Kristin Mmari

When a Parent Goes Off to War: Exploring the Issues Faced by Adolescents and Their Families.

The objectives of this study were (1) to explore the consequences of parental deployment for adolescents and their families and (2) to identify potential strategies that may help adolescents cope with a parents deployment. Eleven focus groups were conducted among adolescents in military families, military parents, and school personnel in military-impacted schools at five military bases. Findings reveal that one of the most prominent sources of stress for families is adjusting and readjusting to new roles and responsibilities. Notably, this stress was primarily felt after the deployed parent returned. School personnel also commented that many teachers and counselors are not prepared to deal with deployment issues among the military students. These findings suggest that parents need to be better prepared to handle the stresses after a deployed parent returns. School personnel also need special training, and military-impacted schools need to offer additional opportunities for students to discuss deployment issues.

Risk and protective factors that affect adolescent reproductive health in developing countries: A structured literature review.

Abstract The primary focus of this article is to determine which risk and protective factors are most important to adolescent reproductive health in developing countries. A comprehensive and systematic literature search was conducted on studies that examined factors in relation to the following outcomes: ever had premarital sex, condom use, pregnancy, early childbearing, sexually transmitted infections, and HIV. While the search identified over 11,000 publications, only 61 were retained for the final analysis. The results show that factors which were significantly associated to the outcomes were primarily related to the adolescents themselves. In fact, very few factors outside the individual were found to be related to sexual risk behaviours. This contrasts to similar research conducted among youth samples in the US. While this review confirms the strong need for a broader research base on the risk and protective factors related to adolescent sexual and reproductive health in developing countries, it also does identify key factors that can be addressed through innovative programmes and policies to help improve adolescent reproductive health in the developing world.

What Increases Risk and Protection for Delinquent Behaviors Among American Indian Youth? Findings From Three Tribal Communities

The primary purpose of this study was to compare the risk and protective factors for delinquent behaviors among American Indian youth in three distinct tribal communities. Focus group discussions were used to gather data from elders, parents, youth workers, and youth in each tribal community. Findings showed that the key source for increasing risk and protection for delinquent behaviors among American Indian youth is the family. In particular is the protective presence of a parent and having a parent available for discussing problems. Participants also revealed how many parents lack the knowledge and confidence to discipline their children. These findings suggest a need for programs that strengthen parent-adolescent communication, parenting skills, and offer cultural teachings and sensitivity training for school personnel. Interventions also need to be specific to the cultural context and cannot assume the same risk and protective factors will apply to all American Indian youth.

A Review of Risk and Protective Factors for Adolescent Sexual and Reproductive Health in Developing Countries: An Update

PURPOSE To conduct a literature review of studies that examined risk and protective factors related to adolescent sexual and reproductive health in developing countries. METHODS A literature search was conducted using multiple databases, including PubMed, PsycINFO, Scopus, JSTOR, and the Interagency Youth Working Group. Review criteria included publications that: were conducted in a low- or middle-income country; had a sample size of at least 100 young people aged 10-24 years, and used multivariate analysis. All studies that were identified were also conducted between 1990 and 2010, a 20-year time frame. The literature search and initial review yielded a total of 244 studies that met the criteria and analyzed risk and protective factors related to the following outcomes: sexual initiation, number of sexual partners, condom use, contraceptive use, pregnancy and early childbearing, human immunodeficiency virus, sexually transmitted infections, and sexual coercion. RESULTS Most studies that were conducted on adolescent sexual and reproductive health in developing countries were largely focused in Sub-Saharan African contexts, and primarily examined factors related to sexual initiation and condom use. Most factors that examined an adolescent sexual and reproductive health outcome were also focused on the individual level, although an increasing number of studies within the past 10 years have focused on family-level factors. Few studies examined factors at the community or neighborhood level, which, to date, has largely been ignored in developing country contexts. CONCLUSIONS The review not only summarizes what is currently known in terms of risk and protective factors that relate to adolescent sexual and reproductive health in developing countries, but also highlights the gaps. Implications for future research are discussed.

Factors influencing sexual initiation, multiple partners and condom use among male slum youth in Pune, India

Abstract This study examines the factors that influence sexual behaviours among young unmarried males living in urban slums in India, a population characterised by high vulnerability to STI and HIV infections. Data were collected from 600 unmarried male slum youth to examine the relationships between three outcomes of heterosexual behaviour (age at sexual initiation, number of sexual partners and condom use at first intercourse) and factors within the family/household social environment, peer environment and individual level during the respondents’ formative years. Regression analyses found factors within the family and peer-level domains such as growing up in a two-parent household, having adequate levels of parental supervision, experiencing violence in the home and having peers who drank significantly impact the age of sexual debut and the subsequent number of lifetime partners. Condom use at first intercourse appears to be significantly influenced by age of sexual debut and type of sexual partner. These findings indicate that in low-resource urban settings, the influence of family and friends as role models can play an important role in determining the initiation of sexual behaviour among male youth and in making behaviour choices that result in favourable health outcomes.

STI Treatment-Seeking Behaviors among Youth in Nigeria: Are There Gender Differences?

