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Renee E Sieving,
Annie-Laurie McRee,
Barbara J McMorris,
Kara J Beckman,
Sandra L Pettingell, Linda H Bearinger,
Ann W Garwick,
Jennifer A Oliphant,
Shari Plowman,
Michael D Resnick,
Molly Secor-Turner
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ABSTRACT: IMPORTANCE Preventing early pregnancy among vulnerable adolescents requires innovative and sustained approaches. Prime Time, a youth development intervention, aims to reduce pregnancy risk among adolescent girls seeking clinic services who are at high risk for pregnancy. OBJECTIVE To evaluate sexual risk behaviors and related outcomes with a 24-month postbaseline survey, 6 months after the conclusion of the Prime Time intervention. DESIGN Randomized controlled trial. SETTING Community and school-based primary care clinics. PARTICIPANTS Of 253 sexually active 13- to 17-year-old girls meeting specified risk criteria, 236 (93.3%) completed the 24-month follow-up survey. INTERVENTION Offered during an 18-month period, Prime Time includes case management and youth leadership programs. MAIN OUTCOME MEASURES Self-reported consistency of condom, hormonal, and dual-method contraceptive use with most recent male sex partner and number of male sex partners in the past 6 months. RESULTS At 24-month follow-up, the intervention group reported significantly more consistent use of condoms, hormonal contraception, and dual-method contraception than the control group. Intervention participants also reported improvements in family connectedness and self-efficacy to refuse unwanted sex, and reductions in the perceived importance of having sex. No between-group differences were found in the number of recent male sex partners. CONCLUSIONS AND RELEVANCE This study contributes to what has been a dearth of evidence regarding youth development interventions offered through clinic settings, where access to high-risk adolescents is plentiful but few efforts have emphasized a dual approach of strengthening sexual and nonsexual protective factors while addressing risk. Findings suggest that health services grounded in a youth development framework can lead to long-term reductions in sexual risk among vulnerable youth.
JAMA pediatrics. 02/2013;
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ABSTRACT: The negative outcomes of early childbearing and sexually transmitted infections (STIs), including HIV/AIDS, threaten the health of adolescents more than any other age group. Ensuring the sexual and reproductive health of the more than 1.5 billion young people aged 10 to 25 around the world is central to global health. Country-level indicators show dramatic variations in sexual risk. Percentages of those who engage in sexual intercourse range from less than 1% of females in Pakistan to 54% of males in Cuba. Divergent rates of early pregnancy and STIs between countries and regions parallel variations in sexual behaviors, including age of sexual debut; number of partners; and use of contraception, including condoms. To understand these variations, many factors affecting the sexual and reproductive health of young people around the world such as age of marriage, norms and expectations around sexual behavior, gender inequities, and educational and economic opportunities must be considered.
Adolescent medicine: state of the art reviews 12/2011; 22(3):521-43, xii.
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ABSTRACT: Prime Time, a youth development intervention, aims to reduce pregnancy risk among adolescent girls seeking clinic service who are at high risk for pregnancy. This article examines sexual risk behaviors and hypothesized psychosocial mediators after 12 months of the Prime Time intervention.
This study was a randomized controlled trial with 253 girls aged 13-17 years meeting specified risk criteria. Intervention participants were involved in Prime Time programming plus usual clinic services for 18 months, control participants received usual clinic services. The intervention used a combination of case management and peer leadership programs. Participants in this interim outcomes study completed self-report surveys at baseline and 12 months after enrollment. Surveys assessed sexual risk behaviors and psychosocial factors targeted for change by Prime Time.
At the 12-month interim, the intervention group reported more consistent use of condoms, hormonal contraception, and dual contraceptive methods with their most recent partner as compared with the control group. The intervention group also reported greater stress management skills with trends toward higher levels of prosocial connectedness at school and with family. No between-group differences were noted in psychosocial measures specific to sex and contraceptive use.
