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      Knowledge of sexually transmitted infections and risky behaviors among undergraduate students in Tirana, Albania: comparison with Italian students

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          Abstract

          Dear Editor, Reading the results of the survey on the knowledge of sexually transmitted infections (STIs) and risky behaviors among Sicilian high-school and university students recently published in your journal [1] prompted us to report our survey on this topic among a group of Albanian students. In a previous study, we analyzed the knowledge of STIs and risky behaviors among Italian adolescents by distributing a questionnaire to a sample of 2867 secondary school students in Genoa (northern Italy) and Lecce (southern Italy): we found a serious lack of knowledge of STIs and considerable exposure to risk factors for STI transmission, such as alcohol and recreational drug use [2]. We subsequently administered the same anonymous questionnaire to undergraduate students at a university in Tirana, Albania, with the aim of assessing knowledge of STIs and risky behaviors among young Albanians and comparing these with the Italian data. The questionnaire, which was written in Italian, comprised 39 questions divided into three sections concerning the social context, knowledge of STIs, and sexual behavior [2]. It was distributed by one of the authors (A.P.) in April 2016 to students attending the first year of the Nursing and of the Physiotherapy degree courses held in the Italian language at the Catholic University “Our Lady of Good Counsel”, a private University in Tirana. Seventy Albanian students (42 from the Nursing course and 28 from the Physiotherapy course completed the questionnaire: 49 females and 21 males). Their average age was 21.8 years (ranging from 18 to 29 years), which was slightly higher than that of the Sicilian students interviewed by Visalli et al. (most of whom were aged 17-19 years) [1] and the Italian students involved in our previous research (average age 17 years) [2]. Regarding the sources of information on STIs, unlike the Sicilian school students [1], but in line with our previous survey [2], the Albanian students obtained information mostly from teachers (49%) and parents (44%). Indeed, 77% of the Albanian students stated that they were sufficiently informed about STIs: sex education received at school was considered good or sufficient by 53%, and communication with parents excellent by 51.4% and good by 37.2%. Conversely, most of the Italian students complained about the lack of information on STIs provided by qualified staff [1, 2]. This difference may reflect the fact that in Albania education in “sexuality and life skills” has been mandatory for students aged 10-18 since 2015, despite opposition from certain segments of the Muslim population [3]. In Italy, by contrast, there are no laws regarding this subject, even though many proposals have been made over the last 30 years. Indeed, the headteacher of each school is in charge of the school’s policy on sex education [4]. Another substantial difference between Albanian and Italian students regards communication with parents, probably because talking about sex in a family setting is considered a taboo in Italy, especially in the southern regions. However, several studies have demonstrated that parents have the potential to protect adolescents against sexual risks, including early sexual behavior, inconsistent condom use and outcomes such as pregnancy and STIs [5, 6]. Notably, Albanian students showed a better knowledge of STIs than their Italian counterparts: 20% of the Albanians recognized all the STIs in a list of diseases, versus only 0.5% of the students from Genoa and Lecce [2] and 7.9% of those from Messina, Sicily [1]. In line with other European and non-European studies, HIV/AIDS was the best-known STI among those listed [1, 2, 7-9]. Furthermore, most of the Albanian students (79%) reported knowing what a PAP test was, while awareness of HPV as an STI and of HPV vaccination proved poor in other European studies [1, 2 7]. The differences between the Albanian and the Italian students reflect the different national policies on sex education in the two countries and highlight the urgent need to introduce sex education as a proper subject in Italian schools. Nevertheless, knowledge of STIs remains unsatisfactory in Albania [10], as in other European countries where sex education programs are compulsory in schools. In Hungary, for instance, although sex education for pupils aged 14 to 18 years was introduced in 1978, high-school students’ knowledge of and attitudes towards STIs remain poor [11]. Moreover, in Germany, where sex education at school begins at the age of 9 years, a recent study involving 1771 secondary school students in Berlin documented suboptimal levels of knowledge of STIs other than HIV [7]. This widespread lack of awareness is particularly noteworthy if we consider that HPV and Chlamydia trachomatis are, respectively, the most frequent viral and bacterial STIs. They have a particularly high incidence among adolescents and young adults, and can cause infertility; HPV can also cause cancers of the mucosa and skin [12]. The percentage of Albanian students who currently used contraceptive methods (51%) was lower than that of the Italians (58% of the students interviewed by us [2] and 76.8% of those interviewed by Visalli G. et al. [1]). In the latter study, however, condom use was investigated specifically with regard to sexual intercourse with a casual partner [1], a risky behavior that seems common (45.5%) among Sicilian students [1], but which was not investigated in the Albanian study. Regarding other risk factors for the transmission of STIs, the Albanian students reported using alcohol (43%) and recreational drugs (21%) much less than their Italian counterparts [2]. Nevertheless, these percentages are not negligible and are a cause for concern, as both alcohol and recreational drugs reduce self-control and increase risky behaviors, such as unsafe sex and violence. In this regard, a recent study on adolescent drinking found that adolescents were more likely to start using alcohol and to experience intoxication at an earlier age when living in families in which alcohol was more readily available [13]. In conclusion, our study emphasizes the importance of sex education in improving young people’s knowledge of STIs and behaviors. Sex education may have a life-long, positive effect on the health and well-being of young people, and is an investment that is likely to pay off later in the form of reduced health-care and social-support costs. Indeed, those European countries that have a long tradition of sex education can boast the lowest teenage pregnancy rate in Europe (The Netherlands) and a very low prevalence of HIV infections (Sweden) [4]. We are aware that the Albanian population studied was smaller smaller and slightly older than the Italian groups used for comparison. However, having had the opportunity to administer to Albanian students the same questionnaires that had been completed by their Italian peers prompted us to compare these two populations.

