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Comparing three theories in predicting reproductive health behavioral intention in adolescent women with diabetes.

BACKGROUND: Understanding factors that affect decision-making in using preconception planning is important to reduce the rate of unplanned pregnancies and pregnancy-related complications in all women with diabetes. Previously, there were no studies of reproductive health-related beliefs, attitudes, or behaviors of adolescent women with diabetes. Constructs from social cognitive models, such as, the health belief model (HBM), theory of reasoned action, and social cognitive theory, are factors that can influence these behavioral outcomes. OBJECTIVE: To compare the predictive powers of these three theories in regard to decision-making with reproductive health behaviors in teens with diabetes and to identify a composite model of the strongest predictors across all three theories. METHOD: Data were collected from a telephone interview by same-gender research assistants on a sample of 87 female adolescents with type 1 diabetes (T1D) from four medical centers using the reproductive health attitudes and behavior (RHAB) questionnaire. Measures represent demographic variables, constructs of the three theories, and behavioral outcomes. Standard multiple regression analyses were used to examine the prediction of the three theories in the outcome variable [intention for using birth control (BC)]. RESULTS: Among the three theories considered, the HBM explained the highest percent of variance (24.4%) in intention to using BC. The best composite model consisted of perceived barriers, cues to action, and self-efficacy (explaining 26.1% of the variance). These three variables were also the strongest predictors among all constructs considered. CONCLUSION: In this sample of adolescent females with T1D, the strongest predictors from the three theories for intention to using BC appeared to be perceived barriers, cues to action, and self-efficacy. Intervention studies to decrease future unplanned pregnancies in this high-risk population could focus on strategies to target these factors that are amenable to change.

Adolescent↗

Adolescent girls' life aspirations and reproductive health in Nepal.

The study described in this paper takes a participatory and positive approach to improving adolescent reproductive health in a rural and urban community in Nepal. It shows that adolescent girls in these communities have dreams and aspirations for a better future and that adults acknowledge and support these ideals. However, social norms and institutions are restrictive, especially for girls, who are often unable to realise their hopes for continuing education, finding better-paid work or delaying marriage and childbearing, and this directly impacts reproductive outcomes. Insight into the broader context of adolescent girls' lives provides a valuable framework for designing positive programmatic actions which take as their entry point the disjuncture between girls' aspirations and realities. Interventions begun in these communities include youth clubs for safe social interaction and literacy classes; training of peer educators to teach life-skills, including for married adolescents; forums for parents, teachers and health service providers to discuss their own concerns and those of adolescents; and work with the community to design programmes that will contribute to greater financial independence and employment opportunities for adolescents.

Adolescent↗

[Experience of epidemiological surveillance of reproductive health in women employed in the health field].

Aim of this paper is to describe the methodology adopted to build up an epidemiological surveillance system on the reproductive health of women employed by the Regional Health System (Hospital Division). The implementation of this system required the set up of a relational database, with personal and health data collected from the 1st January 1998 to the 31st December 1998. The goals of research were: to describe the phenomenon of unfavorable reproductive events such as: death at birth, low weight at birth, birth defects, spontaneous abortions, voluntary abortions (for reasons linked to the child's and the pregnant woman's health), premature births and post term births; to provide the basis for further analytical studies on working activities with exposures of particular interest (antiblastic drugs, ionizing radiations and ergonomic factors); to contribute to evaluate the state of enforcement of the specific legislation. We computed raw, age-specific and standardized rates of the studied population as far as natality, spontaneous and voluntary abortivity and birth defects are concerned. The results showed an increased number of spontaneous abortions. Investigations are still in progress and an estimate of risks associated with chemical and physical exposures in this sector will be determined.

Abortion, Spontaneous↗

Integrating systematic screening for gender-based violence into sexual and reproductive health services: results of a baseline study by the International Planned Parenthood Federation, Western Hemisphere Region.

Three Latin American affiliates of the International Planned Parenthood Federation, Western Hemisphere Region, Inc. (IPPF/WHR) have begun to integrate gender-based violence screening and services into sexual and reproductive health programs. This paper presents results of a baseline study conducted in the affiliates. Although most staff support integration and many had already begun to address violence in their work, additional sensitization and training, as well as institution-wide changes are needed to provide services effectively and to address needs of women experiencing violence.

Counseling↗

Reproductive health for all: a commitment towards the new millennium.

