Early Sexual Activity Research Articles

Childhood Adversity and Early Age Sexual Activity in Taiwan: Gender Differences

The experience of childhood family adversity may affect adolescent sexual behavior, yet the variation in the types of adversities is unknown. We analyzed data from the Taiwan Education Panel Survey. In 2007, 18,995 students aged 18 years retrospectively reported the age of first sexual activity and the experiences of childhood adversities. Multinomial logistic regression was used to examine the association of childhood adversities with the timing of first sexual occurrence. Parental psychopathology and parental death had significant associations with first sex to occur during periods before age 12, ages 12 to 15, and ages 15 to 18. The impact of some types of adversities on sexual behavior started as early as elementary school, but others influenced children’s sexual behavior at a later stage. Parental separation/divorce showed a stronger association with early onset of sex activity for females, that is, sexual debut before age 12.

Bidirectional Associations Between Adolescents' Sexual Behaviors and Psychological Well-Being

PurposeAssessing bidirectional longitudinal associations between early sexual behaviors (≤16.0 years) and psychological well-being (global self-esteem, physical self-esteem, depression) among 716 adolescents, and the direct and buffering effect of parent–adolescent relationship quality. MethodsWe used data from Project STARS (Studies on Trajectories of Adolescent Relationships and Sexuality), a longitudinal study on adolescent sexual development in the Netherlands. Participants were 11.0–16.0 years old (mean age at T1 = 13.3 years). Self-reports from four waves of online questionnaires were used. Bidirectional longitudinal associations were assessed by linear mixed-effects models. ResultsAt most waves, boys had significantly higher levels of psychological well-being than girls, but genders did not differ in experience with sexual behaviors. Engagement in early sexual behaviors did not predict lower levels of psychological well-being over time, and lower levels of psychological well-being did not predict more engagement in early sexual behaviors over time. Parent–adolescent relationship quality did not moderate these associations in either direction, although we found a significant direct effect, in which a higher-quality parent–adolescent relationship predicted more optimal levels of the three indicators of adolescents' psychological well-being (but not lower levels of early sexual activity) over time. ConclusionsOur results show that, among Dutch adolescents, early sexual behaviors and psychological well-being were not interrelated. This may be explained by socio-cultural aspects of the Dutch society, such as more normalization of sexual behaviors during adolescence. As a result, early sexual activity in and of itself was not related to lower psychological well-being over time. Yet, cross-cultural differences in links between adolescents' sexuality and well-being should be further investigated.

Effectiveness of peer education approach on improving HIV/AIDS related healthy behaviors among immigrant street children: A randomized controlled trial

ObjectiveForeign-origin street children are vulnerable to HIV/AIDS mainly due to poverty, violence, early sexual activity and poor access to health care services. This study aimed to highlight the effectiveness of peer education intervention to reduce HIV-risky behavior among street children with Afghan nationality. MethodsSixty-one street children were stratified by sex and then randomly allocated to either an intervention or control group by assigning each participant computerized random numbers. The intervention provided peer education services, focused on mode of disease transmission, prevention approaches and awareness of HIV/AIDS services by peers. ResultsAt least 80% of participants in the intervention and control groups completed the study period, respectively. At the end of the study, statistically significant increase of knowledge and attitude improvement as well as a decreased tendency to do risky sexual intercourse among the intervention subjects was shown. Moreover, there was a time intervention interaction for knowledge and attitude improvements followed by intervention (interaction p value=0.001), while it was not significant for risky sexual behavior (interaction p value=0.44). ConclusionPeer education was an effective and easy-to-apply educational method that increased knowledge and improved attitudes about HIV/AIDS among foreign-origin street children, while it was less efficient with regard to long-term reduction in risky sexual behavior.

Early sexual debut: prevalence and risk factors among secondary school students in Ido-ekiti, Ekiti state, South-West Nigeria.

