A quasi-experimental evaluation of parents as sexual health educators resulting in delayed sexual initiation and increased access to condoms.

OBJECTIVE: To evaluate the effectiveness of an educational intervention for parents of first year high school students in the State of Morelos, Mexico, whose aim was to impact adolescents' sexual behavior, knowledge and access to contraception. MATERIAL AND METHODS: Quasi-experimental prospective study with eleven control and eleven intervention schools using self-administered questionnaires for parents and adolescents pre- and post-intervention. Parent-child dyads in the control and intervention schools were matched according to parents' propensity score; the average treatment effect (ATE) was estimated for adolescent's outcome variables. RESULTS: At follow-up, we found significant differences for adolescents in the intervention schools: 6.8% delayed initiation of sexual intercourse, 14.4% had correct knowledge about emergency contraception (EC), and 164% reported having received condoms from their parents, when comparing with students in control schools. CONCLUSIONS: Our results suggest that parent-focused interventions could be an innovative and effective strategy to promote adolescents sexual health

Exploring awareness and use of evidence synthesis in public decision-making in Mexico

This thesis investigates relationships between research evidence and policy in Mexico with a particular focus on the use of systematic reviews. A mixed-methods study is described which explored the appropriateness of conventional systematic reviews to produce syntheses for policy recommendations and included investigation of the use of systematic reviews by policy-makers and the factors moderating such use. To address the main research questions, a number of evidence syntheses were conducted on the topic of the prevention of youth violence which were complemented by interviews with policy-makers. The case of youth violence exemplifies some of the many challenges that researchers from less developed countries may face when synthesising literature to inform local policy-making. These challenges need to be acknowledged as they question the helpfulness of international evidence for developing policy recommendations at the local level in Mexico. The findings also highlight the many factors shaping the use of systematic reviews and scientific evidence in public institutions in the country. Factors that might be exclusive to the context of policy-making in Mexico emerged in the dialogues of the policy-makers. If the intention is to present usable research, then systematic reviews and research outputs need to be framed under the local policy-making context

Utilización de dos modelos en la atención al aborto en Argentina pre-Ley 27.610: 2016–2019

