SciELO - Scientific Electronic Library Online

 
vol.16 issue45Factors associated with level of pain in admission and high in victims of traumaNursing process to men with laryngeal cancer based on Neuman model author indexsubject indexarticles search
Home Pagealphabetic serial listing  

My SciELO

Services on Demand

Journal

Article

Indicators

Related links

  • On index processCited by Google
  • Have no similar articlesSimilars in SciELO
  • On index processSimilars in Google

Share


Enfermería Global

On-line version ISSN 1695-6141

Enferm. glob. vol.16 n.45 Murcia Jan. 2017  Epub Jan 01, 2017

http://dx.doi.org/10.6018/eglobal.16.1.234921 

Originales

Age, Gender and Resilience in Sexual Risk Behavior of STI among adolescents in Southern Mexico

Lubia del Carmen Castillo-Arcos (orcid: 0000-0002-4368-4735)*  , Alicia Alvarez-Aguirre**  , Yolanda Bañuelos-Barrera***  , Martha Ofelia Valle-Solís****  , Carolina Valdez-Montero (orcid: 0000-0002-4938-3087)*****  , María Amparo de Jesús Kantún-Marín* 

*Nursing Science Doctoral. Professor at Universidad Autónoma del Carmen, Faculty of Health Sciences. E-mail: lubiacastilloa@gmail.com

**Nursing Science Doctoral. Professor at Universidad de Guanajuato

***Nursing Science Doctoral. Professor at Universidad Juárez del Estado de Durango

****Nursing Science Doctoral. Professor at Universidad Autónoma de Nayarit.

*****Nursing Sciences Doctoral. Professor at Universidad Autónoma de Sinaloa. México.

Abstract

Objective

To compare the sexual risk behavior in high school students and differentiate by age, gender and level of sexual resilience.

Methods

Descriptive, transversal and explanatory study. The target population consisted of 182 adolescents aged 15 to 16 years of two educational institutions. The selection of the sample was using a stratified random sampling.

Results

Measuring instruments showed acceptable reliability measures. 69% of adolescents reported having 16 years of age, while 64% were female. Teenagers of 16 years had higher averages in sexual risk behaviors (M = 12.1, SD = 23.3) than adolescents of 15 years (M = 4.76, SD = 14.6, U = 2984.0, p = .038). Regarding gender, significant differences were found, women had (M = 7.45, SD = 2.77) for men (M = 8.01, SD = 2.03, U = 3714.0, p = .017). While the level of sexual resilience was also different, teens 15 years showed lower levels of resilience (M = 60.5, SD = 13.6) than adolescents of 16 years (M = 65.0, SD = 17.3; U = 2809.0, p = .034). The Linear Regression Model identified that the greatest contribution were variables were age, gender and marital status to sexual risk behavior (F = 1.85, R2ajustada = .065, p = .052). In another model age, gender and marital status were significant for the development of resilience (F = 5.4, R2ajustada = .07, p = .001). Research on adolescent sexual behavior and the factors that influence behavior, it is useful to understand what motivates adolescents to participate or avoid sexual risk behaviors.

Keywords Resilience; Sexual risk behavior; ITS (Source: DeCs, Bireme)

Introduction

Sexually Transmitted Infections (STI) affect various vulnerable groups in an alarming way, and despite the campaigns to reduce cases of STIs, such as the Human Immunodeficiency Virus (HIV), the numbers persist. Worldwide, the HIV epidemic has remained stable; however, new cases and deaths from this infection continue being disturbing in some countries. Data from the Joint United Nations Programme on HIV1 indicates that, in 2013, there were 35 million people living with HIV, 2.1 million contracted the disease, and 1.5 million died from this cause. The agency also mentions that if the HIV cases are not reduce in the next five years, the epidemic will emerge with a higher incidence than currently exists. A 45% of people living with HIV are concentrated in America2, and a significant percentage of them are represented by adolescents and young adults (45%).

