Cad . Sa úd e Púb lic a, Rio d e Jane iro , 17(4):833- 842, jul-ag o , 2001
D i ff e rences and similarities in sexual and
cont racept ive knowledge, at titudes, and
behavior among Latino male adolescent student s
in California, United Stat es and Lima, Peru
D i f e re nc ias y similitud e s e n e l c o no c imie nto ,
las ac titud e s y lo s c o mp o rtamie nto s se xuale s
y d e antic o nc e p c ió n e ntre e stud iante s
ad o le sc e nte s varo ne s latino s e n Califo rnia,
Estad o s Unido s, y e n Lima, Pe rú
1 In stitu to de Estu d ios d e Po b l a c i ó n , Un i ve r s i d a d Peru an a Cay et a n o He re d i a . Av. H on ori o D elgad o 43 0, San M a rt ín d e Po r ra s , Lim a 18, Pe r u . 2 Cen t er for Re p ro d u c t i ve Hea lt h Poli cy Re s e a rc h , In st it u t e fo r H eal t h Po l i c y St u d i e s , U n i versi t y of Calif orn i a a t Sa n Fra n c i s c o. 3 333 Ca li forn ia St . , R o o m 2 6 5 , S an Fra n c i s c o , C A 9 4 1 4 3 - 0 9 3 6 , U n it ed St at es of Am e r i c a .
Jesú s L. Ch irin os 1 , 2 C l a i re Brin d is 2 Sh eri Tye 2
Vi rgin ia Mc Ca rt er 2
Abstract To iden t ify t h e differen ces a n d sim ilari ties in sexu a l a n d con tra c e p t i v e k n ow l e d g e ,a t -t i -t u d e s , a n d b eh a v i or a m on g La -t i n o m a le a d o lescen -t s-t u d en -t s l iv i n g i n Ca li fo rn i a a n d Li m a . Se l f - a d m i n i s t e re d , a n o n ym ou s su rveys w ere co m p let ed b y Lat in o m a le st u den t s a ged 12-19 p at icip aat in g in Ca l i f o r n i a , a n d by m a le a d olescen at sat u d en at s in fou r h igh sch ools in Li m a . Bo at h su rv eys con t a in ed sim ila r qu est ion s allow in g for com p a rison s re g a rdin g sex u a l act irvit y a n d con t ra -c e p t i v e beh a v ior. Th e m ea n a ge of m ale st u d en t s w ere 16 a n d 15 yea rs, re s p e -c t i ve l y. Mo re Ca l i f o r-n ia m a les re p o rt ed h a v ir-n g er-n ga ged ir-n sex u al ir-n t ercou rse (69% v s 43%. Th e sex u al deb u t w a s 13 yea rs in bot h sa m p les. Mo re st u d en t s in Ca liforn i a w ere a w a re of t h ei r ri sk of p regn a n cy at first s ex u a l in t ercou rse t h a n in Li m a (82% v s 50%). On e t h i rd of t h e Ca li forn ia m a les re p o rt ed com -m u n i ca t in g w i t h t h eir p a rt n er a bo u t sex a n d con t ra cep t io n t o be “e a s y” a s co -m p a red t o 53% of m a les in Li m a . M o re st u den t s in Californ ia re p o rt ed k n ow in g a p la ce t o o bt a in co n t ra c e p t i ves if t h ey n eed t h em (85% v s 63%), h av in g ev er got t en som eo n e p regn a n t (29% v s 7%), a n d h a v in g fa-t h e red a ch ild (67% vs 16%).
Key words Ad o l e s c e n c e ; Sex Be h a v i o r ; Sch ool He a l t h
Resumen Id en t i fi ca r la s d i feren cia s y si m ili t u d es en cu a n t o a con ocim ien t o, a ct i t u d es y com -p o rt a m ien t o s sex u a les y d e a n t i co n ce-p ción en t re los est u d i an t es a do lescen t es la t in os qu e v iv e n en Ca lifo rn i a y en Li m a . Est u d ia n t es a dolescen t es va ron es lat in os d e 12-19 a ñ os co m p let aron la s en cu est a s a n ón im a s, a u toa p licab les t a n t o en Ca liforn ia com o en cu a t ro colegios secu n da rio s en Li m a . Am b as en cu est a s co n ten ía n p regu n t as sim ilares con resp ect o a a ctiv id ad sex u a l y com p or-t am ien or-t o d e an or-t icon cep ción . La m ed ia d e ed a d fu e d e 16 y 15 añ os, re s p e c or-t i va m e n or-t e . Má s v a ro n e s a dolescen t es en Ca liforn ia señ a la ron h a ber t en i do rela cion es coit a les (69% v s4 3 % ) . En t re ést os, la m edia d e ed ad d e in icio sex u a l fu e d e 13 añ o s en a m b a s m u est ra s . M á s estu d ia n t es en Ca l i f o r-n ia sa bia r-n d el riesgo d e em ba ra z o er-n la p ri m era rela ciór-n sex u a l (82% v s5 0 % ) . Un t ercio d e lo s a d o lescen t es v a ron es d e Ca li fo rn i a señ a l a ro n q u e h a bl a r so bre sex o y a n t i co n cep ci ó n con su p a rej a es “ f á c i l ”, c o m p a ra d os a l 53% d e lo s d e Li m a . M á s est u d i a n t es en Ca li f orn i a señ a la ro n co n o cer u n lu ga r p a ra o bt en er a n t icon cep t i v o s si ellos lo s n ecesi t a n (85% v s6 3 % ) , h a b er em -b a ra za do a a lgu ien algu n a vez (29% v s7%) y h a ber t en id o u n h ij o (67% v s1 6 % ) .
CHIRINO S, J. L. e t al.
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Cad . Saúd e Púb lic a, Rio d e Jane iro , 17(4):833-842, jul-ag o , 2001 I n t ro d u c t i o n
Red u cin g a d o lescen t rate s o f u n in t en d ed p re g-n a g-n cie s (U IPs ) a g-n d se xu a lly t r ag-n sm it t e d d is-e a sis-es (STDs), in clu d in g AIDS, h a s b is-e is-en id is-en ti-fie d a s a n im p o rt a n t so cia l go al fo r t h e la t e 1990s a n d o n e fa cin g o u r s o cie t y in t h e n e w m ille n iu m (Ala n Gu t t m a ch e r In s t i t u t e , 1994; Ozer et a l., 1997). Mu ch h as b ee n le arn ed ab ou t t h e t yp e s of p re gn an cy a n d STD in t e r ve n t i o n s t h at w ork (Dry f o o s, 1997; Ki r b y, 1997). Howe v-e r, a n im p o r t a n t ga p is t h v-e la ck o f sys t v-e m a t ic i n f o rm ation a va ila b le o n b ot h a d o le sce n t s an d yo u n g a d u lt m ales re g a rd in g th e ir role in sh ar-in g resp o n sib ility for sexu al act ivit y a n d re p rod u c t i ve b eh avior an rod p aren tin g, an rod con tra c e p t i ve d ecision m akin g n ecessa ry to a ch ieve a re -d u ction in th e in ci-d en ce of UIPs an -d STDs (Dry-f o o s, 1997; Ed w a rd s, 1994; Mo o re e t a l., 1997).
