(N = 3044)
* Other religions include Jewish, Muslim, Hindu, Buddhist, INK (Iglesia ni Kristo), Aglipay, 7th day, Pentecost, Mormon, Jehova's, Baptist, Filipinist and "other".
† Based on the respondents' perception of family economic status.
Participants were asked how often they got information regarding love and sexuality from different sources. The source most often marked as "always" or "almost always" by males and females respectively, was, by far, friends (57.5% and 69.6%), followed, in the case of males, by the Internet and youth magazines (27.1%); and, in the case of females, by parents (30.7%) (data not shown).
The questionnaire examined how parents' and friends' opinions regarding love, sexuality and other related topics were valued by the youth. Generally, it is observed that the youth (specially girls) value parents' opinion more than friends' in most topics (Figure (Figure2 2 ).
Teens' reported level of importance of parents' vs. friends' opinion by areas of concern . Values are the average scores obtained in each item (in a five-point Likert scale labeled from a low "Not important" to a high "Vey important" score). p value of the adjusted Wald test taking into account the clustered sampling scheme: * p < 0.05. *** p < 0.001.
Parents' and friends' opinions are better appreciated by girls (compared to boys) in all topics. This difference is statistically significant for parents' opinion (p < 0.003 in "choice of friends" and p < 0.001 in all the other topics), and for friends' opinion except for "free time activities" (p = 0.005 for "way of dressing", p = 0.011 for "choice of friends" and p < 0.001 in the other topics) (data not shown).
When asked whether they have talked with their parents about the different aspects of sexuality (biological as well as affective/emotional aspects), they reported relatively few conversations with their parents. Concerning biological aspects of sexuality, topics mostly discussed with parents were, for males, pregnancy (21.7%) and STIs (20.5%); and for females, girls' physical changes (58.9%) and pregnancy (41.1%). On topics regarding feelings and relations, respondents mostly talked about how to better manage feelings and emotions (32.7% for boys, 44.8% for girls), and how to know if the person they are dating is the right one (26.4% and 36.7%) (Table (Table2 2 ).
Conversations with parents and desire to know more
TOPICS | * | Want to know more | ||||
---|---|---|---|---|---|---|
Males | Females | Males | Females | |||
n (%) | n (%) | p | n (%) | n (%) | p | |
Girls' physical changes (menstruation, breast ...) | 90 (9.0) | 1161 (59.9) | <0.001 | 423 (44.0) | 1454 (81.1) | <0.001 |
Boys' physical changes (beard, wet dreams ...) | 204 (18.8) | 174 (10.7) | <0.001 | 695 (67.9) | 759 (47.5) | <0.001 |
AIDS and other sexually transmitted infections | 235 (21.7) | 491 (25.7) | 0.026 | 811 (78.7) | 1496 (83.3) | 0.007 |
Pregnancy, the beginning of life | 251 (23.9) | 800 (41.7) | <0.001 | 672 (66.8) | 1530 (85.3) | <0.001 |
Condoms and methods of contraception | 110 (10.2) | 211 (11.1) | 0.474 | 721 (70.5) | 1126 (63.1) | <0.001 |
How to know when I will be ready to start dating | 224 (20.6) | 671 (34.9) | <0.001 | 762 (74.5) | 1436 (80.3) | 0.002 |
How to know when I will be ready to have sex | 110 (10.2) | 254 (13.4) | 0.022 | 673 (65.5) | 991 (55.7) | <0.001 |
What "falling in love" means | 278 (25.7) | 648 (33.9) | <0.001 | 872 (85.2) | 1627 (89.8) | 0.001 |
How to continue going out with a person without having sexual relationships | 181 (16.8) | 509 (26.7) | <0.001 | 746 (72.6) | 1420 (79.6) | <0.001 |
How to know if the person I am dating is the right one to share my future life with | 281 (26.0) | 702 (36.8) | <0.001 | 839 (81.4) | 1583 (87.8) | <0.001 |
How to better manage my feelings and emotions | 363 (33.5) | 883 (46.1) | <0.001 | 897 (86.9) | 1714 (94.4) | <0.001 |
How to better manage my sexual drive/passion | 133 (12.3) | 291 (15.4) | 0.036 | 741 (72.2) | 1170 (65.9) | 0.002 |
How to tell the difference between desire, sexual attraction and love | 185 (17.1) | 469 (24.7) | <0.001 | 859 (83.0) | 1571 (86.6) | 0.023 |
* Respondents marking the 4 th or the 5 th answer option in the question "I have talked to my parents about ...", with a five-point Likert scale labeled from a low "Nothing" to a high "A lot" score.
