The influence of adolescent friendships on STI/HIV risk behaviors in emerging adulthood

BACKGROUND: The transition from adolescence to adulthood, referred to as emerging adulthood, is accompanied by an increase in risky sexual activity and injection drug use, two behaviors that are the main routes of transmission of sexually transmitted infections and HIV (STI/HIV). Given that adolescents and emerging adults are disproportionately affected by STI/HIV, understanding adolescent predictors of risk behaviors for STI/HIV in emerging adulthood is important to mitigate STI/HIV risk among youth. Three dimensions of friendships (friendship quantity, quality and the friends' risk behaviors) are particularly useful in predicting adolescents' and young adults' STI/HIV risk behaviors. These friendship dimensions have often been considered separately. But recent research suggests that they interact. This study therefore combined developmental and public health perspectives to examine whether dimensions of adolescent friendships interact to influence emerging adults' STI/HIV risk behaviors. Gender and racial differences were investigated. METHODS: Analyses were based on 1,154 respondents, aged 12-18 years at baseline, who participated in Waves I and III of the National Longitudinal Study of Adolescent Health. The STI/HIV risk behaviors scale was created as a composite measure of the sexual activities and drug use behaviors that directly influence STI/HIV transmission. Independent variables included: number of friends (friendship quantity), emotional and behavioral closeness to friends (friendship quality), and friends' STI/HIV risk behaviors. Multiple linear regression models were used to examine the study's aims. RESULTS: In emerging adulthood, the mean number of STI/HIV risk behaviors respondents had engaged in was 3.26 (range: 0-7). No interaction effects were observed between friends' STI/HIV risk behaviors and: number of friends, emotional and behavioral closeness to friends. There was a weak positive relationship between STI/HIV risk behaviors in adolescence and those in emerging adulthood, and a direct effect of behavioral closeness to friends on STI/HIV risk behaviors in emerging adulthood. Most associations did not vary by gender or race. CONCLUSION: Closer friendships in adolescence predicted more STI/HIV risk behaviors in emerging adulthood, regardless of the friends' STI/HIV risk behaviors. Findings are discussed in light of developmental and public health perspectives on the importance of friendships in adolescence

Parents' Support and Knowledge of Their Daughters' Lives, and Females' Early Sexual Initiation In Nine European Countries

The association between early sexual initiation and parenting practices (e.g., support and knowledge) has not been tested in multiple European population-based samples using the same instrument

Decreases in adolescent weekly alcohol use in Europe and North America: evidence from 28 countries from 2002 to 2010

Background: This study examined trends in adolescent weekly alcohol use between 2002 and 2010 in 28 European and North American countries. Methods: Analyses were based on data from 11-, 13- and 15-year-old adolescents who participated in the Health Behaviour in School-Aged Children (HBSC) study in 2002, 2006 and 2010. Results: Weekly alcohol use declined in 20 of 28 countries and in all geographic regions, from 12.1 to 6.1% in Anglo-Saxon countries, 11.4 to 7.8% in Western Europe, 9.3 to 4.1% in Northern Europe and 16.3 to 9.9% in Southern Europe. Even in Eastern Europe, where a stable trend was observed between 2002 and 2006, weekly alcohol use declined between 2006 and 2010 from 12.3 to 10.1%. The decline was evident in all gender and age subgroups. Conclusions: These consistent trends may be attributable to increased awareness of the harmful effects of alcohol for adolescent development and the implementation of associated prevention efforts, or changes in social norms and conditions. Although the declining trend was remarkably similar across countries, prevalence rates still differed considerably across countrie

Adolescent Overweight, Obesity and Chronic Disease-Related Health Practices: Mediation by Body Image

Background/Aims: To examine whether body image mediates the association between overweight/obesity and chronic disease-related health practices (CDRHP), including lack of physical activity (PA), infrequent breakfast consumption (IBC), screen-based media use (SBM), and smoking. Methods: The 2006 Health Behaviors in School-Age Children survey was administered to a nationally representative sample of US students (n = 8,028) in grades 6-10 (mean age = 14.3 years). Outcome variables included self-reported measures of PA, SBM, IBC, and smoking. Body image was assessed with 5 items from the Body Investment Scale (α = 0.87) asking for agreement/disagreement with statements about one's body. Stratifying on gender, an initial regression model estimated the association between overweight/obesity and CDRHP. Mediation models that included body image were then compared to the initial model to determine the role of body image in the relationship between overweight/obesity and CDRHP. Results: Among boys, body image mediated the relationships of overweight/obesity with SBM, and of obesity with IBC. Among girls, it mediated the relationships of obesity with PA, IBC, and smoking, and of overweight with SBM. Conclusion: As the prevalence of overweight/obesity among adolescent boys and girls remains high, efforts to improve their body image could result in less frequent engagement in CDRHP

Parents' support and knowledge of their daughters' lives and females' early sexual initiation In nine European countries.