Mu ch o f t h e su rge in in t e r e st in in t e rve n -t io n p ro g ram s d ire c-t ed a -t m a le s in re ce n -t ye a r s h a s b e e n d ire ct ly re la t e d t o t h e re c o gn it io n o f t h e im p o r t a n t a n d in flu e n t ia l r ole t h a t m a le s p la y in fe m a le s’ co n t ra c e p t i ve u t iliz a t io n , a s we ll a s t h e ir ow n willin gn e ss t o u se c on d o m s ( Brown & Ei s e n b e rg, 1995; Mo o re e t a l., 1997; Sch ulte & Son en ste in , 1995). In a d d ition , t h ere h as b e en a va rie ty o f in t erven t ion s im p le m e n te d , fro m s ch o o l b a ste d t te te n fo cu ste d co n t ra -c e p t i ve -clin i-cs to sexu ality e d u -cation p ro g ra m s, t o re d u c e t h e h igh in c id e n ce o f ad o le s c e n t U I Ps a n d STDs (Bo rgia et al., 1997; Ki r b y, 1997). Wh ile re c e n t t re n d s in d ica t e s o m e s u c ce ss in red u cin g t h e in cid en ce o f b ot h p ro b l e m s, n e v-e rt h v-e l v-e s s, t h v-erv-e co n tin uv-e s t o b v-e a n v-e v-ed t o v-e va l-u ate th e st ren gt h s a n d lim ita tion s of t h e se p ro-g ram s an d to d e ve lop a d d it ion a l st ra t ero-gies t ai-l o re d to t h e un iq u e n ee d s of d iffere n t grou p s o f a d o le s ce n t s (Bo r gia e t a l., 1997; La vin e t a l., 1992; Le vin e & Pit t, 1995; Pe r ry e t a l., 1993).
Me n’s in vo l ve m e n t in d ecision s a b ou t sexu -a l -a ct ivit y, co n t r -ac e p t ion , -a n d c h ild b e -a r i n g s t ro n gly in flu en ce s sexu a l r isk a n d n o n -risk b e-h a vio rs (Bu rger & In d e r b ri t ze n , 1985; Le la n d & Ba r t h , 1992; Ple ck e t a l., 1975). Cu r re n t t re n d s in con t ra c e p t i ve m e t h o d c h o ice a lso su gge st a rise in th e u se of con dom s (Bru gm a n et al., 1 9 9 7 ; Wi t we r, 1997). Cle a rly, m en h ave an im p o rt a n t r o le in d e c is io n - m a kin g re g a rd in g th e u se o f c o n t ra c e p t i ves an d fa m ily p la n n in g re lat ed ser-v i c e s. Re s e a rch fu rt h e r su b st an t ia t es t h e n e e d t o ed u cat e yo u n g p e o p le re g a rd in g th e im p or-t an ce of join or-t resp on sib ilior-ty in p re ve n or-tin g p re g-n ag-n cie s a g-n d STDs (Gra d y e t a l., 1996; Ple ck e t a l., 1975; Sch u lte & So n e n ste in , 1995).
A st ro n g fo cu s o n a d o le s ce n t s, a n d in p a r-t i c u l a r, Lar-t in o you r-t h , is n ece ssar y a s a re sulr-t o f d e m o g r a p h ic s h ift s w h ic h will like ly o c cu r in
Cad . Saúde Púb lica, Rio d e Jane iro , 17(4):833-842, jul-ag o , 2001
o f H isp a n ic a n d b la c k s e xu a lly e xp e r i e n c e d t e e n a ge m a le s re p o r t e d cau sin g a p re g n a n c y, c o m p a re d to on e-t en th of wh ite m ales, a n d j u s t u n d e r t e n p e rcen t of Hisp an ic a n d b lack m ales re p o r t e d a b irt h , co m p a re d t o five p e rc e n t o f wh ite m a les (Mo o re et a l., 1998).
An a lysis o f Ca l i f o r n ia d a t a d e m o n st ra t e s t h a t t h e re is a su b st a n t ia l d iffe re n ce b e t w e e n you n g t ee n age m ot h e rs a n d th e fat he rs of th eir b a b ie s (Bre slin , 1997). On e h alf o f b a b ie s b o rn t o Ca l i f o r n ia wo m e n a ge d 14- 17 in 1993 we re f a t h e re d b y m e n a ge d 20 o r o ld e r ; o n a ve ra g e m e n we re 6.4 ye a rs o ld e r t h an wo m e n , wh ere -a s t e e n -a ge f-a t h e rs we r e on ly 1.5 ye -a r s old e r t h an t ee n m o th e rs. Am o n g Hisp an ic a n d b lack t e e n m o t h e rs, t h e re wa s a 20% le ss like lih o o d o f a d u lt p a t ern i t y, as com p are d to in fa n t s b orn to wh ite wo m e n (Breslin , 1997). Alt h ou gh , t h e re a re fe w d a t a a b o u t re p ro d u c t i ve e xp e ri e n c e am o n g m ale a d o le sce n t s in Lat in Am e r i c a , ad o le sc e n t m a le s t e n d t o d is clo se h a vin g h a d p re m a rit a l se x m o re o ft e n t h a n t e e n wo m e n . Th e p ro p o rtion va ries a m on g ad olesce n t m a les age d 15- 19 wh o d is c lo s e d h avin g p r e - m a ri t a l sex a cross d iffe re n t cou n t ries (e.g. 44% in Me x-i c o, 42% x-in Co st a Rx-ic a , 73% x-in s o m e ar e a s o f Brazil). Th e m ean age of sexu al d eb u t was f o u n d t o b e 15 ye a rs a n d b e t we e n o n e fift h t o o n e -t h i rd o f s e xu ally a c -t ive m a le a d o le sc e n -t s h a d t h e ir fir st se xu a l e xp e rie n ce b e fo re tu r n in g 15 ye a rs o ld . Th e ir fir st se xu a l p a r t n e r w a s 3-4 ye a rs o ld e r. In t h e m a jo rit y o f t h e c it ie s su r-ve ye d , on ly a m in o rit y of se xu a lly exp e ri e n c e d , n o n - m a r r ie d a d o le sc e n t m a le s we re cu r re n t l y se xu ally a c t ive (in t h e la s t m o n t h b e fo re t h e s u r ve y). Fe w c ou p le s u s e d a co n t r a c e p t i ve in t h e ir fir st sexu a l in t erc o u r s e, an d a m o n g sexu -a lly -a ct ive m -a le s -a ge d 15-24, t h e p e rce n t o f c o n t ra c e p t i ve u se va r ie d b e t we e n 14% a n d 31%. Th e like lih o o d o f u s in g a co n t r a c e p t i ve m e t h od in cre a se d w it h a ge o f se xu a l d e b u t . Am o n g th o s e e xp e rie n c in g a p re g n a n c y, b e -t we en 76% a n d 84% we re un in -te n d ed (Ro b ey e -t a l., 1992).
