What predicts the early sexual debut among unmarried adolescents (10–19 years)? Evidence from UDAYA survey, 2015–16

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Abstract

Introduction

The societal norm in India is such that adolescents are expected to respect and follow traditional values and view early sexual debut as undesirable and deviant from the social mores. However, a dramatic shift in attitudes towards sex before marriage has been observed in India. We in this study, aim to study the factors associated with early sexual debut among unmarried adolescents.

Materials and methods

The study used data from the Understanding the lives of adolescents and young adults (UDAYA) survey conducted in 2016 with 15,388 adolescents aged 10–19 years from two Indian states. Bivariate and logistic regression analyses were performed to determine the associated factors.

Results

Adolescent boys (9%) were more prone to early sexual debut compared to girls (4%). Both boys (17.2%) and girls (6%) who were school dropouts had significantly higher chances of early sexual debut. Boys who had rare [OR: 2.28; CI: 1.12–4.64] or frequent media exposure [OR: 2.70; CI: 1.36–5.32] were significantly more likely to report early sexual debut than those who had no media exposure. Further, the likelihood of early sexual debut was significantly higher among boys [OR: 3.01; CI: 2.34–3.87] and girls [OR: 1.87; CI: 1.12–3.12] who had exposure to pornography compared to their counterparts. The odds of early sexual debut were higher among boys [OR: 1.89; CI: 1.19–3.01] and girls [OR: 1.77; CI: 1.30–2.41] who had moderately-severe/severe depressive symptoms compared to their counterparts.

Conclusions

The results highlight that Indian unmarried adolescents demand the appropriate knowledge to promote safer sexual behavior and lead a responsible and healthy lifestyle. The preventive efforts must be multifaceted with involvement at the individual and parental levels. Especially, interventions appear advantageous to be parents-focused emphasizing family life education that can prevent risky sexual behaviors among adolescent boys and girls. And the public programs should focus on sexual health promotion considering the physical and psychosocial changes during early ages of sex life.

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Most cited references 41

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The PHQ-9: validity of a brief depression severity measure.

K Kroenke, R L Spitzer, J. Williams (2001)

While considerable attention has focused on improving the detection of depression, assessment of severity is also important in guiding treatment decisions. Therefore, we examined the validity of a brief, new measure of depression severity. The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as "0" (not at all) to "3" (nearly every day). The PHQ-9 was completed by 6,000 patients in 8 primary care clinics and 7 obstetrics-gynecology clinics. Construct validity was assessed using the 20-item Short-Form General Health Survey, self-reported sick days and clinic visits, and symptom-related difficulty. Criterion validity was assessed against an independent structured mental health professional (MHP) interview in a sample of 580 patients. As PHQ-9 depression severity increased, there was a substantial decrease in functional status on all 6 SF-20 subscales. Also, symptom-related difficulty, sick days, and health care utilization increased. Using the MHP reinterview as the criterion standard, a PHQ-9 score > or =10 had a sensitivity of 88% and a specificity of 88% for major depression. PHQ-9 scores of 5, 10, 15, and 20 represented mild, moderate, moderately severe, and severe depression, respectively. Results were similar in the primary care and obstetrics-gynecology samples. In addition to making criteria-based diagnoses of depressive disorders, the PHQ-9 is also a reliable and valid measure of depression severity. These characteristics plus its brevity make the PHQ-9 a useful clinical and research tool.

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Contraception for adolescents in low and middle income countries: needs, barriers, and access

Venkatraman Chandra-Mouli, Donna McCarraher, Sharon J Phillips … (2014)

Substantial numbers of adolescents experience the negative health consequences of early, unprotected sexual activity - unintended pregnancy, unsafe abortions, pregnancy-related mortality and morbidity and Sexually Transmitted Infections including Human Immunodeficiency Virus; as well as its social and economic costs. Improving access to and use of contraceptives – including condoms - needs to be a key component of an overall strategy to preventing these problems. This paper contains a review of research evidence and programmatic experiences on needs, barriers, and approaches to access and use of contraception by adolescents in low and middle income countries (LMIC). Although the sexual activity of adolescents (ages 10–19) varies markedly for boys versus girls and by region, a significant number of adolescents are sexually active; and this increases steadily from mid-to-late adolescence. Sexually active adolescents – both married and unmarried - need contraception. All adolescents in LMIC - especially unmarried ones - face a number of barriers in obtaining contraception and in using them correctly and consistently. Effective interventions to improve access and use of contraception include enacting and implementing laws and policies requiring the provision of sexuality education and contraceptive services for adolescents; building community support for the provision of contraception to adolescents, providing sexuality education within and outside school settings, and increasing the access to and use of contraception by making health services adolescent-friendly, integrating contraceptive services with other health services, and providing contraception through a variety of outlets. Emerging data suggest mobile phones and social media are promising means of increasing contraceptive use among adolescents.

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Watching sex on television predicts adolescent initiation of sexual behavior.

