Lori-Ann Palen

Inconsistent Reports of Sexual Intercourse Among South African High School Students

PURPOSE This study aims to describe patterns of inconsistent reports of sexual intercourse among a sample of South African adolescents. METHODS Consistency of reported lifetime sexual intercourse was assessed using five semiannual waves of data. Odds ratios related inconsistent reporting to demographic variables and potential indicators of general and risk-behavior-specific reliability problems. RESULTS Of the sexually active participants in the sample, nearly 40% reported being virgins after sexual activity had been reported at an earlier assessment. Inconsistent reporting could not be predicted by gender or race or by general indicators of poor reliability (inconsistent reporting of gender and birth year). However individuals with inconsistent reports of sexual intercourse were more likely to be inconsistent reporters of substance use. CONCLUSIONS These results suggest that researchers need to undertake efforts to deal specifically with inconsistent risk behavior data. These may include modification of data collection procedures and use of statistical methodologies that can account for response inconsistencies.

Substance Use and Sexual Risk Prevention in Cape Town, South Africa: An Evaluation of the HealthWise Program

Sexual behavior and substance use represent major threats to the health and well-being of South African adolescents, especially in light of the high prevalence of HIV infection in this population. However, there is currently a lack of evidence-based school programs designed to address health risk behaviors. The current study details the evaluation of HealthWise South Africa, a leisure, life skills, and sexuality education intervention for eighth and ninth grade students. We hypothesized that, compared to controls, HealthWise participants would have delayed sexual initiation, reduced rates of current sexual activity, increased use of and perceived access to condoms, and lower rates of lifetime and past use of multiple substances. Longitudinal data were analyzed using logistic regression of multiply imputed data. Results indicate that HealthWise was effective in increasing the perception of condom availability for both genders (OR = 1.6). As compared to HealthWise participants, control participants also had steeper increases in recent and heavy use of alcohol (OR = 1.4 [95% C.I. = 1.1–1.8], 1.6 [1.2–2.2], respectively) and recent and heavy cigarette use (OR = 1.4 [1.1–1.7], 1.4 [1.1–1.8], respectively). There were also several significant gender by treatment interactions, which are discussed. These results suggest that HealthWise is a promising approach to reducing multiple health risk behaviors among the population of school-going South African adolescents.

Self-Defining Activities, Expressive Identity, and Adolescent Wellness.

This study examined the relations among activity participation, expressive identity, and wellness in a sample of 115 high school students. Results indicated that most adolescents identify several activities as self-defining. Within-person variation in identity scores across self-selected activities was substantially greater than between-person variability. Mean level identity scores were not statistically different across activity types, but boys did report significantly lower expressive identity scores in instrumental activities (school, job) than did girls. After controlling for background variables, general activity participation and self-defining activities were significantly related to wellness. Expressive identity mediated the relations between self-defining activities and wellness. Implications for interventions promoting activity involvement and identity formation are discussed.

Influencing adolescent leisure motivation: intervention effects of HealthWise South Africa.

Abstract This study investigates changes in self-reported motivation for leisure due to participation in Health Wise, a high school curriculum aimed at decreasing risk behavior and promoting health behavior. Participants were 2,193 mixed race adolescents (M = 14 years old) from 9 schools (4 intervention, 5 control) near Cape Town, South Africa. Students in the Health Wise school with the greatest involvement in teacher training and implementation fidelity reported increased intrinsic and identified motivation and decreased introjected motivation and amotivation compared to students in control schools. These results point to the potential for intervention programming to influence leisure motivation among adolescents in South Africa and represent a first step toward identifying leisure motivation as a mediator of program effects.

Leisure constraints for adolescents in Cape Town, South Africa: a qualitative study

This study identified leisure constraints, constraints negotiation strategies, and their relative frequencies among 114 high school students from one under-resourced area of South Africa. Through focus group discussions, participants identified intrapersonal, interpersonal, structural, and sociocultural constraints to leisure, suggesting some degree of universality in this previously documented typology. Intrapersonal constraints were mentioned most often. Whereas participants readily identified ways to overcome interpersonal and structural constraints, strategies for overcoming intrapersonal and sociocultural constraints were not mentioned frequently, suggesting a potential need to help adolescents identify and employ these types of strategies.