† Respondents saying they would like to know more about each topic.
‡ Proportions are calculated using denominators that range from 961 to 1085 (males) and from 1597 to 1937 (females) because some items were not responded by some participants.
§ p value of the adjusted Wald test taking into account the clustered sampling scheme.
On most topics (biological as well as affective ones), more girls than boys reported conversations with their parents. The highest difference was found on the topic "girls' physical changes", with 9.0% of boys and 59.9% of girls indicating they talked "somewhat" or "a lot" about this topic with their parents (p value < 0.001). On the contrary, "boys' physical changes" was the only topic on which more boys than girls reported conversations with their parents (18.8% of boys and 10.7% of girls, p value < 0.001).
Survey participants were also asked whether they would like to know more about sexuality topics. A wide majority of participants said they would like to know more about all the contents presented. However, both boys and girls expressed greater interest in issues such as how to better manage feelings and emotions (86.9% boys, 94.8% girls) and what "falling in love" means (83.3% and 89.9%). On most topics, girls showed a higher desire to know more, except boys' physical changes, contraception, how to know when one is ready to have sex and how to better manage sexual drive: on these topics, boys' desire to know more was higher (Table (Table2 2 ).
We identified some problems regarding the youth's knowledge about the prevention of STIs and unintended pregnancies. When asked about the risk they believe may occur if one has sex with condoms, the percentages of respondents answering "none" or "I don't know" were 42.9% for risk of AIDS infection, 43.7% for risk of genital warts infection and 40.6% for pregnancy, with higher rates among boys (p = 0.007, p = 0.016 and p < 0.001 respectively) (data not shown).
Attitudes toward sexism were explored by asking the youth whether they agree with media using women or men as "sexual objects", or associating femininity or masculinity to having more sexual relationships. On both items, more girls compared to boys were significantly sensitive and disapproving of sexuality being misused in advertisements (Table (Table3 3 ).
Opinions on sexism
Opinions | Male (N = 1096) | Female (N = 1949) | |
---|---|---|---|
n * (%) | n * (%) | p | |
I do not like it when the media (TV, ads, magazines, films...) show: | |||
- women as "sexual objects"; only giving importance to her body | 435 (39.7) | 1236 (63.4) | < 0.001 |
- men as "sexual objects"; only giving importance to his body | 437 (39.9) | 1099 (56.4) | < 0.001 |
I do not like it when the media (TV, ads, magazines, films ...) associate: | |||
- femininity to having more sexual relationships | 378 (34.5) | 1115 (57.2) | < 0.001 |
- masculinity to having more sexual relationships | 378 (34.5) | 1030 (52.8) | < 0.001 |
* Number of respondents marking the 4 th or the 5 th answer option in a five-point Likert scale labeled from a low "strongly disagree" to a high "strongly agree" score.
† p value of the adjusted Wald test taking into account the clustered sampling scheme. Taking into account the 5 answer levels, the test for trend was also significant (p < 0.001) in the four variables.
After adjusting for sex, age and whether institutions were public or private, the students that believe condoms are 100% effective against AIDS, STIs and pregnancies were more likely to be sexually experienced (OR= 1.59; 95% CI 1.09–2.33). Students that are approving of pornography and masculinity and femininity being equated to having more sexual encounters, were as well more likely to be sexually experienced after the adjustments mentioned above (OR= 1.69; 95% CI 1.25–2.29).
The respondents of the study were representative of private and public schools of the Philippines. We performed weighted analyses in the descriptive results in order for them to be representative of Filipino students.
According to the Philippine National Statistics Office, 81% of Filipinos are Catholic, and 8.2% belong to other Christian religions [ 41 ], which is similar to our weighted sample distribution. Regarding the distribution of sex, institutions report higher enrollment ratios for girls than for boys. Specifically, in secondary education, net enrollment ratios (NER) are 54% for boys and 65% for girls [ 42 ]. Since sex ratio (male/female) for these ages is approximately 1 [ 43 ], this means that approximately 55% of students are girls in high schools. This accounts for the higher female presence in our sample.
