Condom use and sexuality communication with adults: a study among high school students in South Africa and Tanzania

BMC Public Health

Catherine Mathews¹  Annegreet Wubs²  Hans E Onya⁵  Sylvia Kaaya³  Leif Edvard Aarø⁴  Francis Sande Namisi² 

[1] Adolescent Health Research Unit, Department of Psychiatry and Mental Health, University of Cape Town, University Private Bag, Rondebosch, 7700 Cape Town, South Africa;Department of Health Promotion and Development, Faculty of Psychology, University of Bergen, P.O. Box 7807, N-5020, Bergen, Norway;Department of Psychiatry, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania;Division of Mental Health, Norwegian Institute of Public Health, Oslo, Norway;Department of Medical Sciences, Public Health and Health Promotion, School of Health Sciences, University of Limpopo, Turfloop Campus, Private Bag X1106, Sovenga 0727, South Africa

关键词: Tanzania;    South Africa;    Communication;    Condom use;    Parents;    Adolescents;   

Others  :  1161748
DOI  :  10.1186/1471-2458-13-874

 received in 2012-11-01, accepted in 2013-09-17,  发布年份 2013

【 摘 要 】

Background

Fostering adolescents’ communication on sexuality issues with their parents and other significant adults is often assumed to be an important component of intervention programmes aimed at promoting healthy adolescent sexual practices. However, there are few studies describing the relationship between such communication and sexual practices, particularly in sub-Saharan Africa. This study examined the relationships between adolescents’ communication with significant adults and their condom use in three sites in this region.

Methods

Data stem from a multi-site randomized controlled trial of a school-based HIV prevention intervention implemented in Cape Town and Mankweng, South Africa and Dar es Salaam, Tanzania. Only data from comparison schools were used. The design is therefore a prospective panel study with three waves of data collections. Data were collected in 2004 from 6,251 participants in 40 schools. Associations between adolescents’ communication with adults about sexuality issues and their use of condoms were analysed cross-sectionally using analysis of variance, as well as prospectively using multiple ordinal logistic regression analysis.

Results

Cross-sectional analyses showed that consistent condom users had significantly higher mean scores on communication (across topics and communication partners) than both occasional users and never-users, who had the lowest scores. After controlling for condom use at the first data collection occasion in each model as well as for possible confounders, communication scores significantly predicted consistent condom use prospectively in all three ordinal logistic regression models (Model R² = .23 to .31).

Conclusion

The findings are consistent with the assertion that communication on sexuality issues between adolescents and significant adults results in safer sexual practices, as reflected by condom use, among in-school adolescents. The associations between communication variables and condom use might have been stronger if we had measured additional aspects of communication such as whether or not it was initiated by the adolescents themselves, the quality of advice provided by adults, and if it took place in a context of positive adult-adolescent interaction. Studies with experimental designs are needed in order to provide stronger evidence of causality.