Gi ve n t h e re l a t i ve ly lim it e d in fo rm a t i o n a va ila b le on La t in o a d o le sc e n t m a le s in b o t h t h e Un it ed St a t e s a n d La t in Am erica, th e re is a n ee d t o con d u ct re s e a rch o n t h e role of ad o les-ce n t a n d yo u n g a d u lt m a le s in t h eir sexu a l a c-t i v i c-t y, se xu a l a n d re p ro d u c c-t i ve b e h a vio r, a n d t h e ir p a r t icip a t io n in t h e d e cis io n -m a kin g p ro ce ss re g a rd in g h a vin g se xu al re la t io n s an d u sin g co n tra c e p t i ve s. Se con d , it is im p ort an t to u t i l i ze t h is t yp e o f in for m a t io n t o b e t t e r re a c h a n d in vo l ve a t -r isk a d o le s ce n t m a le s in o rd e r to pre ven t STDs/ AIDS a n d early U IPs a n d th eir c o n s e q u e n c e s. T h i rd , give n t h e like ly in cre a s e in t h e p re s e n ce o f t h e H is p a n ic p op u la t ion in
t h e Un it e d St a t e s, it is im p o rt a n t t o id e n t ify s i m i l a rit ies an d d iffe re n ces b e twe en Hi s p a n i c / La t in o p o p u lat io n s in d iffe re n t se t t in gs in or -d e r t o b e t t e r u n -d e r st a n -d t h e in -d ivi-d u a l a n -d g ro u p ch ara c t e rist ics a n d t h e e ffe ct of t h e so -cia l co n t e xt in wh ich th e y live.
In th is st u d y, we c om p are su r ve y d a t a co l-le ct e d b e t w e e n Nove m b e r, 1996 a n d Ma rc h , 1997 fro m t h e Ma le In vo l ve m e n t Pr o g ra m , a m ale foc u s e d t e e n a ge p re gn a n cy p re ve n t i o n p ro g ra m d e ve lo p e d in 23 s it e s in Ca l i f o rn i a a n d t h e Pre ve n t io n o f Se xu a l Risk Be h a v i o r : A S c h o o l Ba se d Sex Ed u cat ion In t e rven tio n Mo d e l, co n d u ct ed b e twee n Ap ril, 1995 an d Nove m -b e r, 1996 in Lim a , Pe ru . Se ve ra l s u r ve y it e m s we re a n a lyzed t o id e n tify d iffe ren ce s a n d sim i-l a r it ies in sexu a i-l a n d con tra c e p t i ve kn ow i-l e d g e, a t t i t u d e s, a n d b eh avio r am on g ad o lescen t m a l e s t u d e n t s in o rd e r t o id e n t ify crit ica l iss u e s fo r i m p ro vin g t h e se p re ve n t ion p ro g ra m s a n d fo r im p lem en tin g n ew in terven tion s aim ed at yo u n g La t in o m en . We we re a lso in t ere ste d in a sse ss-in g t h e s im ilar itie s a n d d iffe re n ce s b e t we e n t h ese t wo gro u ps of La tin o m ale ad ole sce n t s.
M e t h o d s
A self-a d m in istered , an o n ym ou s q u estion n aire was com p le te d by st u d en t s a ges 12 to 19 in th e 3r da n d 4t hg ra d e s (e q u iva le n t t o 9t ha n d 10t h
g ra d e s in th e Un it ed St at es) a tte n d in g fo ur h igh s ch o o ls in Lim a , Pe r u . Th e s c h o o ls we re ra n -d o m ly se le ct e -d fro m a p oo l of 12 sc h oo ls in an u r b a n s ch o o l d is t ric t wh ich m e t cr i t e r ia for p a r t icip a t io n , in clu d in g a s im ilar m ixt u re o f l ow in co m e s t u d e n t s, sc h oo l size, a n d s im ilar n u m b ers o f stu d e n ts wh o h a d b een re f e r re d for h e a lt h se r vice s b y s ch o o l a d m in ist ra t o r s. T h e 50- it e m in st r u m e n t w a s co m p rise d o f q u e s-t io n s cove rin g six areas: (1) so cio -d e m o gra p h i c i n f o rm a tio n ; (2) fa m ily ch ara c t e ristics; (3) p e r-son al a ctivitie s; (4) kn owled ge a n d a tt it u d e s re-g a rd in re-g se xu alit y; (5) sexu al e xp e rien ce; an d (6) c o n t ra c e p t i ve use. Data wa s gat h e red as p a rt o f a b ase lin e s u r ve y wh o se fin d in gs we re u sed t o d e ve lop a s ch o o l-b a se d s e xu alit y e d u ca t io n p ro g ra m .
CHIRINO S, J. L. e t al.
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se xu a l a ct ivit y, c o n t ra ce p t io n , a n d p re g n a n c y. Ma le s we re re c r uite d from a va riet y of se tt in gs, in clu d in g m id d le a n d h igh sc h o o ls, ju ve n i l e ju stice facilities, alt ern a t i ve sch ools, yo u t h a n d re c re at io n ce n te rs, an d ad u lt ja il fa cilit ie s. Fo r t h is st u d y, Lat in o m a le s t u d e n t s cu r re n t ly a t -t e n d in g s ch oo l a ge s 12 -t o 19 we re se le c-t e d -t o a l l ow fo r co m p ara t i ve a n a lysis.
