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BACKGROUND: Understanding sexual behavior before marriage is relatively rare in the East, especially in Islamic societies, because sexuality is a sensitive subject for many Muslims. OBJECTIVES: The purpose of this study was to identify premarital sexual intercourse-related individual factors among Iranian adolescents. PATIENTS AND METHODS: This qualitative study was performed on 30 students of Payame Noor university of Shiraz city, Iran, in 2014. The study sample includes male and female university students selected using the convenience sampling method. Semistructured interviews were used to collect data. All interviews were conducted by the researcher in a comfortable atmosphere and carried out without the presence of others. Each interview lasted between 30 - 20 minutes. Interviews continued until data saturation occurred. Data were analyzed using the qualitative content analysis method. Participation in the study was voluntary by obtaining an informed consent. RESULTS: The study included 30 participants, 56.6% (n = 17) males and 43.4% (n = 13) females. The age range of study, participants was from 19 to 25 years of age. Data analysis showed that three main categories extracted in shaping premarital sexual intercourse in adolescents: health beliefs, religious-spiritual beliefs, and character. CONCLUSIONS: This study can help find a culturally appropriate intervention to delay sexual initiation and prevent sexual behavior before marriage in adolescents and young adults. The results of the present study have both experimental and theoretical implications for future research. Finally, this study is a form of shared experience that can help similar studies.

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BACKGROUND: Premarital sexual relationships could harm youth's health in terms of sexually transmitted infections or increased risk of unprotected sexual behaviors. Sexual abstinence has been recommended to prevent young adolescents from adverse outcomes of premarital sexual relationships. OBJECTIVES: The aim of this study was to explore the viewpoints of sexually active single women about premarital sexual relationships in the Iranian context. PATIENTS AND METHODS: In this qualitative study, we recruited 41 young women aged 18 to 35 years. Data were collected using focus group discussions and individual interviews. We employed conventional content analysis to analyze the data. Multiple data collection methods, maximum variation sampling, and peer checks were applied to enhance the reliability of the findings. RESULTS: Eight themes emerged from the data analysis: 'acceptance of sexual contact in the context of opposite-sex relationships, 'sexual activity as a guarantee for keeping the boyfriend in the relationship', 'premarital sexual relationship as an undeniable personal right', 'having successful marriage in spite of premarital sexual relationships', 'virginity as an old fashioned phenomenon', 'love as a license for premarital sexual behaviors', 'goal-oriented relationship as a license for premarital sexual behaviors', and 'experiencing premarital sexual relationships in order to gain perfection'. CONCLUSIONS: Results of this study could be applied to designing interventions, such as promotion of preventive beliefs or educational programs regarding premarital sexual relationships in conservative societies. These interventions could start within families and continue at schools and universities.

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Objective To assess pre-marital sex behavior and its relationship with gender and experience of migration among 16-24 years-old out-of-school youths in rural Hainan province,China.Methods 160 eligible youths from each of the 2 townships in County A and 80 from each of the 6 townships in County B were recruited,under equal proportion on gender,age distribution and experience of migration.An interviewer-administered,standardized questionnaire was used.Results 760 eligible participants (with each gender of 380) were interviewed.There were no significant differences in the proportions of reporting as sexually active (56.8％ and 57.9％ ) or having premarital sex (54.5％ and 50.0％ ) between male and female youths.However,among those sexually active participants,the average age at first sexual intercourse was (18.2± 1.9 years or 19.2 ± 1.8 years,P＜0.01 ),the average age of first-time leaving hometown for work (18.0 ± 2.3 years or 16.5 ± 1.9 years P＜0.01 ) and the percentage of having first sexual intercourse before 1 8 years old (59.3％ vs.35.5％,P＜0.01) were different between males and females.31.2％ of the male youths reported that their sexual debut happened before they left their hometown for work and 45.9％ of the sex debut appeared within 1 year after they left hometown.However,78.5％ of the sexually active female youths reported their sexual debut happened 1 year after leaving their hometown.Data from the multivariate analysis showed that being away from hometown for more than 3 months and having more friends who presumably had presumably pre-marital sex experiences were more likely to report pre-marital sex behavior.Older men were more likely to report pre-marital sex behavior than the younger ones.Married women were more likely to report pre-marital sex behavior than the unmarried ones.Through multivariate analysis on unmarried men,data showed that those having had experience on migration and at older age were associated with experiencing premarital sex.Conclusion Gender difference was identified on the pattern of migration and its relationship with premarital sex among out-of-school rural youths in Hainan province.When prevention program is developed for rural youth,these differences should be taken into account.

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A school health education programme in primary schools aimed at AIDS prevention in Soroti district of Uganda emphasized improved access to information, improved peer interaction and improved quality of performance of the existing school health education system. A cross-sectional sample of students, average age 14 years, in their final year of primary school was surveyed before and after 2 years of interventions. The percentage of students who stated they had been sexually active fell from 42.9% (123 of 287) to 11.1% (31 of 280) in the intervention group, while no significant change was recorded in a control group. The changes remained significant when segregated by gender or rural and urban location. Students in the intervention group tended to speak to peers and teachers more often about sexual matters. Increases in reasons given by students for abstaining from sex over the study period occurred in those reasons associated with a rational decision-making model rather than a punishment model. A primary school health education programme which emphasizes social interaction methods can be effective in increasing sexual abstinence among school-going adolescents in Uganda. The programme does not have to be expensive and can be implemented with staff present in most districts in the region.

