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1. Nurse. PhD student in Health Sciences at the State University of Campinas (UNICAMP) in the School of Nursing (FENF). Campinas, SP, Brazil
2. Nurse. PhD in Genetics and Molecular Biology and Full Professor at the State University of Campinas (UNICAMP) in the School of Nursing (FENF). Campinas, SP, Brazil
Angela Ferreira da Silva ZIP Code:
37.704-800 ( angelafesi@yahoo.com.br )
Abstract:
OBJECTIVE: To describe the frequency and characteristics of contraceptive method (COM) use and sexual activity among high school adolescents.
METHODS: A descriptive and cross-sectional study was conducted using a questionnaire applied to 1,193 adolescents.
RESULTS: It was found that 41.1% of the adolescents initiated sexual activity between 13 and 15 years of age. The majority used some contraceptive method at their first sexual intercourse (91.1% of the women and 82% of the men). The most commonly used method was the male condom. The adolescents sought information on choosing the COM through suggestions from their family or partner and information provided by their physician and other health professionals.
CONCLUSION: Although most of the adolescents had initiated their sexual life, the majority used the condom as a contraceptive method, either separately or in combination with the pill. The adolescents were mainly influenced in their choice by their family.
Descriptors: Adolescent, sexuality, contraception.
Abstract:
OBJECTIVE: Describe the frequency, characteristics of contraceptive use (MAC) and sexual activity among high school adolescents.
METHODS: A descriptive and cross-sectional study was carried out with the use of a questionnaire applied to 1,193 adolescents.
RESULTS: It was verified that 41.1% of adolescents started sexual activities between 13 and 15 years old. Most used contraception at the first intercourse (91.1% of women and 82% of men). The most commonly used method was the male condom. Adolescents seek information for choosing MAC through family or companion suggestions and information given by their doctors and other health care professionals.
CONCLUSION: Although most adolescents started their sexual lives, most use condoms as a contraceptive method, used separately or in combination with the pill. The adolescents were mainly influenced by their families.
Keyword: Adolescent, sexuality, contraception.
Abstract:
OBJECTIVE: To describe the frequency and characteristics of the use of contraceptive methods (MAC) and sexual activity among middle school adolescents.
METHODS: A descriptive and transversal study was carried out using a questionnaire, applied to 1,193 adolescents.
RESULTS:It was found that 41.1% of adolescents began sexual activities between 13 and 15 years of age. The majority used some contraceptive method in their first sexual relationship (91.1% of women and 82% of men). The most used method was the male condom. Teenagers seek information for MAC selection through suggestions from their family, their partner and information given by their doctor and other healthcare professionals.
CONCLUSION: Although a large proportion of adolescents have started their sexual lives, the majority use the condom as a contraceptive method, separately or in combination with the pill. Teenagers were influenced in their choice mainly by their family.
INTRODUCTION
The World Health Organization (WHO) proposes a strategic change in the work of health professionals in relation to adolescents, focusing on health promotion and effective youth participation, highlighting the need to reflect on the issue of contraception. It is therefore essential that health services at the primary level of care are structured based on the logic of the precepts of health promotion and harm prevention 1 .
According to the WHO, adolescence corresponds to the second phase of life and ranges from 10 to 19 years of age, and this period can be divided into two stages: 10 to 14 years of age and 15 to 19 years of age 1 .
Discussing the topic of contraception with adolescents is extremely important for promoting their health and preventing diseases, as it is a public health problem that brings complications not only to adolescents, but also to children, families and society as a whole.
Studies evaluating the use of contraceptives among adolescents in public high schools in the South of Minas Gerais were not identified. Such studies could support intervention strategies at the time when sexual activity may begin, helping adolescents to make conscious and informed decisions. To this end, it is necessary to know which methods are most commonly used and how they seek information on the subject, which may differ between populations due to their profile.
In view of this, the present study aimed to describe the frequency and characteristics of contraceptive use and sexual activity among high school adolescents in public schools in Poços de Caldas, Minas Gerais.