CONTEXT: Associations between early sexual initiation and parental support and knowledge have not been uniformly tested in multiple European population-based samples. Understanding such associations is important in efforts to discourage females' early sex.METHODS: Data were compiled for 7,466 females aged 14-16 who participated in the 2005-2006 Health Behaviors in School-Aged Children survey in nine countries (Austria, Finland, Greece, Hungary, Iceland, Lithuania, Romania, Spain and Ukraine). Univariate, bivariate and multivariable analyses were run with standard error corrections and weights to assess how sexual initiation before age 16 was related to maternal and paternal support and knowledge of daily activities.RESULTS: Prevalence of early sexual initiation ranged from 7% (in Romania) to 35% (in Iceland). In bivariate analyses, maternal and paternal support were significantly negatively related to adolescent females' early sexual initiation in most countries. In models with demographic controls, parental support was negatively associated with early sexual initiation (odds ratio, 0.8 for maternal and 0.7 for paternal). After parental knowledge was added, early sexual initiation was no longer associated with parental support, but was negatively associated with maternal and paternal knowledge (0.7 for each). These patterns held across countries.CONCLUSIONS: Parental knowledge largely explained negative associations between parental support and early initiation, suggesting either that knowledge is more important than support or that knowledge mediates the association between support and early sex. Perspectives on Sexual and Reproductive Health, 2012, 44(3):167-175, doi: 10.1363/4416712peer-reviewe

Ethnic differences in perceptions of body satisfaction and body appearance among U.S. Schoolchildren: a cross-sectional study

Abstract Background Perceived body appearance and body satisfaction are potentially related to weight problems and poor health. The purpose of this study was to examine how gender, and ethnic differences in body satisfaction, perceived body appearance and weight status change by age in a representative sample of U.S. adolescents 11–17 years old. Methods We used the US Health Behavior in School-Aged Children (HBSC) 2001 survey which assessed perceived body appearance, body satisfaction, self-reported body mass index (BMI) and socio-demographic indicators. The associations between age and perceived appearance, age and body satisfaction, and between z-transformed BMI and body satisfaction were analyzed using separate non-parametric regression models for both genders and the three ethnic groups. Results Body satisfaction did not vary significantly by age except for an increase with age in the proportion of Non-Hispanic White girls who perceived themselves as too fat. Although boys did not report being too fat unless their BMI was above the age- and gender-specific median, one third of Non-Hispanic White girls felt too fat at or below the age- and gender-specific median. Compared to other ethnicities, African-American students’ perceived appearance was significantly more positive and they were less likely to perceive themselves overweight at higher BMI scores. However, during adolescence, the positive self-reported perceived appearance of African-American boys dropped substantially while it remained relatively stable in African-American girls. Conclusions There were substantial differences in body satisfaction and perceived appearance across the three largest ethnic groups of school-age children in the U.S. Stability across age indicates that these perceptions are most likely established before the age of 10 and underline the importance of primary schools and parents in prevention. Special attention should be directed to the dramatic loss of positive perceived appearance among African-American boys.</p

Healthcare and Public Policy

Health disparities often result from social and structural factors driven by existing laws and public policies. Public policy health disparities research examines the impact of such laws and public policies on minority and vulnerable populations. This chapter describes various methods and approaches that can be used to examine the impact of such policies on health disparities. The chapter also provides examples of how such research can make a positive impact. This line of research will become even more pressing during times of rapid political change, when large‐scale initiatives are being legislated that can have negative (or positive) impact on minority health and health disparities

Effectiveness of web-based education on Kenyan and Brazilian adolescents' knowledge about HIV/AIDS, abortion law, and emergency contraception: Findings from TeenWeb

Little evidence is available about the utility of web-based health education for students in low resource settings. This paper reports results from an evaluation of the TeenWeb project, a multi-year, web-based health education intervention implemented in two urban settings: Nairobi, Kenya (N = 1178 school students) and Rio de Janeiro, Brazil (N = 714 school students). A quasi-experimental, school-based pre-test/post-test design was implemented at each study site to determine if easy access to web-based reproductive health information, combined with intellectual "priming" about reproductive health topics, would result in improved knowledge and attitudes about topics such as condom use, access to HIV testing, emergency contraception and abortion laws. Students in web-access schools completed one web-based module approximately every 6-8 weeks, and in return, had access to the Internet for at least 30 min after completing each module. Although students were encouraged to access project-supplied web-based health information, freedom of web navigation was an incentive, so they could choose to access other Internet content instead. Most measures showed statistically significant differences between students in "web" and "comparison" conditions at post-test, but only about half of the differences were in the hypothesized direction. Results of an embedded experiment employing more directed feedback tripled the likelihood of correctly reporting the duration of emergency contraception effectiveness. Review of URL logs suggests that the modest results were due to inadequate exposure to educational materials. Future intervention should focus on teen's purposeful searching for health information when they are in personal circumstances of unmet health needs.Internet Kenya Brazil Adolescents Reproductive health TeenWeb Schools Intervention