CONTEXT There is little research on STIs among young people in Nigeria. It is important to determine gender differences in health-seeking behaviors among youth with self-reported STI symptoms. METHODS Data from 538 males and females aged 15-24 with at least one STI symptom were drawn from the 2003 and 2005 National HIV/AIDS and Reproductive Health Surveys. Bivariate and multivariate analyses were conducted to determine gender differences among those who had sought treatment for their STI symptoms, and the factors related to seeking treatment from formal health care sources versus informal sources. RESULTS A greater proportion of males than of females had sought treatment for their STIs (64% vs. 48%). Among those who had sought treatment, 60% of females had gone to formal sources, most commonly a government clinic; 54% of males had sought care from informal sources, most commonly a traditional healer. Females had lower odds than males of having sought STI treatment (odds ratio, 0.6). Among both males and females, economic status was positively associated with seeking treatment from a formal source rather than an informal source (2.4-4.2); among females, 22-24-year-olds were more likely than those aged 15-18 to have sought treatment from a formal source (2.5). CONCLUSION Programs and policies that aim to increase treatment of STIs among young people in Nigeria need to target males and females differently.

How adolescents perceive their communities: a qualitative study that explores the relationship between health and the physical environment

BackgroundThe Well-Being of Adolescents in Vulnerable Environments (WAVE) study was conducted among adolescents aged 15-19 years in Baltimore, Ibadan, Johannesburg, New Delhi, and Shanghai to examine perceived factors related to their health. A preliminary analysis of the data, unexpectedly, revealed that the influence of the physical environment on adolescent health was a dominant theme across every site examined. To explore this further, this paper analyzed the specific components of the physical environment that were perceived to influence health, and how they contributed to various health outcomes across sites.MethodsResearchers in each site conducted in-depth interviews among adolescents; community mapping and focus groups among adolescents; a Photovoice methodology, in which adolescents were trained in photography and took photos of the meaning of ‘health’ in their communities; and key informant interviews among adults who work with young people. A total 529 participants from across the sites were included in the analysis.ResultsFindings showed that while there was surprising uniformity in how adolescents characterized their physical environment, perceived health outcomes related to the physical environment varied by site and gender. In Baltimore and Johannesburg, vacant homes and the lack of recreation facilities were perceived to impact on sexual and reproductive health problems for girls, while among boys they contributed to drugs and violence. In Shanghai, New Delhi, and Ibadan, garbage and trash observed in their communities were perceived to have a higher impact on infectious and chronic diseases.ConclusionsAs the world continues to urbanize, our study points to a strong need to examine how the physical aspects of a living environment contribute to the health of adolescents. Specific aspects, such as housing, safety, garbage, and recreational spaces must all be examined as possible pathways for making improvements to health of adolescents, particularly among those living in poor urban environments.

Sexual attitudes, behaviours and acculturation among young migrants in Shanghai

Chinas rates of internal migration increased to an all-time high of over 200 million individuals at the beginning of the twenty-first century. Yet, there is a dearth of information on the lives of young migrant populations. The aim of this study was to explore how migration influences the sexual attitudes and behaviours of 18–24-year-old migrant men and women in Shanghai, China. A total of 64 migrants participated in 10 focus-group discussions and 20 in-depth interviews. Guided by acculturation theory, coded data were organised into analytic matrices to compare themes across participants. Factors associated with increased sexual-risk behaviours include acculturative stress, discrimination leading to social isolation, conflicts between traditional and modern city values and increased sexual opportunities. Premarital sex, cohabitation, unprotected sex and visiting sex workers are common among this population. Reasons for not using condoms included being unprepared, lack of knowledge and barriers in accessing reproductive services due to not having urban documentation. Local family planning programmes should help migrants negotiate traditional and modern values and partner with work-sites to provide comprehensive sexual education and services and train health professionals in the specific healthcare needs of young migrant populations.

Risk and Protective Correlates of Young Women's First Sexual Experiences in Rakai, Uganda

CONTEXT Sexually active young women bear the brunt of the HIV epidemic in Sub-Saharan Africa. Information is needed on risk and protective correlates at the family, partner and individual level for the design of programs to encourage safer sexual behaviors and reduce HIV risk among young women. METHODS The study was conducted among 1,675 sexually experienced women aged 15-24 living in Rakai, Uganda. The sample was taken from an ongoing community cohort study initiated in 1994 in 56 villages by the Rakai Health Sciences Program. Contextual variabless at the family, partner and individual levels were analyzed in relation to three outcome variables: sex before the age of 15, coerced first sex and condom use at first sex. RESULTS At the family level, young females who did not live with both parents were more likely than those who did to have had sex before the age of 15 and to have experienced sexual coercion at first sex. Those whose mothers had some secondary education and whose female caregiver did not consume alcohol had elevated odds of using a condom at first sex. Having initiated sex at age 15 or older was the strongest individual-level characteristic associated with having used a condom at first sex. CONCLUSIONS Reproductive health interventions should target adolescents and their parents to delay the onset of sexual activity, prevent sexual coercion and encourage condom use. Both adolescents and their parents should be educated about the risks associated with different types of sexual partnerships.

Risk and protective factors for HIV among orphans and non-orphans in Tanzania

The objectives of this study were to identify risk and protective factors for engaging in unsafe sex among orphans and non-orphans and to explore whether risk and protection differs by gender and orphan status. The study was carried out in Kisesa ward, in the Mwanza region of Northwest Tanzania. A combination of in-depth interviews and focus group discussions were used to collect data from girls and boys as well as from the female caregivers of orphans. Findings revealed that among young people who reported having unsafe sex, those who were female orphans were more likely to state that they ‘had to have sex’ to acquire food and clothing for their households. Caregivers believed that many young people who engage in sexual-risk behaviours do so because they are not provided with adequate supervision and moral guidance. The study suggests that programmes may need to target both girls and young women and their caregivers and create access to education and decent work opportunities.