Adolescent sexual and reproductive health in
the digital age
A/Prof Rachel Skinner
Discipline of Paediatrics and Child Health, Sydney University
Children’s’ Hospital Westmead.
SYDNEY MEDICAL SCHOOL
WHO definition of sexual health
› “...a state of physical, emotional, mental and
social well-being related to sexuality....”
2
Adolescence is marked by immense developmental change
› Increasing neurocognitive development
› Limited life experience and poor impulse control
› Vulnerability to experiences and behaviours with life long consequences
- 2/3 premature adults deaths due to conditions/ behaviours which arise in
adolescents
3
Historical changes in sexual development
Adolescence occurs in a context of new media
› 96% of 12-14 year olds use the Internet
› 33% 12-14 year olds spend 10 hours or more online per week
› 76% 12-14 year olds own a mobile and go online via a mobile
device/hand-held device
› 50% adolescents send 50 or more text messages a day, one in three send
more than 100 texts a day
› 59% of 11-12 year olds have a social networking profile- increasing to 92%
by 15-16 years of age
- more than half log on more than once a day (nearly a quarter more than 10 times
a day)
- more private method of communication and 24-hour access
- Access to peers, strangers and large groups
- Quick communications without immediate consequences
Australian Bureau of Statistics. Australian social trends June 2011: Children of the digital revolution. Available at:
www.abs.gov.au/socialtrends (accessed 2 Feb 2012), 2011. ; Lenhart A. Teens, Smartphones & Texting. Washington: Pew Internet 2012.;
Is Technology Networking Changing Childhood? A National Poll. San Francisco: Common Sense Media, 2009
5
Adolescence occurs in a context of new media
› 59% of 11-12 year olds have a social networking profile- increasing to 92%
by 15-16 years of age
- more than half log on more than once a day (nearly a quarter more than 10 times
a day)
- more private method of communication and 24-hour access
- Access to peers, strangers and large groups
- Quick communications without immediate consequences
› Just under 50% of 13-16 year old adolescents have seen naked images
on-line (AU Kids on-line survey)
- 45% of males
- 38% of females
Australian Bureau of Statistics. Australian social trends June 2011: Children of the digital revolution. Available at:
www.abs.gov.au/socialtrends (accessed 2 Feb 2012), 2011. ; Lenhart A. Teens, Smartphones & Texting. Washington: Pew Internet 2012.;
Is Technology Networking Changing Childhood? A National Poll. San Francisco: Common Sense Media, 2009
6
Sexual behaviour in adolescencewhat is normal?
7
Trends in age of first intercourse- Australia
C. Rissel, J. Richters and A. Grulich et al. 2003
National Survey of Secondary Students and Sexual Health (SSASH)
What is risky sexual behaviour?
Behaviour that leads to unplanned pregnancy/ STI spread
High abortion rate, poor outcomes for teen mothers and babies,
morbidity of STIs
Predictors of STIs and teen pregnancy
Early age of sexual debut
Poor use of condom use/ contraceptives
Number of partners over a short time period
Chlamydia notifications by age, 2011
12
Chlamydia notification rates for indigenous people
13
Teenage births in Australia
120
100
80
NT
Births
60
n/1000
AUS
40
20
0
1971
1977
years
Age specific fertility rates for 15 – 19 year old women ABS.
2006
Sexual related behaviour of interest or concern
› Relationship with other adverse outcomes
- Unwanted sexual activity
- Sexual activity when drunk or high
- Use of social media to send sexual images or
messages which are unwanted or demeaning
- Meeting potential sexual partners on line, or via social
media sites
15
Key points SSASH
› Increasing sexual intercourse, oral sex
- Majority sexual active in some way from year 10
› higher number of recent partners (oral and intercourse)
› Condom use stable- 50% report consistent use
› Very few thought they were at risk of STI
› Perceived risk not associated with condom use, only casual
partner
› Unwanted sex in females has increased
- 10% experienced negative emotions, F sl. higher regret or
feeling used.
Is normal sexual behaviour risky in adolescence??
Biological vulnerability
Reducing age of onset of sexual activity
 Romantic relationships- shorter duration, shorter
between gap
Inconsistent condom use
Social vulnerability-Risk taking, impulsivity, social
contexts and norms important, low perception of risk,
alcohol use
Access to methods
Sexting
› new media communication of a sexual nature involving
photographs, videos, messages
› Just under 50% of 13-16 yr olds have seen sexual images
› 17% of adolescents have engaged in sexting
- 3% in 12 year olds to 32% in 18 years or older.
