Early Sexual Initiation Research Articles

Sexual Intercourse Among High School Students - 29 States and United States Overall, 2005-2015.

Early initiation of sexual activity is associated with having more sexual partners, not using condoms, sexually transmitted infection (STI), and pregnancy during adolescence (1,2). The majority of adolescents initiate sexual activity during high school, and the proportion of high school students who have ever had sexual intercourse increases by grade; black students are more likely to have ever had sexual intercourse than are white students (3). The proportion of high school students overall who had ever had sexual intercourse did not change significantly during 1995-2005 (53.1% to 46.8%) (Division of Adolescent and School Health, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, CDC, unpublished data). To assess whether changes have occurred in recent years in the proportion of high school students who have ever had sexual intercourse, CDC examined trends overall and by grade, race/ethnicity, and sex among U.S. high school students, using data from the 2005-2015 national Youth Risk Behavior Surveys (YRBSs) and data from 29 states* that conduct the YRBS and have weighted data. Nationwide, the proportion of high school students who had ever had sexual intercourse decreased significantly overall and among 9th and 10th grade students, non-Hispanic black (black) students in all grades, and Hispanic students in three grades. A similar pattern by grade was observed in nearly half the states (14), where the prevalence of ever having had sexual intercourse decreased only in 9th grade or only in 9th and 10th grades; nearly all other states saw decreases in some or all grades. The overall decrease in the prevalence of ever having had sexual intercourse during 2005-2015 is a positive change in sexual risk among adolescents (i.e., behaviors that place them at risk for human immunodeficiency virus, STI, or pregnancy) in the United States, an overall decrease that did not occur during the preceding 10 years. Further, decreases by grade and race/ethnicity represent positive changes among groups of students who have been determined in previous studies to be at higher risk for negative outcomes associated with early sexual initiation, such as greater numbers of partners, condom non-use, teen pregnancy, and STI (1-3). More work is needed to understand the reasons for these decreases and to ensure that they continue.

Teenage Pregnancy: A Latin-American Concern

Teenage pregnancy, in the context of social healthcare and gender equity, exemplifies the multiple vulnerabilities and deficiencies in children and teenagers’ rights. Accordingly, this phenomenon may be qualified as one of the most complex and dramatic problems in Latin-America’s present healthcare. In 2013, the teenage fertility rates in Latin-America was 73.2 per thousand, which compared with a 48.9 at a worldwide level, and the 52.7 in developing countries reflects a series of ethical, educational, socio-economic and territorial inequities within these territories. Unfortunately, this situation is related to an early sexual initiation, teenagers’ behavior, a lack of information and comprehensive sexual education, alcohol and drug use at early ages and to the lack of preventive measures for single and repetitive teenage pregnancies and associated risk behaviors by most of the Latin American healthcare system.

Teenage Pregnancy: A Latin-American Concern

Teenage pregnancy, in the context of social healthcare and gender equity, exemplifies the multiple vulnerabilities and deficiencies in children and teenagers’ rights. Accordingly, this phenomenon may be qualified as one of the most complex and dramatic problems in Latin-America’s present healthcare. In 2013, the teenage fertility rates in Latin-America was 73.2 per thousand, which compared with a 48.9 at a worldwide level, and the 52.7 in developing countries reflects a series of ethical, educational, socio-economic and territorial inequities within these territories. Unfortunately, this situation is related to an early sexual initiation, teenagers’ behavior, a lack of information and comprehensive sexual education, alcohol and drug use at early ages and to the lack of preventive measures for single and repetitive teenage pregnancies and associated risk behaviors by most of the Latin American healthcare system.

Risky sex behaviours among college students: The psychosocial profile.

Risky sex behaviours among college students are a growing public health concern. However, few studies have profiled these behaviours using a large range of psychosocial correlates. Participants were 6874 undergraduate and postgraduate students (64.7% female, age range 17-25 years, M = 20.43 years, SD = 1.86 years) drawn from 13 higher-level institutions in Ireland. Regarding prevalence, 75% of the sample report that they have been, or are currently sexually active. Of this sexually active cohort (n = 5111), 27.2% report early sexual initiation, 29.5% report 5 or more lifetime sexual partners and 12.1% report 2 or more sexual partners in the past 3 months. In addition, 47.7% of students report inconsistent condom use and 39.5% report inconsistent use of other contraceptive methods in the past 3 months. Using multivariate logistic regression analyses, significant correlates of risky sex behaviour are identified across 5 groups of psychosocial predictors (demographic, sexuality and relationships, substance use, mental well-being and personal resources). Differences between males and females and between different sexual orientations are highlighted. Suggestions are made for sexual education and intervention programs to specifically target subgroups of the student population.