Fo r t h is st u d y, w e u se d co m p a ra b le q u e s-t ion s re la s-t ed s-t o a ge, m a le s’ m o ss-t im p o rs-ta n s-t a c-t i v i c-t i e s, c-t h e ir kn o wle d ge o f p re gn a n c y r isk a c-t t h e first act o f in t erc o u r s e, ease in t alkin g ab ou t c o n t ra c e p t i ve s wit h p ar t n e r s, m a le s’ s e n se o f resp on sib ility to a void a p re g n a n c y, kn ow l e d g e a b o u t wh e re to get con tra c e p t i ve s, wh eth er th e t e en h a d e ver h a d se x, a ge of sexu a l d e b u t , u se a n d t yp e o f c on t ra c e p t i ve a t t h e las t a ct o f in -t e rc o u r s e, wh e-t h er p ar-t icip an -t h ad e ver go -t-t en s o m e on e p re gn a n t , a n d if t h e y h a d fa t h e re d a c h i l d .
Age ca t e gor ie s we re d e fin ed st a t ist ic a lly in o rd e r to weigh t th e cells, wit h e arly a d olescen t s d e fin e d a s 12 t o 14 ye a r s, m id d le a d o le sce n t s a s 15 ye a r s, a n d lat e ad o le s c e n t s a s 16 t o 19 ye a r s. Th es e b re a k d own s re fle ct t h e m a jo r age g rou p s p ar ticip a tin g in t h is st u d y. Sexu a l act iv-it y w a s d e fin e d b y w h e t h e r t h e t e e n re p o rt e d h avin g e ver e n gage d in sex.
R e s u l t s
A t o t a l o f 1,020 su r ve ys we re a d m in ist e re d in Lim a ; o f t h e s e su rve y s , 991 (97%) m e t d a t a
q u ality cri t e ria an d we re in clu d e d in th is a n aly-s i aly-s. A to tal of 2,071 aly-su rve yaly-s we re collect ed fro m MIP p ar t ic ip a n t s in Ca l i f o r n ia ; o f t h e s e, 836 (40%) m e t s e le ct io n c ri t e ria fo r s u b se q u e n t c o m p a ra b le an a lysis (i.e. Lat in o m a le s, in t h is c a s e, p ri m a rily of Mexica n d esce n t , a ge s 12-19 wh o we re at t en d in g sch o ol). Ch a ra c t e rist ics o f m ales in b o t h sa m p le s a re p re se n t ed in Ta b l e s 1 an d 2, a n d b y a ge in Ta b le s 3 an d 4. Se x u a l l y a c t i ve wa s a n a lyze d a s a d e p e n d e n t va ri a b l e a n d sign ifican t resu lts a re pre sen te d in Tab le 5 a n d 6. Va ria b le s wit h a n RR e q u a l o r gre a t e r th an 1.5 an d fou n d t o b e sign ifican t ly d iffe re n t w e re fit te d in t o a re g re s sio n logist ic m o d e l in o rd e r to id e n t ify va riab les th a t b est p red ict t he p ro file o f sexu ally active m a le s.
Th e m e a n a ge o f su rve y re sp on d e n t s wa s 14.9 + 1.15 (n = 991, m e d ia n = 15 an d ra n ge 12-19) in Lim a a n d 15.8 + 1.71 (n = 836, m e d ia n = 16 a n d ra n ge 1219) in Ca l i f o r n ia . Th e s e lfre -p o rt e d -p re f e r re d a c tivity a m o n g m a le s in b o t h lo ca t io n s wa s sp e n d in g t im e wit h fa m ily (66% in Ca l i f o rn ia an d 76% in Lim a , p < 0.0001).
K n owled ge of p re gn a n cy risk wa s d ist in ctly d i f f e re n t a m o n g t h e t wo gro u p s, wit h 82% of Ca l i f o r n ia La t in o m a le st u d e n t s in d ic at in g a w a ren ess of th eir risk o f p regn an cy at first sex-u al in tercosex-u rse, as com p ared to 50% (p < 0 . 0 0 0 1 ) of m a le s in Lim a . Th e m a jo rit y o f s t u d e n t s in b o th location s (85% am on g th e Ca l i f o rn ia sam -p le a n d 63% am o n g m a le s in Lim a ) in d ica t e d th a t t h e y kn ow wh e re to ob t a in con tra c e p t i ve s if t h e y n e e d t h e m ; Ca l i f o r n ia m a le s we re m ost likely t o re p o rt d ru g s t o res (60%) a s t he ir pr i m
a-Tab le 1
Ag e and ag e o f se xual d e b ut amo ng Latino male stud e nts. Califo rnia, Unite d Sate s and Lima, Pe ru .
Age (years) n % M e a n S D R a n g e p1
C a l i f o rnia, United Stat es
Ag e o f se xual d e b ut 0 . 0 0 0 0 *
≤ 14 5 1 9 . 2 1 3 . 2 7 2 . 9 1 0 7 - 1 9
1 5 7 9 1 4 . 3 1 3 . 1 2 1 . 1 4 0 9 - 1 6
≥ 16 4 2 3 7 6 . 5 1 3 . 6 1 1 . 7 4 0 5 - 1 9
To t a l 5 5 3 1 0 0 . 0 1 3 . 5 1 . 8 1 0 5 - 1 9
Lima, Peru
Ag e o f se xual d e b ut 0 . 0 0 0 0 *
≤ 14 9 3 2 5 . 5 1 2 . 3 3 1 . 6 4 0 5 - 1 6
1 5 1 2 2 3 3 . 5 1 3 . 1 3 1 . 7 9 0 7 - 1 5
≥ 16 1 4 9 4 0 . 9 1 3 . 8 9 2 . 0 5 0 7 - 1 9
To t a l 3 6 4 1 0 0 . 0 1 3 . 2 1 . 9 6 0 5 - 1 9
SD = Standard d e viatio n
Cad . Sa úd e Púb lic a, Rio d e Jane iro , 17(4):833-842, jul-ag o , 2001
r y s o u rce o f co n t r a c e p t i ve s, wh ile Lim a m a le s re p o rt ed h ealth p rovid ers (81%) a s th eir so u rc e o f con tra c e p t i ves (p < 0.0001).
Co m f o rt in co m m u n ica tin g wit h t h e ir p art -n e rs ab o u t sex a -n d co -n t ra ce pt io-n w as a lso d is-tin ct ly d ifferen t b e twee n th e Ca l i f o rn ia a n d Li-m a sa Li-m p le ; 33% a n d 53% (p < 0.0001), re s p e c-t i ve l y, fe lc-t ic-t wa s a lways ea sy c-to c-talk c-to c-th eir p arc-t- art-n e r s. Vie ws oart-n re sp o art-n sib ilit y fo r coart-n t ra c e p t i ve u se d iffe re d b e twee n gro u p s; 79% a n d 69%, re -s p e c t i ve l y, (p < 0.0001) re p o rted tha t b oth m ale-s a n d fe m a le s sh a re e q u a l re sp on sib ilit y for u s-in g co n t ra ce p tio n t o a vo id a p re g n a n c y.
