ارزیابی شبه تجربی از پدر و مادر به عنوان مربیان بهداشت جنسی منجر به شروع جنسی با تاخیر و افزایش دسترسی به کاندوم

Objective To evaluate the effectiveness of an educational intervention for parents of first year high school students in the State of Morelos, Mexico, whose aim was to impact adolescents’ sexual behavior, knowledge and access to contraception. Material and methods Quasi-experimental prospective study with eleven control and eleven intervention schools using self-administered questionnaires for parents and adolescents pre- and post-intervention. Parent–child dyads in the control and intervention schools were matched according to parents’ propensity score; the average treatment effect (ATE) was estimated for adolescent’s outcome variables. Results At follow-up, we found significant differences for adolescents in the intervention schools: 6.8% delayed initiation of sexual intercourse, 14.4% had correct knowledge about emergency contraception (EC), and 164% reported having received condoms from their parents, when comparing with students in control schools. Conclusions Our results suggest that parent-focused interventions could be an innovative and effective strategy to promote adolescents sexual health.

Adolescent health is a world-wide priority, particularly in developing nations where there are more young people than ever, representing an opportunity for development if investments in human capital are made (The World Bank, 2006). Although this population is generally healthy, they may practice behaviors that negatively affect their future well-being. For example, the lack or inconsistent use of condoms is considered an important factor for both adolescent unplanned pregnancies and the spread of sexually transmitted infections (STIs) (Anderson et al., 2006 and Darroch et al., 2001). In Mexico, the last National Health Survey showed that only 64% of adolescent males and 38% of adolescent females reported using a condom during their first sexual relation and that 30% of males and 57% of females stated not having used any method (Olaiz-Fernández et al., 2006). As a consequence of these unprotected practices, in 2007 female minors under the age of 20 accounted for 17% of all pregnancies (Instituto Nacional de Estadística y Geografía, 1990–2007 [INEGI]), remarkable data considering, among other things, that an early pregnancy limits educational and economic potential. In Mexico, the high prevalence of herpes simplex virus 2 (HSV-2) and human papilloma virus (HPV) in young people indicates that this population may be at high risk as a result of their sexual behaviors (Abraham et al., 2003, Gutierrez et al., 2006 and Sánchez-Alemán et al., 2002). In a 2002 study conducted in public high schools in Morelos, Mexico, researchers found a prevalence of 21% for HSV-2 among sexually active adolescents (Gutierrez, Conde-González, Walker, & Bertozzi, 2007). Prevention of high risk behaviors that can jeopardize the futures of adolescents is highly relevant. Among the diverse approaches developed to meet this objective, school-based initiatives are considered an important strategy because of the ability to reach a large group at a relatively low cost. However, even though sex education is obligatory in the curriculum of all primary and secondary schools in Mexico, information and training are neither effective nor complete (Galárraga, Campero, DeMaria, & Walker, 2008). One consistent argument for ineffective implementation of sex education in schools is that some parents are against their children receiving comprehensive sex education in school (Juárez and Gayet, 2005 and Pick et al., 2000). In this context, working directly with parents is receiving increased priority in many countries. Systematic reviews of studies designed to evaluate the effectiveness of interventions that include parent participation provide evidence that they increase parent–child communication about sexuality as well as other known protective factors. Nevertheless, only a few studies have evaluated the impact of these interventions on adolescent sexual behaviors. Among studies evaluating impact on sexual behavior, the results are contradictory. Some report a positive impact whereas others found no effect. Frequently, these studies suffer from methodological limitations, and combine school-based and parent-based strategies, making it difficult to reach a conclusion regarding the effectiveness of the interventions (Kirby, 1999 and Kirby and Miller, 2002). However, some recent interventions with parents indicate positive effects in delaying the initiation of adolescent sexual intercourse (Dilorio et al., 2007, Forehand et al., 2007, Haggerty et al., 2007 and Wu et al., 2003), reducing the rate of sexual activity and unprotected sex (Dilorio et al., 2006, Dilorio et al., 2007 and Wu et al., 2003), as well as increasing condom use and/or reducing the number of sexual partners (Dilorio et al., 2006 and Kirby et al., 2004). Evidence also shows that these interventions increase knowledge about HIV and/or sexual health (Dancy, Crittenden, & Talashek, 2006; Dilorio et al., 2006 and Smylie et al., 2008). A recent school-based educational intervention among Morelos high school students designed to increase knowledge about HIV, prevention, and safe behaviors, showed an important increase in knowledge about prevention and methods, but limited impact on behavior (Walker, Gutierrez, Torres, & Bertozzi, 2006). As a follow-up to such study, we decided to implement an intervention with parents aimed at converting them into agents of behavioral change for their children. This study aims to measure the impact of this educational intervention for parents of public high school students in Morelos, Mexico on their adolescent children’s knowledge and sexual behaviors.