3.

REVIEW OF LITERATURE

A review of related literature is an essential component of any research study or

research project. Literature review through light on the studies and their findings reported

about the problem under study. It gives understanding and inspires insight into the

problem. The reviewof literature in a research report is a summary of current knowledge

about a particular practice problem and included what is known and not known about the

problem.31

Review of literature is an important step in research. The review of literature on a topic of

interest often prepared to put a research problem in context or as a basic for an

implementation of project. It can help with orientation to what research can best make a

contribution to the existing base of evidence.32

Review of literature is a key step in research process. Review of literature refers

to an extensive, exhaustive and systematic examination of publications relevant to

research project. It justifies the need for replication, provides the basis of future

investigations and help to relate the findings from one study to another.33

The review of literature is arranged as follows:

 Reviews related to behavioural problem of smoking

 Reviews related to behavioural problem of Aggressiveness.

 Reviews related to behavioural problem of Suicide.

 Reviews related to behavioural problem of Abnormal Sexual Behaviour.

Reviews related to behavioural problem of smoking

A Greek cross-sectional study finds the emotional, behavioural problems and

cigarette smoking in adolescence. Participants completed a questionnaire which retrieved

information about age, gender, family socioeconomic status, smoking status, parental

smoking, adolescents, leisure time and emotional/behavioural problems. Data were

modelled using multiple logistic regression analysis with adolescents smoking status as

the dependent variable. Results of the study revealed that emotional symptoms, conduct

problems and hyperactivity/inattention were all significantly associated with adolescent’s

current smoking.34

A article published in the journal Bruce Simons-Morton, Tilda Farhat reviewed

the recent findings on peer group influences on adolescent Substance use. The purpose of

this paper was to review and summarize the literature on peer group influences on

adolescent smoking and focusing on the recent publications on smoking and

understanding the social influence on smoking. It summarized that, adolescent’s

experience a range of social influences that may provide some direct effects on the

likelihood of substance use, including smoking but mainly provide indirect effects

through social norms.35

A randomized controlled trial study was conducted on Intervention to Reduce

Intentions to Use Tobacco among pre university college student’s boys. Participants

included 103 pre university college students’ boys between the ages of 10 and 18 years

who were randomly assigned to either a standard care control (SCC) group or a tobacco

intervention (TI) group. The effect of our intervention was assessed by self-reported
knowledge, perceived vulnerability, and intentions at baseline, 6, and 12 months. The

result of the study revealed that the pre university college student’s knowledge, perceived

vulnerability to health risks, and intentions to use tobacco can be modified by a risk

counseling intervention. The delayed effect of our intervention indicates that these

changes may evolve over time.36

A study was conducted on the factors associated with junior high school

personnel advising students to quit smoking School personnel (N = 7129) were recruited

by cluster sampling from 60 junior high schools in Taiwan; of these, 5280 voluntarily

returned self-administered, anonymous questionnaires (response rate = 74.06%) in 2004.

Most personnel (70%) had advised students to quit smoking. School personnel who were

older, male, responsible for teaching health, smokers, with positive attitude against

tobacco, or with more knowledge of tobacco hazards were more likely to advise students

to quit smoking. Personnel with more interest in and access to tobacco-related materials

were more likely to advise students to quit smoking. Personnel who had received

tobacco-prevention training were 2.41 times more likely to persuade students to quit

smoking after adjusting for other factors. The study concluded that reduce youth smoking

prevalence, school tobacco-control programs should support tobacco-prevention training

in school.37

A descriptive study was conducted to evaluate the level of knowledge about

addictions. The research was conducted among a group of 158 people, with 85 studying

physiotherapy and 73 studying physical education at the Academy of Physical Education

in Krakow, Poland. Students of both disciplines had compulsory health promotion

classes. The study showed that the level of knowledge was insufficient and comparable in
both cases. The vast majority of the surveyed knew the definition of psychical and

physical addiction. Students were not capable of listing the consequences of smoking on

health. A relatively high percentage claimed that beer was not addictive. Not all students

knew that marijuana smoking leads to addiction as well.38

A descriptive study was conducted on the evaluation of knowledge about harmful

effects of smoking, drinking alcohol and drug use among students of Silesian University

of Technology and evaluation of health attitudes towards smoking, drinking alcohol and

drug abuse in examined population. One hundred and nine students of Silesian University

of Technology aged between 19-24 years took part in the study and filled the anonymous

questionnaire. The study revealed that 8% of Silesian University of Technology students

smokes cigarettes regularly. Fifteen percent of students declared smoking occasionally

despite most of them knowing the negative effects of such smoking. Almost 80% did not

smoke at all. In the opinion of 66 (7%) passive model of smoking is as harmful as the

active one. Relatively many (8%) of examined students admitted drinking alcohol

regularly. Only 15% did not drink alcohol; 35% of students declared taking a drug at least

once during entire life, and some of examined considered marijuana as not addictive.

