Sexual risk among Colombian adolescents: knowledge, attitudes, normative beliefs, perceived control, intention, and sexual behavior
Date
2018-12-06
2018-12-06
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Abstract
Background: Colombia has one of the highest rates of the human immunodeficiency virus (HIV) and pregnancies - both of which are influenced by lack of condom use -, among adolescent population in Latin America; however, the mechanisms underlying the inconsistent use of condoms in this population are poorly understood. This descriptive and cross-sectional study’s purpose was to examine sexual behavior and its precursors using the theory of planned behavior (TPB) and considering gender-based differences. Another objective was to study the mediating effect of intention in the relationship between behavior precursors and condom use based on the TPB. Methods: We recruited 1100 adolescents aged between 14 and 19 years old (M = 15.94, SD = 1.30, 54.4% female) from Bogotá and Barranquilla, two of the cities with highest adolescent birth rates among adolescents in Colombia. Sociodemographic variables, knowledge on HIV and other sexually transmitted infections (STIs), HIV/AIDS-related attitudes, including attitudes toward the use of condoms, normative beliefs, perceived behavioral control, behavioral intention, and sexual behavior were assessed using self-reports. All analyses were run using SPSS v25. The indirect effect of intention to explain the relationship between precursors and the use of condoms during sexual intercourse was estimated using the PROCESS v3 macro. Results: Descriptive analyses suggest a high risk of contracting sexually transmitted infections and unplanned pregnancies associated to inconsistent condom use, medium-low level of knowledge about sexual health, low normative beliefs regarding peers’ condom use, and a certain perceived difficulty for using condoms. Condoms are used 71% of the times they have sex, but only 22% of the participants use them consistently; girls use condoms more consistently than boys. Sexual risk characteristics differed significantly by gender. Mediation analyses indicated that condom use intention mediates the relationship between behavioral precursors and frequency of condom use, according to the TPB. Conclusions: Findings provide a better understanding of sexual risk and highlight important implications for the sexual and reproductive health of adolescents. There is a need of designing and implementing protocolized sexual health promotion programs in schools with the aim of reducing sexual risk behaviors in Colombian adolescents.
Referencias:
1. World, Health Organization. Adolescente Pregnancy. 2018. Retrieved from: https://www.who.int/es/news-room/fact-sheets/detail/adolescentpregnancy. 2. Plataforma Regional para América Latina y el Caribe. Cuáles son los países de América Latina con más casos nuevos de VIH/sida. [What are the countries in Latin America with the most new HIV / AIDS cases?] 2017. Accessed 3 May 2018. 3. Ministerio de Salud y Protección Social. Encuesta nacional de demografía y salud, ENDS. [National demographic and health survey, ENDS] 2015. Retrieved from: http://microdata.worldbank.org/index.php/catalog/2834 4. Departamento Administrativo Nacional de Estadística. Nacimientos 2017. Preliminares. In: Births 2017 - preliminary; 2017. 5. OPS and UNICEF. Acelerar el progreso hacia la reducción del embarazo en la adolescencia en América Latina y el Caribe [Accelerate progress towards reducing adolescent pregnancy in Latin America and the Caribbean]. 2018. Retrieved from https://www.unicef.org/lac/informes/acelerar-el-progresohacia-la-reducci%C3%B3n-del-embarazo-adolescente-en-am%C3%A9ricalatina-y-el. 6. Villegas-Castaño A, Tamayo-Acevedo LS. Prevalence of sexually transmitted infections, and risk factor for sexual health of adolescents, Medellín, Colombia, 2013. Iatreia. 