Early adolescent sexual activity remains a recurring problem with negative psychosocial and health outcomes. The age at sexual debut varies from place to place and among different individuals and is associated with varying factors. The aim was to determine the prevalence and risk factors of early sexual debut among secondary school students in Ido-Ekiti, South-West Nigeria. This was a cross-sectional study. The respondents were selected using multi-stage sampling technique. Pre-tested, semi-structured, self-administered questionnaire was used to collect data. Data was analyzed using SPSS version 15. More than two-thirds, 40(67.8%), had early sexual debut. The prevalence of early sexual debut was about 11%. The mean age of sexual debut was 13.10±2.82; the mean age for early sexual debutants was 11.68±1.98. The mean number of sexual partners was 2.44±1.99. Male gender, having friends who engaged in sexual activities had association with early sexual exposure (p<0.05). Alcohol intake had the strongest strength of association for early sexual debut among the students. The high prevalence of early sexual exposure among the students calls for urgent interventions to stem the trend. This will help to reduce the devastating negative psycho-social and health sequels.

Adolescents’ childbearing dynamics in urban Mozambique: a qualitative analysis in Maputo, Quelimane and Lichinga cities

Despite the implementation of some policies and programs aimed at reducing early and unsafe adolescent sexual activity, adolescent pregnancy and childbearing are major concerns in Mozambique. About 40% of adolescents aged 15 to 19 are already mothers or pregnant. In light of this high prevalence of early motherhood, this paper aims at discussing socioeconomic and cultural factors influencing adolescent pregnancy and childbearing in urban Mozambique. We use the socioecological perspective framework to analyze focus group discussions data with adolescents, parents and community leaders in the cities of Maputo, Quelimane, and Lichinga. The study reveals that instructions transmitted in the initiation rites, living conditions and the exposure to information and communication technology are the main factors influencing early pregnancy and childbearing among adolescents in Mozambique. Adolescents should be empowered on knowledge about sexuality to prevent early childbearing, and protect them from STIs. Parents should be encouraged to talk openly about sexuality with their children.

Ethnicity, gender and risky sexual behaviour among Nigerian youth: an alternative explanation

BackgroundWhile studies in demography and public health have acknowledged the role of ethnic differences, the influence of ethnicity on youth sexual behaviour in Nigeria has received little or no attention. It is important to know how cultural norms and gender roles, which vary by ethnicity, may promote or prevent risky behaviour. Such information could provide insights into previously undetected sexual behaviour in multi-ethnic situations.MethodsThe Nigeria Demographic and Health Surveys (NDHS) for 2003, 2008 and 2013 were pooled to examine the relationship between ethnicity and youth sexual reproductive health, proxied by age at sexual debut, multiple sexual partners (MSP) and condom use at last sexual activity, among the 6304 females and 1549 males who reported being sexually active in the four weeks preceding the survey. Multivariate analysis using a Cox proportional hazard regression model was used to determine the risk factors for early sexual activity among young people (15–24). Logistic regression was used to predict condom use at last sexual activity and MSP.ResultsThe median age at first sexual activity was 16 for females and 17 for males. 43% of male youths used condoms in their last sexual activity, compared to only 16% among females and a higher number of males (81%) had multiple sexual partners compared to females (35%). For females, elevated risks of first sex was higher among Hausa/Fulanis aged 15–19 and elevated risk of first sex was higher among Yoruba males.ConclusionThis study provides further evidence that in order to promote protective sexual behaviours among youth in Nigeria, social, cultural and gender-specific tactics should be put in place for the prevention of HIV and other STIs.

Parental involvement, depression, and sexual experiences across adolescence: a cross-sectional survey among adolescents of different ages

ABSTRACTBackground: Early sexual activity and multiple sexual partners are deemed risky sexual behaviors and connected to mental disorders such as depression. Parent–adolescent relationship is connected both to risky sexual behaviors and depression.Objective: To ascertain if there is a connection between parental involvement and adolescent sexual behavior in different age groups from early to late adolescence, and the role of depression in this association.Methods: Data from School Health Promotion Study, a cross-sectional school survey in Finland from the years 2010 and 2011 with 186,632 adolescents as informants was used. We examined the association of sexual behaviors and parental involvement with self-reported depression, at first separately and then in the same model. Analyses were conducted in seven age groups, separately for girls and boys. The main outcomes were analyzed by χ2 test and logistic regression.Results: Among both girls and boys, low level of parental involvement was connected to having experienced sexual intercourse and, among those sexually active, reporting more sexual partners in early and middle adolescence. Parental involvement and depression were independently associated with the sexual behaviors studied and had only a slight modifying effect on each other in this context.Conclusion: Promoting parental involvement in adolescents’ lives is likely to be beneficial to adolescents’ sexual health.

