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Title: Saúde reprodutiva – planeamento familiar conhecimentos e comportamentos sexuais dos adolescentes portugueses
Authors: Correia, Teresa
Keywords: Sexual and reproductive health
Issue Date: 2004
Publisher: Universidade do Porto-Faculdade de Medicina
Citation: Correia, Teresa (2004) - Saúde reprodutiva – planeamento familiar onhecimentos e comportamentos sexuais dos adolescentes portugueses. Porto: Faculdade de Medicina. Tese de Doutoramento em Biologia Humana
Abstract: Sexual and Reproductive Health is one of the elements of the individuals general health, and has been a focus of interest in the developed countries. Lifestyle changes, namely in adolescents, will because a global problem. Sexual and Reproductive Health may produce two different feelings. On the one hard, it provides individual satisfaction and a feeling of well-being. On the other hand, misinformation or unreflected attitudes will provoke frustration and several unpleasant feelings. Usually, a person´s behaviour and/or ideas, thoughts and beliefs tend to be consolidated during the adolescence period and maintained throughout the adult life leading to high levels of morbidity and mortality, which represents high costs, both to the individual and also to the society in general. Therefore, it is extremely important to promote it throughout the education process. The first sexual experience is beginning to appear earlier than ever, which is considered a public health concern both in Portugal and in Europe. An early high-risk sexual behaviour, as well as the premature age of the first sexual experience is percetible throughout Europe. The prevalence of the contraceptive methods used is an important indicator in the evaluation of the level of exposure that adolescents experience, regarding the consequences of sexual intercourse. Although it is known that the concomitant use of a condom is the best way to prevent sexually transmitted diseases, the importance of psychosocial factors may influence its usage. High maternal and fetal morbidity has been closely associated to an early pregnancy, i.e. during the adolescence period. Regarding this issue, there are several opinions, nevertheless most recognise it as a risky situation for female adolescents, since its consequences are associated with social problems like school drop out, imposed marriage, child abandonment and abortion. All these situations are considered severe problems of public health. This may also be the cause for emotional changes in adolescents, which may lead them to sub-depression. Sexual behaviour in adolescents, as well as their knowledge on this issue, are an important information in order to adequate and to promote sexual health education. Objectives: this study aims to identify and analyse sexual behaviours and the knowledge that adolescents, who study in Portuguese high-schools, have on the issue. Four specific objectives were set: 1.To identify adolescents sexual behaviours, attitudes and the knowledge towards Sexual and reproductive health. 2.To calculate the condom use prevalence and to determine associated factors for that behaviour. 3.To quantify the adolescents proportion that already have voluntarly interrupted pregnancy and to identify demographic, social and behaviour factors associated to that decision. 4.To analyse the association between sexual behaviours and depressive symptoms. Participants and Methods: A cross-sectional study was made with adolescents studying in high-school. In 18 district capitals, we have only selected one for each district. Two of the selected high-schools refused to participate in this study. Therefore, this study was done in 16 district capitals. Among 8484 students, 429 (5.1%) refused to answer the questionnaires and 123 (1.5%) students answered it incongruosly and inconsistently. Therefore, our final sample was of 7932 adolescents. We have obtained the general information among two anonymous and directly administered questionnaires. One of the questionnaires comprised 34 questions about the participants’ personal, social, behavioural and demographic information. In order to evaluate the depressive symptoms we have used the Beck Depressive Inventory (DBI-II). High-schools were contacted through the Executive Committees in order to cooperate in the questionnaires delivery. They have been informed about the objectives and methods of this study, and it was also given to then the procedures` manual, in order to clarify any doubts. The questionnaires delivery was done during the first and second high-school terms. The teacher handed out the questionnaires to the students in the classroom. Then, the students filled in the questionnaires and in the end, after being filled in, each student put the questionnaires into the specific boxes on the classroom. Their knowledge about Sexual and Reproductive Health was evaluated by the given answers regarding the definitions of family planning and sexually transmitted diseases. Concerning their sexual behaviour, we have gathered information about the context on which their first sexual intercourse occurred, the frequency of the sexual intercourses during the last year, and the number of sexual partners they had at the moment. In this study, we have defined attitudes as opinions and feelings, which have guided the individual towards a specific behaviour. We have considered the following attitudes: the place where the adolescent looked up information about Sexual and Reproductive Health; the adolescent’s sexual satisfaction, his/her opinion on what he/she knows that helps his/hers sexuality. The adolescents were considered as depressed when they presented a value of ≥ 16 in the scale of DBI-II. The information collected in the sample was analysed and informatised with the EpiInfo (6.04d version) and SPSS (9.0 version) programmes. We