High knowledge about harmful effects of smoking among students resulted in a relatively

low percentage of inveterate smokers.39

A longitudinal survey explored the relationship between physical activity

and smoking behavior among adolescents using rich data from a nationally representative

sample of adolescents. Several endogeneity -corrected models were estimated to ascertain

the effect of exercise on both the probability of being a smoker and the intensity of

cigarette smoking. The analysis indicated that 1 additional weekly occurrence of exercise
led to a 0.3% decline in the probability of being a smoker and led to a 4.1% reduction in

the number of cigarettes smoked by a smoker during a month, a result that was robust to

stratification by gender and race/ethnicity. Consistent with the national guidelines,

frequencies of physical activity of at least 7 times per week appeared to exhibit the

biggest benefits in terms of reduction in smoking for both genders and across

races/ethnicities.

A cross sectional study was conducted on knowledge about the health hazards of

tobacco predetermine the intention to quit smoking in Ukraine at a baseline level in 2005

among 2,239 collected questionnaires a sub sample of 775 smokers was analyzed. The

finding of the study revealed that the Level of knowledge was higher in more educated

respondents, men, in those living in the Eastern region Ukraine. Willingness to quit was

higher in younger age groups and in occasional smokers.

A Cross sectional study of Wong, Onna, Anna reviewed on family influence on

smoking behaviour among adolescents. The purpose this review was to examine the

effect of family influences on adolescents smoking behaviour, particularly the association

of parenting style, parental smoking and adolescent smoking behaviour. Results shows

that literature showed authoritative parenting style could reduce the risk of smoking and

also decrease smoking prevalence in among adolescents. Future campaigns on smoking

prevention should increase the involvement of family members, encourage parents to quit

smoking and act as role model to their children; parents are suggested to practice

authoritative parenting which will increase the acceptance of adolescents to their rules

and suggestions and thus, avoid them from smoking. With randomized control trial

studies, are needed in the future to examine family influences that fit the situation in
Hong Kong. More researches are needed to give insights for appropriate acts in the future

smoking prevention campaigns among adolescents in Hong Kong.40

A exploratory study was conduct to know the current state of knowledge about

effective and promising interventions and practices in addressing smoking cessation

among youth. The purpose is, the peer-reviewed and grey literature regarding various

effective and promising interventions aimed at helping youth quit smoking and key

factors to determine the success of such interventions. The literature search was

conducted in January 2014. The following inter disciplinary databases were searched for

relevant peer-reviewed manuscripts published in English between 1985 and 2014. A

number of reviews of the literature on youth smoking cessation have been conducted over

the past decade. The findings from this literature review indicate a number of key

considerations in developing smoking interventions for youth. It is important for tobacco

control programs to take a comprehensive approach to address the systemic,

psychosocial, and environmental factors that influence smoking behaviour and smoking

cessation. The severe and well-known risks of smoking, it is important to continue to

research and develop policies and interventions to prevent the uptake of smoking among

young people, as well as to assist established youth smokers to quit smoking.41

Reviews related to behavioural problem of Aggressiveness.

A study conducted on aggression among engineering college students in relation

to certain demographic variables and concluded that male students exhibited higher level

of aggression as compared to their female counterparts. She also found that students

studying in private colleges depicted higher level of aggression as compared to students

studying in government colleges. However, there was no significant difference in the

aggression level of hostellers and non- hostellers.21

A study conducted on aggression among senior secondary school students in

relation to some selected variables and found no significant difference in aggression

among senior secondary school students at different levels of their self-esteem. There was

no significant gender-wise and family-wise difference in aggression among senior

secondary school students. There was no significant interaction between level of self-

esteem and gender as well as family with regard to their combined influence on

aggression among senior secondary school students. Students studying in private

institutions exhibited higher aggression than students of government schools. Also

students studying in science stream had significantly higher mean of aggression score

than students of arts stream. It was also found that level of self-esteem and institution

type as well as stream of study did not interact significantly with regard to their combined

influence on aggression among senior secondary school students.21

A study on an evaluation of aggression management training programme to cope

with workplace violence in the health care sector. – by Oostrom J.K., Van Mieriott. The

purpose of the study was to find out the effectiveness of an aggression management

training programme.It contains experimental control variables. There was significant

improvement in the experimental variable, therefore aggression management training is

an effective instrument to fight against work place violence.