PIP: Since the first cases of AIDS were identified in Uganda in the early 1980s, an estimated 1.5-2.0 million of Uganda's 18 million inhabitants have been infected with HIV. The spread of HIV in Uganda is thought to have been exacerbated by poverty, a breakdown of health services, social disruption by civil war, a tendency toward multiple sex partners, women's low social status, and a relatively early commencement of sexual activity. A school health education program in primary schools to prevent AIDS in Soroti district of Uganda emphasized improved access to information, improved peer interaction, and improved quality of performance of the existing school health education system. A cross-sectional sample of students of mean age 14 years, in their final year of primary school, was surveyed before and after 2 years of interventions. The percentage of students who stated that they had been sexually active fell from 42.9% to 11.1% in the intervention group, while no significant change was recorded in a control group. These changes remained significant when respondents were segregated by gender or rural and urban location. Students in the intervention group tended to speak to peers and teachers more often about sexual matters. Overall study findings indicate that a primary school health education program which emphasizes social interaction methods can increase the level of sexual abstinence among school-going adolescents in Uganda.

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Like many other countries in South East Asia, Cambodia is experiencing a rapidly developing AIDS epidemic. Groups reported as being particularly seriously affected include sex workers and their clients. Young people too may be at heightened risk: some young women find sex work a lucrative option in the context of low wages and poor employment opportunities, and some young men pay for sex either as individuals or as part of group socializing. These same young men may subsequently have sex with other partners, thus extending networks of transmission. While there is limited knowledge about the form of such sexual networks, little is known about the meanings that underpin young people's sexual relations and partnerships, the sexual identities associated with such meanings, and prevailing socio-sexual cultures. This paper reports on findings from an in-depth qualitative study conducted among two groups of young people: one urban, the other rural. Following an initial Rapid Assessment Process, data was collected via individual interviews, focus group interviews and participant observation. The research team included young people themselves. Data is presented on dominant discourses about sex and sexuality in Cambodia; contemporary patterns of sexual behaviour; sexual meanings and sexual practices; sexual relations among young people involving payment; and sexual relations not involving payment. The implications for more effective HIV prevention efforts are discussed.

PIP: Like many other countries in southeast Asia, Cambodia is experiencing a rapidly growing AIDS epidemic. Particularly seriously affected are prostitutes and their clients. Young people may also be at increased risk, with some young men frequenting prostitutes either individually or in groups, and some young women lured into prostitution by the opportunity to earn relatively high wages. Men who have sex with prostitutes often have sex with other mainstream sex partners, thereby extending networks of HIV transmission. Findings are reported from an examination of dominant discourses about sex and sexuality in Cambodia, contemporary patterns of sexual behavior among young people, sexual meanings and practices, sexual relations among young people involving payment, and sexual relations not involving payment. Fieldwork for the study took place between February 1995 and April 1996, and included the collection of data through individual interviews, focus group interviews, and participant observation. 218 people aged 13-26 years participated in individual interviews. Of those, 71 men and 52 women were interviewed in Phnom Penh, and 75 men and 83 women were interviewed in selected villages.

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PURPOSE: To determine whether high school athletic participation among adolescents in Western New York was associated with reduced rates of sexual behavior and pregnancy involvement. METHODS: A secondary analysis of data from the Family and Adolescent Study, a longitudinal study of a random sample of adolescents (ages 13-16 years) from 699 families living in households in Western New York. A general population sample was obtained with characteristics closely matching the census distributions in the area. Interview and survey methods provided data on athletic participation, frequency of sexual relations during the past year, and risk for pregnancy. Bivariate correlations were used to examine relationships among athletic participation, demographic and control variables, and measures of sexual behavior and pregnancy rates. Next, path analyses were done in order to test for hypothesized relationships between athletic participation, sexual behavior, and pregnancy involvement while controlling for age, race, income, family cohesion, and non-athletic forms of extracurricular activity. Variables that were significantly associated with sexual behavior and/or pregnancy involvement were presented for both sexes within the resulting multivariate models. RESULTS: Lower income and higher rates of sexual activity were associated with higher rates of pregnancy involvement for both sexes. Family cohesion was associated with lower sexual activity rates for both sexes. For girls, athletic participation was directly related to reduced frequency of sexual behavior and, indirectly, to pregnancy risk. Male athletes did not exhibit lower rates of sexual behavior and involvement with pregnancy than male non-athletes. Boys who participated in the arts, however, did report lower rates of sexual behavior and, indirectly, less involvement with pregnancy. CONCLUSIONS: Female adolescents who participated in sports were less likely than their non-athletic peers to engage in sexual activity and/or report a pregnancy. Among male adolescents, athletic participation was unrelated to sexual behavior and pregnancy involvement. Teen pregnancy prevention efforts for girls should consider utilizing sport as a strategic tool.

PIP: A longitudinal study using a random sample of adolescents, aged 13-16 years, was conducted in western New York to determine if athletic participation was associated with a reduced rate of sexual behavior and pregnancy. 699 families were interviewed and surveyed, and bivariate correlations were used to examine the relationships among athletic participation, demographic and control variables, and measures of sexual behavior and pregnancy rates. Findings showed that high rates of pregnancy involvement for both sexes were associated with low income and high sexual activity. Higher levels of family cohesion reduced rates of sexual activity for both sexes. Girls' athletic participation was directly proportional to reduced frequency of sexual behavior and, indirectly, to pregnancy risk. However, lower rates of sexual behavior and pregnancy involvement among adolescent male athletes were not discovered. Female adolescents who participated in sports were less likely than their nonathletic peers to engage in sexual activity and/or report a pregnancy. Among male adolescents, athletic participation was unrelated to sexual behavior and pregnancy involvement.

