Knowledge and attitudes toward sexuality in adolescents and their association with the family and other factors

Adolescence, Spring, 1996 by Raquel Huerta-Franco, George Diaz de Leon, Juan Manuel Malacara

INTRODUCTION

Complications of pregnancy and delivery are the main causes of death among adolescents in Mesoamerica (Suarez, Roberts, Korin, & Cuminsky, 1985). Surveys from such diverse countries as the United States, Mexico, and Germany indicate that 50 to 60% of women are unprotected by contraception at their first sexual experience (Liskin et al., 1987). Early, unprotected sexual activity is associated with diverse risks to health such as unwanted pregnancy, abortion, and sexually transmitted diseases (STD) (Stanley, Henshaw, & Morrow, 1990). The most frequent factors involved in this problem are lack of education, occupation, poverty, and migration (Mayone, 1987; Warren, Powell, Morris, Jackson, & Mamilton, 1988; Loli, Aranburu, & Paxman, 1987). Family environment is also an important factor, but it has not been properly studied. Rigid family patterns or inexact information can lead to psychosexual dysfunction. Tseng & McDermott (1979) propose that in the development of a child's personality, the parents' attitudes are more important than specific education techniques. They point out that family functioning and the division of roles are involved in the communication among members and in transactions that determine psychosexual adaptation. Adolescents who work may acquire different knowledge and attitudes toward sexuality and thus are at risk in different ways from those who are in school. This paper compares the attitudes and knowledge about sexuality, contraception, and STD of students and workers, and the associated factors.

METHOD

This study included 15- to 20-year-old adolescents, living in the city of Leon, Mexico. None of the volunteer participants had any physical or mental disease that might affect their responses to the questionnaire that was administered. Two groups were recruited: students and adolescents who were working in factories. Students were chosen by a random stratified procedure from public and private schools (colleges and a school for nurses) from middle and low socioeconomic levels. For selection of workers, 16 factories were visited, and in three of them the owner denied permission arguing lack of time; 393 adolescents from the 13 remaining factories were interviewed.

The purpose of the study was explained to the participants and confidentiality was assured. The details of the questionnaire were explained by a researcher who also was available to answer questions. Of the 918 students interviewed, 55 questionnaires were excluded because they were too incomplete for analysis. Among the workers, 53 refused to participate and 28 filled out the questionnaire incompletely and were also not included in the analysis.

Questionnaire

The questionnaire contains 110 items divided into four sections:

1. General data included: date of birth, schooling in years, occupation and socioeconomic markers such as income and place of residence, amount of schooling, and occupation of parents.

2. Knowledge and attitudes toward sexuality. Knowledge was evaluated by simple multiple-option questions and summing of correct answers. Attitudes were assessed by answers to questions on the adolescent's opinion on various issues, and the responses were categorized with the Likert method (Hulley & Cummings, 1988). The five options were: total agreement, agreement, indifference, disagreement, and total disagreement. The responses scored from 0 to 4, or from 4 to 0 depending on the polarity of the answers. Attitudes regarding sexuality were evaluated with 16 questions, which included the adolescent's position on sex education, sexual responsibility, and the role of men and women in society. Attitudes toward family planning were investigated with 16 questions on concerns about population growth, the effects of contraception on family health, and their views on the acceptance of contraception by their relatives. Attitudes toward STD were explored with four questions eliciting opinions about multiple sex partners, condom use, and the social impact of STD.

3. Family structure. Type of the family was classified according to number of members living at home: uniparental if it included only one parent: nuclear if it had both parents; and extended if other relatives such as married brothers, grandparents or uncles were living at home. The size of the family and age and occupation of both parents were also solicited.

4. Family function was evaluated with the McMaster model (Epstein, Bishop, & Daldwin, 1978). It included seven areas: Problem solving in the family was evaluated in seven categories, with higher scores awarded for better problem-solving solutions. Communication within the family was rated in four categories with a higher score awarded for clear and direct communication. Positive and negative affective responses contained four categories. The roles assumed by each member of the family included authority, provision of advice, confidence, teaching, counseling, and financial support. These were contained in four categories with higher scores awarded if the roles were assumed by the father or the mother. Affective involvement between the parents included three categories with the higher score awarded for affective involvement by love. Control of behavior in the family contained four categories with higher scores awarded for greater flexible control.