2016;29:5–17. 7. Paredes MC, Gómez YM, Torres AM, Fernández M, Tovar MB. Prevalencia de infecciones por chlamydia trachomatis y Neisseria gonorrhoeae en adolescentes de colegios de la provincia de Sabana Centro, Cundinamarca, Colombia [prevalence of infections by chlamydia trachomatis and Neisseria gonorrhoeae in adolescents from schools in the province of Sabana Centro, Cundinamarca, Colombia]. Biomedica. 2015;35:324. 8. Avellaneda CN, Dávalos E. Identifying the macro-level drivers of adolescent fertility rate in Latin America: the role of school-based sexuality education. Am J Sex Edu. 2017;12:358–82. 9. Leppälahti S, Gissler M, Mentula M, Heikinheimo O. Is teenage pregnancy an obstetric risk in a welfare society? A population-based study in Finland, from 2006 to 2011. BMJ Open. 2013;3:e003225. 10. Kim SH, Gerver SM, Fidler S, Ward H. Adherence to antiretroviral therapy in adolescents living with HIV: systematic review and meta-analysis. AIDS. 2014;28:1945–56. 11. Fishbein M, Ajzen I. Predicting and changing behavior: the reasoned action approach. New York: Taylor & Francis; 2011. 12. Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991;50:179–211. 13. Armitage CJ, Conner M. Efficacy of the theory of planned behaviour: a meta-analytic review. Br J Soc Psychol. 2001;40:471–99. 14. Albarracin D, Johnson BT, Fishbein M, Muellerleile PA. Theories of reasoned action and planned behavior as models of condom use: a meta-analysis. Psychol Bull. 2001;127:142. 15. Espada JP, Morales A, Guillén-Riquelme A, Ballester R, Orgilés M. Predicting condom use in adolescents: a test of three socio-cognitive models using a structural equation modeling approach. BMC Public Health. 2016;35. https:// doi.org/10.1186/s12889-016-2702-0. 16. Girón SL, Palacio H, Mateus JC. HIV sexual risk behaviors in youth 15-24 years of age in Cali, Colombia: do differences exist among neighborhoods? Colombia Médica. 2013;44:72–9. 17. García-Corzo JR, Tarazona-Álvarez Y, Rojas-Gómez JP, Bayona-Millán E, DíazMartínez LA. Knowledge on human immunodeficiency virus mechanisms of transmission among schoolchildren in the age range of 11 to 20 years old from poor districts of Bucaramanga, Colombia. Arch Argent Pediatr. 2016;114:209–15. 18. Vinaccia S, Quiceno JM, Gaviria AM, Soto AM, Gil Llario MD, Ballester Arnal R. Conductas sexuales de riesgo para la infección por VIH/sida en adolescentes colombianos. Terapia. Psicológica. 2007;25:39–50. 19. Gómez-Camargo DE, Ochoa-Diaz MM, Canchila-Barrios CA, Ramos-Clason EC, Salguedo-Madrid GI, Malambo-García DI. Sexual and reproductive health in university students at an institution of higher learning in Colombia. Rev Salud Publica. 2014;16:660–72. 20. Observatorio del Bienestar en la Niñez. Embarazo en adolescentes. Generalidades y percepciones [pregnancy in adolescents generalities and perceptions]. 2015. Retrieved from:https://www.icbf.gov.co/sites/default/ files/embarazo-adolescente-web2015.pdf. 21. Abello-Luque D, Espada JP, García-Montaño, E., Gómez-Lugo, M, Morales A, Pérez-Pedraza D, Vallejo-Medina P. Validation for Colombia of the knowledge scale on HIV and other sexually transmitted infections in adolescents. Manuscript under review. 2018. 22. Gómez-Lugo M, Vallejo-Medina P, Marchal-Bertrand L, Morales A, NieblesCharris J, García-Roncallo P. Psychometric properties of the Colombian version of the HIV attitudes scale for adolescents. Manuscript under review 2018. 23. Cohen J. Statistical power analysis for the behavioral sciences Hillsdale, N.J.: L. Erlbaum Associates; 1988. 24. Hayes AF. Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. New York: Guilford Press; 2013. 25. Escribano S, Espada J, Morales A, Orgilés M. Mediation analysis of an effective sexual health promotion intervention for Spanish adolescents. AIDS Behav. 2015;19:1850–9. 