Referring to our paper sample of teens, the main information source about love and sexuality is friends. This is similar to studies from Sweden, USA, United Kingdom, Czech Republic and Spain [ 44 - 49 ]. Existing literature likewise provides evidence that media (Internet, magazines) are the second source of information, outranking parents, as happens in our male sample [ 45 , 49 ]. A study in Nigeria, however, sets parents in the first place among in-school girls [ 50 ].
Literature shows that communication with parents protects against early sexual initiation and against risky behaviors [ 51 , 52 ]. Conversely, information sources which are mostly used in our sample (peers, media) are not usually described as ideal for educating teens [ 46 , 53 ]. At the same time, parents' opinion regarding sexuality and other related topics is well valued by teens in our study. This is confirmed by surveys which also show parents being rated as preferred sources rather than as actual sources [ 47 ]. Furthermore, parents' attitudes toward certain risk behaviors (such as smoking and drinking alcohol) seem to be protective against those behaviors in their children [ 54 ]. This seems to show that parents' opinions are indeed taken into account when given to children. There is therefore room for further encouraging parents to talk more with their children about sexuality, including aspects related to feelings and emotions that could help them make better sexual and reproductive choices. This is specially valid for daughters, who give in our data much importance to their parents' opinion.
With regard to knowledge of sexuality, we observe that teens in most cases (specially among girls) have not talked about sexuality topics with their parents, but that they would want to know more. We must also stress that teens' desire for information is not limited to the biological aspects of sexuality. In fact, they are much interested to know more about the emotional aspects of relationships and sexuality. Examples are to know more about how to manage one's feelings and sexual drive; meaning of "falling in love"; how to know if the person one is dating is the right person; and how to tell the difference between desire, sexual attraction and love. Having a better understanding of these issues can be very useful to avoid premature sex [ 52 ], and parents agree that these aspects should be addressed [ 55 ]. Indeed, these issues are related to the perceived well-being of teens. With sex education programs concentrating on biological information [ 36 ], they are in effect highlighting topics that are of relatively lower interest to teens while downplaying education in the affective aspects of human sexuality which could be a powerful means to empower teens to make healthier life choices [ 56 ]. To our knowledge, the issue of making emphasis on affective aspects is seldom brought up in sex education policies.
Regarding sex differences in this issue, we find that, in general, girls talk more with their parents about most topics, and also want to know more. Boys only talk more about their own physical changes, and have a bigger desire to know more about these changes and about topics that might be related to their higher sexual drive.
The teens of our study also have incomplete information on some biological facts related to sexuality. Concerning condom effectiveness, for example, several studies show that condoms are "risk reduction" measures with respect to unintended pregnancies, HIV infection and other STIs and should not, therefore, be presented as "risk avoidance" measures [ 57 - 61 ]. We find that around 40% of respondents (even more among boys) have the wrong belief that condoms are 100% effective or report not knowing their effectiveness. This overconfidence or lack of information can lead teens to underestimate the risks they are taking [ 62 ]. Teens who believe condoms can avoid rather than reduce the risk of STIs, underestimate the benefits of abstinence and mutual monogamy, as found in previous studies [ 37 , 63 , 64 ]; this perspective may negatively affect their decision-making in sexuality. Risk compensation may come into play and increase their vulnerability to infections and unintended pregnancies [ 65 ]. Briefly, this hypothesis suggests that the introduction of new technological approaches or messages of prevention could reduce the perception of risk at the broader population level and thus worsen the compliance with other basic preventive behaviors. In the end, higher risk-taking could offset the protective benefits theoretically associated to the new approach. For example, risk compensation was described as an explanation for the initial failure of seat belt laws to prevent road accident deaths because drivers presumed that wearing a seat belt would protect them from riskier driving [ 66 , 67 ]. More recently, other researchers have extended the concept of risk compensation to HIV prevention [ 68 , 69 ]. Campaigns mainly focusing on condom use at the population level could paradoxically lead to an increase in risky behaviors (such as the number of sexual partners), if the population perceives condoms to be absolutely safe, irrespective of specific sexual behaviors. As suggested by a recent community trial in Uganda, the overall effect of some interventions could be offset by riskier behaviors at the population level and thus hinder the targeted decrease of HIV incidence [ 70 ]. Our results are consistent with this cited paradoxical effect since the teens that falsely perceived condoms as being 100% effective were indeed more frequently sexually experienced. More might have to be done to improve the content and quality of the information conveyed to teens. While it seems important to give comprehensive information about all preventive measures, programs should be abstinence centered when targeting teens [ 71 , 72 ]. Teens should be clear that it is better to avoid rather than to reduce risks and they should be helped to achieve risk avoidance as it is indeed the only option 100% effective. By focusing on abstinence one can better avoid the slippery slope of risk compensation [ 62 ].