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CONTEXT: Teenagers are exposed to two potentially conflicting sexual health messages, one emphasizing the prevention of sexually transmitted diseases (STDs) and the other stressing pregnancy prevention. To protect teenagers from both STDs and unwanted pregnancy, it is important to know what method choices they make and why. METHODS: Data from a 1997 national survey of 3,550 Australian secondary school students were used to examine teenagers' method choice and patterns of advice-seeking about contraception and STD prevention. Logistic regression analyses were conducted to identify factors associated with the exclusive use of condoms or the pill. RESULTS: Virtually all 961 currently sexually active students were using at least one contraceptive method--primarily condoms (78%) or the pill (45%). Some 31% were using condoms exclusively, and 10% were using the pill exclusively. Older students and those who had sought contraceptive advice had elevated odds of using the pill rather than condoms exclusively (odds ratios, 4.4 and 2.6, respectively), while those who had had only casual partners in the last year had a reduced likelihood of exclusive pill rather than condom use (0.1). Furthermore, the more students believed that their peers used condoms, the less likely they were to report exclusive pill use (0.4). Parents were the most frequent source of advice about contraception, followed by physicians and teachers. The most common sources of advice about HIV and other STDs were parents, teachers and then physicians. CONCLUSIONS: Young people must be educated about the distinction between safer sex and contraception, and about how to prevent both STDs and pregnancy. Providing parents with current sexual health information may help to improve young people's sexual health.

PIP: Data from a 1997 national survey of 3550 Australian secondary school students aged 15 and 17 years old were used to examine teenagers' method choices and patterns of advice-seeking about contraception and STD prevention. 94.8% of the 961 currently sexually active students were using at least 1 contraceptive method. The most often used method was the condom (78.0%), followed by the pill (44.7%) and withdrawal (13.5%). 31% and 10% were using condoms and the pill exclusively, respectively. Older students and those who had sought contraceptive advice were more likely to use the pill rather than condoms exclusively, while those who had had only casual partners in the past year were less likely to use the pill exclusively instead of condoms. The more students believed that their peers used condoms, the less likely they were to report exclusive pill use. Parents were the most frequent source of advice about contraception, followed by physicians and teachers. The most common sources of advice about HIV and other STDs were parents, teachers, and then physicians.

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This paper examines the biosocial basis of premarital sexual and reproductive behaviour among women in Sudan. It applies Udry's biosocial perspective, which attempts to reconcile the biological and sociological models of premarital sexual and reproductive behaviour. World Fertility Survey (WFS) data were used to study premarital first motherhood. Early puberty was found to be paramount in determining childbearing in a separate biological model, but also in a biosocial model constructed to take account of social controls. This finding suggests that social controls do not influence the biological predisposition to premarital sexual behaviour. However, given the limitations of the WFS data, conclusive evidence must await a more appropriately designed study of reproductive behaviour in Sudan.

PIP: This study explores the biosocial basis of premarital sexual and reproductive behavior among women in Sudan. It uses Udry's biosocial perspective, which attempts to reconcile the biological and sociological models of premarital sexual and reproductive behavior. It incorporates the study of premarital first motherhood using World Fertility Survey (WFS) data. Biological, sociological and biosocial hypotheses were formulated to study the nature of the risks of premarital sexual experience. The analysis showed that the biosocial hypothesis may be partially supported not taking into consideration the lack of statistical significance of the effect of midway maturation. Early puberty was found to be paramount in determining childbearing in a separate biological model, but it was also predeterminant in a biosocial model constructed to take account of social controls. This finding suggests that social controls do not influence the biological predisposition to premarital sexual behavior.

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A questionnaire survey was carried out among 1041 students in secondary schools and colleges in Dar-es-Salaam, Tanzania to evaluate the relationship between HIV-risky sexual behaviour and anti-condom bias, as well as with AIDS-related information, knowledge, perceptions and attitudes. Self-reportedly, 54% of students (75% of the boys and 40% of the girls) were sexually active, 39% had a regular sexual partner and 13% had multiple partners in the previous year. The condom use rate was higher than previous reports. However, 30% of sexually active respondents did not always use condoms (Risk-1 behaviour) and 35% of those with multiple partners in the previous year did not always use condoms (Risk-2 behaviour). Multiple logistic regression analyses indicated that 'sex partner hates condom' had association with both Risk-1 behaviour (OR 2.47; 95% CI 1.58-3.85) and Risk-2 behaviour (OR 2.47; 95% CI 1.10-5.48). 'Use of condom prevents HIV infection' also had association with both Risk-1 behaviour (OR 2.09; 95% CI 1.19-3.67) and Risk-2 behaviour (OR 3.73; 95% CI 1.28-11.03). Students engaging in risky behaviour were aware of the risk, even though they failed to change their behaviour. Reasons for the AIDS epidemic among Tanzanian students and the importance of more effective AIDS education are also discussed.