26. Espada JP, Escribano S, Orgilés M, Morales A, Guillén-Riquelme A. Sexual risk behaviors increasing among adolescents over time: comparison of two cohorts in Spain. AIDS Care. 2015;27:783–8. 27. Espada JP, Escribano S, Morales A, Orgilés M. Two-year follow-up of a sexual health promotion program for Spanish adolescents. Eval Health Prof. 2017; 40:483–504.28. Morales A, Espada JP, Orgilés M. Mediation of an efficacious HIV risk reduction intervention for adolescents: a cluster-randomised controlled trial. J Health Psychol. 2017. https://doi.org/10.1177/1359105317707256 . 29. Navarro E, Vargas R. Conocimientos, actitudes y prácticas sobre SIDA en adolescentes escolarizados. [Knowledge, attitudes and practices on AIDS in school-aged adolescents]. Salud Uninorte. 2004;19:14 –24. 30. Valencia CP, Canaval GE. Factors predisposing, facilitating and strengthening condom use amongst university students in Cali, Colombia. Rev Salud Publica. 2012;14:810 –21. 31. Mittal M, Senn TE, Carey MP. Intimate partner violence and condom use among women: does the information –motivation –behavioral skills model explain sexual risk behavior? AIDS Behav. 2012;16:1011 –9. 32. Ybarra ML, Korchmaros JD, Prescott TL, Birungi RA. Randomized controlled trial to increase HIV preventive information, motivation, and behavioral skills in Ugandan adolescents. An Behav Med. 2015:1 –13. 33. Romero LM, Galbraith JS, Wilson-Williams L, Gloppen KM. HIV prevention among African American youth: how well have evidence-based interventions addressed key theoretical constructs? AIDS Behav. 2011;15:976 –91. 34. Faílde-Garrido JM, Lameiras-Fernández M, Bimbela-Pedrola JL. Prácticas sexuales de chicos y chicas españoles de 14-24 años de edad [sexual practices of Spanish boys and girls 14-24 years of age]. Gac Sanit. 2008;22: 511 –9. 35. Eversole JS, Berglas NF, Deardorff J, Constantine NA. Source of sex information and condom use intention among Latino adolescents. Health Edu & Behav. 2017;44:439 –47. 36. Espada JP, Guillén-Riquelme A, Morales A, Orgilés M, Sierra JC. Validación de una escala para evaluar el conocimiento sobre el VIH y otras infecciones de transmisión sexual en población adolescente. Aten Prim. 2014;46:558 –64. 37. Espada JP, Orgilés M, Morales A, Ballester R, Huedo-Medina TB. Effectiveness of a school HIV/AIDS prevention program for Spanish adolescents. AIDS Educ Prev. 2012;24:500 –13. 38. Morales A, García-Montaño E, Barrios-Ortega C, Niebles-Charris J, GarcíaRoncallo P, Abello-Luque D, et al. Adaptation of an effective school-based sexual health promotion program for youth in Colombia. Soc Sci Med. 2018. In Press. 39. Espada JP, Morales A, Orgilés M. Riesgo sexual en adolescents según la edad de debut sexual. Acata Colombiana de Psicología. 2014;17:53 –60. 40. Bleakley A, Hennessy M. The quantitative analysis of reasoned action theory. Ann Am Acad Pol Soc Sci. 2012;640:28 –41. 41. Noar SM, Zimmerman RS. Health behavior theory and cumulative knowledge regarding health behaviors: are we moving in the right direction? Health Educ Res. 2005;20:275 –90. 42. Jemmott JB. The reasoned action approach in HIV risk-reduction strategies for adolescents. Ann Am Acad Pol Soc Sci. 2012;640:150 –72
1. World, Health Organization. Adolescente Pregnancy. 2018. Retrieved from: https://www.who.int/es/news-room/fact-sheets/detail/adolescentpregnancy. 2. Plataforma Regional para América Latina y el Caribe. Cuáles son los países de América Latina con más casos nuevos de VIH/sida. [What are the countries in Latin America with the most new HIV / AIDS cases?] 2017. Accessed 3 May 2018. 3. Ministerio de Salud y Protección Social. Encuesta nacional de demografía y salud, ENDS. [National demographic and health survey, ENDS] 2015. Retrieved from: http://microdata.worldbank.org/index.php/catalog/2834 4. Departamento Administrativo Nacional de Estadística. Nacimientos 2017. Preliminares. In: Births 2017 - preliminary; 2017. 