It is true that some studies about abstinence programs have found no statistically significant effects on sexual behavior [ 73 - 75 ]. However, some of these studies had several methodological problems, as reviewers themselves recognize, which might account for the lack of significant findings. Furthermore, other studies do find some abstinence encouraging programs being effective in both developed and developing countries [ 76 - 78 ]. Besides, even if lack of effects was proven, it should not be a surprise that a few hours of sex education programs in school are unable to compensate for the opposite message often conveyed by some parents, media, authorities and society in general [ 79 ]. The question is not whether to promote abstinence among teens, but rather how to achieve this.
Finally, the existing literature shows several dangers in the generalization of sexism. The American Psychological Association points out several problems associated to the sexualization of girls [ 80 ]. These include cognitive difficulties, mental health problems and risk behaviors. On the other hand, boys' exposure to pornography increases the risk of aggressiveness, rape myths and gender stereotypes, all of which may be indirectly harmful for women and equality between males and females [ 81 - 83 ]. In our sample, we observe that while sexism is rejected by a majority of girls, it is accepted by most boys. Most males do not seem to find anything wrong with the misuse of men or women as sexual objects, or associating masculinity or femininity to having more sexual relationships. Having these aforementioned opinions and perceptions was likewise associated with a higher incidence of sexual experience in our study.
There are several limitations in our study. First of all, the cross-sectional nature of any study does not enable to easily infer causality between dependent and independent variables. However, some insight is possible to understand the teens' feelings and opinions, and how these dispositions consequently affect their behavior. Cross-sectional studies do have the advantage of being less costly and thus more efficient to obtain certain useful results. Our data do suggest sensible and plausible associations. For example, the association between perceptions and beliefs about condom effectiveness, sexism and sexual experience are consistent with the theory of risk compensation as described by other researchers [ 69 ]. In addition, reverse causation, i.e. that early sexual initiation produces incorrect knowledge about condom effectiveness, does not seem very plausible. The fact that more boys than girls want to know more about controlling their sexual drive and more girls than boys want to know more about how to manage their feelings is consistent with the natural mindset of each sex and what is expected. Aforementioned socio-demographic data are likewise consistent with existing population data for the Philippines. In summary, we did not find inconsistent responses nor important alternative explanations of our findings.
Another possible limitation is that our data is based on self-reported responses. It is notable, however, that our results are not what one would expect from respondents giving socially desirable answers. Research indicates that self-reported data such as those found in Youth Risk Behavior Surveys (YRBS) of the United States can be gathered credibly from youth surveys [ 84 ]. Internal reliability checks were used to identify the percentage of students who possibly falsify their answers. To obtain truthful answers, students were made to understand why the survey is important, and procedures were developed to protect their privacy and allow for anonymous participation.
The survey environment, questionnaire design and content, edit checks, logic within groups of questions, and some comparisons of our results with other studies give us confidence on the validity of our data.
As described in the methods section, the in-class and casual setting where the questionnaires were administered, has presumably minimized invalid responses because respondent privacy and anonymity were ensured. Furthermore, students were adequately instructed to leave any discomforting question blank. Students sat as far apart as possible throughout the survey venue and had an envelope to cover their responses. Only a few skip patterns were used in the questionnaire and, in any case, they were used in such a way that the difference in the time needed to complete the questionnaire between youth with or without sexual experience was insignificant. The questionnaire was designed to suit the reading level of at least a junior high school student.
The questionnaire was previously piloted on a sample of 180 students in order to assure not only comprehension and cultural relevance of items, but also to avoid leading questions that may influence students' responses. In summary, we have no reason to believe that self-reporting could have compromised our results.
Despite its limitations, our study has several strengths. The analyses we have performed and presented are consistent with our sample being representative of the Filipino student youth. To our knowledge, this is the first representative study of a student population in the Philippines that has studied the issues of relationships, love and sexuality in such depth. Since STIs are increasing all over the world and STIs are associated to having more lifelong sexual partners, and the latter with earlier sexual initiation, the study of whether certain messages are associated to earlier sexual initiation is relevant across different cultures and countries. There are no studies associating the perception of 100% condom effectiveness with earlier sexual debut. This is the most novel aspect of our paper, and it is also the aspect presented with multivariate adjustment. Our data bring up the important issue that teens themselves are requesting more emphasis on affective aspects of human sexuality when educating them. Furthermore, beyond the issue of external validity due to the representative nature of our sample, its large sample size has enabled us to perform better statistical adjustment where needed, analyses accounting for the clustered sampling strategy and thus improve the validity of our results.