The world government community made a commitment in 1994 to make reproductive health care universally available no later than the year 2015. The commitment has been confirmed by a special session of the United Nations General Assembly in July 1999. The commitment has to be backed up by resources, and the health profession has to provide the know-how. Social action will also be needed. Progress has been made, but challenges remain.

Contraception↗

Adult male involvement in reproductive health: an ethnographic study in a community of São Paulo City, Brazil.

The purpose of this research was to explore the involvement in reproductive health of adult men in a low-income community in São Paulo City, Brazil. The ethnonursing research method was used and data were collected through interviews with seven key and eight general informants. Lack of common sex education was found and informants' knowledge depended on their own families' involvement and individual life experience with machismo. Informants' behaviors and attitudes toward women were constructed by their own male-centered values. Leininger's culture care modes were used to explain culturally meaningful nursing care actions and decisions.

Adult↗

Barriers to sexual and reproductive health care: urban male adolescents speak out.

CONTEXT: Risky sexual behaviors among adolescent males put them at risk for sexually transmitted diseases, HIV/AIDS, and unplanned fatherhood, yet few facilities in the United States provide focused sexual and reproductive health services to these young men. A general acknowledgement exists that the development of such services is needed, yet there is little research to guide providers in making existing services more attractive to young males and in developing new sexual health services for this population. OBJECTIVES: This research aimed to explore attitudes and perceptions of urban black male adolescents regarding the availability of and access to reproductive healthcare. METHODS: Eighteen black male adolescents participated in three focus group discussions held in a central New Jersey city. Transcripts of the discussions were analyzed using the constant comparative method. Resulting categories were grouped into themes, which reflected the adolescents' perceptions and experiences. Member checks were used to verify findings. RESULTS: The adolescents felt that obtaining sexual health services was a stressful experience fraught with both internal and external barriers. Internal barriers included a fear of stigma and a loss of social status, shame, and embarrassment. External barriers included disrespectful providers, a lack of privacy/confidentiality, and challenges in accessing and negotiating the healthcare system. The young males described an idealized clinic environment as informal, welcoming, and respectful. DISCUSSION AND CONCLUSIONS: Providers should focus on improving the quality of care in existing clinics, particularly in the areas of access, privacy, and confidentiality, and on developing adolescent-friendly clinics focusing on male services. Adolescents should be encouraged to visit clinics prior to an acute need for services. There also is a need for providers who are comfortable with and able to communicate with male adolescents.

Adolescent↗

[Cultural dynamics in sexual and reproductive health. Reflections on prevention programs in Latino communities in the United States].

This presentation focuses on the thesis that successful attainment of sexual and reproductive health promotion goals in U.S. Latino communities depends on: 1) the effect of the transcultural and transnational experience in explanatory models of sexuality and human reproduction, 2) the reassessment and redefinition of women's power, 3) the inclusion of men in sexual health education programs, 4) the integration of sexual health education in community systems, and 5) the development of education interventions with economic development components.

Attitude to Health↗

An evaluation of the effectiveness of targeted social marketing to promote adolescent and young adult reproductive health in Cameroon.

This study examines the effectiveness of the PSI/PMSC Horizon Jeunes youth-targeted social marketing program for improving adolescent reproductive health in urban Cameroon. The program targeted adolescents through peer education, youth clubs, mass media promotion, and behavior change communications. After about 13 months of intervention, knowledge of the program was nearly universal, and the majority of youths had direct contact with the program. Program effectiveness is examined using a quasi-experimental research design with a preintervention and postintervention survey in an intervention and comparison site. The intervention had a significant effect on several determinants of preventive behavior, including awareness of sexual risks, knowledge of birth control methods, and discussion of sexuality and contraceptives. The intervention increased the proportion of female youths who reported using oral contraceptives and condoms for birth control. However, condom use is not yet consistent. Although the proportion of young men who reported using condoms for birth control also increased, this change could not be attributed to the intervention. Although this short intervention successfully increased the reported use of various birth control methods, including condoms, there is no evidence that the intervention increased use of condoms for STD prevention of sexually transmitted diseases.

Adolescent↗

[Physical activity and reproductive health].