METHOD
A descriptive and cross-sectional study was conducted with a quantitative approach. The research was conducted between May and July 2011, in Poços de Caldas, a city in the interior of Minas Gerais, located in the southwest region of the state. According to the IBGE, Poços de Caldas has an estimated population of 166,085 inhabitants 4 .
The study population consisted of adolescents enrolled in public high schools. There were 3034 adolescents enrolled, of which 747 did not meet the inclusion criteria and refused to participate in the Municipal School research (n=464), 1823 received the TCLE, 620 did not return the signed TCLE and 1203 returned the TCLE and received the questionnaire, of which 10 did not return the questionnaire and 1193 answered and returned the questionnaire, of which the latter comprised the research sample.
Students of both sexes, aged 14 to 19 years, and who attended daytime classes were included. Students who refused to participate in the study, were not present on the days when data collection was authorized, and those who did not return the Informed Consent Form (ICF) or the questionnaire were excluded.
To determine the sample size, in order to facilitate calculations, a population of 3,000 subjects was considered, representing high school adolescents from public schools, a statistical significance level of 5% and a sampling error of 6% for a sample stratified by sex, with equal proportion, resulting in 384 adolescents per sex 5 . The proportion of 50% was assumed to generate the largest sample necessary, thus, the sample would not be underestimated.
Authorization from the Municipal Department of Education and the Regional Superintendence of Education to collect data within the schools and from the principals of each public high school was requested to conduct the research. The research was submitted to the Research Ethics Committee (CEP) of the School of Medical Sciences of the State University of Campinas (UNICAMP), and duly approved by means of Opinion CEP nº 1195/2010, CAAE: 6521.0.000.146-10. It is worth noting that, at the time the project was approved, the signing of the Term of Assent was not required and the processing was not carried out by Plataforma Brasil.
The questionnaire “Locus of control, knowledge, attitude and practice of the use of pill and condom among university adolescents” was used, after authorization from the author, which provides, among others, data regarding sociodemographic characteristics (age, sex, color or race, religion, paid work, family income, presence of partner, with whom the person lives) and characteristics of sexual life (age of onset of sexual activity, use of MAC in the first sexual intercourse, age of onset of use of MAC, current use of MAC, number of pregnancies and influences on the choice of method) (6) .
To ensure the confidentiality of the respondents, each school was identified by an alphabetical code (for example: A, B, C, D, and so on). The researcher kept the list containing the codes of the respective schools for her own control.
An initial contact was made with the class to present the project and to provide the consent form to the adolescents, so that their parents could sign the authorization in the case of minors. The date for returning the form for data collection was also agreed upon in this first contact for two days after the initial contact. At this time, the participant received information about the research, as well as the option to not participate or withdraw at any time.
The adolescents were approached in their respective classrooms, after authorization from the teacher, under the supervision of the researcher. The self-explanatory questionnaire was given to the students, and upon completion, the students placed the questionnaire in a single envelope identified only by the alphabetical code corresponding to the school.
A database was created in the Excel 2007, 6.0 program from Microsoft Corporation ® for performing the statistical analyses. The sociodemographic characteristics of the sample and the responses regarding the contraceptive method were analyzed descriptively, by calculating the absolute (n) and relative (%) frequencies of the variables.
RESULTS
The sociodemographic characteristics of the group studied are presented in Table 1. Among the 1,193 adolescents, 62.8% were female and 37.2% were male. Age ranged from 14 to 19 years, with the highest frequency being 16 years (36.5% of females and 33.9% of males). The majority of respondents were female (62.8%), white (54.6% of women and 51.2% of men), Catholic (58% and 53.7% of women and men, respectively), did not work (72.7% of women and 56.4% of men) and lived with their family (96.4% of women and 96.6% of men). Among the 494 adolescents who had initiated sexual activity, 41.4% were female and 49.2% were male.
Regarding sexual characteristics, 41.3% of adolescents and 28.5% of adolescents declared not having a partner at the time of the survey and 63.7% of women and 50.8% of men reported that they had not yet initiated sexual activity, as shown in Table 2.