Moreover, adolescents often have wrong thoughts about sexuality and believe that sex is not risky. They are impulsive and tend to fantasize so; they do not consider the consequences of their actions and do not seek prompt medical attention when they suffer changes in their health. Therefore, sexual health in adolescents is a topic of interest for health systems of the low- and middle-income countries, since STIs are increasing despite prevention campaigns implemented on a large scale 3),(4. Various authors5),(6),(7) consider that adolescents who initiate sex at an early age and those who think they are too young to get sick and die, are more prone to acquire an STI, so they become a vulnerable group.

In this sense, there are several factors that may influence the risk of STI in adolescents, one of them is gender, which is considered as the experience of meanings related to sexuality; constructions of concepts and roles that men and women must assume are framed by social and cultural norms, supporting the specific sexual pattern and power exercised by certain gender in relationships8. Age is also a determining factor in the practice of risk behaviors; several authors report that the onset of sexual intercourse at an earlier age, becomes a higher risk of pregnancy and STIs, as the teenager is still in a cognitive evolution of construction and reconstruction of his or her thoughts, ideas and personality that regulate sexual behavior 5),(9.

On the other hand, sexual resilience enables safe behavior, under its positive influence, the adolescent exercises responsible and self-determined behaviors, developing the ability to respond in a critical and creative way to various situations of sexual risk and harmful influences. Also, it stimulates in the adolescent the need to improve his or her health. The development of resilient capacity in teenagers becomes a unique opportunity for health personnel involved in sexual care of this population, allowing them to modulate the risk effect10. Therefore, the objective of this study was to compare sexual risk behaviors among high school students and the differences based on age, gender, and level of sexual resilience.

Methodology

Descriptive, cross-sectional and explanatory study11. A stratified random sampling was used with a statistical power of 90%. The sample consisted of 182 adolescents, ages 15 and 16 years old, from two educational institutions of Campeche, Mexico.

Selection of participants

Inclusion criteria: teenagers who agreed to participate voluntarily in the study and with their parents' consent. Exclusion criteria: married adolescents or those living with their partner. Elimination criteria: incomplete questionnaires.

Instruments

A socio-demographic data sheet was applied to describe the participants of the study. Two instruments were also used to measure the concepts of interest. First, the Sexual Behavior Scale12),(13, which measures the frequency of condom use, sex with multiple partners, and sexual behavior in the past three months; it consists of 38 items with a total score range of 0-76. Secondly, the Sexual Resilience Scale 14, 15, which measures the level of resilience for safe sex, and consists of 22 items, with a range of 22-110.

Procedures

The protocol was submitted to the Research Committee of the Faculty of Nursing at the Universidad Autonoma del Carmen. The authorization by the administration of the educational institutions for the study was obtained; further information was given to parents about the project at both institutions to obtain their consent and informed consent from the adolescents. Then, data collection was scheduled with school authorities; data was collected by social service interns, with nursing majors, previously trained for this purpose. Adolescents were informed about the voluntary and anonymous character of the questionnaire. Instructions were read aloud, clarifying the doubts that were presented, emphasizing that they must not leave unanswered questions. During the application of the questionnaires pollsters were present. At the end, adolescents placed questionnaires into an urn to ensure confidentiality and anonymity of the information.

Statistical Analysis

The Statistical Package for the Social Sciences (SPSS), version 17 for Windows, was used to analyze statistical data. Descriptive and inferential statistics were applied; for categorical variables frequencies and percentages were calculated, and measures of central tendency and dispersion for quantitative variables. After the verification of the variables distribution, the statistical test of Mann Whitney U was performed to verify differences between them. Linear Regression Models were performed. The value of p <0.05 was used to demonstrate statistical significance of the results.

Ethical aspects

The study took into account the provisions of Chapter I, Article 13 of the Regulations of the General Law of Health in Research for Health16, ethical aspects of research in humans. Dignity, anonymity, protection of the rights, and welfare of participants in the study, during recruitment, selection of participants, and data collection were observed. The information collected was only handled by the head researcher and was released in general terms.