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          Most cited references 13

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          Is always authoritative the optimum parenting style? Evidence from Spanish families.

          The aim of this paper is to establish which parenting style is associated with optimum youth outcomes among adolescents of Spanish families. A sample of 1,416 teenagers from 12 to 17 years of age, of whom 57.2% were females, reported on their parents' child-rearing practices. The teenagers' parents were classified into one of four groups (authoritative, authoritarian, indulgent, or neglectful). The adolescents were then contrasted on four different outcomes: (1) self-esteem (academic, social, emotional, family and physical); (2) psychosocial maladjustment (hostility/aggression, negative self-esteem, negative self-adequacy, emotional irresponsiveness, emotional instability, and negative worldview); (3) personal competence (social competence, grade point average, and number of failing grades); and (4) problem behaviors (school misconduct, delinquency, and drug use). Results showed that both the indulgent and authoritative parenting styles were associated with better outcomes than authoritarian and neglectful parenting. Overall, our results supported the idea that in Spain the optimum style of parenting is the indulgent one, as adolescents' scores in the four sets of youth outcomes were equal or better than the authoritative style of parenting.
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            How can parents make a difference? Longitudinal associations with adolescent sexual behavior.

            Parents have the potential to protect against adolescent sexual risk, including early sexual behavior, inconsistent condom use, and outcomes such as pregnancy and sexually transmitted infections (STIs). Identification of the specific parenting dimensions associated with sexual risk in adolescence and young adulthood is necessary to inform and focus prevention efforts. The current study examined the relation of proximal (e.g., discussions of sexual costs) and distal (e.g., parental involvement, relationship quality) parenting variables with concurrent and longitudinal adolescent sexual behavior. The National Longitudinal Study of Adolescent Health (Add Health) provided a nationally representative sample with information about the family using adolescent and parent informants. Longitudinal information about sexual risk included adolescent condom use and adolescent sexual initiation, as well as young adult unintended pregnancy, reports of STIs, and biological assay results for three STIs. Higher parent-adolescent relationship quality was associated with lower levels of adolescent unprotected intercourse and intercourse initiation. Better relationship quality was also associated with lower levels of young adult STIs, even when accounting for prior sexual activity. Unexpectedly, more parent reports of communication regarding the risks associated with sexual activity were negatively associated with condom use and greater likelihood of sexual initiation. These results demonstrate that parents play an important role, both positive and negative, in sexual behavior, which extends to young adulthood, and underscores the value of family interventions in sexual risk prevention.
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              A Survey of Current Knowledge on Sexually Transmitted Diseases and Sexual Behaviour in Italian Adolescents

              Worldwide, 500 million people a year acquire a sexually transmitted disease (STD). Adolescents, accounting for 25% of the sexually active population, are the most affected. To analyze sexual behavior among Italian adolescents and their knowledge of STDs, with the goal of preventing their transmission, a questionnaire was administered to 2867 secondary school students (1271 males and 1596 females) aged 14–21 years. For the study, 1492 students were interviewed in Genoa (Northern Italy) and 1375 in Lecce (Southern Italy). For 37% of the respondents, parents and teachers were the main source of information on sex, and 95% believed that school should play the primary role in sex education. However, only 9% considered the sex education they received in school good. Noteworthy, only 0.5% of the teenagers recognized the sexually transmitted diseases from a list of diseases, and 54% of them did not know what a Pap test was. Confusion about the meaning of contraception and prevention was evident; only 22% knew that condoms and abstinence are the only methods for preventing STDs. Finally, a consistent number of students are exposed to risk factors for STDs transmission; e.g., alcohol and recreational drug use, promiscuity and improper condom use. On the basis of our study, there is an urgent need for the introduction of sex education as a proper subject in Italian schools.
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                Author and article information

                Journal
                J Prev Med Hyg
                J Prev Med Hyg
                JPMH
                Journal of Preventive Medicine and Hygiene
                Pacini Editore Srl
                1121-2233
                2421-4248
                02 April 2020
                March 2020
                : 61
                : 1
                : E3-E5
                Affiliations
                [1 ] Dermatologic Clinic, Policlinico San Martino , Genoa, Italy
                [2 ] Section of Dermatology, Department of Health Science, University of Genoa , Italy
                [3 ] Section of Dermatology, Department of Health Science, University of Genoa , Italy
                [4 ] Department of Experimental Medicine-Medical Pathophysiology, Food Science and Endocrinology Section, Sapienza University of Rome , Italy
                [5 ] Section of Hygiene Department of Health Sciences, University of Genoa , Italy
                Author notes
                Correspondence: Giulia Ciccarese, Dermatologic Clinic, Policlinico San Martino, largo Rosanna Benzi 10, 16132 Genoa, Italy. Phone: +39 010 5555753 - E-mail: giuliaciccarese@ 123456libero.it
                Article
                10.15167/2421-4248/jpmh2020.61.1.1413
                7225650
                ©2020 Pacini Editore SRL, Pisa, Italy

                This is an open access article distributed in accordance with the CC-BY-NC-ND (Creative Commons Attribution-Non-Commercial-NoDerivatives 4.0 International) license. The article can be used by giving appropriate credit and mentioning the license, but only for non-commercial purposes and only in the original version. For further information: https://creativecommons.org/licenses/by-nc-nd/4.0/deed.en

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