Se xu a l a c t ivit y wa s re p o r t e d t o h a ve o c -c u r re d m ore freq u en t ly in Ca l i f o rn ia th an in Lim a ; 69% a n d 42% o f st u d e n t s (p < 0.0001), re -s p e c t i ve l y, re p o r t e d h a vin g e n ga ge d in -s e xu a l a c t i v i t y. Am o n g sexu ally active m a les, th e m e a n a ge for sexu a l in it iat io n w as 13 yea rs in b ot h lo -c a t i o n s. Am o n g t h o se s e xu a lly a -ct ive m a le s, 28% an d 37%, re s p e c t i ve l y, re p o rte d u sin g con t ra c e p t i ve s at t he tim e of t h e ir last se xu al exp e r i e n c e . Th e m o st c om m o n m e t h o d o f c o n t ra -cep tion wa s co n d om s, wh ich we re u se d in b o th p o p u la t io n sa m p le s (83% a n d 84%) a t t h e la st act of in te rc o u r s e. Am on g se xua lly a ctive m a l e s, 29% a n d 7% re s p e c t i ve l y, re p o rt ed e ve r ge t tin g so m e o n e p re gn a n t (p < 0.0001). Fu rt h e rm o re, 67% o f Ca l i f o r n ia a n d 16% o f Lim a yo u t h wh o h a d got t en th e ir girlfrie n d s p re gn a n t , h a d a lso f a t h e re d a ch ild (p < 0.0001). Re fle ct in g t h e g re at e r in cid en ce of se xu a l a ct ivit y an d t h e in -con siste n t u se of co n tra c e p t i ve s, t h e in cid e n ce of a d o le sc e n t p re gn a n cy w a s fa r m o re like ly am on g th e Ca l i f o rn ia m ale s t h a n in Lim a .
Fo r b o t h p o p u la t io n s, kn o wle d ge o f t h e risk of p re gn an cy at first in t e rco u rse in cre a s e d b y a ge (p < 0.0001), a s d id t h e le ve l o f co m fo r t m a le s re p o r t e d in d iscu s sin g co n t ra c e p t i o n with th eir se xua l p a rtn e rs (p = 0.0034). No t su r-p ri s i n g l y, o ld e r t e e n s in b o t h s am r-p le s we re m o re like ly t o re p o r t h a vin g h a d s e x a n d h a v-in g e ve r got t e n so m e o n e p re gn an t (p < 0.0001 a n d p = 0.0041, re s p e c t i ve ly). We fo u n d sign ific an t d iffe re n ific e s in t h e p ro p o r t ion o f ad o le s -cen ts in b oth sa m p le s wh o we re se xu ally active ( Ta b le 5). In Ca l i f o rn ia , a c t ivit ie s su c h a s a t -te n d in g sch o ol (RR = 0.82, p < 0.0001), so cializ-in g wit h frie n d s (RR = 0.89, p < 0.05), an d sp o rt s (RR = 0.76, p < 0.0001) we re p ro t e c t i ve fac to rs. How e ve r, in Lim a, so cia lizin g wit h frie n d s was a s so c ia t e d w it h a gre a t e r like lih o o d o f se xu a l a ct ivity (RR = 1.19, p = 0.0354) alth o u gh p layin g s p o rts wa s a p ro t e c t i ve facto r aga in st early sex-ua l in itiat ion (RR = 0.81, p = 0.0104).
In Ca l i f o rn ia , kn owin g t h a t p re gn a n cy is p o s sib le at firs t se x (RR = 1.56, p < 0.0001), k n owin g wh ere to ge t co n t ra c e p t i ves (RR = 2 . 0 4 ,
Tab le 2
Favo rite ac tivitie s, se xual kno wle d g e , attitud e s, b e havio rs and p re g nanc y
e xpe rie nc e amo ng Latino male stud e nts. C alifo rnia, Unite d State s and Lima, Pe ru .
Va r i a b l e C a l i f o rn i a L i m a p1
n % n %
Favorit e act ivit ies
Atte nd ing scho o l 8 9 6 9 7 9 0 . 0 0 0 1 *
Ye s 3 9 3 4 7 . 0 3 7 2 3 8 . 0
Be ing with family 8 3 6 9 8 7 0 . 0 0 0 0 *
Ye s 5 4 8 6 5 . 6 7 4 6 7 5 . 6
So c ializing with frie nd s 8 3 6 9 5 4 0 . 0 0 0 0 *
Ye s 3 7 4 4 4 . 7 2 8 5 2 9 . 9
S p o rt s 8 3 6 9 5 4 0 . 0 0 0 0 *
Ye s 2 2 5 2 6 . 9 3 3 9 3 5 . 5
K n o w l e d g e
P re g nancy p o ssib le 8 1 0 9 5 0 0 . 0 0 0 0 * 1s ttime se x
Ye s 6 6 6 8 2 . 2 6 0 2 6 3 . 4
Kno w whe re to g e t 8 1 0 9 5 0 0 . 0 0 0 0 *
c o n t r a c e p t i v e s
Ye s 6 9 0 8 5 . 2 6 0 2 6 3 . 4
S o u rce s o f c o ntrac e p tive s 5 9 1 5 5 8 0 . 0 0 0 0 *
He alth p ro v i d e r s 2 2 7 3 8 . 4 4 5 4 8 1 . 4
D ru g - s t o re s / o t h e r s 3 6 4 6 1 . 6 1 0 4 1 8 . 6
A t t i t u d e s
Re sp o nsib le to avo id 8 0 6 9 4 5 0 . 0 0 0 0 * p re g n a n c y
Male o r fe m ale 1 7 0 2 1 . 1 2 9 3 3 1 . 0
B o t h 6 3 6 7 8 . 9 6 5 2 6 9 . 0
Easy to talk abo ut 7 8 8 9 6 4 0 . 0 0 0 0 *
c o n t r a c e p t i v e s
Ye s 3 1 8 4 0 . 4 5 0 8 5 2 . 7
B e h a v i o r s
Eve r had se x 7 7 7 9 4 2 0 . 0 0 0 0 *
Ye s 5 3 8 6 9 . 2 4 0 1 4 2 . 6
Use c o ntrac e p tive s last 5 8 4 4 1 6 0 . 8 2 5 9 time had se x
Ye s 2 2 3 3 8 . 2 1 5 6 3 7 . 5
Type o f c o ntrace p tive 1 9 3 1 2 6 0 . 7 6 9 2
C o n d o m 1 6 5 8 5 . 5 1 0 6 8 4 . 1
O the r me tho d s 2 8 1 4 . 5 2 0 1 5 . 8
P regnancy experience
Eve r g o tte n a g irl p re g n a n t 5 3 8 4 0 1 0 . 0 0 0 0 *
Ye s 1 5 0 2 7 . 9 3 1 7 . 7
Eve r fathe re d a c hild 1 5 0 3 1 0 . 0 0 0 0 *
Ye s 1 0 1 6 7 . 3 5 1 6 . 1
1p value fo r χ2
CHIRINO S, J. L. e t al.