Sending and receiving text messages with sexual content: Relations with early sexual activity and borderline personality features in late adolescence

This research examined adolescents' written text messages with sexual content to investigate how sexting relates to sexual activity and borderline personality features. Participants (N = 181, 85 girls) completed a measure of borderline personality features prior to 10th grade and were subsequently given smartphones configured to capture the content of their text messages. Four days of text messaging were micro-coded for content related to sex. Following 12th grade, participants reported on their sexual activity and again completed a measure of borderline personality features. Results showed that engaging in sexting at age 16 was associated with reporting an early sexual debut, having sexual intercourse experience, having multiple sex partners, and engaging in drug use in combination with sexual activity two years later. Girls engaging in sex talk were more likely to have had sexual intercourse by age 18. Text messaging about hypothetical sex in grade 10 also predicted borderline personality features at age 18. These findings suggest that sending text messages with sexual content poses risks for adolescents. Programs to prevent risky sexual activity and to promote psychological health could be enhanced by teaching adolescents to use digital communication responsibly.

Young Hungarian Students' Knowledge about HPV and Their Attitude Toward HPV Vaccination.

(1) Background: Hungarys’s estimated cervical cancer mortality was 6.9/100,000 in 2012, above the average of the EU27 countries (3.7/100,000) in the same year. Since 2014, the bivalent HPV vaccine has been offered to schoolgirls aged 12–13. (2) Methods: We conducted a cross-sectional study among 1022 high school seniors (492 girls, 530 boys) in 19 randomly selected schools in Budapest. Our anonymous questionnaire contained 54 items: basic socio-demographic data, knowledge about HPV infection/cervical cancer and HPV vaccination. (3) Results: 54.9% knew that HPV caused cervical cancer, and 52.1% identified HPV as an STD. Knowledge of risk factors such as promiscuity (46.9%) and early sexual activity (15.6%) was low, but higher than that of further HPV-induced diseases: genital warts (in females 9.9%, in males 9%), anal cancer (in females 2.2%, in males 1.9%), penile cancer (9.4%), and vulvar cancer (7.8%). A percentage of 14.6% feared getting infected, and 35.7% supported compulsory HPV vaccination. A percentage of 51.2% would have their future children vaccinated—significantly more girls than boys. (4) Conclusion: Our results support the findings of previous studies about young adults’ HPV-related knowledge, which was poor, especially regarding pathologies in men. Despite the low level of awareness, the students’ attitude was mostly positive when asked about vaccinating their future children.

NATIVE-It's Your Game: Adapting a Technology-Based Sexual Health Curriculum for American Indian and Alaska Native youth.

Sexually transmitted infection (STI) and birth rates among American Indian/Alaska Native (AI/AN) youth indicate a need for effective middle school HIV/STI and pregnancy prevention curricula to delay, or mitigate, the consequences of early sexual activity. While effective curricula exist, there is a dearth of curricula with content salient to AI/AN youth. Further, there is a lack of sexual health curricula that take advantage of the motivational appeal, reach, and fidelity of communication technology for this population, who are sophisticated technology users. We describe the adaptation process used to develop Native It's Your Game, a stand-alone 13-lesson Internet-based sexual health life-skills curriculum adapted from an existing promising sexual health curriculum, It's Your Game-Tech (IYG-Tech). The adaptation included three phases: (1) pre-adaptation needs assessment and IYG-Tech usability testing; (2) adaptation, including design document development, prototype programming, and alpha testing; and (3) post-adaption usability testing. Laboratory- and school-based tests with AI/AN middle school youth demonstrated high ratings on usability parameters. Youth rated the Native IYG lessons favorably in meeting the needs of AI/AN youth (54-86% agreement across lessons) and in comparison to other learning channels (57-100%) and rated the lessons as helpful in making better health choices (73-100%). Tribal stakeholders rated Native IYG favorably, and suggested it was culturally appropriate for AI/AN youth and suitable for implementation in tribal settings. Further efficacy testing is indicated for Native IYG, as a potential strategy to deliver HIV/STI and pregnancy prevention to traditionally underserved AI/AN middle school youth.

