Predictors and Outcomes of Adolescents’ Sexual and Reproductive Health : An Ecological Approach

Experiences with sexual behaviors and intimate relationships typically start during adolescence. These experiences are a normative and integrated part of overall development, yet they may have consequences for adolescents’ sexual and reproductive health (SRH) and psychological wellbeing. Worldwide, estimates of the World Health Organization indicate that about 333 million sexually transmitted infections occur yearly, of which a considerable part affects adolescents aged 15–19 years. In addition, globally, about 17 million teenage girls younger than 20 years give birth every year. SRH problems among adolescents are a challenge for most countries, and are not restricted to low- and middle-income countries (LMIC). Understanding the factors that affect adolescents’ SRH behaviors and outcomes is a fundamental step towards the improvement of adolescents’ SRH. In the current thesis, we applied a holistic approach to understanding adolescent sexuality (ecological systems theory). The studies presented in this thesis investigate adolescents’ SRH behaviors and outcomes and various predictors thereof. Specifically, the SRH behaviors and outcomes included: adolescents’ experiences with early sexual behaviors, timing of first sexual intercourse, number of sexual partners, condom use, contraceptive use, and teen pregnancy. The predictors were classified into: 1) individual factors (e.g., gender, ethnic background, depression); 2) social factors (e.g., mother– and father–adolescent relationship quality, parental monitoring, in-school sexuality education). The studies described in this thesis illustrate the relevance of factors from diverse levels, from individual to social. Overall, our findings support that various stakeholders (e.g., parents, health professionals, and schools), and adolescents themselves, can contribute to a positive sexual development

Early sexual intercourse: Prospective associations with adolescents physical activity and screen time

Objectives: To 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. Methods: We 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. Results: The 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. Conclusion: These 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

Longitudinal Associations Between Sexual Communication With Friends and Sexual Behaviors Through Perceived Sexual Peer Norms

The role of peers in adolescents’ sexual behaviors is not yet fully understood. We investigated the association between sexual communication with friends (at T1) and subsequent changes in adolescents’ experience with sexual behaviors (between T1–T3), and examined whether this association was explained by adolescents’ perceptions of three sexual peer norms (at T2): (1) peers’ se

Validation of the clinical "diagnosis vascular trauma" in children from 6 months until years

Prospective cohort study aimed to realize the clinical validation of the nursing diagnoses “Peripheral Vascular Trauma” and analyze his incidence in children between 6 months and 12 years old. Participants investigated had multiple entries in the cohort defined by the first puncture demítrio. Techniques were used triangulation of methods for data collection. The output of the cohort was defined by high or by the removal of the catheter when not identified any manifestation of vascular trauma. The data were analyzed in accordance to simple and percentual incidence, risk chance obtained from relative risk, Pearson Test, Factorial Analyses and Logistic Regression. It was evaluated 338 peripheral punctures, being 63.9% in boys, 45.9% in children of 6 months to 2 years old, 65.4% in skins brown or black and 68.9% without risk factor for cardiovascular disease. The average length of hospital stay was 5.69 days and average length of stay of 2.7 days in the cohort. The vessels were punctured small caliber (95%), non-palpable (86.4%), straight (27.5%) out of the joint (60.4%) and located on the back of the hands (51.2%). The catheters used were flexible and Chuck, with 94.4% of 24G. Demítrio punctures occurred in the left (54.7%) in the proximal third (24.6%) and the posterior (60.7%). Some related factors (intervening variables: size of the catheter, hygiene and humidity) were associated with defining caracteristics (outcome variables: occurrence of discoloration, integrity, local temperature, functional capacity and sensitivity) in diagnosing vascular trauma peripheral.The characterization and descriptive analysis of the process of puncturing the peripheral vessels in children followed in the present investigation possible: 1) addressing the validation of the nursing diagnoses peripheral vascular trauma; 2) delineate the specificity of this process the child audience, 3) highlight the need for the nurse to control intervening variables that can be prevented or treated with conduct of its technical and legal competence.Coorte prospectiva que objetivou realizar a validação clínica do diagnóstico “Trauma vascular periférico” e analisar sua incidência em crianças de 6 meses a 12 anos. Participantes da investigação tiveram entrada múltipla na coorte definida pela primeira punção por demítrio. Foi utilizada triangulação de técnicas para identificar a ocorrência de características definidoras de trauma vascular periférico. A saída da coorte foi definida pela alta do paciente ou pela remoção do cateter quando não identificada qualquer manifestação de trauma vascular. Os dados foram analisados segundo a frequência simples, frequência percentual, incidência de trauma segundo a variável analisada, razão de risco dada pelo risco relativo, pelo teste de Pearson, análise fatorial e regressão logística. Foram avaliadas 338 punções periféricas, sendo 63,9% em meninos; 45,9% na idade entre 6 meses e 2 anos incompletos; 65,4% em peles pardas ou negras e 68,9% sem fator de risco para doenças cardiovasculares. A média de dias de internação foi de 5,69 dias e a média de permanência na coorte de 2,7 dias. Os vasos puncionados foram de pequeno calibre (95%); não palpáveis (86,4%); retilíneos (27,5%); fora da articulação (60,4%) e localizados no dorso das mãos (51,2%). Os cateteres usados foram flexíveis e com mandril, sendo 94,4% de 24G. As punções ocorreram no demítrio esquerdo (54,7%); no terço proximal (24,6%) e na face posterior (60,7%). Alguns fatores relacionados (variáveis intervenientes: calibre do cateter, higiene e umidade) foram associados as característics definidoras (variáveis de desfecho: ocorrência de alteração na coloração, na integridade, na temperatura local, na capacidade funcional e na sensibilidade para o diagnóstico trauma vascular periférico. A caracterização e a análise descritiva do processo de punção de vasos periféricos em crianças acompanhadas na presente investigação possibilitaram: 1) abordar a validação clínica do diagnóstico de enfermagem trauma vascular periférico; 2) delinear a especificidade desse processo no público infantil; 3) evidenciar a necessidade de o Enfermeiro controlar as variáveis intervenientes passíveis de ser prevenidas ou tratadas com condutas de sua competência legal e técnica.CAPES - Coordenação de Aperfeiçoamento de Pessoal de Nível Superio

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

Purpose: Assessing 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. Methods: We 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. Results: At 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. Conclusions: Our 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

Results of logistic regression analyses of the prospective associations of physical activity behaviors and screen time with early sexual intercourse, stratified by gender (n = 2,141).

<p>Results of logistic regression analyses of the prospective associations of physical activity behaviors and screen time with early sexual intercourse, stratified by gender (n = 2,141).</p

Descriptive characteristics of the prospective analysis sample, and gender differences, at baseline (n = 2,141).

<p>Descriptive characteristics of the prospective analysis sample, and gender differences, at baseline (n = 2,141).</p