Contextualizing Gender and Acculturative Influences on Sexual Initiation of Asian Indian Emerging Adults

Although Asian Indians represent one the fastest growing demographics in the United States, no studies exist on the sexual behavior of Asian Indian youth or its association with acculturation. Previous research has demonstrated a link between earlier sexual initiation and subsequent sexual risk and the role of acculturation and sexual initiation in other Asian groups. The present exploratory study examined gender and acculturation with regard to sexual initiation in Asian Indians (n = 37). Results reveal no significant gender differences in sexual initiation and total acculturation scores. Gender differences did emerge for the association among sexual behaviors and the influence of specific areas of acculturation on sexual initiation. Findings suggest that gender and acculturation may be important variables in understanding sexual behavior but that current acculturation measures may be insufficient to adequately assess acculturation levels of Asian Indian youth. Future research should focus on Asian Indians as an understudied minority group.

Child Sexual Abuse and Intimate Partner Violence Victimization in Adulthood: Sex-Differences in the Mediating Influence of Age of Sexual Initiation

ABSTRACTChild sexual abuse is a major public health concern in the United States with devastating sequelae. Although the relationship between child sexual abuse and intimate partner violence victimization in adulthood is known, little is known about the mediating influence of the age of sexual initiation on the association, or whether sex differences exist. Using data from waves I, III, and IV of the National Longitudinal Study of Adolescent to Adult Health (N = 1,163), we aimed to examine the mediating influence of age of sexual initiation on the association between child sexual abuse and intimate partner violence victimization in adulthood and identify sex differences. Findings reveal that in female survivors, age of sexual initiation partially mediated the association between child sexual abuse and physical intimate partner violence victimization in adulthood. In male survivors, no mediational effect was observed. Public health practitioners should be aware of sex differences in the effect of early sexual initiation on intimate partner violence victimization in adulthood among child sexual abuse survivors.

Prevalence of HIV, hepatitis B virus and Treponema pallidum in inmates in the Preventive Detention Center of Arica, Chile

The risk groups for sexual transmitted diseases (STDs) are sex workers, drug addicts, young people in early sexual initiation, and population in prison. To determine the prevalence of HIV, Treponema pallidum and hepatitis B Virus (HBV) in male inmates at the Preventive Detention Center (CDP) of Arica. The study was conducted in 140 inmates, with informed consent. Epidemiological survey and blood sampling was conducted. The positive tests were sent to the Hospital Regional of Arica for confirmation and the National Reference Laboratory for confirmation. STD prevalence was 13.6%. The most prevalent was VDRL positive (7.1%) followed by HIV infection (5.7%) and HBV (2.9%). The highest rate (57.9%) occurred in individuals under 31 years old. 63.2% were in an overcrowded situation, 42.1% of cases corresponded to those whose age of sexual activity onset of was before age 15 and 94.7% used drugs. The study reasserts the predisposing factors for the transmission of STDs as age, early sexual debut, drug abuse and overcrowding, noting that prisons are highly vulnerable environments where overcrowding, sexual condition, early sexual initiation, high drug abuse and the lacking spouses visits provide an epidemiological context favorable for increased STD.

Using Intervention Mapping for Program Design and Production of iCHAMPSS: An Online Decision Support System to Increase Adoption, Implementation, and Maintenance of Evidence-Based Sexual Health Programs.