8 3 8
Cad. Saúd e Púb lica , Rio d e Jane iro , 17(4):833-842, jul-ag o , 2001
p < 0.0001), a n d ease in sp ea kin g a b o u t se x an d c o n t ra c e p t i ve s w it h t h e ir p a rt n er s we re fo u n d t o b e a ssocia t ed with se xu a l a ctivity. In Lim a, a s im ila r r e la t io n sh ip wa s fo u n d fo r t e e n a ge m a le s wh o re p o rt ed t h at it is e a sy t o t alk a b ou t sex an d con tra c e p t i ves with th eir p artn ers (RR = 1.43, p < 0.0001).
D i s c u s s i o n
Th is c om p a ra t i ve st u d y fo u n d a n u m b e r o f s i m i l a rit ie s an d d iffe ren ce s in th ese t wo gro u p s o f La t in o yo u t h -o n e livin g in Lim a , Pe r u a n d t he ot h e r, o f Me xican d e sce n t, livin g in Ca l i f o r-n ia . Th e a b ilit y t o p re se r-n t re su lt s o r-n t h e se d if-f e re n t La tin o gro u p s aim s at p rovid in g im p o r-t an r-t in sigh r-t s in r-to r-th e d ifferen r-t n e e d s o f a sim i-lar et h n ic gro u p, give n cu lt u ra l a n d co n te xtu al d i f f e re n ces with in t h is et h n ic gro u p.
Bot h sam p les we re co m p a ra b le in re p o rt i n g t h a t t h e m o st p o s itive fo rce in t h e ir live s a re t h e ir fa m ilies, b u t n o a ssocia tion wa s fou n d b e-t we en fa m ily in vo l ve m e n e-t an d a re d u ce d le ve l
o f se xu a l a ctivity in e it h e r gro u p . In vo l ve m e n t in sp orts was se en to h ave a p ro t e c t i ve effect in d e la yin g se xu a l a ct ivit y in b ot h gr o u p s, w h ile socia lizin g wit h frien d s wa s fou n d n o t to b e a s-sociated with sexu al activity in Californ ia m a l e s, b u t wa s se en a s a risk co n d it io n in Lim a .
Th ese fin d in gs su p p ort oth er fin d in gs w h i c h p o in t t o t h e im p o rt a n c e o f in clu d in g p e e rs, as we ll a s re c re a t io n a l a ct ivit ie s, su ch as sp o rt s, wh en p la n n in g st rat egies t o d e la y se xu a l d eb u t an d p re ven t STDs a n d ea rly p regn a n cy (Co l l i n s & Re p in ski, 1994; No l l e r, 1994; Re sn ick e t al., 1997). Alt h o u gh fa m ilies we re n o t fou n d t o b e a p ro t e c t i ve fa ct o r in t e r m s o f s e xu al b e h avio r, re ce n t re s e a rc h fin d in gs m a ke a cle a r ca s e fo r fam ily in vo l ve m e n t in re d u cin g o t h e r r isk t a k-in g b e h avio rs (Resn ick e t a l., 1997).
We fo u n d im p o r t a n t d iffe re n ce s b e t we e n th e tw o sa m p les in te rm s o f awa ren e ss of p re gn a gn cy risk, kgn owled ge o f wh e re t o o b t a ign co gn -t ra c e p -t i ve s, a n d c o m m u n ic a -t io n w i-t h s e xu a l p a rt n e r s. Ne a rly t wo t im e s a s m an y Ca l i f o rn i a m a le s u n d e r s to o d t h e ir r isk o f p re gn a n cy a t first se xu a l in t e rcou r se a s c om p a re d to t h e
Li-Tab le 3
Favo rite ac tivitie s, se xual kno wle dg e and attitud e s, b e havio r, and p re g nanc y e xp e rie nc e b y ag e
amo ng Latino male stud e nts. Califo rnia, Unite d State s.
Va r i a b l e ≤ 1 4 1 5 ≥ 16 To t a l p1
n % n % n % n %
A g e 1 8 6 2 2 . 2 1 4 6 1 7 . 5 5 0 4 6 0 . 3 8 3 6
Favorit e act ivities
S p o rt s 8 3 6 0 . 0 0 2 5 *
Ye s 7 6 4 0 . 9 4 4 3 0 . 1 1 0 5 2 0 . 8 2 2 5 2 6 . 9
K n o w l e d g e
P re g nanc y p o ssib le 1s ttime se x 8 1 0 0 . 0 0 6 6 *
Ye s 1 2 5 6 9 . 4 1 1 4 8 2 . 6 4 2 7 5 2 . 7 6 6 6 8 2 . 2
Kno w whe re to g e t c o ntrace p tive s 8 1 0 0 . 0 0 0 7 *
Ye s 1 3 3 7 4 . 7 1 0 9 7 6 . 8 4 4 8 9 1 . 4 6 9 0 8 5 . 2
A t t i t u d e s
Easy to talk ab o ut co ntrac e p tive s 7 8 8 0 . 0 0 0 0 *
Ye s 3 2 1 8 . 2 5 0 3 6 . 0 2 3 6 4 9 . 9 3 1 8 4 0 . 4
B e h a v i o r s
Eve r had se x 7 7 7 0 . 0 0 0 0
Ye s 4 5 2 7 . 9 8 4 6 0 . 0 4 0 9 8 5 . 9 5 3 8 6 9 . 2
P regnancy experience
Eve r g o tte n so me o ne pre g n a n t 5 3 8 0 . 0 2 3 3
Ye s 1 0 2 2 . 2 1 1 1 3 . 1 1 2 9 3 1 . 5 1 5 0 2 7 . 9
Eve r fathe re d a c hild 1 5 0 0 . 9 7 8 3 *
Ye s 8 8 0 . 0 7 6 3 . 6 8 6 6 6 . 7 1 0 1 6 7 . 3
1p value fo r χ2
Cad . Sa úde Púb lica, Rio d e Jane iro , 17(4):833-842, jul-ag o , 2001
m a s a m p le. Th e m a jo rit y in b o t h lo ca t io n s k n ow wh e re t o o b t a in c o n t ra c e p t i ve s if t h e y n ee d th em , b u t t h e o p t ion s m a y b e m ore lim it -e d in Lim a, wh -e r-e t h -e ov-e r wh -e lm in g m a jo r i t y cit ed h e alth p rovid er s a s t h e ir re s o u rce of care. In co n t r a st t o o b t a in in g c on d o m s t h ro u g h d ru g s t o res o r a syst e m o f fre e -st a n d in g fa m ily p lan n in g clin ics p rovid in g free o r red u ce d co st fam ily p lan n in g care, accessin g con tra c e p t i ve s t h ro u gh t h e h e alt h ca re s yst e m in Lim a re q u i res set tin g u p an ap p oin t m en t , fu tu re p lan -n i-n g, a-n d su fficie-n t t ru st o f a m e d ica l p rov i d e r. T h e re a re a lso fe we r co n fid en tia lit y gu id e lin es e m b e d d e d in t h e Pe r u via n h e alt h ca re syst e m in co n t rast t o t h e Un it e d St a t e s.
