FACTORS ASSOCIATED WITH THE SEXUAL EXPERIENCES OF UNDERPRIVILEGED MEXICAN ADOLESCENTS.
Family functioning impacts diverse aspects of adolescent psychology. For example, elements of the parental relationship are related to children's emotional autonomy (Lamborn & Steinberg, 1993). Adolescent depression has been found to be associated with a family history of affective impairment, poor parental relations, dysfunctional family interaction, and insecure bonding (Morton & Maharaj, 1993). Family psychodynamics are related to adolescents' body image and eating behavior (Jimenez, Diaz de Leon, & Malacara, 1992). Noller, Seth-Smith, Bouma, and Schweitzer (1992) found a strong relationship between adolescent self-concept and diverse family functioning variables. Novy, Gaa, Frankiewicz, Liberman, and Amerikaner (1992) found an association between the adaptation and cohesion of family members and the ego development of juvenile offenders.
In regard to adolescent sexuality, attitudes and knowledge may be related to family structure and functioning (Huerta-Franco, Diaz de Leon, & Malacara, 1996). Tseng and McDermott (1979) have noted the importance of parental attitudes, as well as the division of roles and interpersonal transactions within the family, for psychosexual adaptation.
The present research investigated family and personal characteristics and their association with adolescents' sexuality. Specifically, underprivileged adolescents in Mexico were studied. These adolescents were unable to continue at school and lived in areas with limited social services and work opportunities.
Three groups of adolescents - unemployed, underemployed, and factory workers - were sampled. Unemployed and underemployed adolescents were drawn from suburban areas of the city of Leon (Los Castillos; La Laguna; Rivera de la Presa; El Carmen; Valle Hermoso 1, 2, and 3; Santa Cecilia; Casa Blanca; Nuevo Amanecer; La Sandia; and Leon II). The fully employed adolescents were randomly selected from 16 of 26 footwear and tannery factories (10 of the proprietors refused to allow their workers to participate, citing lack of time).
A total of 712 adolescents agreed to participate after the purpose of the study was explained and assurances of confidentiality were provided. Those who did not complete the questionnaire fully were dropped from the analyses. The final sample included 523 youths, ages 14 to 20.
The questionnaire was validated in a previous study (Huerta-Franco et al., 1996). It contained 121 items and solicited the following information.
General data. Data on age, education, occupation, and place of residence were obtained.
Socioeconomic markers. Socioeconomic level was determined on the basis of parents' education and annual income. If the father was absent, only the education and income of the mother was included. An index combining these two variables, with values ranging from 2 to 8, was used in the analyses.
Family structure. The family was classified according to the members living at home: without parents - neither of the parents was present in the home; uniparental - single-parent family; nuclear - both parents were present in the home; and extended - other relatives, such as married siblings, grandparents, uncles, or aunts, were also present. Data on number of siblings, their ages, and religious beliefs and practices were also collected.
Family functioning. Several aspects of family functioning were evaluated using the McMaster model (Epstein, Bishop, & Daldwin, 1978). Problem solving in the family was evaluated using five categories, with better solution of problems rated highest. Communication in the family was classified into four categories, with clear and direct communication rated highest. Affective responsiveness to positive and negative situations was rated using four categories. Responsibility, or role, assumed by each family member, such as economic support, nurturance, decision making, teaching of ethics/social skills, and leadership, was evaluated using four categories, with higher scores if the role was assumed by either the father or the mother. Affective involvement between the parents was measured using three categories, with love garnering the highest score. Behavior control in the family was evaluated using four categories, with flexible control rated highest.
Sexuality: knowledge and attitudes. Multiple-choice questions about sexuality, contraceptives, and sexually transmitted diseases (STDs) were used to assess knowledge (five items for each topic). Correct answers were summed. Attitudes toward sexuality were evaluated using a Likert scale (Hulley & Cummings, 1988). Twenty-five questions solicited the youths' opinions on sex education, sexual responsibility, and the role of men and women in society. Attitudes toward family planning were evaluated with 15 questions on population growth, the effects of contraception on family health, and relatives' acceptance of the use of contraceptives. Four questions assessed attitudes toward STDs, including such topics as multiple sexual partners, condom use, and the social impact of STDs.
Sexual experiences. Twenty-four questions dealt with sexual experiences, number of sexual partners, number of sexual encounters per month, use and type of contraception, sexual abuse, homosexual experiences, contraceptive use at first sexual experience, and drug abuse. The same questions were pilot tested and used in a previous study (Huerta-Franco et al., 1996).