Results

Data corresponded to 182 high school teenagers, of which, 69% were 16 years old, and 64% were female. Ninety percent of the participants were second semester students, and 68% reported being single. Regarding the number of people in the family who lived at the same address, 67% reported living in a household of 4 or 5 people, including the father and the mother (75% and 99% respectively) and a brother or sister in 60% and 55% of the cases (see Table 1).

Variable f %
Gender
Female 166 63.7
Male 64 35.2
Age
15 56 30.8
16 126 69.2
Semester
1st. 17 9.3
2nd. 163 89.6
Marital Status
Single 124 68.1
In a relationship 56 30.8
Sexual Experience
No 153 84.1
Yes 27 14.8
Didn't answer 2 1.1

Note: f = Frecuency; % = Percentage

When the participants were asked whether or not they had received information on sexuality in the last three months, 87% answered yes, and 91% received specific information on STIs. Moreover, 83.5% reported having received information about HIV or AIDS, and 98% had never been tested for HIV.

The reliability of the scales with Cronbach's alpha was obtained and presented alphas .97 and .87 for scales of sexual risk behavior and sexual resilience, which are considered acceptable. Regarding the scales used, the level of sexual risk behavior showed an average of 9.8 (SD = 21.3) and the scale of sexual resilience showed an average of 63.6 (SD = 16.3).

The objective of this study was to compare sexual risk behaviors among high school students and the differences based on age, gender, and level of sexual resilience. In order to demonstrate it, the statistical test of Mann Whitney U was performed, and the results showed that adolescents aged 16 years had higher averages on sexual risk behaviors (M = 12.1, SD = 23.3) than aged 15 years (M = 4.76, SD=14.6), U=2,984.0, p=.038. Regarding gender, significant differences were found (U=3,714.0, p=.017) between females (M = 7.45, SD = 2.77) and males (M = 8.01, SD=2.03).

Significant differences were also found in the level of sexual resilience (U=2,809.0, p=.034), the age 15 group presented lower levels (M=60.5, DE=13.6) than the age 16 group (M=65.0, SD=17.3) (see Table 2). When comparing gender, males showed a higher levels of resilience (M = 69.5, SD = 13.3) than females (M = 60.2, SD = 17.1), showing a statically significant difference (U = 2,532.5, p =. 001; see Table 2).

Table 2 Mann-Whitney U test for sexual risk behavior and sexual resilience. 

Variable Mean SD U p
Sexual risk behavior 2,984.0 .038
Age 15 4.76 14.6
Age 16 12.14 23.3
Sexual risk behavior 3,714.00 .017
Female 7.45 2.77
Male 8.01 2.03
Sexual Resilience 2,809.0 .034
Age 15 60.57 13.6
Age 16 65.05 17.3
Sexual Resilience 2,532.5 .001
Female 60.25 17.1
Male 69.54 13.3

Note: Mean= Arithmetic average; SD = Standard deviation; U = Mann-Withney U; p = significance value.

In a further analysis, a Linear Regression Model (LRM) was adjusted, which introduced sociodemographic characteristics and the history of sexuality, knowledge about STIs, HIV and AIDS, as independent variables (IV), and sexual risk behavior as dependent variable (DV), which tended to significance (F = 1.85, R2ajusted = .065, p = .052). When the model was analyzed it was found that the greatest contribution variables were age, gender and marital status, so another LRM was adjusted where those variables were introduced as IV and sexual risk behavior was included as the DV. The model was significant finding that 8.4% of the variation in sexual risk behavior was due to age, gender and marital status (F = 6.38, R2ajusted = .084, p = .000).

Moreover, in another MRL, age, gender, and marital status were used as IV and the level of sexual resilience as DV, which was significant (F = 5.4, R2ajusted = .07, p = .001), finding that 7% of the variation in the level of sexual resilience was due to the influence of the independent variables in the model.

Discussion

Sexual behavior in adolescents is a topic that is becoming more relevant due to the implications for the health of this population. According to various studies and to the alarming statistics on STI-HIV, unwanted pregnancies, school dropout, social exclusion, among others, the sexual problem is compounded, when having a behavioral origin, the risks will always be latent for adolescents. Therefore, this research was conducted to learn about sexual risk behaviors in high school students and differences by age, gender and level of sexual resilience.