In Texas and across the United States, unintended pregnancy, HIV, and sexually transmitted infections (STIs) among adolescents remain serious public health issues. Sexual risk-taking behaviors, including early sexual initiation, contribute to these public health problems. Over 35 sexual health evidence-based programs (EBPs) have been shown to reduce sexual risk behaviors and/or prevent teen pregnancies or STIs. Because more than half of these EBPs are designed for schools, they could reach and impact a considerable number of adolescents if implemented in these settings. Most schools across the U.S. and in Texas, however, do not implement these programs. U.S. school districts face many barriers to the successful dissemination (i.e., adoption, implementation, and maintenance) of sexual health EBPs, including lack of knowledge about EBPs and where to find them, perceived lack of support from school administrators and parents, lack of guidance regarding the adoption process, competing priorities, and lack of specialized training on sexual health. Therefore, this paper describes how we used intervention mapping (Steps 3 and 4, in particular), a systematic design framework that uses theory, empirical evidence, and input from the community to develop CHoosing And Maintaining Effective Programs for Sex Education in Schools (iCHAMPSS), an online decision support system to help school districts adopt, implement, and maintain sexual health EBPs. Guided by this systematic intervention design approach, iCHAMPSS has the potential to increase dissemination of sexual health EBPs in school settings.

Factors Affecting Contraceptive Use among Adolescent Girls in South Korea

Purpose This study was done to identify contraceptive practices in adolescent girls in South Korea and predictors of contraceptive practices. Methods The study sample included 743 girls who had experienced sexual activity. Using statistics from the 12th (2016) Korea Youth Risk Behavior Web-based Survey, hierarchical logistic regression analysis was conducted. Results The contraceptive practice rate for adolescent girls was 34%. Contraceptive practice was associated with ‘age at first intercourse’ and ‘sexual intercourse after drinking’. For adolescent girls who had early sexual initiation and drank alcohol before sexual intercourse there was a tendency to reduce the practice of contraception. Conclusion It is necessary to provide practical sex education to improve the practice of contraception in these adolescents. In addition, adolescent girls should be encourage to delay their first intercourse. The results of this study can also be used to develop education interventions regarding healthy sexuality behaviour including the practice of contraception. Key words: ì²­ì†Œë „; 피임; ë¬¸ì œí–‰ë™; 성행동 Key words: Adolescent; Contraception; Problem behavior; Sexual behavior

Ethnic Variations in Perception of Human Papillomavirus and its Vaccination among Young Women in Nepal .

Background: The Human Papillomavirus (HPV) is strongly associated with cervical and other cancers. In women, cervical cancer is the third most common cancer. HPV infection can be largely prevented through vaccination of (adolescent) girls. At the same time, Nepal is a low-income country experiencing a cultural change in attitudes towards sex and sexual behaviour. However, in the adolescent population knowledge about HPV, factors associated with an increased risk of HPV and the existence of the vaccination is often low. Materials and Methods: This was a cross-sectional study with female students enrolled in health and non-health science courses in Pokhara, Nepal. The questionnaire included demographic details, knowledge and attitude questions related to HPV, associated risk behaviour and its vaccination. Descriptive statistics, including Chi-Square test, were used to identify statistically significant relationships. Ethical approval was granted by the relevant authority in Nepal. Results: Hindu religion (75.0 %; 95% CI: 70.9, 78.6) and Newari caste (75.5%; CI: 61.1, 86.7) were more aware about HPV, HPV vaccination. Hindus religion (55.6%; 95% CI: 51.2, 60.0) and Dalit caste (61.6%, 95% CI: 53.3, 69.4) more willing to be vaccinated than other religions and other castes, respectively. Not unsurprisingly, students on health-related courses had a greater awareness of HPV, HPV vaccination and were more willing to be vaccinated than students on other courses. Similar patterns of association arose for knowledge related to those sexually active at an early age; HPV risk and multiple sex partners; and fact that condoms cannot fully prevent the transmission of HPV. Conclusion: Knowledge about the link between HPV and (a) early sexual initiation, (b) having multiple sexual partners, and (c) the limited protection of condoms and other birth control measures was poor in our study compared to similar research conducted in other parts of the world. One key implication is the need for education campaigns in Nepal to educate young women and their parents about HPV, its risk factors and the benefits of vaccination. .

Understanding the relationship between religiosity and caregiver-adolescent communication about sex within African-American families.