The general characteristics of male and female youth were examined (descriptive statistics) and differences were analyzed (unpaired Student's t test). Attitudes, knowledge, and sexual experiences were compared according to family type (ANOVA). Frequency of sexual practices was compared by gender (chi-square test). Multivariate logistic analysis, with sexual experiences as dependent variables, had the following candidates for regressors: age, education, parents' ages, adolescents' birth order, socioeconomic level, and variables related to family structure and functioning (problem solving, communication, family roles, affective involvement between parents, positive and negative affective responsiveness, and behavior control). The statistical analysis was performed using the Statistica program (p [less than] .05 significance level).
Characteristics of the Sample
Table 1 shows the personal and family characteristics of the 235 males and 288 females. More than 70% of the males were underemployed (e.g., shoe shiners, newspaper vendors, part-time workers at a tannery); only 7% were full-time factory workers. Thirty-three percent of the females did not have fixed employment and 20% were employed at factories. Eleven percent of the males and 40% of the females were unemployed. Seventy percent of the males and 41% of the females contributed to household income. Their parents had little education, and over 40% were tannery workers.
No significant gender difference in age or education was found. Females came from significantly larger families, and had a higher number of persons per room, than did males. Males had significantly earlier sexual experiences than did females, but less knowledge about contraception.
Family Type and Functioning
Table 2 shows that more than half of the families of the adolescents were nuclear. Nearly a fifth lived in extended families, and approximately a tenth had single-parent families. Few lived without any parents.
Over 60% of the adolescents perceived their families as finding appropriate solutions to problems. A higher percentage of females, as compared with males, perceived family communication as clear and direct. A higher percentage of females also indicated that economic and affective roles were fulfilled by their parents.
[TABULAR DATA FOR TABLE 1 OMITTED]
Affective responses in the face of positive or negative situations were perceived by females, as compared with males, to be significantly more intense. Females also perceived more rigid control of behavior in the family and greater family cohesion (in terms of social gatherings, friendships, and decision making) than did males.
Twenty-seven males (11.5%) and 40 females (13.9%) were married. Thirteen males (5.8%) and 31 females (10.9%) had children.
Table 3 presents several aspects of the sexual experiences of the adolescents. Approximately 41% of the males and 24% of the females [TABULAR DATA FOR TABLE 2 OMITTED] [TABULAR DATA FOR TABLE 3 OMITTED] were sexually active. Females overwhelmingly indicated that love was their primary motivation for engaging in sexual activity. Among the sexually active adolescents, 29% of the males and nearly 12% of the females had more than two sexual partners. About half of the sexually active adolescents did not use any method of contraception. A greater percentage of males, as compared with females, had homosexual experiences. Seven women had a history of abortions. One hundred ten males (48.2%) and 125 females (43.9%) had experienced problems with their parents regarding sexual behavior. Fifty-one males (23.3%) and 61 females (21.8%) considered it taboo to talk about sexuality at home. Interestingly, the use of contraceptives was greater for adolescents from households without parents (p = .006).
Factors Associated with Sexual Experiences
Table 4 shows the factors that were significantly associated with adolescents' sexual experiences (logistic regression analysis). Strong [TABULAR DATA FOR TABLE 4 OMITTED] associations were found for the following: history of sexual abuse with both age at first sexual experience and number of persons in the family (negative associations for both); sexual activity with age of the youth, knowledge about STDs, and attitudes toward sexuality; number of sexual partners with age of the youth and knowledge about STDs; use of contraceptives with age of the youth; homosexual experiences with age at first sexual experience; and drug abuse with attitudes toward sexuality, knowledge about sexuality, and knowledge about STDs.
Health problems related to pregnancy and sexually transmitted diseases are more severe for poorer, less educated adolescents. Additionally, those on the margin of society have limited access to social services and work opportunities. Thus, the present study sought to shed light on the relationships between personal and family factors and the sexual experiences of underprivileged Mexican adolescents.
Typical of a traditional society with low socioeconomic level, the families of the adolescents had an average of 6 children and frequently included other relatives (nearly 20% were extended families). Ortigosa, Cortes, Garcia, and Martinez (1991) reported similar findings for their Mexico City sample (22% were extended families). The influence of more distantly related family members on adolescents' sexual practices and attitudes has not been established.
In the present study, a frequently reported family characteristic was rigid control of behavior, particularly for female youths. Also worth noting is that chaotic control was reported by more than 19% of the youths. In addition, greater family cohesion was perceived by females. These findings indicate more strict family monitoring of female children, which is common in traditional societies.