5. OPS and UNICEF. Acelerar el progreso hacia la reducción del embarazo en la adolescencia en América Latina y el Caribe [Accelerate progress towards reducing adolescent pregnancy in Latin America and the Caribbean]. 2018. Retrieved from https://www.unicef.org/lac/informes/acelerar-el-progresohacia-la-reducci%C3%B3n-del-embarazo-adolescente-en-am%C3%A9ricalatina-y-el. 6. Villegas-Castaño A, Tamayo-Acevedo LS. Prevalence of sexually transmitted infections, and risk factor for sexual health of adolescents, Medellín, Colombia, 2013. Iatreia. 2016;29:5–17. 7. Paredes MC, Gómez YM, Torres AM, Fernández M, Tovar MB. Prevalencia de infecciones por chlamydia trachomatis y Neisseria gonorrhoeae en adolescentes de colegios de la provincia de Sabana Centro, Cundinamarca, Colombia [prevalence of infections by chlamydia trachomatis and Neisseria gonorrhoeae in adolescents from schools in the province of Sabana Centro, Cundinamarca, Colombia]. Biomedica. 2015;35:324. 8. Avellaneda CN, Dávalos E. Identifying the macro-level drivers of adolescent fertility rate in Latin America: the role of school-based sexuality education. Am J Sex Edu. 2017;12:358–82. 9. Leppälahti S, Gissler M, Mentula M, Heikinheimo O. Is teenage pregnancy an obstetric risk in a welfare society? A population-based study in Finland, from 2006 to 2011. BMJ Open. 2013;3:e003225. 10. Kim SH, Gerver SM, Fidler S, Ward H. Adherence to antiretroviral therapy in adolescents living with HIV: systematic review and meta-analysis. AIDS. 2014;28:1945–56. 11. Fishbein M, Ajzen I. Predicting and changing behavior: the reasoned action approach. New York: Taylor & Francis; 2011. 12. Ajzen I. The theory of planned behavior. Organ Behav Hum Decis Process. 1991;50:179–211. 13. Armitage CJ, Conner M. Efficacy of the theory of planned behaviour: a meta-analytic review. Br J Soc Psychol. 2001;40:471–99. 14. Albarracin D, Johnson BT, Fishbein M, Muellerleile PA. Theories of reasoned action and planned behavior as models of condom use: a meta-analysis. Psychol Bull. 2001;127:142. 15. Espada JP, Morales A, Guillén-Riquelme A, Ballester R, Orgilés M. Predicting condom use in adolescents: a test of three socio-cognitive models using a structural equation modeling approach. BMC Public Health. 2016;35. https:// doi.org/10.1186/s12889-016-2702-0. 16. Girón SL, Palacio H, Mateus JC. HIV sexual risk behaviors in youth 15-24 years of age in Cali, Colombia: do differences exist among neighborhoods? Colombia Médica. 2013;44:72–9. 17. García-Corzo JR, Tarazona-Álvarez Y, Rojas-Gómez JP, Bayona-Millán E, DíazMartínez LA. Knowledge on human immunodeficiency virus mechanisms of transmission among schoolchildren in the age range of 11 to 20 years old from poor districts of Bucaramanga, Colombia. Arch Argent Pediatr. 2016;114:209–15. 18. Vinaccia S, Quiceno JM, Gaviria AM, Soto AM, Gil Llario MD, Ballester Arnal R. Conductas sexuales de riesgo para la infección por VIH/sida en adolescentes colombianos. Terapia. Psicológica. 2007;25:39–50. 19. Gómez-Camargo DE, Ochoa-Diaz MM, Canchila-Barrios CA, Ramos-Clason EC, Salguedo-Madrid GI, Malambo-García DI. Sexual and reproductive health in university students at an institution of higher learning in Colombia. Rev Salud Publica. 2014;16:660–72. 20. Observatorio del Bienestar en la Niñez. Embarazo en adolescentes. Generalidades y percepciones [pregnancy in adolescents generalities and perceptions]. 2015. Retrieved from:https://www.icbf.gov.co/sites/default/ files/embarazo-adolescente-web2015.pdf. 21. Abello-Luque D, Espada JP, García-Montaño, E., Gómez-Lugo, M, Morales A, Pérez-Pedraza D, Vallejo-Medina P. Validation for Colombia of the knowledge scale on HIV and other sexually transmitted infections in adolescents. Manuscript under review. 2018. 