› Social media sites
- Facebook, Tumbler, Instagram, Snapchat, Tinder, Blendr, Grindr
18
Sexting
› 17% of sexually active teens vs 8% of non sexually active
shared their own naked images
› 45% of teens who had sex in the past 7 days reported one
sexting-related activity (sending, receiving, forwarding) in that
time
› Huge community concern about sexting and adolescent
sexual development
› Research is unclear on cause and effect
19
Understanding teenage sexual behaviour
› First sexual experience
› Use of contraception, condoms for STI and pregnancy
prevention in females and males
› Choices around pregnancy outcomes
Smith, Fenwick, Skinner et al, J Adol Health, 2008; J
Reproductive Health Care 2010, Sexual Health 2009,
Archives of Sexual Behaviour 2010, Journal of Adolescent
Research 2011 (in press), Women and Birth 2009
Themes around first sexual experience
› I was ready for sex- a natural happening, right time- right person
› I wanted to see what it was all about- unrealistic perceptions about
sex
› Everyone else was doing it- perceptions of peer sexual activity
› I did it to keep him happy- importance of romantic relationship
› When you’re drunk you just do it- intoxication
Findings re 1st intercourse
› Loss of personal control over first intercourse
- through drunkenness, social norms, peer norms
- Partner pressure
› Perceived control influenced how they reflected on their first experience and
the meanings
- Regret was linked to loss of personal control
- Loss of control tended to be younger age (earlier developmental stage)
› Control linked with self-efficacy
› Implications for sexual health education/ promotion
Beliefs of teen females re contraception use/
pregnancy risk
› Sexually active girls fall into 3 groups
- Those who have accurate risk perceptions about fertility, don’t use contraception
and are happy to fall pregnant
- Those who have accurate risk perceptions, use contraception well, and don’t fall
pregnant
- Those who have inaccurate risk perceptions, don’t use protection consistently or
effectively, and are shocked when they fall pregnant
› These 3 groups should have different approaches in education, management
Beliefs of young males regarding condomss
› Use is linked to the nature of the sexual relationship
› Pregnancy main concern- condoms used mainly for contraception rather than STI
prevention, with regular partner
› Responsibility for use of hormonal contraception is considered to be the role of
female partner
› No discussion with partner about effective contraception use, or attitudes to
hormonal contraception, pregnancy
Implications for education/ clinical
care
› Don’t assume that all female teens want to avoid pregnancy
- For some, motherhood a logical choice
› pregnancy intentions & contraceptive behaviour doesn’t always
follow
- contraceptive attitudes, sexual context & accuracy of risk perceptions, intentions to
remain non-pregnant
› Main concern is pregnancy, risk perceptions regarding STIs may
be flawed for both males and females
› Responsibility for pregnancy prevention in a relationship is left to
female partner, with little discussion regarding effective use
STI interventions in Australia
› Direct access to STI screening in non-clinical setting achieved the highest
participation rates
› More support for STI screening in GP practice is needed
› School based sexual health education has not been evaluated in Australia
› Use of new social media technology for education/ promotion and improving
access
› Good media campaigns can influence behaviour
Kang et al, Sexual Health, 2011;
Kang et al Sex Trans Infect 2012
Education in schools and online
› “They’re busting to talk about the complexities of things, not just oh it goes in
and phfw, and oh oops there’s a baby in nine months, like everyone knows that...
any education that goes forward has a lot to do with, a lot broader than sort of
facts and figures, you know.”
› “A lot of people use the internet now and I guess that’s probably the best place
to go because it’s so anonymous too. You don’t actually have to talk to anyone
face to face. It might be a lot less confronting for people.”
Making condoms easier to access
› “For a lot of people it’s a very daunting experience walking up to a counter and
putting a packet of condoms on there. I’m not sure how you combat that,
perhaps there’s vending machines...”
› “One of the things we went through high school was about whether we were
going to get condom vending machines in the males’ toilets... the school was like
oh no we don’t want to do that cause then we’re just encouraging sex. Well
isn’t it better to encourage safe sex than just to turn a blind eye to it?”
Thank you
29