Caregiver-adolescent communication about sex plays a critical role in the sexual socialization of youth. Many caregivers, however, do not engage their youth in such conversations, potentially placing them at risk for negative sexual health outcomes. Lack of caregiver-adolescent communication about sex may be particularly harmful for rural African American youth, as they often report early sex initiation and are disproportionately impacted by STIs. Moreover, sexual communication may be particularly challenging for families with strong religious backgrounds, potentially affecting the occurrence and breadth of topics covered during communication. Study aims were to: determine whether there was a relationship between caregiver religiosity and type of topics covered during communication about sex (e.g., general sexual health vs. positive aspects of sexuality) among 435 caregivers of early adolescent, African American youth; and if so, identify factors that might explain how religiosity affects communication about sex. Results indicated that caregiver religiosity was positively associated with communication about general, but not positive aspects of sexuality for caregivers of males. Attitudes towards communication about sex and open communication style mediated the relationship. There was no association between religiosity and communication about sex for caregivers of females. The findings from this study could provide a base to better understand and support the sexual socialization process within religious, African American families.

Early menarche: A systematic review of its effect on sexual and reproductive health in low- and middle-income countries.

BackgroundAdolescent girls aged 15–19 bear a disproportionate burden of negative sexual and reproductive health outcomes in low- and middle-income countries. Research from several high-income countries suggests that early age at menarche is an important determinant of sexual and reproductive health. We conducted this systematic review to better understand whether and how early menarche is associated with various negative sexual and reproductive health outcomes in low- and middle-income countries and the implications of such associations.MethodsWe systematically searched eight health and social sciences databases for peer-reviewed literature on menarche and sexual and reproductive health in low- and middle-income countries. Two reviewers independently assessed all studies for inclusion, overall quality and risk of bias, and performed data extraction on all included studies.ResultsTwenty-four articles met all inclusion criteria–nine of moderate quality and fifteen with several methodological weaknesses. Our review of the minimal existing literature showed that early menarche is associated with early sexual initiation, early pregnancy and some sexually transmitted infections in low- and middle-income countries, similar to what has been observed in high-income countries. Early menarche is also associated with early marriage–an association that may have particularly important implications for countries with high child marriage rates.ConclusionsEarly age at menarche may be an important factor affecting the sexual and reproductive health of adolescent girls and young women in low- and middle-income countries. More research is needed to confirm the existence of the identified associations across different settings and to better understand the process through which early menarche and other markers of early pubertal development may contribute to the increased vulnerability of girls to negative sexual and reproductive health outcomes in low- and middle-income countries. Given the association of early menarche with early marriage, ongoing efforts to reduce child marriage may benefit from targeting efforts to early maturing girls.

Trends in the sexual behaviour of 15-year olds in Scotland: 2002-14.

Early sexual initiation and inadequate contraceptive use can place adolescents at increased risk of unplanned pregnancy and sexually transmitted infections. These behaviours are patterned by gender and may be linked to social inequalities. This paper examines trends in sexual initiation and contraceptive use by gender and family affluence for Scottish adolescents. Cross-sectional data from four nationally representative survey cycles (2002, 2004, 2010, 2014) (n = 8895) (mean age = 15.57) were analysed. Logistic regressions examined the impact of survey year on sexual initiation, condom use and birth control pill (BCP) use at last sex; as well as any changes over time in association between family affluence and the three sexual behaviours. Analyses were stratified by gender. Between 2002 and 2014, adolescent males and females became less likely to report having had sex. Low family affluence females were more likely to have had sex than high family affluence females, and this relationship did not change over time. Condom use at last sex was reported less by males since 2002, and by females since 2006. Low family affluence males and females were less likely to use condoms than high family affluence participants, and these relationships did not change over time. There were no effects of time or family affluence for BCP use. There has been a reduction in the proportion of 15-year olds in Scotland who have ever had sex, but also a decrease in condom use for this group. Economic inequalities persist for sexual initiation and condom use.

The socio-political context of migration and reproductive health disparities: The case of early sexual initiation among Mexican-origin immigrant young women

Prior research often explains the lower risk of early sexual initiation among foreign-born Mexican-origin young women by a patriarchal and sexually conservative “traditional Latino culture.” This definition overlooks structural factors such as exploitation of migrant workers, and conflates gender inequality and sexual expectations. I use an intersectional framework and the theory of gender and power to explore how gender inequality and sexual expectations are both influenced by structural factors and affect reproductive health outcomes. I integrate data from qualitative interviews with 21 first and second generation Mexican-origin women in 2013–2014 with data from discrete time hazard models with 798 Mexican-origin young women in the National Longitudinal Study of Adolescent to Adult Health. Qualitative results demonstrate that gender inequality and sexual expectations in Mexican-origin immigrant households are associated with structural factors. Gender inequality occurs more often in households with family instability, greater poverty, and among parents who migrated independently. Qualitative data also demonstrate that parental gendered expectations are sometimes at odds to what parents are actually doing in the household. Finally, contrary to assumptions that a patriarchal “traditional Latino culture” protects against early sexual initiation, qualitative and multivariate quantitative data suggest that household gender inequality increases risk of early sexual initiation. These findings challenge the utility of a culturalist approach that views culture as determining health behavior among immigrants and demonstrate the need to incorporate an intersectional framework that includes structural factors. This approach may reduce stereotypes and identify meaningful interventions to reduce reproductive health disparities.