Regarding the use of contraceptive pills during the first sexual intercourse, considering only the 487 adolescents who answered this question, a total of 388 (91.1% of women and 82% of men) used some form of contraceptive pill. The age at which contraceptive pills began to be used ranged from 9 to 19 years, and the predominant age group was 13 to 15 years (58.5% and 62% among female and male adolescents). Most adolescents currently used some form of contraceptive pill (81.4% of females and 82% of males).
The frequency of sexual intercourse was two to four times a week (84.5% for females and 87.7% for males). Nine cases of pregnancy were reported, occurring most frequently at the age of 14 (37.5%), with the youngest age being 11 years and the oldest being 17 years. Three pregnancies resulted in abortion (spontaneous), three resulted in normal births, and three in cesarean sections.
Table 3 presents the methods used in the first sexual intercourse. The predominant method was the male condom (66.6%), followed by the combination of the male condom and contraceptive pill (8%). The methods most used by adolescents at the time of the study were also the male condom (59.9%), the contraceptive pill (14%) and the combination of the male condom and contraceptive pill (10.3%).
The questionnaire presented several response options for the question regarding the reason for not using contraceptive pills, namely: I don’t like it; my partner doesn’t like it; I don’t know how to get a method; it’s expensive; I think contraceptive pills are bad for my health; I don’t know how to use any method to prevent pregnancy; I’m afraid someone in my family will find out; I didn’t think about it at the time; I want to get pregnant/I want my partner to get pregnant; I didn’t think about it at the time; I thought I wasn’t at risk of getting pregnant; this is my partner’s responsibility; and lastly, “other”, in which case the reason(s) should be reported. The most cited reason by adolescents for not using contraceptive pills during their first sexual intercourse was “I didn’t think about it at the time” (59.4%). Regarding the reason for not using contraceptive pills currently, 29% answered “other” as justification, but did not provide the reason, or “I don’t like it” (23.2%).
Table 4 shows that, of the 379 adolescents who used CAM at the time of the study, 292 (77.0%) said that they had been influenced in choosing the current method. The importance of family suggestions (38.3% of women and 52.3% of men), as well as of the partner (32.1% and 19.2%, respectively) and information given by the doctor/health professionals (25.9% and 22.3%) was noted.
Table 5 shows the distribution of adolescents according to the age at which sexual activity began and the age at which use of contraceptive pills was initiated. Among the 494 adolescents who initiated sexual activity, considering only those who answered the questions, 63.8% (173/271) of the female adolescents and 65.3% (141/216) of the male adolescents were between 13 and 15 years old when they initiated sexual intercourse. In this same age group, 58.4% (90/154) of the female adolescents and 62% (72/116) of the male adolescents initiated use of contraceptive pills, and 45.3% (224/494) of the adolescents did not answer this last question.
DISCUSSION
In the group studied, 41.1% of the adolescents had initiated sexual activity and had their first sexual intercourse between the ages of 13 and 15, for both sexes. A study with adolescents conducted in Piauí found similar results: adolescents initiated sexual activity at an average age of 15 years 7 , which corroborates the study with adolescents in Cuiabá 8 . Another study also conducted in Piauí with adolescent nursing students, the age of first sexual intercourse was approximately 17 years 9 . The Study of Cardiovascular Risks in Adolescents (ERICA) 10 , a cross-sectional, national, school-based study, indicated that in 32 geographic strata of the country, 28.1% of adolescents had initiated sexual activity, with a higher prevalence at age 17 (56.4%). These data corroborate the study conducted with nursing students mentioned above.
Early sexual intercourse among young people can result in unwanted and unplanned pregnancies 11 , which is why it is important to use some form of contraceptive, not only during the first sexual intercourse, but during all sexual intercourses. In fact, recent data from the Live Birth Information System (SINASC) of the Ministry of Health showed a 17% reduction in teenage pregnancies, probably related to greater access to contraceptive methods, among other actions 12 . In the present study, 91.1% of women and 82% of men used some form of contraceptive during their first sexual intercourse, frequencies much higher than those found among pregnant adolescents at a Health Center in Sobradinho II, where only 54% of adolescents used some form of contraceptive 13 .