Preventing early pregnancy among high-risk adolescents requires multifaceted, sustained approaches. An important research focus involves testing youth development interventions offered through clinic settings, where access to high-risk adolescents is plentiful and few efforts have emphasized a dual approach of building protective factors while addressing risk. Findings suggest that youth development interventions through clinic settings hold promise in reducing pregnancy risk among high-risk youth.
Journal of Adolescent Health 08/2011; 49(2):172-9. · 3.33 Impact Factor
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ABSTRACT: To examine parental perspectives toward sources of sex information.
Interviews were conducted with 1605 parents.
Most parents indicated that youth should receive information from their parents; however, in reality, believe they obtain most of their information from friends and the media.
Nearly all parents want young people to receive information about sex from their parents.
Journal of Adolescent Health 07/2011; 49(1):87-9. · 3.33 Impact Factor
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ABSTRACT: To provide a description of Prime Time, an intervention to reduce pregnancy risk behaviors among high-risk adolescent girls.
Prime Time, a clinic-based, multicomponent youth development intervention aims to reduce sexual risk behaviors, violence involvement, and school disconnection.
We highlight key considerations in conceptualization, design, and methods for a Prime Time randomized trial.
Prime Time comes at a time of great interest in restructuring adolescent health services. This study represents an important effort to expand preventive and youth development services among young people most vulnerable to early pregnancy, for whom services must go beyond traditional problem-oriented approaches.
American journal of health behavior 05/2011; 35(3):346-58. · 1.31 Impact Factor
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Research in Nursing & Health 12/2010; · 1.71 Impact Factor
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Research in Nursing & Health 10/2010; 33(5):381-5. · 1.71 Impact Factor
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ABSTRACT: To examine the likelihood of weapon-carrying among urban American Indian young people, given the presence of salient risk and protective factors.
The study used data from a confidential, self-report Urban Indian Youth Health Survey with 200 forced-choice items examining risk and protective factors and social, contextual, and demographic information. Between 1995 and 1998, 569 American Indian youths, aged 9-15 years, completed surveys administered in public schools and an after-school program. Using logistic regression, probability profiles compared the likelihood of weapon-carrying, given the combinations of salient risk and protective factors.
In the final models, weapon-carrying was associated significantly with one risk factor (substance use) and two protective factors (school connectedness, perceiving peers as having prosocial behavior attitudes/norms). With one risk factor and two protective factors, in various combinations in the models, the likelihood of weapon carrying ranged from 4% (with two protective factors and no risk factor in the model) to 80% of youth (with the risk factor and no protective factors in the model). Even in the presence of the risk factor, the two protective factors decreased the likelihood of weapon-carrying to 25%.
This analysis highlights the importance of protective factors in comprehensive assessments and interventions for vulnerable youth. In that the risk factor and two protective factors significantly related to weapon-carrying are amenable to intervention at both individual and population-focused levels, study findings offer a guide for prioritizing strategies for decreasing weapon-carrying among urban American Indian young people.
Journal of Adolescent Health 07/2010; 47(1):43-50. · 3.33 Impact Factor
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ABSTRACT: With over 1.5 billion young people in the world who are between the ages of 10 and 25, ensuring the sexual and reproductive health of adolescents is essential for global health. Extensive variations exist in the prevalence of adolescent sexual and reproductive health behaviors and outcomes around the world. This chapter uses an ecological perspective to explore individual, social, and environmental-level risk and protective factors related to adolescent sexual and reproductive health behaviors and outcomes. Implications include strategies to promote sexual and reproductive health that address individual behaviors, as well as the social and environmental context in which adolescents live.
Adolescent medicine: state of the art reviews 12/2009; 20(3):1005-25, xii.
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ABSTRACT: This study examined support for the human papillomavirus (HPV) vaccine among a representative sample of Minnesota parents after approval from the U.S. Food and Drug Administration. Support for the vaccine was high; 87% supported its use. Although individual characteristics predicted support, support was high across subgroups with two-thirds or more of parents supporting the vaccine.