A Study conducted by Martin K.H. (Hospital of the University of Pennsylvania,

Department of Psychiatric Nursing, Philadelphia 19104, U.S.A.Improving staff safety

through an aggression management programme.This article provides information

regarding the relationship of a formal inpatient aggression management program and

subsequent aggression related staff injuries at one university medical centre. Data was

related to staff injuries, collected before and after the program, they were compared as a

means of measuring the progrommes effectiveness. The frequency of injury changed

slightly, the results indicates that there was a decrease in the severity of aggression –

related staff injuries after institution of formal program, it also brought about

improvements of other aspects of care such as resource management and staff

satisfaction.42

A study was conducted in Italy on 2667 middle and secondary school students

who were randomly selected. Revised questionnaire was used to measure physical,

verbal, relational, sexual, cyber, and racist forms of bullying. The results showed that

Prevalence of having bullied others at school at least once in the last 2 months was 11.6%

for physical, 52% for verbal, 47.9% for relational, 18.5% for sexual, 19.4% for cyber, and

9.4% for racist bullying. Compared to girls, boys were more likely to be involved in

physical bullying; moreover, boys were more involved as bullies in verbal, sexual, cyber,

and racist bullying. The study also reveals that, girls were more likely to be victims of

verbal, relational, sexual, and cyber bullying than boys .43

A study was conducted in Cincinnati Children's Hospital Medical Center,

Cincinnati, USA to assess the aggressive behavior of 418 hospitalized children and

adolescents, over a period of 6 months. The children’s were assessed using 16-item

questionnaire by ED staff and hospital staffed used the Overt Aggressive Scale. The

results showed that a total of 292 aggressive acts was committed by 120(29% of 418)

hospitalized children plus adolescents and Fourteen of the 16 items predicted (p < .007)
inpatient aggression and showed good internal consistency (Cronbach's α = 0.837). Thus

the study shows that children and adolescents show aggressive behavior when they are

hospitalized.

A Cross-sectional study was conducted in South Delhi, India to assess risk

behavior related to interpersonal violence and its epidemiological correlates among 550

adolescents of various schools and colleges aged 14-19 years. The study used a pre-

tested, semi-open-ended and self-administered questionnaire to assess the fighting done

by adolescents. The study revealed that, 65 (11.8%) carrying a weapon in past 30 days,

74 (13.5%) had threatened or injured someone with a weapon and almost one in every

two boys (49.1%) reported being involved in a physical fight in past 12 months. The

study also identified that there is a significant relationship with age (P = 0.007) and

gender (P ≤ 0.001) of the adolescents. The logistic regression analysis of the study

showed significant correlation of interpersonal violence with male gender, lower age, and

number of close friends, having seen role models who smoke/drink, and residing in

resettlement colonies, slums or villages. (17)

A study conducted on depression and aggressive behaviour in adolescents

offenders and non offenders by Anna L Lorca Mestre. The aim of this study is 1) analyse

the differences between young offenders and non-offenders in emotional instability,

anger, aggressive behaviour, anxiety and depression, and also the differences according

to sex 2) compare the relation between emotional instability and anxiety, depression and

aggressive behaviour mediated or modulated by anger in both groups. The sample of

participants are 440 adolescents, both male and female (15-18 years old). 220 were young

offenders from four different correctional centres of the Valencia Region. The other 220
participants were randomly chosen from ten public and private schools in the Valencia

metropolitan area. In the Schools the instruments were applied collectively in the

classroom, with a 50 minutes maximum duration. In the Youth Detention Centre the

application was carried out in small groups. It results gives the structural equation model

(SEM) carried out on each group, young offenders and non-offenders show a relation

between the assessed variables. Emotional instability appears strongly related with anger

in both samples, but anger just predicts depression and aggressive behaviour in the

offender population. It concludes that the results give relevant information for treatment

and prevention of aggressive behaviour and delinquency in teenagers through emotional

regulation.44

A study reported that female senior secondary school students had significantly

higher aggression level in comparison to male senior secondary school students. There

was no significant difference in aggression among senior secondary school students in

relation to their family type, institution type and type of social class. Also there was

significant difference in aggression among senior secondary school students at different

levels of their optimistic-pessimistic attitude.21

A study found that level of aggression among adolescent boys were higher than

the adolescent girls. There was no significant difference between the scholastic

achievement of highly aggressive boys and girls as well as low aggressive boys and girls.