Alt h o u gh c o n d o m s m a y b e m o re re a d i l y a vaila b le t o Ca l i f o rn ia you t h , t h e re m ay still b e e m b a r ra ss m e n t in p u rch a sin g co n t ra c e p t i ve s u p p l i e s. In sp it e o f kn owin g wh e re t h e y ca n a cce ss b irt h con t ro l, t wo -t h ird s o f st u d e n t s in Ca l i f o rn ia in d ica t e d t h a t it is d ifficu lt t o t a lk ab o u t s e x a n d c o n t ra c e p t i ve s wit h t h e ir p ar t -n e r s, as co m p ared to h a lf o f resp o-n d e -n t s i-n Li-m a . Th e s e fin d in gs ar e iLi-m p o rt a n t in or d e r t o
e va lu a t e t h e re la t io n s h ip b e t we e n t h e kn ow l-e d gl-e b a s l-e o f a d o ll-e scl-e n t m a ll-e s, t h l-e ir at t it u d l-e s re g a rd in g se x an d con tra ce p tion , a n d th eir lev-e l o f c o m fo rt in d isc u ssin g th lev-e slev-e t o p ic s wit h t h e ir se xu a l p a rt n e r s (H u e rt a - Fra n c o e t a l., 1996; Le la n d & Ba rt h , 1992; Millan e t a l., 1995). Th e le ve l o f co m m u n ica t io n is a n im p o rt a n t fa cto r b ecau se re s e a rch h a s d em o n stra te d th at t h e c o n s ist e n t u se o f co n t ra c e p t i ve s is m o re like ly wh e n t h e re is o p e n co m m u n ica t io n b e -t we e n sexu a l p a r-t n e rs a b o u -t con -t ra c e p -t i ve u s-a ge (Le ls-a n d &s-amp; Bs-a r th , 1992; Wilso n et s-a l., 1994).
De sp it e t h is d isc o m fo rt , n e a rly t wo -t h ird s o f Ca l i f o r n ia m a le s a n d o n e - h a lf o f p a r t i c i-p a n t s in Lim a , in it ia t e d th eir sexu a l a ct ivit y at a n e a rly a ge . Sim ila r fin d in gs fo r m a le s h ave b e e n d o c u m e n t e d in o t h e r s t u d ie s in b o t h No r t h a n d So u t h - A m e r ic a n s am p le s (CDC, 1992; La u rit s e n & Swice go o d , 1997; Mo r ri s, 1988; Wa l ron d e t a l., 1993). Early se xu al a ct ivity p la ce s m a le s a t r isk o f a cq u ir in g a n STD o r c a u s in g a n u n in t e n d e d p re g n a n c y. Yo u n g e r m a le s m ay b e le ss like ly to re c o g n i ze t h e ir ri s k o r fe e l t h e y are so m e h ow in vu ln e ra b le t o s u ch
Tab le 4
Favo rite ac tivitie s, se xual kno wle d g e and attitud e s, b e havio r, and p re g nanc y e xp e rie nc e b y ag e
amo ng Latino male stud e nts. Lima, Pe ru .
Va r i a b l e ≤ 14 1 5 ≥ 16 To t a l p1
n % n % n % n %
A g e 3 9 4 3 9 . 8 3 2 7 3 3 . 0 2 7 0 2 7 . 2 9 9 1
Favorit e act ivit ies
Be ing with family 9 8 7 0 . 0 2 0 1 *
Ye s 3 1 1 7 9 . 3 2 5 0 7 6 . 7 1 8 5 6 8 . 8 7 4 6 7 5 . 6
So cializing with frie nd s 9 5 4 0 . 0 0 4 2 *
Ye s 9 1 2 3 . 9 1 0 7 3 4 . 2 8 7 3 3 . 5 2 8 5 2 9 . 9
K n o w l e d g e
P re g nanc y p o ssib le 1s ttime se x 9 6 3 0 . 0 0 0 0 *
Ye s 1 8 0 4 6 . 3 1 6 1 5 0 . 3 1 3 8 5 4 . 3 4 7 9 4 9 . 7
A t t i t u d e s
Easy to talk ab o ut co ntrac e p tive s 9 6 4 0 . 0 0 3 4 *
Ye s 1 7 9 4 5 . 9 1 7 0 5 3 . 0 1 5 9 6 2 . 8 5 0 8 5 2 . 7
B e h a v i o r s
Eve r had se x 9 4 2 0 . 0 0 0 0 *
Ye s 1 1 0 2 9 . 5 1 3 4 4 3 . 2 1 5 7 6 0 . 6 4 0 1 4 2 . 6
P regnancy experience
Eve r g o tte n so me o ne p re g n a n t 4 0 1 0 . 0 8 4 5
Ye s 6 5 . 4 5 3 . 7 2 0 1 2 . 7 3 1 7 . 7
Eve r fathe re d a child 3 1
Ye s 1 1 6 . 7 0 0 4 2 0 . 0 5 1 6 . 1
1p value fo r χ2
CHIRINO S, J. L. e t al.