【 授权许可】

   
2013 Namisi et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]UNAIDS: UNAIDS report on the global AIDS epidemic 2010. Geneva: Joint United Nations Programme on HIV/AIDS; 2010. Downloaded July 19th 2012 from: http://www.childinfo.org/files/20101123_GlobalReport_em.pdf webcite
• [2]UNICEF: AIDS: 2009. Opportunity in Crisis: Preventing HIV from early adolescence to young adulthood. New York: United Nations Childrens Fund (UNICEF); Downloaded September 2012 from: http://www.unicef.org/publications/files/Opportunity_in_Crisis-Report_EN_052711.pdf webcite
• [3]Collins WA, Laursen B: Parent-adolescent relationships and influences. In Handbook of adolescent psychology (Second edition). Edited by Lerner RM, Steinberg L. Hoboken, New Jersey: Wiley; 2004:331-361.
• [4]Stattin H, Kerr M: Parental monitoring: a reinterpretation. Child Dev 2000, 71(4):1072-1085.
• [5]Beveridge RA, Berg CA: Parent-adolescent collaboration: an intepersonal model for understanding optimal interactions. Clin Child Fam Psychol Rev 2007, 10(1):25-52.
• [6]Darling N, Steinberg L: Parenting style as context: an integrative model. Psychol Bull 1993, 113(3):487-496.
• [7]Baumrind 1966: Effects of authoritative control on child behavior. Child Dev 1966, 37:887-907. http://persweb.wabash.edu/facstaff/hortonr/articles%20for%20class/baumrind.pdf webcite
• [8]Kerr M, Stattin H: What parents know, how they know it, and several forms of adolescent adjustment: further support for a reinterpretation of monitoring. Dev Psychol 2000, 36(2):366-380.
• [9]Bastien S, Kajula LJ, Muhwezi WW: A review of studies of parent–child communication about sexuality and HIV/AIDS in sub-Saharan Africa. Reprod Health 2011, 8(25):1-17.
• [10]DiClemente RJ, Wingood GM, Crosby R, Cobb BK, Harrington K, Davies SL: Parent-adolescent communication and sexual risk behaviors among African American adolescent females. J Pediatr 2001, 139(3):407-412.
• [11]Huebner AJ, Howell LW: Examining the relationship between adolescent sexual risk-taking and perceptions of monitoring, communication, and parenting styles. J Adolesc Health 2003, 33:71-78.
• [12]Hutchinson MK: The influence of sexual risk communication between parents and daughters on sexual risk behaviors. Fam Relat 2002, 51:238-247.
• [13]Miller KS, Levin ML, Whitaker DJ, Xiaohe X: Patterns of condom use among adolescents: the Impact of mother-adolescent communication. Am J Public Health 1998, 88(10):1542-1544.
• [14]Whitaker DJ, Miller KS, May DC, Levin ML: Teenage partners’ communication about sexual risk and condom use: the importance of parent-teenager discussions. Fam Plan Perspect 1999, 31(3):117-121.
• [15]Deptula DP, Henry DB, Schoeny ME: How can parents make a difference? Longitudinal associations with adolescent sexual behavior. J Fam Psychol 2010, 24(6):731-739.
• [16]Rasamimari A, Dancy B, Talashek M, Park CG: Predictors of sexual behaviors among Thai young adults. J Assoc Nurses AIDS Care 2007, 18(6):13-21.
• [17]Wang R-H, Hsu M-T, Wang HH: Potential factors associated with contraceptive intention among adolescent males in Taiwan. Kaohsiung J Med Sci 2004, 20(3):115-123.
• [18]Wight D, Williamson L, Henderson M: Parental influences on young people’s sexual behaviour: a longitudinal analysis. J Adolesc 2006, 29:473-494.
• [19]Adu-Mireku S: Family communication about HIV/AIDS and sexual behaviour among senior secondary school students in Accra, Ghana. Afr Health Sci 2009, 3(1):7-14.
• [20]Maticka-Tyndale E, Tenkorang EY: A multi-level model of condom use among male and female upper primary school students in Nyanza, Kenya. Soc Sci Med 2010, 71:616-625.
• [21]Karim AM, Magnani RJ, Morgan GT, Bond KC: Reproductive health risk and protective factors among unmarried youth in Ghana. Int Fam Plan Perspect 2003, 29(1):14-24.
• [22]Biddlecom A, Awusabo-Asare K, Akinrinola B: Role of parents in adolescent sexual activity and contraceptive use in four African countries. Int Perspect Sex Reprod Health 2009, 35(2):72-81.
• [23]Markham CM, Lormand D, Gloppen KM, Peskin MF, Flores B, Low B, House LD: Connectedness as a predictor of sexual and reproductive health outcomes for youth. J Adolesc Health 2010, 46:S23-S41.
• [24]Erulkar AS, Ettyang LIA, Onoka C, Nyagah FK, Muyonga A: Behavior change evaluation of a culturally consistent reproductive health program for young Kenyans. Int Fam Plan Perspect 2004, 30(2):58-67.
• [25]Maticka-Tyndale E, Wildish J, Gichuru M: Quasi-experimental evaluation of a national primary school HIV intervention in Kenya. Eval Program Plann 2007, 30:172-186.
• [26]Hutchinson MK, Jemmot JB, Jemmott LS, Braverman P, Fong GT: The role of mother–daughter sexual risk communication in reducing sexual risk behaviors among urban adolescent females: a prospective study. J Adolesc Health 2003, 33:98-107.
• [27]DiIorio C, Resnicow K, McCarty F, De AK, Dudley WN, Wang DT, Denzmore P: Keepin’ It R.E.A.L.! Results of a Mother–Adolescent HIV Prevention Program. Nurs Res 2006, 55(1):43-51.
• [28]Campero L, Walker D, Atienzo EE, Gutierrez JP: A quasi-experimental evaluation of parents as sexual health educators resulting in delayed sexual initiation and increased access to condoms. J Adolesc 2011, 34:215-223.
• [29]Aarø LE, Flisher AJ, Kaaya S, Onya H, Fuglesang M, Klepp K-I, Schaalma H: Promoting sexual and reproductive health in early adolescence in South Africa and Tanzania: development of a theory- and evidence-based intervention programme. Scand J Public Health 2006, 34:150-158.
• [30]Mukoma W, Flisher AJ, Helleve A, Aarø LE, Mathews C, Kaaya S, Klepp K-I: Development, reliability and validity of a research instrument designed to evaluate school-based HIV/AIDS interventions in South Africa and Tanzania. Scand J Public Health 2009, 37(Suppl. 2):7-15.
• [31]Namisi F, Flisher AJ, Overland S, Bastien S, Onya H, Kaaya S, Aarø LE: Sociodemographic variations in communication on sexuality and HIV/AIDS with parents, family members and teachers among in-school adolescents: a multi-site study in Tanzania and South Africa. Scand J Public Health 2009, 37(Suppl. 2):65-74.
• [32]Luwaga LC: Parent-adolescent communication on sexuality in the context of HIV/AIDS in Uganda: An exploratory study. Bergen: University of Bergen, Department of Health Promotion and Development; 2004.
• [33]Namisi FS: Communicating on sexuality within the Kenya family setting in the context of HIV/AIDS: The perceptions of parents and 14–17 year old adolescents. Bergen: University of Bergen, Department of Health Promotion and Development; 2004.
• [34]Clawson CL, Reese-Weber M: The amount and timing of parent-adolescent sexual communication as predictors of late adolescent sexual risk-taking behaviors. J Sex Res 2003, 40(3):256-265.
• [35]DiIorio C, Pluhar E, Belcher L: Parent–child communication about sexuality. J HIV/AIDS Prev Educ Adolescents Child 2003, 5(3/4):7-32.
• [36]Byrnes JP, Miller DC, Schafer WD: Gender differences in risk taking: a meta-analysis. Psychol Bull 1999, 125(3):367-383.
• [37]Eaton L, Flisher A, Aarø LE: Unsafe sexual behaviour in South African youth. Soc Sci Med 2003, 56:149-165.
• [38]Burgard SA, Lee-Rife SM: Community characteristics, sexual initiation, and condom use among young black South Africans. J Health Soc Behav 2009, 50:293-309.
• [39]Kim J, Pronyk P, Barnett T, Watts C: Exploring the role of economic empowerment in HIV prevention. AIDS 2008, 22(Suppl 4):S57-S71.