Sexual Activity of the Youth Population in Malawi: The Emerging Health Care Scenario

The sexual behaviour of youths in Malawi is believed to play an important role in the spread of sexually transmitted infections (STIs). Relevant data from the Malawi Demographic and Health Survey 2010 and a sample of 16,217 youths aged 15–24 have been studied and subjected to bivariate and logistic regression analysis. The results show that married youths were not interested in using condoms (94.2%, p &lt; 0.05) and that those who were living together were 69 times (OR = 1.69, 95% CI, 1.26–2.26) more likely to be involved in early sexual activity than those who were not living together. It is argued that the results should help other researchers, policy makers and planners to create strategies to encourage these youths make use of contraception.

Endometrial polyps in the reproductive age: the finishing touches to the clinical portrait

The article presents the results of the study of clinical presentation, history of reproductive aged women with endometrial polyps and micropolyps. Possibility of the diagnosis of this disease on clinical manifestations was estimated. The study involved 130 patients aged 18–35 years: 70 patients with endometrial polyps (group I), 30 patients with micropolyps (group II) and 30 patients of the control group (group III). Analysis of complaints showed that the most common reason for hospital treatment in the majority of the surveyed women was infertility. The prevalence of infertility suggests that the structural and functional changes in the endometrium if there are micropolys are not only a serious obstacle for the embryo implantation and pregnancy development, but can also be а basis for the endometrial polyps formation. And such clinical symptoms of micropolyp as perimenstrual bleeding, discharge from the genital tract, algodysmenorrhea, menorrhagia, pain in women with endometrial polyps only prove common pathogenetic mechanisms. Analysis of menstrual blood loss indicates that 46% of women with endometrial polyps and 87% with micropolyps this criterion differs from the normal values. The amount of menstrual blood loss in groups I and II was the same, but significantly different from the control group. Analysis of the gynecological diseases structure in women of major groups revealed that the proportion of patients with infertility in the group with endometrial polyps was 66%, predominantly due to primary infertility, which suffered 49% respondents. Thus formed the following clinical picture of patients with endometrial polyps. Women with micropolyps are women with secondary infertility dominant. Starting early sexual activity before the age of 18, they use ineffective contraception. Pregnancy occurs without much difficulty, but often results in spontaneous abortions and frequent abnormal uterine bleeding in these women makes them regular gynecological hospital patients.

Predicting Primary and Secondary Abstinence Among Adolescent Boys and Girls in the Western Cape, South Africa

Two of the most effective health behaviours with regard to HIV prevention are condom use and sexual abstinence. While determinants of condom use among sub-Saharan African adolescents have been studied extensively, factors related to abstinence have received far less attention. This study identified socio-cognitive determinants of primary and secondary abstinence intentions and of early sexual activity. This study also assessed whether these factors had a direct or indirect association with intentions to abstain from sex. A longitudinal design was used in which 1670 students (age 12–16) of non-private South African high schools filled in a questionnaire, with a follow-up after 6 months, concerning sexual abstinence, attitudes, social norms, self-efficacy, risk perception and knowledge. Logistic and linear regression analysis with latent factors was used to assess determinants of intentions and abstinence, and structural equation modelling was used to assess indirect effects. Results showed that among sexually inactive students, social norms predicted the intention to abstain from sex in the next 6 months. Among sexually active students, reporting less disadvantages of abstinence predicted the intention to abstain. Sexual activity at follow-up was predicted by attitudes and intention among sexually inactive girls, and by knowledge among sexually inactive boys. No predictors were found for sexually active adolescents. Structural equation modelling further showed that risk perception was indirectly related to intentions to abstain from sexual intercourse. We conclude that addressing socio-cognitive factors in order to motivate adolescents to delay sex is more likely to be successful before they experience sexual debut. In addition, this study shows that the effect of increasing risk perceptions, a strategy often applied by parents and HIV prevention programmes, is to a large extent mediated by more proximal cognitive factors such as attitude. Research is needed to identify factors that influence the execution of intentions to abstain from sex.

