Abstract
Objectives
We applied the Integrative Model of Behavioral Prediction to analyze factors associated with risky sexual behaviors for adolescent students living in the poorest segments in Costa Rica.
Methods
We used data from a school-based knowledge, attitudes, and behaviors survey from the poorest districts of Costa Rica, collected for Salud Mesoamerica Initiative. We analyzed responses of 919 male and female students (12–19 years old) to determine factors associated with sexual intercourse and condom use.
Results
One of every four students reported being sexually active. Students that reported being sexually active were more likely to consume excessive alcohol (OR 3.04 [95 % CI 1.94–4.79]). While 88.0 % [95 % CI 73.5–95.1] of sexually active adolescents said they would use a condom the next time they have sex, only 53.1 % [95 % CI 39.3–66.5] reported condom use the last time. Non-condom-users felt purchasing condoms was uncomfortable (OR 0.34 [95 % CI 0.12–0.93]).
Conclusions
Poor adolescents in Costa Rica begin sexual activities early and undertake behaviors that increase their risk for unwanted pregnancies and sexually transmitted infections. We found the urgent need to address alcohol abuse, and recognize gender differences in youth health programs.
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References
Archer KJ, Lemeshow S (2006) Goodness-of-fit test for a logistic regression model fitted using survey sample data. Stata J 6:97–105
Atkin C (2004) Media intervention impact: evidence and promising strategies. In: Bonnie RJ, O’Connell ME (eds) Reducing underage drinking: a collective responsibility. National Academies, Washington, DC
Azevedo JP, Favara M, Haddock SE et al (2012) Teenage pregnancy and opportunities in latin america and the caribbean: on teenage fertility decisions, poverty and economic achievement. The World Bank, Washington, DC
Baliunas D, Rehm J, Irving H, Shuper P (2010) Alcohol consumption and risk of incident human immunodeficiency virus infection: a meta-analysis. Int J Public Health 55:159–166. doi:10.1007/s00038-009-0095-x
Bersamin M, Todd M, Remer L (2011) Does distance matter? Access to family planning clinics and adolescent sexual behaviors. Matern Child Health J 15:652–659. doi:10.1007/s10995-010-0618-3
Chandra-Mouli V, Lane C, Wong S (2015) What does not work in adolescent sexual and reproductive health: a review of evidence on interventions commonly accepted as best practices. Glob Health Sci Pract. doi:10.9745/GHSP-D-15-00126
Dehne KL, Riedner G, World Health Organization et al (2005) Sexually transmitted infections among adolescents: the need for adequate health services. Department of Child and Adolescent Health and Development, World Health Organization; Deutsche Gesellschaft für Technische Zusammenarbeit, Division for Health, Education and Social Protection, Geneva, Eschbom
Espindola E, Leon A (2002) La deserción escolar en América Latina: un tema prioritario para la agenda regional. Rev Ibero-Am Educ 30:39–62
Fishbein M, Yzer MC (2003) Using theory to design effective health behavior interventions. Commun Theory 13:164–183. doi:10.1111/j.1468-2885.2003.tb00287.x
González Gómez A (2013) Uniones tempranas y embarazo en la niñez y en la adolescencia. UNFPA, San Jose
Groves RM (2006) Nonresponse rates and nonresponse bias in household surveys. Public Opin Q 70:646–675. doi:10.1093/poq/nfl033
IAFA (2013) Encuesta nacional sobre consumo de drogas en población de educación secundaria: Costa Rica 2012. Instituto sobre Alcoholismo y Farmacodependencia, San Jose
INEC (2012) Encuesta Nacional de Hogares Julio 2012: Resultados Generales. Instituto Nacional de Estadística y Censos, San Jose
INEC (2013) Costa Rica Mapas de Pobreza 2011. Instituto Nacional de Estadística y Censos, San Jose
INEC (2015) Indicadores Demográficos Cantonales. 2013, 1st edn. Instituto Nacional de Estadística y Censos, San Jose
Kinsman SB, Romer D, Frustenberg FF, Schwarz DF (1998) Early sexual initiation: the role of peer norms. Pediatrics 102:1186–1192
Kirby D (2011) Reducing adolescent sexual risk: a theoretical guide for developing and adapting curriculum based programs. ETR Associates, Scotts Valley
Klepinger D, Lundberg S, Plotnick R (1999) How does adolescent fertility affect the human capital and wages of young women? J Hum Resour 34:421. doi:10.2307/146375
Miller JW, Naimi TS, Brewer RD, Jones SE (2007) Binge drinking and associated health risk behaviors among high school students. Pediatrics 119:76–85. doi:10.1542/peds.2006-1517