BACKGROUND: The purpose of this article is to review the present knowledge about physical activity and reproductive health. METHODS: Medline and manual search for articles related to exercise and menstrual function, and exercise and pregnancy were performed. RESULTS: Repetitive intensive exercise with increased stress hormone utilisation seems to partly explain the disturbances in the hypothalamic-pituitary-adrenal axis. The prevalence of menstrual irregularities is higher among athletes who participate in sports in which leanness is considered important for performance. Most of the studies concerning exercise-induced amenorrhoea have focused on low body weight and low fat ratio of body weight. However, energy drain and nutrient deficiency have been found to be important variables explaining menstrual irregularity in athletes. Loss of bone mass is related to menstrual irregularities hence it is important that menstrual irregularity not is considered a "normal" aspect of being an athlete. There are a number of positive effects and a few hypothetical risks related to exercise during pregnancy. There are no clinically controlled studies allowing us to draw conclusions about the effect of intensive training during pregnancy. INTERPRETATION: Physically active women should be aware of the importance of sufficient energy intake to keep their regular menstrual cycle. Moderate exercise during pregnancy is recommended.

Amenorrhea↗

Reproductive health, the Arab world and the internet: usage patterns of an Arabic-language emergency contraception web site.

Emergency contraception (EC) has the potential to reduce significantly the incidence of unintended pregnancy worldwide. In May 2003, the first Arabic-language web site dedicated to disseminating information about and increasing awareness of EC was launched. This paper examines patterns of web site use and user profiles over a 19-month period. Analysis of use shows that the Arabic web site users are interested in different aspects of EC than the English web site users, suggesting the importance of creating culturally specific content when adapting and translating health education materials. Arabic web site users demonstrate significant interest in general reproductive health issues not specific to EC, suggesting a need for greater availability of Arabic-language health education resources through the Internet.

Arab World↗

The sexual and reproductive health in men with generalized epilepsy: a multidisciplinary evaluation.

This study was specifically aimed to evaluate the sexual and reproductive health in a group of men with generalized epilepsy. In total, 44 men with generalized epilepsy were included in this study, their ages between 18 and 48 years (29.2+/-9.9) and duration of illness between 2 and 35 years (11.2+/-7.4); 34 patients were treated with conventional antiepileptic drugs (AEDs). Sexological and psychological interviews together with serum total testosterone, E(2), FSH, LH and prolactin were determined. Hyposexuality was diagnosed in 61.4%. Erectile dysfunction (ED) and premature ejaculation represented 70.4 and 66.7%, respectively. Variables such as hyposexuality, seizure duration and its poor control on AEDs were significantly associated with depressive symptoms. Compared to the normal control group, all patients reported elevated E(2) levels (P<0.001), 10 had FSH (n=4) and LH (n=6) levels exceeding that of the normal range for controls and two had hyperprolactinemia. Although the patients' mean value of total testosterone remained within the normal range, but it was significantly lower in hyposexual men compared to nonhyposexual (P<0.002), only two epileptic patients had markedly reduced level of total testosterone beyond normal control levels. This study strongly supports that: (1) The risk of hyposexuality and reproductive disturbances is high in epileptic patients with GTC convulsions despite the AEDs utilized. The risk for SD is further increased by poor seizure control and the frequently accompanied depressive manifestations. (2) It is possible that elevated E2 could increase the risk of SD by reducing active testosterone through negative feedback and the reduction of active testosterone could increase seizure intractability to antiepileptic medications.

Adult↗

Fish consumption and other characteristics of reproductive-aged Michigan anglers--a potential population for studying the effects of consumption of Great Lakes fish on reproductive health.

There has been considerable interest in the benefits and risks of eating Great Lakes fish, particularly with regard to reproductive health. We report the results of a survey conducted from 1993-1995 among Michigan anglers. The survey was designed to identify a reproductive-aged cohort of persons who consume high or low levels of Great Lakes fish in order to study the impact of polyhalogenated biphenyl (PHB) compounds and other toxins on human reproduction outcomes. Using fishing license data obtained from the Michigan Department of Natural Resources, we identified anglers of early reproductive age (18-34 years) in ten Michigan counties. The screening survey ascertained demographic, behavioral, fish consumption, and reproductive history information on anglers and their partners. Over 4,000 angler households were contacted. One thousand nine hundred fifty questionnaires were returned from 1,168 households. The median age of respondents was 30 years; 58% were male and 64% reported being married. Slightly more than one-half the respondents had attended or graduated from college, and less than 10% had not completed high school. In the past year, most respondents (46%) reported having eaten sport-caught fish 1-12 times, while 20% reported having eaten no sport-caught fish; 20% had consumed 13-24 meals. More sport-caught fish was consumed in the spring and summer than in the fall and winter, and males reported eating more fish than females. About 43% of our respondents reported that they intend to have one or more children in the next five years. Of these respondents, 287 couples had no identified impairments to reproduction and therefore would be eligible to participate in the future reproductive study.

Adolescent↗