OBJECTIVE: Explore the use of two abortion care models in Argentina over the period 2016-2019: pro-rights private medical service providers and abortion accompaniment (via self-management and via health institutions); and compare the profile of who accesses these models and when. METHODS: We used data from accompaniment collectives in the Socorristas en Red and private service providers. We estimated annual abortion rates via these service models and compared the profile of the populations by type of service and gestational age (2019) using descriptive statistics and Chi-square tests. RESULTS: In 2016, 37 people per 100,000 women of reproductive age obtained accompanied self-managed abortions, and the number increased to 111 per 100,000 in 2019, a threefold increase. The rate of abortions via care providers was 18 per 100,000 in 2016 and 33 in 2019. Higher proportions of those who obtained abortion via care providers were 30 years or older. A higher proportion of those accompanied were 19 years or younger; 11% of those who obtained accompanied self-managed abortions were more than 12 weeks gestation compared with 7% among those who had accompanied abortions via health institutions and 0.2% among those who had abortions with private providers. A higher proportion of those who accessed accompanied abortions after 12 weeks gestation had lower educational levels, did not work or have social security coverage, had more past pregnancies, and attempted to terminate their pregnancies prior to contacting the Socorristas compared to those who had accompanied abortions at 12 weeks or earlier. CONCLUSIONS: In Argentina, prior to Law 27.610 models of care guaranteed access to safe abortions. It is important to continue making visible and legitimizing these models of care so that all those who decide to have an abortion, whether inside or outside health institutions, have safe and positive experienceOBJETIVO: Explorar la utilización de dos modelos para la atención al aborto en Argentina en el período 2016-2019: abortos con proveedores de servicios médicos privados proderechos y abortos acompañados (vía autogestión y vía instituciones de salud); y comparar el perfil de quiénes acceden a estos modelos y cuándo. MÉTODOS: Utilizamos datos de sistematizaciones de colectivas de acompañamiento en Socorristas en Red y de proveedores de servicios privados. Estimamos tasas anuales de abortos mediante estos servicios y comparamos el perfil de las poblaciones por tipo de servicio y edad gestacional (2019) utilizando estadísticas descriptivas y prueba Chi-cuadrado. RESULTADOS: En el 2016, 37 personas por cada 100.000 mujeres en edad reproductiva obtuvieron abortos acompañados vía autogestión, aumentando a 111 por 100.000 en 2019, es decir, se triplicó. La tasa de abortos con proveedores fue de 18 por 100.000 en 2016 y de 33 en 2019. Mayor proporción de quienes acudieron con proveedores tenía 30 años o más y mayor proporción de personas acompañadas tenía 19 años o menos; el 11% de quienes obtuvieron abortos acompañados vía autogestión tenía más de 12 semanas de gestación en comparación con el 7% entre quienes tuvieron abortos acompañados vía instituciones de salud y el 0,2% entre quienes abortaron con proveedores. Una mayor proporción de quienes accedieron a abortos acompañados después de 12 semanas de gestación tenía menor nivel educativo, no trabajaban ni tenían cobertura de obra social, y habían tenido más embarazos e intentado interrumpir su embarazo comparando con quienes abortaron acompañadas a las 12 semanas o antes. CONCLUSIONES: En Argentina existen modelos de atención que han garantizado el acceso a abortos seguros desde antes de la Ley 27.610. Es importante continuar visibilizando y legitimando estos modelos para que todas las personas que deciden abortar, dentro o fuera de instituciones de salud, tengan experiencias seguras y positivas

Interventions to prevent youth violence in Latin America: a systematic review

Objectives: This review aims to summarise evidence on the effectiveness of interventions to prevent youth violence in Latin America. Methods: A systematic search on 13 academic databases was conducted to locate studies evaluating a primary or secondary prevention intervention in Latin America. Studies could use any type of quantitative design to assess outcomes related to youth violence. A search of websites, references and citation searching was also carried out. The quality of each study was assessed. Results: Nine studies were identified. Most documented positive effects of the interventions on the perception of youth violence present in the community/school. Evidence was found of a reduction in homicides and juvenile crimes in three studies, two of which evaluated a community-based intervention. There were mixed results for the self-report of participation on violent acts. The majority of the studies lacked of a rigorous design. Conclusions: Most of the interventions had some promising results, including the reduction of homicides within communities. Community-based programmes were the most consistent regarding an effectiveness to prevent violence. However, the evidence for Latin America is still scarce and relies on non-rigorously designed studies

Socioeconomic status, urbanicity and risk behaviors in Mexican youth: an analysis of three cross-sectional surveys

<p>Abstract</p> <p>Background</p> <p>The relationship between urbanicity and adolescent health is a critical issue for which little empirical evidence has been reported. Although an association has been suggested, a dichotomous rural versus urban comparison may not succeed in identifying differences between adolescent contexts. This study aims to assess the influence of locality size on risk behaviors in a national sample of young Mexicans living in low-income households, while considering the moderating effect of socioeconomic status (SES).</p> <p>Methods</p> <p>This is a secondary analysis of three national surveys of low-income households in Mexico in different settings: rural, semi-urban and urban areas. We analyzed risk behaviors in 15-21-year-olds and their potential relation to urbanicity. The risk behaviors explored were: tobacco and alcohol consumption, sexual initiation and condom use. The adolescents' localities of residence were classified according to the number of inhabitants in each locality. We used a logistical model to identify an association between locality size and risk behaviors, including an interaction term with SES.</p> <p>Results</p> <p>The final sample included 17,974 adolescents from 704 localities in Mexico. Locality size was associated with tobacco and alcohol consumption, showing a similar effect throughout all SES levels: the larger the size of the locality, the lower the risk of consuming tobacco or alcohol compared with rural settings. The effect of locality size on sexual behavior was more complex. The odds of adolescent condom use were higher in larger localities only among adolescents in the lowest SES levels. We found no statically significant association between locality size and sexual initiation.</p> <p>Conclusions</p> <p>The results suggest that in this sample of adolescents from low-income areas in Mexico, risk behaviors are related to locality size (number of inhabitants). Furthermore, for condom use, this relation is moderated by SES. Such heterogeneity suggests the need for more detailed analyses of both the effects of urbanicity on behavior, and the responses--which are also heterogeneous--required to address this situation.</p