PIP: Tanzania has reported to the World Health Organization (WHO) the largest number of AIDS cases of any country in Africa. As of the end of November 1996, 82,174 AIDS cases had been officially reported to WHO, although the Tanzanian Ministry of Health estimated that about 400,000 people in Tanzania had AIDS at the end of 1995. 419 male and 622 female students aged 16-24 years in secondary schools and colleges in Dar-es-Salaam, Tanzania, answered questionnaires during March-April 1996 in a study conducted to evaluate the relationship between HIV risky sexual behavior and anti-condom attitudes, as well as with AIDS-related information, knowledge, perceptions, and attitudes. Self-reportedly, 75% of the boys and 40% of the girls were sexually active, 54% of the sample overall. 39% had a regular sex partner and 13% had multiple partners in the previous year. 30% of the sexually active respondents and 35% of those with multiple sex partners did not always use condoms when having sex. Multiple regression analysis found that the belief that a sex partner hates condoms was positively associated with inconsistent condom use. Belief in the use of a condom to prevent HIV infection was also associated with inconsistent use. While these students were aware of their risk in having unprotected sexual intercourse, they failed to adopt risk reduction behavior.

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CONTEXT: Although a limited amount of research has retrospectively explored the childhood and adolescent heterosexual experiences of lesbians, little is known about the prevalence of heterosexual behavior and related risk factors or about pregnancy histories among lesbian and bisexual teenagers. METHODS: A secondary analysis was conducted using responses from a subsample of 3,816 students who completed the 1987 Minnesota Adolescent Health Survey. Behaviors, risk factors and pregnancy histories were compared among adolescents who identified themselves as lesbian or bisexual, as unsure of their sexual orientation and as heterosexual. RESULTS: Overall, bisexual or lesbian respondents were about as likely as heterosexual women ever to have had intercourse (33% and 29%, respectively), but they had a significantly higher prevalence of pregnancy (12%) and physical or sexual abuse (19-22%) than heterosexual or unsure adolescents. Among sexually experienced respondents, bisexual or lesbian and heterosexual women reported greater use of ineffective contraceptives (12-15% of those who used a method) than unsure adolescents (9%); bisexual or lesbian respondents were the most likely to have frequent intercourse (22%, compared with 15-17% of the other groups). In the sample overall, among those who were sexually experienced and among those who had ever been pregnant, bisexual or lesbian women were the most likely to have engaged in prostitution during the previous year. CONCLUSIONS: Providers of reproductive health care and family planning services should not assume that pregnant teenagers are heterosexual or that adolescents who say they are bisexual, lesbian or unsure of their sexual orientation are not in need of family planning counseling. Further research should explore the interactions between adolescent sexual identity development and sexual risk behaviors.

PIP: The influence of sexual orientation on adolescents' sexual behaviors and pregnancy histories was investigated in a subsample of 3816 female adolescents, 12-19 years old, who completed the 1987 Minnesota (US) Adolescent Health Survey. 182 identified themselves as bisexual or lesbian, 1753 were unsure of their sexual orientation, and 1881 were heterosexual. Bisexual/lesbian respondents were about as likely as heterosexual respondents ever to have had intercourse (33.0% and 29.3%, respectively), but they had a significantly higher prevalence of childhood physical abuse (19.3% vs. 11.9%) and sexual abuse (22.1% vs. 15.3%) than their heterosexual counterparts. Among sexually experienced respondents, 29.8% of bisexual/lesbian adolescents, 43.5% of those unsure about their identity, and 23.1% of heterosexuals used no contraception and 12.3%, 8.5%, and 14.5%, respectively, of those who used contraception used an ineffective method. 12.3% of bisexual/lesbian women, 6.1% of those unsure about their sexual orientation, and 5.3% of heterosexual adolescents had experienced a pregnancy; 2 or more pregnancies were reported by 23.5%, 15.1%, and 9.8%, respectively, of ever-pregnant teens. Finally, 9.7% of bisexual/lesbian women had engaged in prostitution in the year preceding the survey, compared with 1.9% of heterosexuals and 3.4% of those unsure about their orientation. These findings suggest that adolescents who identify themselves as lesbian or bisexual are at high risk of pregnancy and poor contraceptive practices. Providers of reproductive health care and family planning services should not assume that their pregnant adolescent patients are heterosexual or that lesbian clients or those unsure of their sexual orientation are not in need of contraception.

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CONTEXT: Teenagers' communication with their partners about sex and their use of condoms may be influenced by the discussions teenagers have with their parents about sex. However, little is known about the process of parent-teenager communication on this topic. Understanding both what parents discuss with their children and how they discuss it may lead to a greater understanding of teenagers' sexual behavior. METHODS: Interviews were conducted with 372 sexually active black and Hispanic youth aged 14-17 from Alabama, New York and Puerto Rico. Regression analyses were used to examine parent-teenager discussions about sexuality and about sexual risk, and parental communication skills as predictors of teenagers' discussions about sexual risk with a partner and teenagers' condom use. RESULTS: Parent-teenager discussions about sexuality and sexual risk were associated with an increased likelihood of teenager-partner discussions about sexual risk and of teenagers' condom use, but only if parents were open, skilled and comfortable in having those discussions. Teenagers' communication with their partner about sexual risk also was associated with greater condom use, but the relationship between parent-teenager communication and teenagers' condom use was independent of this association. CONCLUSIONS: The influence on teenagers of parent-teenager discussions about sexuality and sexual risk depends on both what parents say and how they say it. Programs that foster parent-teenager communication about sexuality and sexual risk must emphasize both of these aspects.