According to the results, it was observed that women were more participatory; this may be due to the Latino culture where women show greater participation for their health care, which agrees with other studies17),(18.

On the other hand, a protective factor to prevent sexual risk behavior is the support of the family. In the present study we found that most teenagers live with their parents. In their home teens are economically and emotionally supported, and families are the first pillar of support. Family members strengthen protection, communication, love, and affection among themselves. This is a very strong link that enables the adolescent in risk situations to go to his or her family for support and guidance. All this coincides with several authors19),(20) who report that adolescents perceive the family as the primary source of support; when they have doubts they turn to their families for information. Also, this support is even more perceived by teens who are not sexually active.

It was also found that most of the teens have received information about sexuality, STI-HIV and AIDS in the last three months, which represents another protective factor linked to knowledge, which allows them at this stage of cognitive maturity to internalize relevant data that can help them become aware of their sexual health and the risks that they could face living that important stage in their lives. However, a small percentage of teens reported having no information on these topics, placing them in a position of risk which it is consistent with other authors19),(21 who mentioned that at the stage of adolescence there is a need for more information on sexuality issues to achieve self-protection strategies. However, having information is not equivalent to having the right knowledge to prevent STIs.

At the same time, it was found that older adolescents were more likely to practice sexual risk behaviors, which could be because at this stage adolescents are in a process of constant change that makes them vulnerable, with negative consequences for their health; this is consistent with other authors' reports18),(20 who state that older adolescents begin their first dating around age 15. This suggests that they are more likely to practice sexual risk behaviors because they are in a stage of experimentation and discovery of their sexuality where the forbidden and mysterious become a constant challenge.

In this study, significant differences were found among genders regarding sexual risk behaviors; men had a higher score. This is consistent with other studies8),(23, where it was found that men have more risk behaviors initiating their sexual activity at an earlier age (15.2 years). Also, male adolescents are less inhibited because of cultural practices such as polygamy, casual partners, use of commercial sex, less parental supervision for being men, among others; they have a predisposition to risk behaviors17),(24.

Regarding resilience older adolescents had a higher level of resilience. This agrees with other authors25 who mention that a high level of resilience helps prevent sexual risk behavior. The results showed that men are more resilient than women, which could indicate that females are more prone to risk, consistent with Matta26 in his study where he found that males have a high degree of resilience, indicating that men have greater capacity to counter sexual risk factors.

It was also found that age, gender, and marital status are determinants that contribute to sexual risk behavior. Several studies have shown that having a dating relationship is associated with the onset of sexual relations, as well as being older and being male7),(28). The influence of a romantic person, age, and gender impacts sexual initiation and the adolescent's sexual health.

In this sense, it was shown that age, gender, and marital status have an influence in the development of sexual resilience; the latter is regarded as the ability to counteract risk situations through the use of protective factors that the person has, which agrees with Esparza29 who said that if adolescents have an adequate level of resilience, they can make assertive decisions about changes that may arise regarding sexual behavior. However, in the present study we found that older male adolescents, with a dating relationship and low resilience, were more likely to practice sexual risk behaviors.

Conclusions

According to the above, it can be concluded that adolescents are more likely to perform sexual risk behaviors due to the vital process they are going through, and to the social and cultural norms that rule over them. Gender and age play an important role in addressing educational programs, since they provide guidelines to assist men and women; this is relevant to the design of prevention programs, which should seek the strengthening of information through a variety of teaching strategies that are interesting and novel for teens that may also generate significant interest and significant learning on the prevention of sexual risk behaviors.

For the health professional, this represents an opportunity to direct objectives to help improve the skills in making right decisions for the postponement of first sexual intercourse and reduction of risk in this population. Nurses must participate in sexual health care to provide comprehensive care for adolescents, with a focus on detection and prevention of potential risks to physical and psychosocial health related to negative behaviors. In addition, health institutions should enable practices that encourage free and confidential access to sexual health services.