They also found that self-concept level of highly aggressive boys and low aggressive

boys were higher than the highly aggressive girls and low aggressive girls.21
Reviews related to behavioural problem of suicide

A co-relational study of the Eastern Mediterranean Region finds the suicide

ideation and its associated risk factors among adolescent students in order to reduce

suicide related behaviors and injuries among youth in EMR countries. The study also

examined the correlates and variables associated with suicide ideation as differentiated by

gender in an effort in an effort to see how these behaviors varied between boys and girls.

The result of the study were derived using secondary analysis of data sets from the global

school based student health survey(GSHS)which is conducted by the world health

organization. The study analyzed data on students who fell primarily between the ages of

12-16 from the countries of Jordan, Lebanon, Morocco and United Arab Emirates. The

data was analyzed using logistical regression. The results of the suggest that suicidal

ideation among youth in EMR countries may influenced by social, political, cultural and

economic factors and it may be useful to those looking to design and implement

educational suicide prevention programmes among school age children in the EMR.45

A plethora of literature exists on the connections between adolescent suicidality .

In fact, it as been identified as one of the most commonly associated contributing factors

to adolescent suicide attempts (Kim et al., 2011). It is estimated that “1 in 6 American

females and 1 in 12 males” suffer from depression; of those adolescents, at least half will

attempt suicide at some point (Rice & Sher, 2013, p. 69). Depression and adolescent

suicide attempts are strongly associated with each other because suicidal ideation and

recurrent thoughts of death are both identified symptoms of depression and identified risk

factors for suicide attempts (American Psychiatric Association, 2013).46

 A cross-sectional study conducted on the prevalence of suicidal behavior and its

epidemiological correlates amongst adolescent students. Study conducted in three schools

and two colleges. A total of 550 adolescent students aged 14 to 19 years selected by

cluster sampling. Statistical Analysis done by Proportions, chi square test, bivariate

logistic regression. Results of study shows about 15.8% reported having thought of

attempting suicide, while 28 (5.1%) had actually attempted suicide, both being more in

females than in males. Statistically significant associations were observed with the age of

the student, living status of parents, working status of mother, and whether the student

was working part-time. The two variables found significant on multivariate analysis were

female gender and the number of role models the student had ever seen smoking or

drinking. The prevalence of suicide-risk behavior was found to be quite high and is a

matter that should evoke public health concern.47

A study conducted on rates and factors associated with suicide. The main

outcome measure was death by suicide diagnosed by detailed verbal autopsy and census

and birth and death data to identify population base. Result shows the average suicide

rate was 92.1 per 1,00.000. The ratio of male to female suicide was 1:0.66. The age

specific suicide rate for women showed two peaks: 15-24 year and over 65 years of age.

Hanging (49%) and poisoning with organo-phosphorus compound (40.5%) were

commonest method of suicide. Acute or chronic stress was elicited for nearly all subjects.

More men suffered from chronic stress while more women had acute precipitating events

(x2= 4.58; p<0.04). People less than 44 age had more acute precipitating events before

death while older subjects reported more chronic stress (x2=17.38;p<0.001). Conclusion
of study is there is need for sentinel centers in India and in developing countries to

monitor trends and to develop innovative strategies to reduce death by suicide.(9)

A study conducted on suicide prevention in adolescent; a controlled study of the

effectiveness of school based psycho-educational programme. Sample collected from 172

high school students in the 16-18 age group include 108 girls and 64 boys. Method used a

structured self-report questionnaire. The results show that the programme had no effect

on coping styles and level of hopelessness. However positive effect on knowledge could

be identified an interaction effect of the programme with gender on attitude was also

found. A negative impact of programme could not be found. Result indicated effect of

gender and pretest knowledge attitude and coping. Findings from study suggest that

psycho-educational programs in schools may influence knowledge about suicide and

attitudes towards suicidal persons but may not affect the use of coping styles or levels of

hopelessness.

A study conducted on the evaluation of the signs of suicide prevention program.

Data collected from 4133 students in 9 schools. Method used self administered

questionnaires completed by students in both groups approximately 3 month after the

program implementation. Result shows significantly lower rates of suicide attempts and

greater knowledge and more adaptive attitude about depression and suicide were

observed in intervention group.