PIP: Teenagers' communication with their partners about sex, an important factor in sexual risk reduction, has been shown to be influenced by discussions teens have with their parents about sex. The present study confirmed that parent-teen communication about sex does indeed promote teenagers' discussions with their partners about sex and condom use, but only when parents communicate in a skilled, comfortable, and open manner. Interviews were conducted during 1993-94 with 372 sexually active Black and Hispanic US high school students 14-17 years old from Alabama, New York, and Puerto Rico. On average, teens had first intercourse at age 13.7 years and had had 3.9 partners. The association between parent-teen discussions about sexuality and sexual risk and teenager-partner communication about sex was high when parental responsiveness (openness, skill, comfort) was rated high by the teenager, but this association was weaker and of only marginal significance when responsiveness was rated as low. Similarly, when parental responsiveness was high, sexuality and risk discussions were significantly associated with increased condom use during most recent intercourse and lifetime condom use. However, at low levels of parental responsiveness, sexuality discussions were negatively associated with most recent and lifetime condom use. The association between parent-teen communication and condom use was direct and independent. These findings highlight the importance of communication skills training for parents.

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OBJECTIVES: The availability of long-acting hormonal birth control methods has created new contraceptive options for adolescents. The purpose of this study was to determine whether teens initiating these methods use condoms less frequently than teens using oral contraceptive pills or condoms alone and may therefore be at an increased risk of acquiring sexually transmitted infections. STUDY DESIGN: To investigate ongoing condom behavior in teens using levonorgestrel (Norplant) contraceptive implants, oral contraceptives, and condoms alone, we examined data from a 2-year prospective cohort study of 399 urban teens. The study consisted of 3 clinic-based cohorts of adolescent female contraceptive users: Norplant contraceptive implants (n = 200), oral contraceptives (n = 100), and condoms alone (n = 99). Data were collected at an admission interview and at 1- and 2-year follow-up from method continuers. RESULTS: Norplant contraceptive implant users were less likely than oral contraceptive or condom users to report condom use at last sex or consistent condom use at 1- and 2-year follow-up. The implant group showed a significant decrease in condom use from admission to 2 years after method initiation. The proportion of implant users self-reporting new sexually transmitted infections at 2-year follow-up, however, was not significantly greater than that of oral contraceptive or condom users. CONCLUSIONS: Our findings indicate that teen users of Norplant contraceptive implants are less likely to use condoms than teens who choose oral contraceptives but, probably because of differences in sexual behavior, are no more likely to self-report sexually transmitted infections. Our findings also indicate that teens who choose oral contraceptives and condoms do not use them consistently enough to avoid pregnancies or sexually transmitted infections.

PIP: Ongoing condom behavior was examined among teens using Norplant contraceptive implants, oral contraceptives, and condoms alone. Data were examined from a 2-year prospective cohort study of 399 urban teens in San Francisco, California; 200 female adolescents used Norplant, 100 used oral contraceptives, and 99 used only condoms. Norplant users were less likely than oral contraceptive or condom users to report condom use at most recent sexual intercourse or consistent condom use at the 1- and 2-year follow-ups. However, while Norplant users had a significant decrease in condom use from admission to 2 years after method initiation, the proportion of implant users self-reporting new sexually transmitted infections at the 2-year follow-up was not significantly higher than that of oral contraceptive or condom users.

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Although the teenage pregnancy rates in the UK are falling in the 16 to 19 year old range, they are still rising in the 13 to 15 year olds. Overall, they remain one of the highest within Western Europe. Teenagers continue to present a challenge to the health services due to the increase in their sexual risk taking behaviour, the earlier age at which they are starting sexual activity and a reluctance to utilise services available to them. In an attempt to develop current services and make them more 'user friendly', a sexual health needs assessment was carried out on teenagers, part of which looked at their attitudes towards risk taking sexual behaviour and their declared sexual behaviour. A quantitative survey, using a questionnaire in schools, was answered by 1500 pupils aged between 13 and 18 years old, and showed that the majority of teenagers had declared some form of sexual contact with a partner with a degree of sexual activity increasing with age. Twenty per cent of 13 year olds reported that they had already had either full or oral sexual intercourse with a partner. Feeling peer pressure, not knowing the facts about sexual risk taking and a declared intent that would increase the likelihood of putting themselves or others at risk sexually were significantly more likely in the younger teenage boys surveyed. This study confirms that there remain many different factors involved in teenagers' decision-making processes, about their developing attitudes towards sex and their resultant behaviour. Despite a lack of maturity, such opinions and attitudes are bringing about definite views and sexual behaviour patterns in teenagers as young as 12 or 13 years old who are becoming fully sexually active. In particular teenage boys are becoming fully sexually active at a younger age than the girls and are taking risks in doing so. They are being influenced by peer pressure, condoning promiscuity and are declaring the intent to practice unsafe sexual intercourse. Their level of maturity would appear to be inadequate for them to comprehend the implications and consequences of their actions. This study has shown a need for developing adequate education and provision of sexual health services for teenagers, particularly for teenage boys, and that this may go some way in helping to address the imbalances found.