Ministerio de Salud, Costa Rica (2011) Informe de Resultados: Encuesta de Salud Sexual y Reproductiva, Costa Rica, 2010. Ministerio de Salud, San Jose, Costa Rica
Mokdad AH (2009) The behavioral risk factors surveillance system: past, present, and future. Annu Rev Public Health 30:43–54. doi:10.1146/annurev.publhealth.031308.100226
Mokdad AH, Colson KE, Zúñiga-Brenes P et al (2015) Salud Mesoamérica 2015 Initiative: design, implementation, and baseline findings. Popul Health Metr. doi:10.1186/s12963-015-0034-4
Mokdad AH, Forouzanfar MH, Daoud F et al (2016) Global burden of diseases, injuries, and risk factors for young people’s health during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet. doi:10.1016/S0140-6736(16)00648-6
Murray CJL, Ortblad KF, Guinovart C et al (2014) Global, regional, and national incidence and mortality for HIV, tuberculosis, and malaria during 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 384:1005–1070. doi:10.1016/S0140-6736(14)60844-8
Näslund-Hadley E, Binstock G (2010) The miseducation of Latin American girls: poor schooling makes pregnancy a rational choice. Inter-American Development Bank, Washington, DC
Newson R (2006) Confidence intervals for rank statistics: Somers’ D and extensions. Stata J 6:309–334
Nic Gabhainn S, Baban A, Boyce W et al (2009) How well protected are sexually active 15-year olds? Cross-national patterns in condom and contraceptive pill use 2002–2006. Int J Public Health 54:209–215. doi:10.1007/s00038-009-5412-x
Pradhan R, Wynter K, Fisher J (2015) Factors associated with pregnancy among adolescents in low-income and lower middle-income countries: a systematic review. J Epidemiol Community Health 69:918–924. doi:10.1136/jech-2014-205128
Pregibon D (1979) Data analytic methods for generalized linear models. Dissertation, University of Toronto, Toronto, Canada
Santelli JS, Robin L, Brener ND, Lowry R (2001) Timing of alcohol and other drug use and sexual risk behaviors among unmarried adolescents and young adults. Fam Plann Perspect 33:200–205
Shah IH, Åhman E (2012) Unsafe abortion differentials in 2008 by age and developing country region: high burden among young women. Reprod Health Matters 20:169–173. doi:10.1016/S0968-8080(12)39598-0
UNICEF (2008) Desarrollo positivo adolescente en América Latina y el Caribe. Oficina Regional para América Latina y El Caribe, Panama City
Vivo S, López-Peña P, Saric D (2012) Sexual and reproductive health for youth: review of evidence for prevention. Inter-American Development Bank, Washington, DC
WHO (2002) World report on violence and health. World Health Organization, Geneva
WHO (2011) Preventing early pregnancy and poor reproductive outcomes among adolescents in developing countries. World Health Organization, Geneva
WHO (2014a) Adolescent pregnancy. World Health Organization, Geneva, Switzerland. http://www.who.int/mediacentre/factsheets/fs364/en/. Accessed 26 Aug 2015
WHO (2014b) Adolescents: health risks and solutions. World Health Organization, Geneva
WHO (2014c) Alcohol and inequities: guidance for addressing inequities in alcohol-related harm. World Health Organization, Regional Office for Europe, Copenhagen
Acknowledgments
We would like to thank the team by the University of Costa Rica, directed by Eyleen Alfaro Porras, for conducting in-country data collection, and the Ministries of Health and Education in Costa Rica for their support to complete this study.
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All authors declare that there are no conflicts of interest.
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This study was funded by the Bill & Melinda Gates Foundation, the Carlos Slim Foundation, and the Spanish Agency for International Development Cooperation, through the Inter-American Development Bank. The opinions expressed in this publication are those of the authors and do not necessarily reflect the views of the Inter-American Development Bank, its Board of Directors, or the countries they represent.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study.
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A. H. Mokdad and E. Iriarte are joint senior authors.
This article is part of the special issue “Development and Public Health”.
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Rios-Zertuche, D., Cuchilla, J., Zúñiga-Brenes, P. et al. Alcohol abuse and other factors associated with risky sexual behaviors among adolescent students from the poorest areas in Costa Rica. Int J Public Health 62, 271–282 (2017). https://doi.org/10.1007/s00038-016-0859-z
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DOI: https://doi.org/10.1007/s00038-016-0859-z