A study of 295 college students from a city in the interior of São Paulo showed that 48.8% had initiated sexual activity, and 91.7% reported having used a contraceptive method (CMP) during their first sexual intercourse 2 . The most commonly used method was the condom, which was used in combination with the pill. Adolescents were influenced to use CMP by their doctor or health professional (53.4%) and by the media (30.2%) 2 .
Another study conducted with adolescents from a public school in São José, SC, revealed, in agreement with the previous study, that the most commonly used methods were the condom and the pill. They received information about CMP from school, friends, and family, but demonstrated insecurity and lack of information about which method was safer when initiating sexual activity 3 .
Regarding the current use of some type of contraceptive, 81.4% and 82% of young people (women and men, respectively) did so, corroborating the research carried out in Patos de Minas in public and private high schools, where 85% of young people in public schools used male condoms and 89% in private schools 14 and with ERICA (82.3%) 10 .
Among the methods most used in the first sexual intercourse, used separately or in combination, the male condom stood out, followed by the contraceptive pill. These data confirm what has already been reported in other studies 8,13-15 .
Regarding the justification for not using any contraceptive method, the study with adolescents from public institutions in Santa Maria, RS, showed that 30% of the young women thought they would not get pregnant, 28% were afraid that their parents would find out, 28% claimed that they had been dating for some time and 24% had not even thought about using contraceptives 16 . In the present study, the main reason (59.4%) was not having thought about some method at that time (during their first sexual intercourse).
The high number of adolescents who did not respond (45.3%) did not allow us to assess whether there was a significant difference between the age at which sexual activity began and the age at which they began using contraceptive methods, although it was found that the vast majority practiced safe sex during their first intercourse and afterward.
In the present study, it was found that adolescents sought information on choosing contraceptive methods through suggestions from their family or partner and information provided by their doctor and other health professionals. In a study of adolescents from public and private schools on contraceptive methods, it was found that most students from public schools sought information about sexuality from their parents (39%) and friends (39%), while in private schools, they sought information at school (42%) and on the Internet (41%) 14 . In view of this, it was noted that the family is an important source of information, since 54% of students from public schools speak openly about sexuality with their parents, compared to 39% from private schools 14 . Data from the aforementioned studies differ from the study conducted in Nigeria with adolescents, where the main source of information was the Internet (91%) and the media (89.3%) 17 . In another study conducted in Teresina, adolescents’ sources of information about family planning were health professionals, family and partners 18 .
Comparing the data from this study with another that used the same questionnaire among university students 2, it was observed that some data are similar, while others differ. Regarding the similarities, the vast majority used contraceptive contraceptives during their first sexual intercourse (91.7%); the most commonly used method was also the male condom, during their first sexual intercourse (66%) and at the time of data collection (38.3%). Regarding the differences, the main reason for not using contraceptive contraceptives currently among university students was that they “don’t have sexual intercourse” (40.0%), and in the present study, “I don’t like it” was the most cited reason (23.3%). University students responded that books, magazines, television, the Internet, and information provided by health professionals had influenced their choice of contraceptive contraceptives. In the present study, family and partner were the most frequently cited. It is possible that the difference in age group (13 to 15 vs. 17 to 19 years) and level of education may explain these differences, in addition to cultural background, origin, and others, and further studies to investigate these variables are necessary.
The study contributed to outlining the profile of the population studied, which may be useful for future intervention studies. However, it has the limitation of being a cross-sectional study, which does not allow for more in-depth analyses. Furthermore, the fact that a relatively high percentage of students did not answer some questions did not allow for other comparisons.
CONCLUSION
Most adolescents participating in the study used contraceptive methods, with the male condom, used alone or in combination with the pill and/or other methods, being the most commonly used contraceptive method. Although a large proportion of adolescents had initiated their sexual life, most used contraceptive methods and were influenced in their choice mainly by their family and partner.
In view of the above, it is recommended that sexual education be provided in schools, but considering the triad: educators, family members and health professionals. The family plays an important role in not only transmitting information, but also in values; health professionals transmit correct and up-to-date information; and educators offer strategies that allow adolescents to feel welcomed and involved in the learning process.
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