PIP: A needs assessment conducted by the Barking and Havering Health Authority (England) focused on the sexual attitudes and behaviors of British adolescents. 1500 young people 13-18 years old completed a questionnaire. 78% of respondents reported some form of sexual contact with a partner and 23% had experienced sexual intercourse. 38% of male respondents and 11% of females indicated that their peers pressured them to regard sex as the most important thing in a relationship. 10% of teens indicated they would be embarrassed to suggest condom use to a partner and 37% were concerned about appearing clumsy when using a condom. 23% of males and 9% of females claimed they would be willing to have sexual intercourse without use of a condom, despite awareness of the risks involved. Sexually active youth under 16 years old were significantly less likely to use condoms than their older counterparts. Although these findings suggest that teenage boys are at especially high risk of sexual promiscuity and non-use of contraception, service provision remains focused on teenage girls.

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BACKGROUND AND OBJECTIVES: To describe (a) demographic characteristics, (b) sexual history, (c) perceived HIV susceptibility, and (d) current sexual behavior, condom use, and alcohol and marijuana use of heterosexual, low-income African American and Hispanic youth categorized as relatively monogamous (n = 577), serial monogamous (n = 171), or nonmonogamous (n = 278). STUDY DESIGN: Data were drawn from personal interviews with a probability sample of low-income youth, age 15 to 24 years, conducted in Detroit in 1991. RESULTS: Many group differences were found. For example, relatively monogamous youth were most likely to be female and Hispanic and to have engaged in unprotected intercourse. Serial monogamous youth were younger and most likely to have used condoms at last intercourse. Nonmonogamous youth initiated intercourse earlier and were most likely to have experienced oral and anal intercourse and to have used alcohol and marijuana. CONCLUSION: Risk reduction programs may need to be tailored differently to accommodate the needs of these three distinct subgroups of youth.

PIP: An understanding of differences in contraceptive use patterns among monogamous, serially monogamous, and nonmonogamous adolescents is essential to the design and targeting of condom promotion interventions. Interviews were conducted in Detroit, Michigan (US), in 1991 with a probability sample of 1062 heterosexual, low-income, African American and Hispanic youth 15-24 years of age. 577 were categorized as relatively monogamous, 171 as serially monogamous, and 278 as nonmonogamous. Monogamous youth were most likely to be female, Hispanic, married, and to have engaged in unprotected intercourse. Those who practiced serial monogamy were likely to be younger and to have used condoms at last intercourse. Nonmonogamous youth initiated intercourse earlier, were most likely to have experienced oral and anal intercourse, tended not to use contraception, and had the highest use rates of alcohol and marijuana. Condom use at last intercourse was reported by 38.6% of monogamous youth, 57.3% of the serially monogamous, and 38.2% of nonmonogamous youth; consistent condom use during the past year was reported by only 3.0%, 3.1%, and 2.5%, respectively. Discriminant analysis indicated that age at first intercourse, experience with oral sex, and number of partners best distinguished monogamous youth from serial and nonmonogamous youth. The 3 groups differed significantly in their perceived susceptibility to HIV; 11.0%, 17.8%, and 23.6%, respectively, had ever worried about contracting HIV from a partner. Risk reduction programs should be tailored to accommodate the different needs of these 3 subgroups. For example, nonmonogamous youth tend to be sensation seekers and may be more responsive to condom promotion campaigns that emphasize pleasure enhancement than to fear-based interventions.

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CONTEXT: The formulation of policies and development of programs regarding adolescent sexual and reproductive health requires up-to-date information on levels of and trends in teenage sexual activity. METHODS: Analysis of three NSFG surveys, carried out in 1982, 1988 and 1995, allows examination of the sexual behavior of teenage women over a 13-year time period, using comparable data for the entire time period. RESULTS: The proportion of adolescent women who ever had sexual intercourse increased somewhat during the 1980s, but this upward trend stabilized between the late 1980s and the mid-1990s. Throughout the period, there has been little change in the proportion currently sexually active: In each of the surveys, about 40% of all 15-19-year-olds had had sexual intercourse in the last three months. The average number of months in the past year in which sexually experienced teenagers had had intercourse declined during the 1980s, with no change in the continuity of sexual intercourse taking place between 1988 and 1995, when the mean remained at 8.6 months. Differences in teenage sexual behavior across poverty and racial and ethnic subgroups were large in the early 1980s, but narrowed over the 13-year period. CONCLUSIONS: Only continued monitoring will tell whether the patterns observed during 1988-1995 signify a temporary leveling off in the trend toward increasing adolescent sexual activity, stability in behavior or the beginnings of a decline. Nevertheless, the sustained level of initiation of sexual activity during adolescence is by now a recognized pattern of behavior, and is an important characteristic of the transition to adulthood in the United States.

PIP: A study on the trends in sexual activity among adolescent American women over a 13-year period is presented. Data from the National Survey of Family Growth (NSFG) carried out in 1982, 1988 and 1995 were used to examine the sexual behavior of teenage women. Analysis of these three NSFG surveys demonstrated an increase in the proportion of adolescent women who ever had sexual intercourse during the early to mid-1980s. This upward trend stabilized between the late 1980s and the mid-1990s. All the surveys revealed that about 40% of all teenagers age 15-19 years had sexual intercourse in the last 3 months. Large differences in teenage sexual behavior across poverty and racial and ethnic subgroups were observed in the early 1980s, but narrowed over the 13-year period. These findings suggest that trends in levels of sexual activity among American adolescents must be viewed from a long-term perspective. Only continued monitoring will show whether the patterns observed from 1988 to 1995 indicate stability in behavior, a temporary leveling off in the trend toward increasing adolescent sexual activity or the precursor of a decline. Nevertheless, the constant level of initiation of sexual activity during adolescence is by now a recognized pattern of behavior. It is considered an essential characteristic of the transition to adulthood in the US.

