unmet need for contraception, infant mortality rates, or neonatal mortality rates. Results were consistent across SCM and DID models, although DID estimates were slightly attenuated. I discuss mechanisms and policy implications. The results of this study provide evidence that strong legal frameworks for gender equality may be effective catalysts in facilitating social change around child marriage.

Uptake of Sexual And Reproductive Health Services and Associated Factors Among Rural Adolescents in Southern Ethiopia, 2020

Introduction: Although 25% of Ethiopia’s population is an adolescent cohort of age 15-19 yrs, the Adolescent Sexual and Reproductive Health Service (ASRH) service utilization has not been adequately researched and addressed, and, therefore, they have had to deal with multiple reproductive health problems. Therefore, assessing the determinants of sexual and reproductive health service uptake in this age group is critical to boosting service use and, in doing so, reducing the burden of illness and disability among adolescents. And so, the motivation at the rear of this research was to look into the level of sexual and reproductive health services utilization and to find out determinants among adolescents who reside in rural districts of Guraghe zone, southern Ethiopia. Methods: A community-based cross-sectional study was undertaken from May 1-30, 2020. A multi-stage method of sampling was employed. A total of 1028 adolescents have been randomly chosen and participated in the study. Pre-tested structured questionnaires were used for data collection. The data was encoded and entered into Epi-Data version 3.1 and exported for analysis to SPSS version 23. A bivariable logistic regression analysis was conducted, and variables with a p-value less than 0.25 were considered candidates for a multivariable logistic regression model. In multivariate logistic regression, variables with p-values &lt;0.05 were declared as statistically significant. Results: of the sampled 1028 participants, 1009 took part in the study and yielded a response rate of 98.1%. The study found that 281 (27.8%) of adolescents received sexual and reproductive health services. Accordingly, among these SRH service users (n = 281), provision of SRH information and education was the most common item received by 171(60.8%) of adolescents whereas relatively few respondents 32(11.4%) got safe and /or postabortion care. Variables that became important determinants of SRH service utilization were; taking part in peer education (AOR:2.07; 95%CI:1.46-2.94), parental discussion (AOR:3.94; 95%CI:2.77-5.60), availability of youth clubs (AOR:3.15; 95%CI:2.22-4.49), and being knowledgeable on SRH issues (AOR:3.48; 95%CI: 2.44-4.96). Conclusion: In the study area, sexual and reproductive health service utilization was low. Since most adolescents are enrolled in school, schools can be an excellent way to increase adolescents’ awareness of SRH services through behavioral change communication (BCC). Furthermore, special attention should be given to promoting discussion between parents and adolescents and the creation and strengthening of youth clubs as important steps to improving the use of Sexual and reproductive services for adolescents by the relevant stakeholders.

ANALYSIS OF SEXUAL AND REPRODUCTIVE HEALTH RISK PREFERENCES OF ZIMBABWE UNIVERSITY STUDENTS

Although the Zimbabwean government launched an Adolescent and Youth Sexual and Reproductive Health policy in 2010, HIV prevalence and incidence among youth remains amongst the highest in sub-Saharan Africa. Zimbabwean Youths in tertiary education institutions exhibit high-risk sexual behaviours. The study aimed to estimate the risk preference parameters of youths in a tertiary education setting to understand their risky behaviour better using prospect theory. It involved 250 students completing a socioeconomic questionnaire and making a choice from over three series of pairwise lottery questions framed around sexual and reproductive health prevention interventions. The study used bivariate techniques to examine differences in risk-taking behaviour. Ordinary least squares and interval regression techniques determined the socioeconomic determinants of the risk behaviour function. The study established an average risk aversion parameter of 0.7 and a probability weighting parameter of 0.8. The probability weighting parameter implies that the participants were more focused on the outcomes with less concern for their likelihood. The study estimated the loss aversion parameter at 2.26, which indicates the need to reduce loss-framed messages in favour of positively framed awareness campaigns. Bivariate and multivariate regression analyses showed that income, prior sexual and reproductive health knowledge and alcoholism were associated with risk and loss aversion. We recommend positive framing of youth sexual and reproductive health awareness campaigns. We also recommend youth economic emancipation to increase economic prospects which in turn improves reference points which changes the viewing of health interventions and outcomes from the loss domain to gain domain.