Journal of Adolescent Health 11/2009; 45(5):525-7. · 3.33 Impact Factor
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ABSTRACT: Increasing correct and consistent condom use among sexually active adolescents continues to be a critical public health goal, with schools serving as key agents for achieving this goal through sexuality education and condom use provision. This research aims to describe the views of parents regarding school-based condom distribution and education programs, and examines how these views differ across demographic groups.
Parents of school-age children in Minnesota were surveyed in telephone interviews (N = 1605; 63% participation) regarding their beliefs about condom availability and education. Chi-square tests of significance were used to detect differences in agreement with each statement for 10 demographic and personal characteristics.
A majority of respondents held supportive views about condom availability and education programs. Strongest support centered on statements in the survey about teenagers needing information about condoms (86%) and showing actual condoms during classroom lessons (77%). Approximately two thirds of the parents agreed that school-based instruction about condoms should be "allowed" at the high school level (65%), and one fifth (21%) believed that this type of education should be "required." Support for condom availability and education programs differed significantly according to certain personal characteristics, with less supportive views from self-identified Born Again Christians and politically conservative parents.
Public discourse regarding school-based sexuality education should include the viewpoints of parents of school-aged children as key stakeholders. Parents' perspectives provide unique and critical insights that school administrators and educators should consider as they develop educational and programmatic offerings regarding condoms.
Journal of School Health 10/2009; 79(9):416-24; quiz 438-9. · 1.34 Impact Factor
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ABSTRACT: We compared protective factors among bisexual adolescents with those of heterosexual, mostly heterosexual, and gay or lesbian adolescents.
We analyzed 6 school-based surveys in Minnesota and British Columbia. Sexual orientation was measured by gender of sexual partners, attraction, or self-labeling. Protective factors included family connectedness, school connectedness, and religious involvement. General linear models, conducted separately by gender and adjusted for age, tested differences between orientation groups.
Bisexual adolescents reported significantly less family and school connectedness than did heterosexual and mostly heterosexual adolescents and higher or similar levels of religious involvement. In surveys that measured orientation by self-labeling or attraction, levels of protective factors were generally higher among bisexual than among gay and lesbian respondents. Adolescents with sexual partners of both genders reported levels of protective factors lower than or similar to those of adolescents with same-gender partners.
Bisexual adolescents had lower levels of most protective factors than did heterosexual adolescents, which may help explain their higher prevalence of risky behavior. Social connectedness should be monitored by including questions about protective factors in youth health surveys.
American Journal of Public Health 12/2008; 99(1):110-7. · 3.93 Impact Factor
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ABSTRACT: Latino youth experience disproportionate rates of mental health problems including suicide and depression. Better understanding of underlying risk and protective factors on the part of school-based health professionals, teachers, and health care providers in their lives is warranted. The aims of this secondary analysis of 2004 Minnesota Student Survey data were to (1) describe the mental health status of a statewide sample of Latino 9th- and 12th-grade students; (2) explore relationships of family protective factors (communication, caring, and connection) with suicidal ideation, suicidal attempts, and emotional distress; and (3) highlight similarities and differences in family protective factors among subgroups of Latino students.
Parallel analyses were completed for Latino-only and Latino-mixed students. Bivariate logistic regression models were used to examine associations between each family variable and each study outcome.
Nearly 1 in 5 Latino high school students have had suicidal thoughts in the past year; past year suicide attempts ranged from 6% to 18.5% across grade and gender subgroups. Most concerning are ninth-grade Latino girls, a group in which 30-40% reported suicidal thoughts and 14-19% reported attempting suicide in the past year.
An important study finding is the high rate of suicidal ideation, suicide attempts, and emotional distress among students who self-identified as being of mixed ethnicity. Study findings can be used to inform mental health promotion initiatives and culturally tailor interventions with Latino students.
Journal of School Health 10/2008; 78(9):487-95. · 1.34 Impact Factor
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ABSTRACT: Controversy about school-based sexuality education in public schools has continued over the past decade, despite mounting evidence that comprehensive sexuality education effectively promotes sexual health and that parents support these programs in public schools. The present study replicates and expands upon previous findings regarding public views on school-based sexuality education.