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PIP: This study examined the factors associated with sexual behavior and attitudes of never-married youth in Thailand. Data obtained from 577 never married males and 517 never married females aged 15-24 years were analyzed. Multivariate analyses using a logistic regression revealed that there was a difference in male-female sexual attitudes and behavior bearing important consequences. More than half of the Thai male adolescents were sexually active and the majority of their sexual encounters appeared to be with commercial sex workers. In contrast, the majority of young sexually active Thai female adolescents engaged in sexual acts with their boyfriends. The results suggested that although family variables had no effect on never-married youths' sexual behaviors, it had an influence in the formation of their attitudes. The factors that were most likely to affect the probability of having premarital sex were related to loosening constraints, especially parental and community control. In terms of cultural norms pertaining to sexuality in Thailand, differences in attitude and behavior between males and females can be explained by the impact of early socialization on the patterns of sexual behavior. Young women in this study expressed more nonpermissive attitudes about premarital sexuality and had much lower rates not only of sexual intercourse but also of all types of sex-related behaviors compared to their male counterparts.^ieng

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In Imperial China sexual behaviour was regarded as an indispensable activity to reach harmony with the universe, through the unity of the interaction of two opposing forces: yin and yang. Sexual intercourse was accepted when linked to procreation within a family context, while an individual's sexuality was not considered important. Homosexuality was tolerated although not advocated, while masturbation was denounced. Since the One Child Family and Open Door policies in the 1970s and the economic reforms of the 1980s, attitudes towards sexuality in China have changed. Premarital sex has become widely accepted among young people and people in China are now more tolerant toward extramarital sex. Nowadays young people consider that love should dominate marriage and the quality of an individual's sex life is currently more valued than it used to be. Attitudes towards masturbation have become more tolerant and though homosexuality has been hidden by society for a long time, in recent years it has begun to be considered as a legitimate lifestyle choice. Attitudes towards sex and sexual behaviour have become recognized as an individuals' responsibility as long as no offence occurs against society or the interests of other individuals, resulting in the recognition of diversity of sexual behaviour. As part of the changing attitudes to sex and sexual behaviour, heterosexual transmission is becoming the most important route of HIV transmission in China. This is complicated by the internal migration of an estimated 120 million labourers moving from the countryside to the cities as the result of economic reforms, most of whom are sexually active young men. Unless addressed directly, these factors may add to the estimated 300,000 HIV-infected Chinese, further fuelling an already rapidly spreading epidemic. The ramifications of the Chinese HIV epidemic will not only be felt within China, but also within the surrounding Asian countries thereby fuelling the HIV pandemic.

PIP: This paper discusses the changing attitudes towards sex and sexual behavior in China and its implications for the potential future spread of HIV. Two important philosophies have influenced the evolution of imperial Chinese attitudes toward sex and sexual behavior. Confucianism stressed conformity of sexual behavior within the boundaries set by society, while Taoism encouraged multiple sexual partners and prolonged sexual intercourse to promote better health and pleasure. In addition, homosexuality and commercial sex was tolerated, but masturbation was denounced. This tolerant attitude came to an end in the 17th century when the government exerted effort against all forms of extra-marital sexuality including homosexuality and masturbation. However, with the introduction of the One Child Family and Open Door policies by the end of the 20th century, attitudes toward sex and sexuality changed again. The Chinese have widely accepted premarital sex and are more tolerant toward extramarital sex. Homosexuality has begun to be considered as a legitimate lifestyle choice and attitudes towards masturbation have become more tolerant. Attitudes towards sex and sexual behavior have become recognized as an individual's responsibility as long as no offence occurs against society or other individuals, resulting to an increasing diversity of sexual behavior. Consequently, HIV infections are also rapidly increasing with heterosexual transmission becoming the most important route of transmission. This critical situation needs to be addressed immediately in order to control the AIDS epidemic in China as well as the rest of the Asian region.

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PIP: It is not easy to collect valid and reliable data on sexual behavior, and despite the development of more sophisticated survey instruments since the 1980s, largely in response to the HIV/AIDS pandemic, many problems persist. Since the advent of AIDS, there is a greater need to obtain accurate data on sexual behavior. Findings are presented from a comparison of data collected in a questionnaire survey with those collected through in-depth interviews. 58 young men from Glasgow were interviewed twice at a year's interval, first as part of a general health and lifestyle survey and then in an in-depth interview focusing upon sex. Considerable discrepancies were observed between the 2 studies in reported sexual behavior and knowledge. Poor concordance was observed between the 2 studies on age and contraception at first intercourse and upon the number of sex partners at age 18 years. Moreover, there was almost no consistency between the 2 studies regarding participants' understanding of the notion of safer sex. The most likely explanations for the discrepancies between the studies are poor recall, inadequate understanding of the question, and differing presentational concerns, especially related to embarrassment. Poor recall and embarrassment are particularly possible explanations because they can account for discrepancies in both directions. While the evidence suggests that the in-depth interview data may have greater validity than the survey data, the analysis nonetheless identifies ways of improving survey methods on sex.^ieng