A study conducted on suicidal tendencies and attitude towards freedom to choose

suicide among school children. The sample of school children, aged 11-15yr, wear

surveyed in 1994 (n=5428), 1998 (n=4513) and 2002 (n=5645). Result shows about

suicidal ideation plans or attempts to commit suicide. In the study period of 8 years, the
percentage of adolescent who reported sometime suicidal ideation decreased but the

percentage of adolescent who declared serious suicidal behavior remained on the same

high level (8.1%, 9.8% and 8.4% correspondingly in 1994, 1998 and 2002). Moreover,

the number of suicidal attempt changed from 1.0% in 1994 to 1.8% in the year 1998 and

to 1.7% in the year 2002. The school children’s attitude towards suicide become more

agreeable: 36.6%, 41.9% and 62.5% of respondent correspondently in 1994, 1998 and

2002, answered that they agree with persons freedom to make a choice between life and

suicide. The study concluded, suicidal tendency are quite frequent among Lithuanian

adolescent.48

A study conducted on the associations between peer and parental relationships

and suicidal behavior in early adolescents. Survey Method is used for data collection.

This cross sectional sample included 1049 girls and 1041 age 12 to 13 years. Answers

obtained through self- report questionnaires that included measures of peer relationships,

parental nurturance, and parental rejection, suicidal ideation and attempts. Result shows

that among early adolescent boys and girls, depression, poor peer relationships, decrease

parental nurturance and increase parental rejection wear all significantly associated with

suicidal ideation and attempt.

A survey conducted in Kolkata supports the findings that the prevention of suicide

is an urgent need. The study revealed that the suicide count among students in Kolkata

had more than doubled in the first three months, compared with the same period in the

previous year. It was mostly teenage girls who are ending their lives and the primary

cause remains conflicts with parents. The survey further revealed that the sex ratio of

suicide was 71 girls and 29 boys. The reasons as found in the survey were discord with
patents, academic and examination related pressure, love affair gone wrong, abuse and

molestation. The most common method adopted by the students to commit suicide was:

hanging: 42, poisoning: 16, burns: 8, railway tracks: 11, unknown: 23. The study

suggested that the parental relation with the children should be positive, rather than

putting the pressure of academics, then the parents can play a vital role in prevention of

suicide rate of adolescents. (23)

An exploratory, quantitative study that sought to contribute to on-going efforts to

prevent adolescent suicide. Structural equation modeling was used to develop a

theoretical model using dataset number 117 of the National Data Archive on Child Abuse

and Neglect to identify and explain relationships between variables that may contribute to

suicidal behavior within adolescents. Three models were developed. Two Post-hoc

theories were developed. One, that sex has an indirect path to adolescent suicide through

depression and PTSD. Two, that internalization may be a latent factor not included in

Model 3 that further explains adolescent suicidal behavior. Further research is needed to

replicate the study and test the two Post-hoc hypotheses.49

A prospective cohort study of the Young-HUNT on Risk factors for suicidal

thoughts in adolescence, examining the associations between health and lifestyle factors

recorded in the participants’ early teens and development of suicidal thoughts recorded 4

years later. All students in the two relevant year classes in Nord-Trondelag County were

invited, 80% attended both waves of data collection. Participants are 2399 secondary

school students who participated in the Young-HUNT1 study in 1995–1997 (13–15 years

old) were included in a follow-up study 4 years later (17–19 years old).It results that 408

of the adolescents reported suicidal thoughts at follow-up, 158 boys and 250 girls. One in
six young adults experienced suicidal thoughts, girls predominating. Suicidal thoughts

were most strongly associated with symptoms of anxiety/depression, conduct problems,

pain/tension and overweight reported when participants were 13–15 years old. Specific

preventive efforts in these groups might be indicated. Future research should investigate

whether similar associations are seen with suicide/suicidal attempts as endpoints. 50

Reviews related to behavioural problem of Abnormal sexual behaviour.