One thousand six hundred five parents of school-age children in Minnesota responded to telephone surveys in 2006-2007 (63% participation rate), including items regarding general sexuality education, 12 specific topics, the grade level at which each should be taught, and attitudes toward sexuality education.
The large majority of parents supported teaching about both abstinence and contraception (comprehensive sexuality education [CSE]; 89.3%), and support was high across all demographic categories of parents. All specific sexuality education topics received majority support (63.4%-98.6%), even those often viewed as controversial. Parents believed most topics should first be taught during the middle school years. Parents held slightly more favorable views on the effectiveness of CSE compared to abstinence-only education, and these views were strongly associated with support for CSE (odds ratio [OR](CSE) = 14.3; OR(abstinence) = 0.11).
This study highlights a mismatch between parents' expressed opinions and preferences, and actual sexuality education content as currently taught in the majority of public schools. In light of broad parental support for education that emphasizes multiple strategies for prevention of pregnancy and sexually transmitted infections (including abstinence), parents should be encouraged to express their opinions on sexuality education to teachers, administrators, and school boards regarding the importance of including a variety of topics and beginning instruction during middle school years or earlier.
Journal of Adolescent Health 05/2008; 42(4):352-9. · 3.33 Impact Factor
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ABSTRACT: This ethnographic study describes the health-related perceptions of immigrant Latino adolescents from Mexico.
Fourteen adolescents, purposively recruited from two non-health-based community settings, participated. Each was interviewed twice and completed a visual narrative project using disposable cameras. Audiotaped transcripts and photographs were inductively analyzed.
Being healthy is holistically perceived by these adolescents and includes physical, mental, spiritual, social, and environmental factors. Pictures portrayed healthy and unhealthy influences and behaviors, including eating habits, exercise, self-care, relationships, garbage, and pollution. Personal responsibility was important in being healthy and in promoting one's health. Family was identified as an important source of health-related information.
Nurses recognizing the holistic, comprehensive health-related perceptions of immigrant Latino adolescents can promote their health and design culturally and developmentally appropriate educational strategies and health interventions aimed at eliminating health disparities.
Journal of Holistic Nursing 07/2007; 25(2):81-91; discussion 92; quiz 93-5.
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ABSTRACT: Worldwide, societal shifts and behavioural patterns exacerbated by unique developmental vulnerabilities create a confluence of factors that place today's adolescents at heightened risks for poor health outcomes. Country-level data show that continued investment in effective prevention and treatment strategies is essential to protect adolescents' sexual and reproductive health. Whereas strategies must be tailored to the developmental needs of this age group and their social contexts, effective approaches are multifaceted. All adolescents need access to quality youth-friendly services provided by clinicians trained to work with this population. Sex education programmes should offer accurate, comprehensive information while building skills for negotiating sexual behaviours. Girls and boys also need equal access to youth development programmes that connect them with supportive adults and with educational and economic opportunities. Although progress has been made since the 1994 International Conference on Population and Development, adolescents continue to be disproportionately burdened by threats to their sexual and reproductive health.
The Lancet 05/2007; 369(9568):1220-31. · 38.28 Impact Factor
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ABSTRACT: To encourage dual contraceptive method use--protection from both STD and pregnancy--health behavior change efforts must target powerful risk and protective factors that are amenable to change. This study examines longitudinal relationships between adolescents' contraceptive-related cognitions and dual method use.
Data are from 1123 sexually active 7-11th-grade participants in the National Longitudinal Study of Adolescent Health, Waves 1 and 2 (W1, W2). A series of nested path models examined relationships between participants' contraceptive use level at most recent intercourse (zero, one, two methods) and contraceptive-related cognitions. Parallel analyses were completed with four grade/gender groups.
Dual method use at most recent intercourse ranged from 14.3% to 25.0%. Path models suggested that contraceptive use levels and contraceptive-related cognitions were moderately stable over time. Cross-sectionally, contraceptive use level was associated with parent approval of birth control (older youth, younger girls), birth control attitudes (older youth, younger boys), perceived pregnancy consequences (older youth), perceived sexually transmitted disease risk (older girls), perceived benefits of sex (younger girls), and contraceptive self-efficacy (older youth). W1 father approval of birth control (younger girls), mother disapproval of sex (older girls), and birth control attitudes (older boys) predicted W2 contraceptive use levels. W1 contraceptive use levels predicted several W2 cognitions among older youth.