Early Sexual Initiation and Mental Health: A Fleeting Association or Enduring Change?

The present research examined how the within-person association between sexual initiation and internalizing symptoms decays over time, using data with annual measurement occasions across adolescence (N=1,789) and statistical models of within-person change. Sexual initiation was associated with increased levels of internalizing symptoms for early-initiating girls (ninth grade, approximately age 15), but not for on-time-initiating girls or for boys. The association between girls' early sexual initiation and internalizing symptoms declined precipitously over time. Indeed, 1year after sexual debut, early-initiating girls were similar to on-time or noninitiating girls on internalizing symptoms, suggesting early sexual initiation does not produce lasting detriments to girls' mental health. Findings inform how researchers perceive sexual initiation, both as a developmental milestone and as a prevention target.

Społeczno-demograficzne i rodzinne uwarunkowania pierwszych doświadczeń seksualnych i inicjacji seksualnej młodzieży

The study analyses the relationship of selected socio-demographic characteristics of adolescents (gender, place of residence, type of school) and selected characteristics of their families (education of parents, family wealth, support and communication) with their pre-initiation sexual experiences and sexual initiation. The results of a research carried out on a sample of 1,266 second- and third-class students of post-secondary schools have been analysed. The survey used an auditorium questionnaire. It has been shown that: three-fifths of the respondents had sexual experiences, of whom two-fifths already had sexual intercourse; girls were less likely than boys to have had sexual initiation, but more often than they got involved into pre-initiation forms of sexual activity; people who had a sexual initiation got involved into early forms of sexual activity earlier than those who didn’t have it yet. Factors that differentiate young people’s sexual behaviour have also included: the type of school, family support and material resources of the family. It has been established that in the case of boys, the risk factor for early sexual initiation is low family support and high level of affluence, while the protective factor is attendance at general secondary school or technical secondary school, and in the girls’ group, the protective factor is attendance at general secondary school, while the risk factor is living in a large city.

The Impact of a Sexual and Reproductive Health Intervention for American Indian Adolescents on Predictors of Condom Use Intention

PurposeAmerican Indian (AI) adolescents experience inequalities in sexual health, in particular, early sexual initiation. Condom use intention is an established predictor of condom use and is an important construct for evaluating interventions among adolescents who are not yet sexually active. This analysis evaluated the impact of Respecting the Circle of Life (RCL), a sexual and reproductive health intervention for AI adolescents, on predictors of condom use intention. MethodsWe utilized a cluster randomized controlled trial design to evaluate RCL among 267 AIs ages 13–19. We examined baseline psychosocial and theoretical variables associated with condom use intention. Generalized estimating equation regression models determined which baseline variables predictive of condom use intention were impacted. ResultsMean sample age was 15.1 years (standard deviation 1.7) and 56% were female; 22% had initiated sex. A larger proportion of RCL versus control participants had condom use intention post intervention (relative risk [RR] = 1.39, p = .008), especially younger (ages 13–15; RR = 1.42, p = .007) and sexually inexperienced adolescents (RR = 1.44, p = .01); these differences attenuated at additional follow-up. Baseline predictors of condom use intention included being sexually experienced, having condom use self-efficacy, as well as response efficacy and severity (both theoretical constructs). Of these, the RCL intervention significantly impacted condom use self-efficacy and response efficacy. ConclusionsResults demonstrate RCL intervention efficacy impacting variables predictive of condom use intention at baseline, with greater differences among younger, sexually inexperienced adolescents. To sustain intervention impact, future RCL implementation should reinforce education and training in condom use self-efficacy and response efficacy and recruit younger, sexually inexperienced AI adolescents.