A Study on the Prevalence of Chlamydia Trachomatis and Neisseria Gonorrhoeae Infections Using Polymerase Chain Reaction

INTRODUCTION : Sexually transmitted infections (STIs) are a major global cause of acute illness, infertility, long term morbidity and mortality, with severe medical and psychological consequences of millions of men, women and infants. STIs most commonly affect people aged between 15 to 44 years. In 2006, 1,030,911 Chlamydial infections and 3,58,366 Gonococcal infections were reported to CDC from 50 states and the districts of Columbia in United states. Chlamydia trachomatis and Neisseria gonorrhoeae remain the two most preventable causes of human infertility. Untreated Gonococcal and Chlamydial infections in women will result in pelvic inflammatory disease in upto 40% of cases. One in four of these will result in infertility. Demographic risk factors for the acquistion of gonorrhoeae include migration of population, unemployment, lack of education, poverty, early onset of sexual activity, unmarried marital status, past history of gonorrhoeae,illicit drug use and now commercial sex have been operative universally, but more severely in certain societies and countries. AIMS AND OBJECTIVES : 1. To study the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infections in patients attending the Out-Patient Department of Institute of Venereology, using AMPLICOR CT/NG Polymerase chain reaction. 2. To study the prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae infections among HIV positive patients in the study group. 3. To study about the age distribution, socioeconomic background, educational level and marital status among the patients in the study group. 4. To compare the sensitivity and specificity of AMPLICOR CT/NG Polymerase chain reaction with Culture for Gonococci and IgM ELISA test for Chlamydia trachomatis. CONCLUSION : 1. Gonococcal infections (males –14.64%, females –13.34%) was more common than Chlamydia trachomatis (males-3.57%, females –3.70%) infections. Gonococcal infection was more common in men (14.64%) compared to women (13.34%). Chlamydial infection was more common in women (3.70%) when compared to men (3.57%). 2. In HIV positive patients also, gonococcal infections (M-14%, F- 7%),were more common than chlamydial infections (M-3%, F-11%). 3. AMPLICOR CT /NG PCR for urine specimens (M-16, F-15) was highly sensitive than male urethral (13) and female endocervical swab (13) specimens in detecting gonococcal infections. In Chlamydial infections, urine PCR (7) was highly sensitive than urethral swab PCR (2) in males but in females, endocervical swab PCR(6) was more sensitive than urine PCR (3). 4. Asymptomatic gonococcal infection was common in affected males (29.26%) when compared to affected females (27.78%). Asymptomatic Chalmydial infection was common in affected females (40%) compared to affected males(20%).Asymptomatic gonococcal (M-57.14%, F- 57.14%) and chlamydial infections (M-66.67%, F-100%) were common in HIV positive patients compared to HIV negative patients. 5. AMPLICOR CT/NG PCR had 100% sensitivity in detecting gonococcal infections compared with gonococcal culture and also had 100% sensitivity in detecting chlamydial infections compared with IgM ELISA for C. trachomatis. 6. Majority of gonococoal (M-43.90%, F-47.23%) and Chlamydial (M- 50%, F-60%) infection positive patients belonged to 20-29 years age group. Majority of the affected patients belonged to lower socioeconomic status. 7. Burning micturition (NG-53.65%, CT-80%) was the main complaint in affected males and genital discharge (NG-50%,CT-50%) was the main complaint in affected females. In gonococcal infection positive males, urethral discharge (14.63%) was the common clinical finding and in chlamydial infection positive males genital ulcer (30%) was the common clinical finding .Cervical erosion (NG-58.34%, CT-70%) was the common clinical finding in affected females. 8. In Chlamydial infection positive patients, gonococcal infection was the most commonest associated STI (M-30%, F-70%). In gonococcal infection positive males, C. trachomatis (7.31%) was the commonest associated STI and in females, Bacterial vaginosis (41.67%) was the commonest associated STI. AMPLICOR CT/NG PCR had 100% sensitivity in detecting gonococcal and chlamydial infections. PCR screening will diagnose asymptomatic cases of both gonococcal and chlamydial infections. Since coinfection rate of gonococcal and chlamydial infection were high, all cases of gonorrhoeae should be treated presumptively for chlamydial infection as recommended by CDC and WHO.

Tanner’s Puberty Scale: Exploring the historical entanglements of children, scientific photography and sex

Globally, increasing numbers of children are thought to be going through early onset puberty. This much debated fact leads to significant concerns about young people’s sexualities, as early developers are thought to be more likely to engage in early sexual activity. Underpinning historical, national and subpopulation (including ‘racial’) comparisons is a standard measurement tool: the Tanner Scale of sexual development. The scale is based on James M. Tanner and R.H. Whitehouse’s ground-breaking longitudinal study of children’s growth undertaken in London between 1949 and 1971. This article explores the largely over-looked and under-theorized significance of the scale’s history, arguing that the study’s focus on children living in an English care institution and its material practices of documenting their growth, including photography, has important ethical and scientific implications for understanding sexual development as a bio-psycho-social process.