Sexually active adolescents' perceptions of parent expectations about sex and contraception have important links to dual method use. Adolescents' attitudes about practical, social, and moral implications of using birth control are also linked to their use of dual contraceptive methods.
Journal of Adolescent Health 04/2007; 40(3):275.e15-22. · 3.33 Impact Factor
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ABSTRACT: This study explored the prevalence, disparity, and cohort trends in suicidality among bisexual teens vs. heterosexual and gay/lesbian peers in 9 population-based high school surveys in Canada and the U.S. Multivariate logistic regressions were used to calculate age-adjusted odds ratios separately by gender; 95% confidence intervals tested cohort trends where surveys were repeated over multiple years. Results showed remarkable consistency: bisexual youth reported higher odds of recent suicidal ideation and attempts vs. heterosexual peers, with increasing odds in most surveys over the past decade. Results compared to gay and lesbian peers were mixed, with varying gender differences in prevalence and disparity trends in the different regions.
Journal of LGBT Health Research 01/2007; 3(2):25-36.
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ABSTRACT: Parents may wait to talk to their teens about sexuality until they believe their child is in a romantic relationship. To examine this, telephone surveys were conducted with 1069 parents of adolescents. Measures assessed parents’ perception of teens’ romantic involvement and parent-child communication about several sexuality topics. Multivariable regression models determined the odds of talking about each topic among parents who reported their teen had been in a romantic relationship compared to those who did not. Most parents reported talking at least a moderate amount about some sex-related topic. Parents who believed their teen had been romantically involved were more likely to have discussed most of the topics examined here (ORs=1.64 – 2.56). For some topics, associations were more pronounced among parents of younger teens. Findings suggest that parents may miss important opportunities to influence behavior, and should initiate conversations about sexuality before they believe their child to be romantically involved.
Journal of Youth and Adolescence 11/2006; 35(6):893-902. · 2.72 Impact Factor
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ABSTRACT: Influencing adolescents' sexual behaviors has the potential to influence trajectories of risk for sexually transmitted infections (STIs) among young adults.
To determine whether family, school, and individual factors associated with increased duration of virginity also protect against STIs in young adulthood.
Prospective cohort study. Wave I of the National Longitudinal Study of Adolescent Health occurred in 1995 when participants were in grades 7 through 12. Six years later, all wave I participants who could be located were invited to participate in wave III and provide a urine specimen for STI testing.
In-home interviews in the continental United States, Alaska, and Hawaii.
Population-based sample. Of 18,924 participants in the nationally representative weighted wave I sample, 14,322 (75.7%) were located and participated in wave III. Test results for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis were available for 11,594 (81.0%) of wave III participants.
Positive test result for C. trachomatis, N. gonorrhoeae, or T. vaginalis.
Controlling for biological sex, age, race/ethnicity, family structure, and maternal education, adolescents who perceived that their parents more strongly disapproved of their having sex during adolescence were less likely to have STIs 6 years later (adjusted odds ratio, 0.89; 95% confidence interval, 0.81-0.99). Those with a higher grade point average during adolescence were also less likely to acquire STIs (adjusted odds ratio, 0.84; 95% confidence interval, 0.71-0.99). Stratified analyses confirmed these findings among female, but not male, adolescents. Feelings of connection to family or school, reported importance of religion, attending a parochial school, and pledges of virginity during adolescence did not predict STI status 6 years later.
Perceived parental disapproval of sexual intercourse and higher grades in school during adolescence have protective influences on the trajectory of risk for acquiring STIs, primarily among female adolescents. Most factors associated with increased duration of virginity in adolescence do not influence the trajectory of STI risk.
Archives of Pediatrics and Adolescent Medicine 08/2005; 159(7):657-64. · 4.14 Impact Factor