Adolescent Students and Their Experiences of Dealing with Pregnancy: A Mixed-Method Study in Public Schools from Central Mexico

In impoverished communities in Mexico, most adolescent mothers do not attend school; but typically, they become pregnant once they dropped out. Understanding the experiences of adolescents who have had a pregnancy and continue in school is complicated since few manage to do it. The goal of this study is to describe experiences within the family and school context and plans for the future of a sample of Mexican students who have had a pregnancy. We analyze information from the questionnaires of 68 women and 44 men and interviews to 6 women and 5 men. First intercourse was at age 15 and first pregnancy at 16; 39% of men and 57% of women already have a child; 54% of men and 19% of women work and study simultaneously. Dropping out because of a pregnancy/marriage was reported by 41% of women and 14% of men. The support of family and teachers is crucial to stay in school; but the institution remains indifferent to their plight. The immediate needs easily defeat their aspirations. It is fundamental to acknowledge and notice the experiences of these vulnerable young people in order to design focused strategies promoting their success in adult life

Between contradictions and risks: Mexican male adolescents’ views about teenage pregnancy and its association with sexual behavior.

Objective. To explore the opinions of Mexican male adolescents regarding teenage pregnancy and analyze its association with sexual behavior. Materials and methods. This is a cross-sectional study using a self-administered questionnaire among a conventional sample of male students (15-19 years old) in eight public schools in Morelos and Mexico City. Analyses include multivariate models to identify the association between opinions and sexual behaviors. Results. Overall, 68% agree that a teenage pregnancy is a negative event. In a hypothetical case, if a girlfriend got pregnant in this moment 56% would continue in the school whereas 18% would definitely abandon it. Those who affirm that a teenage pregnancy is something very bad have greater odds of using condoms (OR=1.8; p menor que 0.05). Conclusions. Male adolescents’ views about teenage pregnancy are associated with some sexual behaviors; however their opinions reflect several contradictions. The design of surveys directed exclusively to explore male adolescents’ opinions about reproductive health is urgent

A rapid review of interventions to prevent first pregnancy among adolescents and its applicability to Latin America

Study Objective: To summarize recent literature on the effectiveness of interventions to prevent adolescent pregnancy and to explore the applicability of these interventions to Latin America (LA). Design, Setting, Participants, Interventions, and Main Outcome Measures: We carried out a rapid review of the literature (2005-2019). Studies were included if: they evaluated interventions targeting adolescents and prevention of pregnancy; they used a randomized controlled design; and pregnancy was measured as an outcome. Applicability of the interventions to LA was assessed using the following information: target population; intervention design and resources; type, skills, and training of providers; system arrangements; and acceptability and social context. Results: Nine studies were included, 5 described interventions in African countries, 2 in the United Kingdom, and 2 in the United States. Interventions were rated as highly applicable to LA in the context of target population, profile of the providers, and design; however, variations arose when assessing system arrangements and social context. Incentive-based interventions showed significant effects in the prevention of adolescent pregnancy and were rated as highly applicable. Conclusion: This review provides professionals, policymakers, researchers, and educators potential criteria to consider when adapting successful evidence-based interventions to prevent adolescent pregnancy in LA