Early sexual initiation and multiple sexual partners among Vietnamese women: analysis from the Multiple Indicator Cluster Survey, 2011

IntroductionUnder current HIV transmission mechanisms operating in Vietnam, women are seen as victims of their male partners. Having multiple sexual partners is one of the well-known risk factors for HIV infection. However, little is known about women's risky sexual behaviour and their vulnerability to HIV in Vietnam. This study aims to explore association between early sexual initiation and the number of lifetime sexual partners in Vietnamese women. Although the Vietnamese culture is socially conservative in this area, identifying women's risky sexual behaviour is important for the protection of women at risk of HIV and other sexually transmitted diseases.DesignA total of 8,791 women, who reported having had sexual intercourse, were included in this analysis of data from the 2011 Multiple Indicator Cluster Survey in Vietnam. Data were collected using two-stage strata sampling, first at the national level and second across six geographical regions (n=8,791). Multivariable logistic regressions describe association between early initiation of a sexual activity and lifetime multiple sexual partners.ResultsEarly sexual intercourse was significantly associated with having lifetime multiple sexual partners. Women who were aged 19 or younger at first sexual intercourse were over five times more likely to have multiple sexual partners, compared with women whose first sexual intercourse was after marriage; aged 10–14 years (OR=5.9; 95% CI=1.9–18.8) at first intercourse; and aged 15–19 years (OR=5.4; 95% CI=4.0–7.2) at first intercourse. There was significant association with having multiple sexual partners for women of lower household wealth and urban residence, but the association with educational attainment was not strong.ConclusionsThe study results call for health and education policies to encourage the postponement of early sexual activity in young Vietnamese women as protection against risky sexual behaviour later in life.

The Effects of Sex Education on the Risky Sexual Behaviour of School Going Adolescents

Adolescents are at a high risk for a number of health consequences associated with early and unsafe sexual activity including infection with HIV/AIDS, sexually transmitted infections (STIs) and unintended pregnancies. The amplified sexual risk-taking behaviour among adolescents culminates into thinking that perhaps lack of knowledge pertaining to sex and sexuality provokes adolescents into undertaking sexual risks. Consequently, sex education was introduced as a means of introducing youths in the field of sexual and reproductive health in Malawi to help them go for informed decisions. The use of several interventions countrywide is cited to have decreased the rates of sexual activity in some adolescents, however, despite the positive trend many adolescents remain at risk for unintended pregnancy, STIs and HIV/AIDS infection. This study empirically evaluates how sex education has impacted risky sexual behaviours undertaken by the schooling youths in the Machinga district particularly in three schools namely: Mbenjere, Ntaja and Nsanama Community Day Secondary Schools. Both qualitative and quantitative techniques were employed in the study. Questionnaire and focus group discussions served as data collection tools. Results of the study revealed that a good number of schooling youths had enough sexual knowledge but still undertook sexual risks. The study however concludes that sex education is failing to positively impact schooling youth’s behaviour because of some cultural and personal factors which seems to contradict the whole purpose of sex and sexuality education amongst youths in Machinga.

Interventions for promoting reintegration and reducing harmful behaviour and lifestyles in street-connected children and young people.