Dennis Kunkel, David Kanouse, Jennifer J. P. Collins … (2004)

Early sexual initiation is an important social and health issue. A recent survey suggested that most sexually experienced teens wish they had waited longer to have intercourse; other data indicate that unplanned pregnancies and sexually transmitted diseases are more common among those who begin sexual activity earlier. The American Academy of Pediatrics has suggested that portrayals of sex on entertainment television (TV) may contribute to precocious adolescent sex. Approximately two-thirds of TV programs contain sexual content. However, empirical data examining the relationships between exposure to sex on TV and adolescent sexual behaviors are rare and inadequate for addressing the issue of causal effects. We conducted a national longitudinal survey of 1792 adolescents, 12 to 17 years of age. In baseline and 1-year follow-up interviews, participants reported their TV viewing habits and sexual experience and responded to measures of more than a dozen factors known to be associated with adolescent sexual initiation. TV viewing data were combined with the results of a scientific analysis of TV sexual content to derive measures of exposure to sexual content, depictions of sexual risks or safety, and depictions of sexual behavior (versus talk about sex but no behavior). Initiation of intercourse and advancement in noncoital sexual activity level, during a 1-year period. Multivariate regression analysis indicated that adolescents who viewed more sexual content at baseline were more likely to initiate intercourse and progress to more advanced noncoital sexual activities during the subsequent year, controlling for respondent characteristics that might otherwise explain these relationships. The size of the adjusted intercourse effect was such that youths in the 90th percentile of TV sex viewing had a predicted probability of intercourse initiation that was approximately double that of youths in the 10th percentile, for all ages studied. Exposure to TV that included only talk about sex was associated with the same risks as exposure to TV that depicted sexual behavior. African American youths who watched more depictions of sexual risks or safety were less likely to initiate intercourse in the subsequent year. Watching sex on TV predicts and may hasten adolescent sexual initiation. Reducing the amount of sexual content in entertainment programming, reducing adolescent exposure to this content, or increasing references to and depictions of possible negative consequences of sexual activity could appreciably delay the initiation of coital and noncoital activities. Alternatively, parents may be able to reduce the effects of sexual content by watching TV with their teenaged children and discussing their own beliefs about sex and the behaviors portrayed. Pediatricians should encourage these family discussions.

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Author and article information

Contributors

T. Muhammad: Role: ConceptualizationRole: Writing – original draftRole: Writing – review & editing

Shobhit Srivastava:

ORCID: https://orcid.org/0000-0002-7138-4916

Role: ConceptualizationRole: Formal analysisRole: MethodologyRole: Software

Pradeep Kumar:

ORCID: https://orcid.org/0000-0003-4259-820X

Role: ConceptualizationRole: Data curationRole: Formal analysisRole: MethodologyRole: SoftwareRole: SupervisionRole: ValidationRole: Visualization

Sangram Kishor Patel:

ORCID: https://orcid.org/0000-0002-0689-6704

Role: Funding acquisitionRole: Writing – review & editing

Enamul Kabir: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS One

Journal ID (publisher-id): plos

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 10 June 2021

Publication date Collection: 2021

Volume: 16

Issue: 6

Electronic Location Identifier: e0252940

Affiliations

[1 ] Department of Population Policies and Programs, International Institute for Population Sciences, Mumbai, Maharashtra, India

[2 ] Department of Mathematical Demography & Statistics, International Institute for Population Sciences, Mumbai, Maharashtra, India

[3 ] Population Council, New Delhi, India

University of Southern Queensland, AUSTRALIA

Author notes

Competing Interests: The authors have declared that no competing interests exist.

* E-mail: pradeepiips@ 123456yahoo.com

Author information

Shobhit Srivastava https://orcid.org/0000-0002-7138-4916

Pradeep Kumar https://orcid.org/0000-0003-4259-820X

Sangram Kishor Patel https://orcid.org/0000-0002-0689-6704

Article

Publisher ID: PONE-D-21-05967

DOI: 10.1371/journal.pone.0252940

PMC ID: 8192016

PubMed ID: 34111205

SO-VID: 74d8c0e2-599c-49df-87c0-f99294716fb4

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 22 February 2021

Date accepted : 25 May 2021

Page count

Figures: 1, Tables: 3, Pages: 15

Funding

Funded by: funder-id http://dx.doi.org/10.13039/100000865, Bill and Melinda Gates Foundation;

Funded by: funder-id http://dx.doi.org/10.13039/100000008, David and Lucile Packard Foundation;

This paper was written using data collected as part of Population Council’s UDAYA study, which is funded by the Bill and Melinda Gates Foundation and the David and Lucile Packard Foundation. No additional funds were received for the preparation of the paper. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Data Availability The authors would like to state that they are only authors of the article and no way were related to the data collection process. The data was collected by Population Council, India and it was ethically approved by the ethical committee of Population Council, India. The data is now stored in Harvard Data-verse repository and whosoever is interested in accessing the data can follow the link provided. The data is owned and stored by Harvard Data-verse and therefore, there are certain legal and ethical restrictions involved in accessing the data. Those who wish to download the data can follow the link here: https://dataverse.harvard.edu/dataset.xhtml?persistentId=doi:10.7910/DVN/RRXQNT.

What predicts the early sexual debut among unmarried adolescents (10–19 years)? Evidence from UDAYA survey, 2015–16

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Abstract

Introduction

Materials and methods

Results

Conclusions

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Most cited references 41

The PHQ-9: validity of a brief depression severity measure.

Contraception for adolescents in low and middle income countries: needs, barriers, and access

Watching sex on television predicts adolescent initiation of sexual behavior.

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