Transitions to Substance Use and Sexual Intercourse Among South African High School Students

This study examined longitudinal patterns of initiating substance use and sexual intercourse among a sample of 1,143 high school students from a low-income township in Cape Town, South Africa. Longitudinal data on lifetime incidence of sexual intercourse and alcohol and marijuana use were collected semiannually from 2004 to 2006. Latent transition analysis (LTA) was used to test competing models of transitions to these behaviors. Participants were more likely to move from no risk behavior to substance use, rather than from no risk behavior to sexual intercourse. At all time points, the proportion of youth who had engaged in sexual intercourse but not substance use was very small. The studys limitations and directions for future research are discussed. This research was funded by NIH Grants R01 DA01749 and T32 DA017629-01A1.

A Theater-Based Approach to Primary Prevention of Sexual Behavior for Early Adolescents.

Early adolescence is a crucial period for preventing teen pregnancy and sexually transmitted infections. This study evaluated STAR LO, a theater-based intervention designed to affect antecedents of sexual activity among urban early adolescents (N = 1,143). Public elementary/middle schools received the intervention or served as a wait-listed comparison group in a quasi-experimental study. Students completed pretest and posttest questionnaires. Multivariate regression models were used to examine treatment effects. Comparison students showed significantly greater increases in sexual intentions and decreases in pro-abstinence attitudes and intended age of first sex than treatment group adolescents. Comparison girls showed significantly greater increases in desire to be a teen parent than STAR LO girls. Treatment group adolescents exhibited greater increases in sexual knowledge than comparison group adolescents, with stronger effects for boys than girls. The results suggest that this theater-based prevention program can help early adolescents develop knowledge, attitudes, and intentions that may prevent future sexual risk behavior.

A mixed-method analysis of free-time involvement and motivation among adolescents in Cape Town, South Africa

Using focus group (N = 114) and survey (N = 946) data, this study employed self-determination theory (SDT) as an organizing framework to examine free-time use and motivation among predominantly mixed-race adolescents from one area in South Africa. Adolescents reported participating in a broad range of activities, with socializing, media use, sports, risk behaviour and performing arts being the most frequently mentioned. All of the motivation types proposed by SDT were spontaneously mentioned by focus group participants. Free time was most strongly characterized by intrinsic motivations, such as competence, relatedness and positive affect. Activities were also seen as a way to achieve outside goals. With few exceptions, multiple motivations were identified for the same activities, and specific motivations were reported across multiple activity types. The findings suggest that positive motivational experiences were not limited to a specific subset of activities. However, future longitudinal research on participation, motivation and outcomes is needed to determine the developmental implications of different forms of free-time motivation.

Effects of media campaign messages targeting parents on adolescent sexual beliefs: a randomized controlled trial with a national sample:

Using a randomized controlled trial, this study evaluated the effects of media messages targeting parents on the sexual beliefs of 404 adolescents. The messages aimed to increase parent-child communication about waiting to initiate sexual activity. Compared with children of unexposed parents, children of parents exposed to media messages were more likely to believe that teen sexual activity is psychologically harmful. However, effects varied by parent and adolescent gender; treatment effects were only significant among adolescents whose opposite-sex parent was exposed. Parent exposure strengthened beliefs that teen sexual activity is physically harmful only among adolescents with at least 1 sexually active friend.

The Use of Reconsent in a National Evaluation of Adolescent Reproductive Health Programs

PURPOSE Reconsent involves asking research participants to reaffirm their consent for study participation when there have been significant changes in the studys procedures, risks, or benefits. We described the reconsent process, identified the reconsent rate, and examined the comparability of youths enrolled via consent and reconsent in a national evaluation of adolescent reproductive health programs. METHODS Evaluation participants from five abstinence education projects (N = 2,176) and nine projects serving pregnant or parenting adolescents (N = 878) provided either parent or youth consent or reconsent to participate in the national evaluation. Participants completed surveys that included demographic characteristics; sexual intentions, norms and behaviors; and pregnancy history. Multivariate logistic regression was used to examine associations between consent status, demographic characteristics, and risk indicators. RESULTS The reconsent rates in the abstinence education and pregnant or parenting samples were 45% and 58%, respectively. Participants age was positively associated with reconsent. Hispanic adolescents (and, for abstinence education, other racial/ethnic minorities) were underrepresented among youth with reconsent. Among abstinence education study participants, risk indicators were not associated with consent status. Among pregnant or parenting teens, those who had experienced repeat pregnancy were less likely than those who had experienced only one pregnancy to have been enrolled via reconsent. CONCLUSIONS Reconsent can bolster sample size but may introduce bias by missing some racial/ethnic and age-groups. Among high-risk adolescents, reconsent may also yield a sample that differs from consented samples on risk characteristics, necessitating statistical adjustments when analyzing data.