Research on adolescent sexual behavior and the factors that influence behavior, is useful to understand what motivates adolescents to practice or avoid sexual risk behaviors. Many teens are involved in many risks; knowledge, skills and values to develop over the course of their lives provide them the possibility of having a safe and happy life, unlike someone without these elements who would have more chances of contracting an STI including HIV, which consequently, increases greatly the risk of dying at an early age. That is why it is important to help adolescents to become sexually healthy adults, with the ability to avoid risk by making right decisions.

Referencias

1. Programa Conjunto de las Naciones Unidas sobre el VIH/sida (ONUSIDA). Comunicado de prensa. [Citado el 05 enero 2015]. Disponible en: http://www.unaids.org/es/resources/presscentre/pressreleaseandstatementarchive/2014/november/20141118_PR_WAD2014reportLinks ]

2. Programa Conjunto de las Naciones Unidas sobre el VIH/sida (ONUSIDA). Informe sobre VIH/sida. [Citado el 10 julio 2015]. Disponible en: http://www.unaids.org/es/resources/presscentre/pressreleaseandstatementarchive/2014/july/20140716prgapreportLinks ]

3. Pai H, Lee S. Sexual self-concept as influencing intended sexual health behaviour of young adolescent Taiwanese girls. J Clin Nurs. 2012; 21:1988-97 [ Links ]

4. Sychareun V, Thomsen S, Chaleunvong K, Faxelid E. Risk perceptions of STIs/HIV and sexual risk behaviours among sexually experienced adolescents in the Northern part of Lao PDR. BMC Public Health. 2013; 13:1126. [ Links ]

5. Monasterio E, Hwang LY, Shafer MA. Adolescent sexual health. Curr Probl Pediatr Adolesc Health Care. 2007; 37(8):302-25. [ Links ]

6. Bradley-Stevenson,C, Mumford J. Adolescent sexual health. Pediatrics Child Health. 2007; 17(12):474-79. [ Links ]

7. Jones R, Bradley E. Health issues for adolescents. Paediatr Child Health. 2007; 17(11): 433-38. [ Links ]

8. García-Vega E, Menéndez E, Fernández P, Cuesta M. Sexualidad, Anticoncepción y Conducta sexual de riesgo en adolescentes. Int J Psychol Res. 2012; 5(1): 79-87. [ Links ]

9. García-Vega E, Menéndez E, Fernández P, Rico F. Influencia del sexo y del género en el comportamiento de una población adolescente 2010; Psicothema, 22(4): 606-12. [ Links ]

10. Díaz G. Consideraciones teóricas acerca del empoderamiento psicológico en salud sexual de actores sexuales vinculados a niños/as preescolares. Rev Cubana Med Integr. 2011; 27(1):23-32. [ Links ]

11. Burns N, Grove S. The practice of nursing research. Appraisal, synthesis, and generation of evidence 6th ed. 2009. St. Louis: Elsevier Saunders. [ Links ]

12. Jemmot, JB III, Jemmott LS, Fong GT. Reduction in HIV risk-associated sexual behaviors among black male adolescents: Effects of an AIDS prevention intervention. Am J Public Health.1992; 82(3): 372-77. [ Links ]

13. Villarruel A M, Jemmontt J B III, Jemmontt L S, Ronis D L. Predictors of sexual intercourse intentions and condom use among Spanish dominant youth: A test of the theory of planned behavior. Nurs Res.2004; 53(3): 172-81. [ Links ]

14. Wagnild GM, Young HM. Development and psychometric evaluation of the resilience scale. J Nurs Meas. 1993; 1(2): 165-78. [ Links ]

15. Castillo-Arcos L, Benavides-Torres R, López-Rosales F. Vol. XIV de la Psicología Social en México. Validación de la escala de resiliencia para sexo seguro, 2012. México. [ Links ]