Millions of street-connected children and young people worldwide live or work in street environments. They are vulnerable to many risks, whether or not they remain connected to families of origin, and despite many strengths and resiliencies, they are excluded from mainstream social structures and opportunities. Primary research objectivesTo evaluate and summarise the effectiveness of interventions for street-connected children and young people that aim to:• promote inclusion and reintegration;• increase literacy and numeracy;• facilitate access to education and employment;• promote mental health, including self esteem;• reduce harms associated with early sexual activity and substance misuse. Secondary research objectives• To explore whether effects of interventions differ within and between populations, and whether an equity gradient influences these effects, by extrapolating from all findings relevance for low- and middle-income countries (LMICs) (Peters 2004).• To describe other health, educational, psychosocial and behavioural effects, when appropriate outcomes are reported.• To explore the influence of context in design, delivery and outcomes of interventions.• To explore the relationship between numbers of components and duration and effects of interventions.• To highlight implications of these findings for further research and research methods to improve evidence in relation to the primary research objective.• To consider adverse or unintended outcomes. We searched the following bibliographic databases, searched for the original review, from inception to 2012, and various relevant non-governmental and organisational websites: Cochrane Central Register of Controlled Trials (CENTRAL); MEDLINE and Pre-MEDLINE; EMBASE and EMBASE Classic; Cumulative Index to Nursing and Allied Health Literature (CINAHL); PsycINFO; Education Resource Information Center (ERIC); Sociological Abstracts; Social Services Abstracts; Social Work Abstracts; Healthstar; Latin American Caribbean Health Sciences Literature (LILACS); System for Grey literature in Europe (OpenGrey); ProQuest Dissertations and Theses; EconLit;IDEAS Economics and Finance Research; JOLIS Library Catalog of the holdings of the World Bank Group and International Monetary Fund (IMF) Libraries; British Library for Development Studies (BLDS); Google and Google Scholar.We updated the search in April 2015 for the review update, using the same methods. This review includes data from harm reduction or reintegration intervention studies that used a comparison group study design; all were randomised or quasi-randomised studies. Studies were included if they evaluated interventions provided for street-connected children and young people, from birth to 24 years, in all contexts. Two review authors independently extracted data and assessed risk of bias and other factors presented in the Discussion and Summary quality assessment (Grades of Recommendation, Assessment, Development and Evaluation (GRADE)).We extracted data on intervention delivery, context, process factors, equity and outcomes, and grouped outcomes into psychosocial outcomes, risky sexual behaviours or substance use.We conducted meta-analyses for outcomes where the outcome measures were sufficiently similar. We evaluated other outcomes narratively. We included 13 studies evaluating 19 interventions from high-income countries (HICs). We found no sufficiently robust evaluations conducted in low- and middle-income countries (LMICs). Study quality overall was low and measurements used by studies variable. Participants were classified as drop-in and shelter-based. No studies measured the primary outcome of reintegration and none reported on adverse effects.We found no consistent results on a range of relevant outcomes within domains of psychosocial health, substance misuse and sexually risky behaviours . Interventions evaluated consisted of time-limited therapeutically based programmes that proved no more effective than standard shelter or drop-in services and other control interventions used for most outcomes in most studies. Favourable changes from baseline were reported for outcomes for most participants following therapy interventions and standard services. We noted considerable heterogeneity between studies and inconsistent reporting of equity data. No studies measured the primary outcome of reintegration or reported on adverse effects. Analysis revealed no consistently significant benefit for focused therapeutic interventions compared with standard services such as drop-in centres, case management and other comparable interventions for street-connected children and young people. Commonly available services, however, were not rigorously evaluated. Robust evaluation of interventions, including comparison with no intervention, would establish a more reliable evidence base to inform service implementation. More robust research is needed in LMICs to examine interventions for street-connected children and young people with different backgrounds and service needs.

Interventions for promoting reintegration and reducing harmful behaviour and lifestyles in street‐connected children and young people: a systematic review

Interventions for promoting reintegration and reducing harmful behaviour and lifestyles in street‐connected children and young people: a systematic review

Communication and US-Somali Immigrant Human Papillomavirus (HPV) Vaccine Decision-Making.

The current study uses a multiple goal theoretical perspective to explore how Somali immigrant families living in Ohio, USA, make decisions regarding whether to vaccinate their children against human papillomavirus (HPV)-a leading cause of cervical cancer. A focus was placed on the communication goals of parents in HPV vaccine discussions with their child and health care provider. Semi-structured interviews were audiotaped, transcribed, and analyzed using a grounded theory approach. Key themes are the implications of the vaccine for early sexual activity, confusion between HPV and HIV (human immunodeficiency virus), the perception that the HPV vaccine is unnecessary, uncertainty about the vaccine's efficacy and side effects, avoidance of parent-child communication about the vaccine, and a preference for framing the vaccine as a health promotion behavior. Framing the threat of HPV in the context of initiation of sexual activity, uncertainty regarding vaccine efficacy, and anticipated regret account for the inconsistency in HPV vaccine uptake among Somali parents. Clinicians should consider talking about HPV as a distal versus an immediate threat and HPV vaccine uptake as a health-promotion behavior rather than a sexually transmitted infection prevention behavior.