Sexual experiences were reported by approximately 41% of the males and 24% of the females. These percentages are lower than those found for adolescents in several other Latin American countries, which ranged from 46% to 63% (Wulf & Singh, 1991). However, Morris, Nunez, Monroy de Velasco, Bailey, Cardenas, and Watley (1988) found that 44% of the males and 13% of the females in their Mexico City sample were sexually active. Similar results have been reported for 17- to 19-year-old Costa Ricans (Rosero-Bixby, 1991). It is important to note that it is difficult to obtain accurate responses regarding sexuality for most populations (Friedman, 1992). In addition, the percentages in the present study differed from those found in a previous study conducted with more highly educated adolescents in the same city; 25% of the males and 9.5% of the females were sexually active (Huerta-Franco et al., 1996).
Sexual experience increased with age, more positive attitudes toward sexuality, and greater knowledge about STDs. Sexual experience was also associated with positive affective responsiveness in the family. In addition, family roles and problem-solving capability were negatively related to adolescents' sexual activity. These findings should be explored in more detail.
Contraception is an important public health issue. In a study by Friedman (1992), more than 50% of the adolescents investigated had engaged in unprotected intercourse. Herold et al. (1988) found that few adolescents in their Guatemala City sample used contraceptives the first time they had intercourse because it was an unexpected event. In the present study, adolescents' age and knowledge about contraceptives were associated with contraceptive use. Affective involvement between parents was also associated with adolescents' contraceptive use, which may indicate that an appropriate affective environment at home encourages the development of more responsible attitudes toward sexuality.
The condom was found to be the main method of contraception for sexually active adolescents, in accord with the results of other studies (De Buono, Zinner, Daamen, & McCormack, 1990; Catania et al., 1992). The prevalence of homosexuality, an important risk factor for STDs, was similar to that in other populations (Hamer, Hu, Magnuson, Hu, Pattatuci, 1993; ACSF Investigators, 1992). A higher percentage of males, as compared with females, reported homosexual experiences. It is noteworthy that similar results were reported in a previous study of adolescents with higher socioeconomic status in the same city (Huerta-Franco et al., 1996). Age at first sexual experience was the only factor associated with homosexual experiences.
The number of sexual partners is a relevant risk factor for STDs. Of the sexually active adolescents, 47.6% of the males and 20.0% of the females reported two or more sexual partners. The main regressors for this factor were age and knowledge about STDs. Positive affective responsiveness was also associated with number of sexual partners.
Sexual abuse is not uncommon at any socioeconomic level, and has been found to be a risk factor for suicide and drug abuse (Bayapourt, Wells, & Holdforf, 1992). In the present study, 3.0% of the males and 2.4% of the females reported being victims of sexual abuse. Sexual abuse was associated with younger age at first sexual experience and lower number of persons in the family. Associations were also found for knowledge about contraceptives, age at marriage, and attitudes toward sexuality.
Mostly males reported drug abuse, primarily marijuana and inhalation of solvents. Cocaine use was reported only by two male adolescents. Positive associations were found for attitudes toward sexuality, knowledge about STDs, and positive affective responsiveness in the family; knowledge about sexuality was negatively associated with drug abuse.
Lidz (1975) found that the family was important in the transmission of sexual knowledge. Ortigosa, Cortes, Garcia, and Martinez (1991) noted that nearly half of the adolescents in their study reported parental influences on their sexual education. However, education increases knowledge but does not necessarily affect attitudes or practices. For example, in a Costa Rican sample, improvement in knowledge did not have a direct effect on the attitudes of females toward extramarital sexual activity (Rosero-Bixby, 1991). The influence of education on attitudes toward sexuality have also been questioned by other investigators (Stout & Rivara, 1989).
Nevertheless, the results of the present study underline the relevance of the family environment for adolescents' sexual attitudes and behaviors. Communication and emotional climate in the family are important for the development of adolescent sexuality. Sorensen (1972) found that 50% of the males and 63% of the females in an adolescent sample wanted to discuss topics related to sexuality, but their parents did not. In the present study, sexuality was considered a forbidden topic in more than 20% of the families.
In summary, about a third of the adolescents came from nonnuclear families. Rigid control of behavior in the family was prominent for females. Fewer than half of the sexually active adolescents used a method of contraception. Knowledge about, and attitudes toward, sexuality, contraception, and STDs were strong predictors of sexual experiences. Several aspects of family functioning (e.g., roles, problem solving, positive affective response) were also associated with adolescents' sexual experiences.
This project was made possible by a grant from the Social Science Research Unit of the World Health Organization's Special Program for Research in Human Reproduction.
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