22. Gómez-Lugo M, Vallejo-Medina P, Marchal-Bertrand L, Morales A, NieblesCharris J, García-Roncallo P. Psychometric properties of the Colombian version of the HIV attitudes scale for adolescents. Manuscript under review 2018. 23. Cohen J. Statistical power analysis for the behavioral sciences Hillsdale, N.J.: L. Erlbaum Associates; 1988. 24. Hayes AF. Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. New York: Guilford Press; 2013. 25. Escribano S, Espada J, Morales A, Orgilés M. Mediation analysis of an effective sexual health promotion intervention for Spanish adolescents. AIDS Behav. 2015;19:1850–9. 26. Espada JP, Escribano S, Orgilés M, Morales A, Guillén-Riquelme A. Sexual risk behaviors increasing among adolescents over time: comparison of two cohorts in Spain. AIDS Care. 2015;27:783–8. 27. Espada JP, Escribano S, Morales A, Orgilés M. Two-year follow-up of a sexual health promotion program for Spanish adolescents. Eval Health Prof. 2017; 40:483–504.28. Morales A, Espada JP, Orgilés M. Mediation of an efficacious HIV risk reduction intervention for adolescents: a cluster-randomised controlled trial. J Health Psychol. 2017. https://doi.org/10.1177/1359105317707256 . 29. Navarro E, Vargas R. Conocimientos, actitudes y prácticas sobre SIDA en adolescentes escolarizados. [Knowledge, attitudes and practices on AIDS in school-aged adolescents]. Salud Uninorte. 2004;19:14 –24. 30. Valencia CP, Canaval GE. Factors predisposing, facilitating and strengthening condom use amongst university students in Cali, Colombia. Rev Salud Publica. 2012;14:810 –21. 31. Mittal M, Senn TE, Carey MP. Intimate partner violence and condom use among women: does the information –motivation –behavioral skills model explain sexual risk behavior? AIDS Behav. 2012;16:1011 –9. 32. Ybarra ML, Korchmaros JD, Prescott TL, Birungi RA. Randomized controlled trial to increase HIV preventive information, motivation, and behavioral skills in Ugandan adolescents. An Behav Med. 2015:1 –13. 33. Romero LM, Galbraith JS, Wilson-Williams L, Gloppen KM. HIV prevention among African American youth: how well have evidence-based interventions addressed key theoretical constructs? AIDS Behav. 2011;15:976 –91. 34. Faílde-Garrido JM, Lameiras-Fernández M, Bimbela-Pedrola JL. Prácticas sexuales de chicos y chicas españoles de 14-24 años de edad [sexual practices of Spanish boys and girls 14-24 years of age]. Gac Sanit. 2008;22: 511 –9. 35. Eversole JS, Berglas NF, Deardorff J, Constantine NA. Source of sex information and condom use intention among Latino adolescents. Health Edu & Behav. 2017;44:439 –47. 36. Espada JP, Guillén-Riquelme A, Morales A, Orgilés M, Sierra JC. Validación de una escala para evaluar el conocimiento sobre el VIH y otras infecciones de transmisión sexual en población adolescente. Aten Prim. 2014;46:558 –64. 37. Espada JP, Orgilés M, Morales A, Ballester R, Huedo-Medina TB. Effectiveness of a school HIV/AIDS prevention program for Spanish adolescents. AIDS Educ Prev. 2012;24:500 –13. 38. Morales A, García-Montaño E, Barrios-Ortega C, Niebles-Charris J, GarcíaRoncallo P, Abello-Luque D, et al. Adaptation of an effective school-based sexual health promotion program for youth in Colombia. Soc Sci Med. 2018. In Press. 39. Espada JP, Morales A, Orgilés M. Riesgo sexual en adolescents según la edad de debut sexual. Acata Colombiana de Psicología. 2014;17:53 –60. 40. Bleakley A, Hennessy M. The quantitative analysis of reasoned action theory. Ann Am Acad Pol Soc Sci. 2012;640:28 –41. 41. Noar SM, Zimmerman RS. Health behavior theory and cumulative knowledge regarding health behaviors: are we moving in the right direction? Health Educ Res. 2005;20:275 –90. 42. Jemmott JB. The reasoned action approach in HIV risk-reduction strategies for adolescents. Ann Am Acad Pol Soc Sci. 2012;640:150 –72
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