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This paper presents findings from a survey of 424 people attending nine young people's clinics within the Southampton Community Health NHS Trust. In addition to recording some descriptive background data on the people attending the clinics, one major aim of the study was to investigate whether talking to the sexual partner about contraception before their first intercourse together and delaying this first intercourse influenced contraceptive use. Overall, 40 per cent of people attending the clinics were aged 16 or under, although there was some variation between clinics in the age groups attracted. Most clients were female (88 per cent), had ever had sexual intercourse (92 per cent), reported four or more lifetime partners (42 per cent) but only one partner within the last six months (73 per cent) and were currently in a relationship (75 per cent). Potential for contraception and sexually transmitted infection was widespread; 46 per cent (of non-virgins) had had intercourse without contraception at least 'a few times' and 18 per cent used condoms 'rarely' or 'never'. In terms of first intercourse with current/most recent partner, 17 per cent had not used any contraception and 32 per cent had failed to use condoms. The most important findings from this study were that use of contraception (and condoms in particular) on the occasion of first intercourse with the current or most recent partner was significantly associated with the following; if partners had talked to each other about contraception before having intercourse together for the first time (p<0.001), and also if this first intercourse was delayed beyond four weeks as opposed to over a few days of first 'going-out' together (p<0.001). Suggestions for further in-depth research are made.

PIP: Findings are presented from a May-June 1997 survey of 424 people aged 12-34 years, of mean age 18.7 years, attending 9 young people's clinics within the Southampton Community Health NHS Trust. 40% of clinic attenders were aged 16 years or younger, although there was some variation between clinics in the age groups attracted. 88% of clients were women, 92% had ever had sexual intercourse, 28% of non-virgins reported having ever had only 1 sex partner, 42% reported having 4 or more lifetime sex partners, and 75% were currently in a relationship. 46% of non-virgins had had intercourse without using contraception at least a few times, and 18% rarely or never used condoms. With regard to the first act of intercourse with the most recent sex partner, 17% had not used contraception and 32% had not used a condom. The use of contraception, and condoms in particular, on the first act of sexual intercourse with the current or most recent partner was significantly associated with whether partners had discussed contraception with each other before having intercourse together for the first time, and if that first intercourse was delayed beyond 4 weeks rather than for just a few days after having started dating each other.

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PURPOSE: To determine whether sexually active adolescent males who report being the victim of forced sexual contact and engaging in health risk and problem behaviors are more likely to report getting someone pregnant. METHODS: In 1995, 4159 students in Grades 9-12 in 59 randomly selected public high schools in Massachusetts were anonymously surveyed using the Youth Risk Behavior Survey (YRBS). Data were analyzed for 824 sexually active males. Demographic variables and indicators of sexual behavior, pregnancy, violence, and suicide were assessed. Data were analyzed with multiple logistic regression. RESULTS: A total of 12.0% of sexually active males reported having been involved in a pregnancy. The proportion of males who reported getting a partner pregnant increased with age. Of the sample, 8.1% gave a history of having had sexual contact against their will. Of those who reported forced sexual contact, 36.4% reported having been involved in a pregnancy; of the males who did not report a history of forced sexual contact, 9.4% were involved in a pregnancy (CV = 0.23; p < 0.00001). Based on multiple logistic regression, forced sexual contact [odds ratio (OR) 3.56; 95% confidence interval (CI) 1.79-7.09], frequency of weapon carrying on school property (OR 1.39; 95% CI 1.18-1.64), number of cigarettes smoked per day (OR 1.22; 95% CI 1.08-1.38), number of sexual partners in the previous 3 months (OR 1.43; 95% CI 1.25-1.65), and condom nonuse at last intercourse (OR 1.80; 95% CI 1.06-3.02) correctly classified 89.9% of the males who were involved in a pregnancy. CONCLUSION: This study highlights the association between health-risk and problem behaviors, forced sexual contact, and involvement in pregnancy among sexually active male high school students. In our analysis, a history of forced sexual contact was associated with a higher risk of high school males' involvement in pregnancy. These results strongly suggest the importance of screening sexually active males for a history of forced sexual intercourse and health risk and problem behaviors in the effort to prevent teenage pregnancy and childbearing.

PIP: The hypothesis that adolescent males who cause a pregnancy are more likely to have been victims of forced sexual contact and to have engaged in health risk and problem behaviors in the recent past than their sexually active counterparts who have not been involved in a pregnancy was investigated through use of a subset of data from the Massachusetts (US) 1995 Youth Risk Behavior Survey. 99 (12%) of the 824 sexually active male survey respondents reported having caused a pregnancy. A history of forced sexual contact was reported by 8.1%. Among those acknowledging forced sexual conduct, 36.4% had caused a pregnancy; of those without such a history, only 9.4% were involved in a pregnancy (p 0.00001). In addition, males who were involved in a pregnancy reported a greater likelihood of engaging in 16 health risk and problem behaviors in the previous 1, 3, and 12 months than those not involved in a pregnancy. Multiple logistic regression analysis identified 5 significant, independent predictors of having impregnated a female adolescent: number of sex partners in the previous 3 months (adjusted odds ratio (OR), 1.43; 95% confidence interval (CI), 1.25-1.65); history of forced sexual contact (OR, 3.56; 95% CI, 1.79-7.09); carrying weapons on school property (OR, 1.39; 95% CI, 1.18-1.64); cigarettes smoked/day (OR, 1.22; 95% CI, 1.08-1.38); and condom nonuse at last intercourse (OR, 1.80; 95% CI, 1.06-3.02). This model correctly classified 89.9% of sexually active male students who had been involved in a pregnancy. These findings suggest a need to screen sexually active males for these risk factors, especially a history of forced sexual contact, as part of interventions aimed at preventing adolescent pregnancy.

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