Assessment of access and utilization of adolescent and youth sexual and reproductive health services in western Ethiopia

BackgroundDespite Ethiopia's enormous effort in youth-friendly service provision, little was investigated about the challenges of accessing sexual and reproductive health services in Western Ethiopia. Thus, this study aimed to assess factors associated with the utilization of adolescent and youth sexual and reproductive health services in this area.MethodsA community-based cross-sectional quantitative method mixed with the qualitative inquiry was conducted among 771 adolescents and youth aged 15 to 24 years from February 1 to 28, 2020. Data were collected through face-to-face interviews using pretested structured questionaries. Data were entered using EPI-INFO version 7.0 and analyzed by SPSS version 25. Descriptive analysis and logistic regressions were performed. The adjusted odds ratio with a 95% confidence interval was used and statistical significance was declared at P-value < 0.05. The qualitative inquiry was collected through in-depth interviews with service providers, focus group discussions, and observation checklists of service units in the study facilities. Data were analyzed thematically.ResultsThe mean age of participants was 18.99 years (SD ± 2.49). Two hundred seventeen (28.1%) of participants reported that they have ever heard about adolescents' and youth’s reproductive health services. Only 66 (8.6%) have ever visited health facilities for sexual and reproductive health (SRH) services. Factors associated with the utilization of sexual and reproductive health service were age from 15 to 19 years (AOR = 0.36; 95%CI: 0.17, 0.76), history of having sexual intercourse(AOR = 5.34;95%CI: 2.53, 11.23), ever heard about sexual reproductive health service (AOR = 11.33; 95%CI: 5.59, 22.96), and visited a health facility for other health services (AOR = 5.12; 95%CI:1.72,15.24).ConclusionSexual and reproductive health service utilization among adolescents and youth was found to be low. The factors associated with adolescents and youth sexual and reproductive health services utilization were age, history of ever having sexual intercourse, ever heard about SRH services, and visit the health facility for other services. Therefore, it is better if the concerned bodies work on improving awareness of adolescents and youth towards SRH services and integrating these services into other routine services.

Enhancing Human-Centered Design With Youth-Led Participatory Action Research Approaches for Adolescent Sexual and Reproductive Health Programming.

Existing participatory research approaches have failed to identify innovative methods that overcome the persistent barriers to adolescent sexual and reproductive health service demand and access. Increasingly, programmers have turned to human-centered design (HCD), a problem-solving process that centers the needs, perspectives, and experiences of people, when developing solutions to complex SRH challenges. This article describes the application of a youth-engaged version of HCD as part of Adolescents 360, a transdisciplinary initiative to increase 15- to 19-year-old girls' use of modern contraception in Nigeria, Ethiopia, and Tanzania. Youth-adult design teams (including 111 "youth designers" trained in HCD methods) undertook formative research to inform the design and implementation of interventions. We reflect on the practical implications of using instrumental strategies of HCD with a youth-led participatory approach. Our experience indicates that (1) engaging youth as project partners in transdisciplinary teams requires planned and dedicated financial and human resources; (2) involving youth as action researchers can help identify opportunities to improve program empathy and responsiveness; (3) it is difficult to recruit "extreme users" as project partners because of the high competencies needed in HCD; (4) centering empathy and employing design standards during prototyping can drive decision-making and resolve questions raised by conflicting evidence claims in existing bodies of literature; and (5) testing tangible services and products in real-world settings continues long after the intervention design phase. Youth-adult partnership should continue throughout this iterative and adaptive phase to ensure that the adolescent experience of the intervention remains at the core of intervention delivery.

Enhancing Human-Centered Design With Youth-Led Participatory Action Research Approaches for Adolescent Sexual and Reproductive Health Programming

Enhancing Human-Centered Design With Youth-Led Participatory Action Research Approaches for Adolescent Sexual and Reproductive Health Programming

Gender Differences in Attitudes and Behaviors Toward Condoms and Birth Control Among Chicago Adolescents

Research shows that gender norms play a notable role in pregnancy prevention, often placing responsibility on females and allowing some males to pursue sexual encounters without considering the consequences of unprotected sex. This paper examines gender differences in attitudes and behaviors related to condom use and birth control among adolescents using survey, focus group, and interview data gathered from the evaluation of Chicago Healthy Adolescents and Teens (CHAT), a comprehensive sexual health education program implemented with adolescents in Chicago Public High Schools. Results indicate that safe sex attitudes and behaviors differ between male and female adolescents, specifically those related to condoms and birth control. Our findings suggest that (i) females have higher knowledge and presumed responsibility for pregnancy prevention, (ii) infrequent condom use among adolescents prioritizes male pleasure over female health needs, and (iii) social norms discourage females, but not males, from accessing and using birth control. We use the Theory of Gender and Power to show how our findings reflect gender dynamics within the United States and explain the potential health implications for adolescent sexual health.