8 4 0
Cad. Saúd e Púb lica , Rio d e Jane iro , 17(4):833-842, jul-ag o , 2001
a risk (Mo r ri s, 1988; Ple ck et a l., 1993; We i s m a n , 1989). Th es e risk b e h a vio rs m a y b e fu rt h e r re -i n f o rc e d b y t h e -ir s h o rt - t e r m p o s -it -ive e ffe ct s , s u c h a s se xu a l p le a s u r e a n d a p p r o va l fro m p e e r s in sp it e o f t h e p o t e n t ia l n e gat ive re p e r-c u s s i o n s, s u r-ch a s a p re gn a n r-cy o r STD, wh ir-c h t h e y m a y n o t a lwa ys e xp e r ie n ce (Hu n t e r & S c h a e c h n e r, 1992).
It is im p o rta n t to em p h a size t h a t o n ly on e-t h i rd o f m a le s in Ca l i f o rn ia , a s we ll a s in Lim a , re p o r t e d u sin g co n t r ac e p t ion a t t h e t im e o f t h e ir la st ac t o f in t e rc o u r s e. Am o n g th o se wh o u se d con t ra ce p t io n , t h e m ajo r it y ch o se a co n d o m , s u gge s t in g a le ve l o f kn o wle d ge a n d in -t en -tio n o f p ro -t ec-t in g -th e m se lve s a gain s-t STDs, a s well a s a n u n in t e n d e d p re g n a n c y. Howe ve r, fo r t h e m a jo r it y o f st u d e n t s in b o t h sa m p le s , t h e r is k fo r b o t h wa s n o t e ffe c t ive ly re d u c e d b e ca u se co n d o m s we re n o t u s e d co n s ist e n t ly b y t h e m a le s (Br u gm a n e t a l., 1997; Milla n e t al., 1995; Pleck et al., 1993).
Th e lim it a t io n s o f t h is st u d y a re p ri m a ri l y re la t e d t o t h e co lle ct io n o f s e n sit ive d a t a in sc h o ol s e tt in gs, a n d t h u s re s u lt s ca n o n ly b e g e n e ra l i ze d t o p op u la t ion s wit h sim ila r c h a r-a c t e ri s t i c s. In r-a d d it ion , t h e re wr-a s r-a d iffe re n c e o f a p p roxim a t e ly o n e ye a r b e t we e n sa m p le s th u s p o te n t ially im p a ctin g th e stu d y re s u l t s.
In sp it e o f t h e se lim ita tion s, t h e se fin d in gs h a ve im p o rt a n t im p lica t io n s fo r fu t u re e ffor t s to ad d ress t h e m a le role in STD a n d p re g n a n c y p re ven tion effo rt s, in clu d in g in creasin g h e a l t h y ac t ivit ie s as a n a lt e r n a t i ve t o e a rly se xu a l in -vo l ve m e n t. Bu ild in g a d olescen t s’ kn owled ge in o rd er to a vo id risky b e h a vio rs is also an im p o rt a n rt srt ra rt e g y. Alrt h o u gh kn owle d ge alo n e is in -su ffic ie n t t o as -su re b e h a vio ra l ch a n ge , it is a n i m p o rtan t cor n ersto n e in assu rin g th at ad oles-cen t s h a ve a so lid kn owle d ge b a se u po n wh ich th ey can m ake d ecision s. Com b in ed with expe -ri e n t i a l l y-b a se d e d u ca t ion al st ra t e g i e s, a s we l l a s b ro a d e r-b a s e d e ffo r t s aim e d a t ch a n ge s in
Tab le 5
P ro file o f se xually active Latino male stud e nts. Califo rnia, Unite d Sate s and Lima, Pe ru .
Va r i a b l e Sexually act ive N on-sexually act ive RR (CI 95% ) p
n % n %
C a l i f o rnia, Unit ed St at es
Favorit e act ivities
Atte nd scho o l 5 3 8 2 3 9 0. 8 (0. 75-0.91) 0 . 0 0 0 0 *
Ye s 2 2 5 6 2 . 1 1 3 7 3 7 . 9
So c ializing with frie nd s 5 3 8 2 3 9 0. 89 (0.80- 0.9 8) 0 . 0 1 3 3 *
Ye s 2 2 1 6 4 . 6 1 2 1 3 5 . 4
S p o rt s 5 3 8 2 3 9 0.76 (0.67- 0.8 7) 0 . 0 0 0 0 *
Ye s 1 1 4 5 6 . 2 8 9 4 3 . 8
K n o w l e d g e
P re g nanc y p o ssible 1s ttime se x 5 3 3 2 3 5 1.5 (1.30- 1.8 8) 0 . 0 0 0 0 *
Ye s 4 7 0 7 4 . 0 1 6 5 2 6 . 0
Kno w whe re to g e t c o ntrace ptive s 5 3 4 2 3 7 2. 0 (1. 60- 2.62) 0 . 0 0 0 0 *
Ye s 4 9 3 7 4 . 8 1 6 6 2 5 . 2
A t t i t u d e s
Easy to talk ab o ut c o ntrac e p tive s 5 1 7 2 2 8 1.6 (1.50- 1.80) 0 . 0 0 0 0 *
Ye s 2 7 4 9 0 . 4 2 9 9 . 6
Lima, Peru
Favorit e act ivities
So c ializing with frie nd s 3 8 4 5 2 6 1.1 (1.02- 1.3 9) 0 . 0 3 5 4 *
Ye s 1 3 0 4 7 . 4 1 4 4 5 2 . 6
S p o rt s 3 8 4 5 2 6 0. 8 (0. 68-0.96) 0 . 0 1 0 4 *
Ye s 1 1 6 3 6 . 5 2 0 2 6 3 . 5
A t t i t u d e s
Easy to talk ab o ut c o ntrac e ptive s 3 9 2 5 2 7 1. 4 (1. 22- 1.67) 0 . 0 0 0 0 *
Cad . Saúde Púb lic a, Rio d e Jane iro , 17(4):833-842, jul-ag o , 2001 R e f e re n c e s
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A c k n o w l e d g e m e n t
We w o u ld like to a ckn o w le d ge t h e Office o f Fa m i l y Pl a n n i n g’s M a le In vo l ve m e n t Pro g ra m in Ca l i f o rn i a , Un it e d St a t es a n d t h e Pre ve n t io n o f Se xu a l Ris k Be -h a v i o r: An Sc-h o ol-Ba se d Se x Ed u cat io n In t e r ve n t i o n Mo d e l in Lim a , Pe r u fu n d e d b y Fo rd Fo u n d a t i o n ( Gra n t 950- 0442).
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It is a lso im p or t a n t t o b e gin t o a sc e rt a i n h ow t o m o re act ively en gage fam ilies an d p eers in co n ve yin g an d re i n f o rcin g m essage s re g a rd -in g t h e n e e d for re sp o n sib le s e xu a l b e h a vio r, su ch a s th e va lu e o f ab st in e n ce an d / or t h e u se
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