Having a better understanding of what teens feel and think about relationships, love and sexuality, seems to be an important consideration in planning public health strategies to address common reproductive health problems in teen populations. This study highlights that Filipino students do not communicate as much as they would want with their parents on these issues. It seems that more can be done to improve parent-child communication as friends and the Internet are not the best information channels. Aside from improving the information source, more has to be done also to improve the content and quality of the information conveyed to teens. True informed choice and empowerment goes hand by hand with accurate information. In particular, condoms should be presented for what they are: a risk reduction strategy and never for risk avoidance. Survey findings seriously suggest that some messages conveyed to teens can indeed be harmful as these are associated with earlier sexual initiation. More public health resources should be spent on the maintenance of the lifestyle that better protects youth, i.e., in the case of this study, a lifestyle that is truly risk avoiding and beneficial to a larger section of the targeted teens. Our data suggests teens are requesting help to achieve a healthier lifestyle, and they are in fact more interested in character education encompassing affective aspects of sexuality rather than biological information. Global strategies should seriously take this request into consideration.
The authors declare that they have no competing interests.
JI, CLB, VAB, FOG, MCC and ANT designed the study and the questionnaire. CLB, AO and JI analyzed the data. AO and JI made the first draft of the paper. All authors contributed to the final manuscript.
The pre-publication history for this paper can be accessed here:
http://www.biomedcentral.com/1471-2458/9/282/prepub
To Intermedia Consulting, for having promoted this research project.
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2019, Asian journal of multidisciplinary studies
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win-myint oo
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JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH
Sagar Bhagat
Medical Journal IMJ Health
—Sexual health (SH) and sexual behavior of young people have become a growing public concern. But few studies have been conducted to investigate the prevalence and psychosocial correlates of this phenomenon. Purpose: To understand college students' sexual knowledge (SK), sexual attitudes (SA), sexual desire (SD) and sexual behavior (SB). Methods: A self-reported questionnaire survey on SK, SA, SD, and SB was conducted among 520 university students. Their demographic data, SK, SA, SD, and SB were assessed. Results: A total of 500 students completed the questionnaire. The SKS total score had a mean of 23.05; 105 (21.0%) subjects had had premarital sex; 121 (24.2%) had a partner; 117 (23.4%) had a medical educational background. The results demonstrated an increased risk of premarital sex amongst males and subjects with the risk factors of smoking, drinking, having a partner, and having higher levels of SD and SK and more open SA. Conclusions: This study provides support for the idea that university students lack SK (especially regarding contraception knowledge), even though the students had a medical educational background. Additionally, a considerable amount of them engaged in premarital SB. Our findings also suggest that university students need sex education, particularly in combining sexuality with their life, in relating to others maturely as a sexual individual, in employing contraception, and in preventing sexually transmitted diseases (STDs). Our study suggests that interventions aimed at expanding university students' SK and other related skills are required.
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Kindu Tsegaye
Robert Strack
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andi chaerul
Ray Peramathevan Ravendran
Nursing and Midwifery Studies
Fazlollah Ghofranipour
1st Annual Conference of Midwifery
Dian Septiriani
Marcos Bollido
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Elmer De Jose
Peter Xenos
Lucia Libutaque
International Journal of Reproduction, Fertility & Sexual Health (IJRFSH)
Friday Oko ORJI, PhD
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COMMENTS
The problem of Philippine’s teenage pregnancy issue roots from the lack of sex education and the age of consent. As a predominantly Catholic nation, it is expected that one saves themselves for marriage;
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This study determined the perception of college students towards premarital sex (PMS) amid the continuum of sexual conservatism and liberalism. It also investigated on the engagement and extent...
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Say It Isn't Sex: The Politics of Sex Education in the Philippines. Cardinal Javier Lozano Barragan of Mexico, told The Associated Press that condoms could sometimes be condoned - such as when a woman cannot refuse her HN-positive husband's sexual advances - since preserving her life is paramount.