have used the Chi-Square test to compare the proportions, using Yates for correction when the expected value was less than 20. Whenever that value was less than 5, we have used the Fisher test. To estimate relative risk (Odds Ratios, we have used the non-conditional logistic regression for 95.0% confidence intervals (CI: 95%). The quantitative variables were compared by Kruskal-Wallis. Results: The smokers’ prevalence was 34.4%, being significantly higher in male adolescents 37.7% (vs. 31.8%), older than 17 years old, 41.6% (vs. 32.1%) and whose parents’s education was higher than 12 years, 38.5% (vs. 33.5%). The prevalence of drugs consumption was 3.7%, which was also significantly higher in male adolescents, 5.2% (vs. 2.6%) and lower in those whose parents’ education was lower 4 years, 2.6% (vs. 4.1%). Violence was referred by 26.1% of the adolescents, and the most frequent type of violence was the psychological one (44.6%). Sexual violence prevalence was higher in girls, 5.6% (vs. 3.5%) and in adolescents older than 17 years 6.1% (vs. 3.9%). The adolescents’ specific knowledge on family planning and sexually transmitted diseases was of 57.1% and 56.5%. The female and the older male adolescents had more knowledge about family planning and sexually transmitted diseases. The adolescents elected the media (35.8%) as the best way to obtain any information concerning sexuality. The preference of the media was higher among boys. Only 3.2% of the adolescents seeked information among health professionals. Male adolescents stated they were more sexually satisfied, 72.5% (vs. 59.9%). Male adolescents older than 17 years were the most satisfied with their sex life, 70.5% (vs. 63.8%). Thirty-nine percent of the adolescents said they had already had sexual intercourse. The prevalence of sexual behaviour considered as a risk was higher on boys: the first not planned sexual intercourse, 82.5% (vs. 73.8%); practice of an irregular way of sexual intercourse, 60.4% (vs. 46.1%); five or more sexual partners, 18.3% (vs. 3.1%). Regarding the concomitant use of a condom, 55.0% of the adolescents said they use it, and 12.0% mentioned that they had never used it. Those who answered that they had never used it were girls,the older adolescents, those who live in a rented house, those who had their first sexual intercourse at the age of 15, and those which maintained more frequent sexual intercourses. After the variables adjustment, the factors which were associated with the non-concomitant use of the condom were: to be female adolescents (OR=2.0 CI 95%: 1.70-2.44), older than 19 (OR=1.7 CI 95%: 1.20-12.50), to live in a rented home (OR=1.2 CI 95%: 0.96-1.51), to have more frequent sexual intercourse (OR=2.5 CI 95%: 1.35-3.51), to consume drugs (OR=2.1 CI 95%: 1.03-4.42), to have been a victim of violence (OR=1.2 CI 95%: 1.02-1.47). The male adolescents pointed out some reasons for the non-concomitant use of the condom: dimineshed sexual satisfaction (66.5%), the certainty of the fidelity of the sexual partner (20.9%). For the female adolescents the reasons were: the use of another contraception method (49.6%), the certainty that her partner is faithful to her (29.9%) and finally the diminished sexual satisfaction/pleasure (28.3%). The global frequency of the voluntary pregnancy interruption was of 2.5%. This prevalence was significantly different among the country districts. The highest was in the district of Faro (7.5%), and in the districts of Viseu, Viana do Castelo, Castelo Branco, Braga and Portalegre it wasn`t declared any abortion. The risk of voluntary interruption of pregnancy was higher for those who considered themselves atheist, (OR=2.9 CI 95%: 1.10-7.44), for those who suffered some kind of violence (OR=3.5 CI 95%: 1.48-18.30), and for those who had more than 5 sexual partners in the last year (OR=18.9 CI 95%: 6.40-55.99). The average of depression symptoms did not varied significantly between adolescents that already had sexual intercourse (10,5 ± 10,0) and those who hadn`t yet started their sexual life (10,3 ± 9,3, p=0,810). Conclusions: 1.The adolescents, who have shown to be more informed about Sexual and Reproductive Health, were girls and older adolescents in general. The sexual behaviour considered as high-risked, like not planning the first sexual intercourse, the irregular sexual practice in an intense way and the high number of sexual partners were mainly practiced by male adolescents. The adolescents’ attitudes towards sexual and reproductive health vary particularly according to their sex, age and their parents’ education. The adolescents seek information on Sexual and reproductive health preferably in the media, and those who felt more satisfied with their sexual life were male adolescents and the eldest. 2.The prevalence of the concomitant use of a condom in the adolescents was of 55.0% and of 12.0% for those who answered that they had never used it. The concomitant use of a condom was positively associated with a lower number of sexual partners, with the absence of violence, sexually transmitted diseases and also with the non-consumption of drugs. 3.The global frequency value of the voluntary interruption of pregnancy was of 2.5%. The risk of voluntary interruption of pregnancy was higher for those who considered themselves atheists, for those who were victims of violence and for those who which had had more than 5 sexual partners during the last year. 4.The Portuguese student adolescents between 15 and 19 years old showed a depression symptoms prevalence of 21.6%, which was higher in female adolescents. The average of the depressive symptom was similar among adolescents that already had sexual intercourse and those who still had not started their sexual life.
Peer review: yes
Appears in Collections:CVSP - Teses de Doutoramento

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