Early sexual initiation among adolescents: A longitudinal analysis for 15-year-olds in Peru

The percentage of teenage Peruvian women reporting having had sex is increasing. There are few studies in Latin America aimed at identifying the predictors of this behaviour. This study uses a unique longitudinal dataset from Peru to explore which individual, family and community variables and changes of these over time predict sexual behaviour by age 15. Results show that early sexual initiation was positively associated with male gender, having a mother with less than complete secondary education, an increase in his/her family wealth over time, reporting having good peer relationships by age 12, being overage in school and reporting alcohol consumption and sexual behaviour of his/her group of friends. We found that peer relations were significant only for boys, while relations with parents were so only for girls. Finally, 11% of participants didn’t know if their last sexual partner used protection.

A AÇÃO DAS POLÍTICAS PÚBLICAS NA PREVENÇÃO DO CÂNCER DO COLO DO ÚTERO E MAMA NA ATENÇÃO BÁSICA EM SALVADOR-BA

O câncer de colo de útero e mama ocupa um lugar de relevância nas taxas de morbidade e mortalidade entre a população feminina. A infecção prévia pelo Papiloma Vírus Humano (HPV) foi apontado como principal fator para desencadear o câncer de colo uterino, associada a idade precoce na primeira relação sexual, múltiplos parceiros sexuais e parceiros com múltiplas parceiras sexuais anteriores. O exame citológico cérvico vaginal é um eficiente método de detecção precoce e prevenção, além do rastreamento oportunístico para detecção do câncer de mama, ambos simples e econômico. O Programa de Assistência Integral à Saúde da Mulher constitui um conjunto de princípios e diretrizes para orientar a população feminina acima dos 10 anos de idade, incluindo ações educativas, preventivas, de diagnóstico, tratamento e recuperação. O objetivo dessa pesquisa foi identificar a atuação do enfermeiro na prevenção do câncer de colo de útero e mama, a partir das políticas públicas de saúde da Atenção Básica na cidade de Salvador-BA, no ano de 2012/2013. Os dados foram coletados por meio de entrevistas semiestruturadas, que foram gravadas e os dados analisados transcritos na íntegra, não interferindo nas respostas sendo agrupados de acordo com as respostas dadas pelos entrevistados. A rotina do profissional de Enfermagem não está organizada o suficiente para atender todas as necessidades da saúde da mulher. A má condição das estruturas físicas, na maioria das unidades,somado a carência de informação técnica e científica dos enfermeiros acabam impossibilitando a efetividade do Serviço.

Early Sexual Intercourse: Prospective Associations with Adolescents Physical Activity and Screen Time.

ObjectivesTo assess the prospective associations of physical activity behaviors and screen time with early sexual intercourse initiation (i.e., before 15 years) in a large sample of adolescents.MethodsWe used two waves of data from the Rotterdam Youth Monitor, a longitudinal study conducted in the Netherlands. The analysis sample consisted of 2,141 adolescents aged 12 to 14 years (mean age at baseline = 12.2 years, SD = 0.43). Physical activity (e.g., sports outside school), screen time (e.g., computer use), and early sexual intercourse initiation were assessed by means of self-report questionnaires. Logistic regression models were tested to assess the associations of physical activity behaviors and screen time (separately and simultaneously) with early sexual intercourse initiation, controlling for confounders (i.e., socio-demographics and substance use). Interaction effects with gender were tested to assess whether these associations differed significantly between boys and girls.ResultsThe only physical activity behavior that was a significant predictor of early sexual intercourse initiation was sports club membership. Adolescent boys and girls who were members of a sports club) were more likely to have had early sex (OR = 2.17; 95% CI = 1.33, 3.56. Significant gender interaction effects indicated that boys who watched TV ≥2 hours/day (OR = 2.00; 95% CI = 1.08, 3.68) and girls who used the computer ≥2 hours/day (OR = 3.92; 95% CI = 1.76, 8.69) were also significantly more likely to have engaged in early sex.ConclusionThese findings have implications for professionals in general pediatric healthcare, sexual health educators, policy makers, and parents, who should be aware of these possible prospective links between sports club membership, TV watching (for boys), and computer use (for girls), and early sexual intercourse initiation. However, continued research on determinants of adolescents’ early sexual initiation is needed to further contribute to the strategies for improving adolescents’ healthy sexual development and behaviors.