16. Secretaria de Salud. Reglamento de la ley general de salud en materia de investigación para la salud. 1987. (México). [Citado el 05 enero 2015]. Disponible en: http://www.salud.gob.mx/unidades/cdi/nom/compi/rlgsmis.htmlLinks ]

17. Morales-Mesa S, Arboleda-Álvarez O, Segura-Cardona A. Las prácticas sexuales de riesgo en poblaciones universitarias. Rev Salud Publica. 2014; 16(1): 27-39. [ Links ]

18. Fennie T, Laas, A. HIV/AIDS-related Konowledge, Attitudes and Risky Sexual Behavior among a Sample of South African University Students. Gender and Behaviour. 2014; 12(1):6035-44. [ Links ]

19. Orcasita L, Uribe A, Castellanos L, Gutiérrez M. Apoyo social y conductas sexuales de riesgo en adolescentes de Lebrija-Santander. Rev Psicol. 2012; 30(2): 371-406. [ Links ]

20. Wil E, Koo H. Mother, fathers, son, and daughters: gender differences in factors associated with parent-child communication about sexual topics. Reprod Health 2010; 7:31 [Citado el 30 de septiembre 2015]. Disponible en: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3019147/Links ]

21. Uribe F, Orcasita LT, Vergara T. Factores de riesgo para la infección por VIH/SIDA en adolescents y jovenes colombianos. Act Colom Psicol. (2010); 13(1):11-24. [ Links ]

22. Shishana O, Rehle T, Simbayi LC, Zuma K, Jooste S, Pillay-van-Wyk V, Mbelle N, Van Zyl J, Parker W, Zungu NP, Pezi S & the SABSSAM III. South African National HIV prevalence, incidence, behavior and communication survey, 2008: A turning tide among teenagers?. Cape Tawn. Human Sciences Research Council. South Africa. 2009. [Citado el 20 julio 2015]. Disponible en: http://www.health-e.org.za/wp-content/uploads/2013/05/2966e129fc39e07486250fd47fcc266e.pdfLinks ]

23. Romero-Estudillo E, Gonzáles-Jiménez E, Mesa-Franco M, García-García I. Gender-based differences in the high-risk sexual behaviours of young people aged 15-29 in Melilla (Spain): a cross-sectional study. BMC Public Health, 2014; 14:745. [ Links ]

24. Adejumo AO. Influence of psycho-Demographic factors and effectiveness of psycho-behavioral interventions on sexual risk behavior of in-school adolescents in Ibadan, Nigeria. Ife PsychologIA. 2012; 20(1):1-18. [ Links ]

25. Oppong K, Mayer-Weitz A, Petersen I. Correlates of psychological functioning of homeless youth in Accra, Ghana: a cross-sectional study. Int J Ment Health Syst 2015; 9:1. [ Links ]

26. Matta S. Grado de desarrollo de la resiliencia y su relación con los factores protectores y de riesgo, en adolescentes de instituciones educativas de Lima, Ica, Ayacucho Huánuco. Tesis de Maestria. 2010. [Citado el 10 febrero 2015]. Disponible en: http://cybertesis.unmsm.edu.pelbitstream/cybertesis/3276/1/matta_sh.pdfLinks ]

27. Ott M, Millstein SG, Ofner S, Halpem-Felsher,BL. Greater expectations: adolescent positive motivations for sex. Perspect Sex Reprod Heald. 2006; 38(2): 84-9. [ Links ]

28. Widdice LE, Cornell JL, Liang W, Halpem-Felsher BL. Having sex and condon use: potencial risk and benefits report by young, sexually inexperienced adolescents. J Adolesc Health. 2006; 39(4): 588-95. [ Links ]

29. Esparza P. Apoyo social percibido para sexo seguro y resiliencia sexual en el adolescente. Tesis de Maestría. 2014. [Citado el 10 abril 2015]. Disponible en: file:///C:/Users/HP/Downloads/TESIS%202014%20PALOMA.pdf [ Links ]

Received: August 01, 2015; Accepted: October 16, 2015

Creative Commons License Este es un artículo publicado en acceso abierto bajo una licencia Creative Commons