A cross sectional study on knowledge attitude and behavior towards sexually

transmitted diseases behavior of Turkish Cypriot adolescence related to STDs among

secondary school students with a sample size of 423 students was conducted by using

semi structured questionnaire. Simple random sampling method was applied during the

selection of samples. Results the mean age of all participate was 15.61± 1.22,

211(49.88%) of them are male and 212(50.12%) female. Awareness raising educational

events on this matter should be reviewed and revised in order to come up with more

powerful ways of fighting against STDs transmission in this young population group of

Turkish Cypriot community.51

A systematic review to determine awareness and knowledge of school-going male

and female adolescents in Europe regarding STDs. By using various combinations of the

terms "STD", "HIV","HPV", "Chlamydia", "Syphilis", "Gonorrhea", "herpes", "hepatitis

B", "knowledge”, “awareness", and "adolescents. It results a total of 15 studies were

included in the review. All were cross-sectional surveys conducted among school-

attending adolescents aged 13 to 20 years. Generally, awareness and knowledge varied

among the adolescents depending on gender. Six STDs were focused on in the studies
included in the review, with awareness and knowledge being assessed in depth mainly for

HIV/AIDS and HPV. The studies reported similar low levels of knowledge and

awareness of sexually transmitted diseases, with the exception of HIV/AIDS. Although,

as shown by some of the findings on condom use, knowledge does not always translate

into behavior change, adolescents' sex education is important for STD prevention, and the

school setting plays an important role. Beyond HIV/AIDS, attention should be paid to

infections such as Chlamydia, Gonorrhea and syphilis.52

An exploratory descriptive study on students from a private suburban college in

the Mid-Atlantic region of the United States to examine the college students sexual risk

taking behaviour and their knowledge level. Other research of interest would be to do a

study on the older population and the risky sexual behavior particularly the divorced,

widowed or those who are sexually active outside of their marriages and compare finding

to the same study done on a younger sexually active population.53

A study had explored the issue on sexual behavior and knowledge of STD among

in-school and out of school adolescents in northern Nigeria. The main purpose of this

descriptive study were to collect data to plan appropriate interventions. A baseline

questionnaire was administered to systematic sample of 226 in-schools (boys and girls)

from schools and out of school (boys and girls) from the street within the area of the

studies. It result the higher the level of knowledge of HIV/AIDS of the teenage

respondents the more positive attitude to premarital sex, prostitution and multiple sexual

partners and sex education. The study reveals an adolescents population that is vulnerable

and at increase risk of STDs/HIV infection as a result of their sexual behaviors and

knowledge.54
 A descriptive study was conducted to assess Sexual behaviour and Sexually

Transmitted Diseases among young men in Zambia. . The aim of the study was to

explore views about sexual practices and attitudes towards Sexually Transmitted

Diseases. 126 young men aged between 16 and 26 years were selected by purposive

sampling technique. data was collected by interviews and focus group discussions. The

results suggested that Fifty-eight (59%) young men reported having had pre-marital or

extra-marital sexual partners during the past year. The maximum number was five

partners for six individuals. Forty-two (43%) had pre-marital or extra-marital sexual

partners at the time of the interviews Twenty-two (23%) reported having suffered from

an Sexually Transmitted Diseases in the past. Seventy-nine (81%) said they were likely to

inform their sexual partners if they had an Sexually Transmitted Diseases. Although

condoms were believed to give protection against Sexually Transmitted Diseases by the

majority (94%), only 6% said they always used condoms. The study concluded that

Sexually Transmitted Diseases, multiple sexual relationships and unprotected sex are

common among the young men of Chiawa and Health messages that target the young

men should take into account the local perceptions and values that seem to sustain risky

sexual behaviour. (9)

A systematic review conducted on the physiology of adolescent sexual

behaviour. The main aim of this study is to examine physiological influences of

adolescent sexual behaviour, including associated psychosocial factors. The result

showed that Thirteen studies met the inclusion criteria relating to adolescents, physiology

and sexual behaviour. We excluded studies relating to abnormal development. Findings

highlighted hormonal and gender differences. Females appear to be more influenced by

psychosocial aspects, including the effects of peers, than males. Males may be more

inclined to engage in unprotected sex with a greater number of partners. Early maturing

adolescents are more likely to be sexually active at an early age. This study conclude that

Hormonal, psychosocial context, and sexual preference need to be acknowledged in

intervention development. Stage of readiness to receive information may differ according

to gender and physiological maturity.

A descriptive study to assess the Knowledge and practices related to sexually

transmitted infections and HIV among sex workers in an urban area of Gujarat, India. . In

the clinic specially set up in their area, after an informed consent from the participants,

knowledge, attitude and practices (KAP) questionnaire schedule was administered to 125

SWs; 2/3rds of them were below the age of 30 years, 81.5% had never gone to school and

76.6% of them had their first sexual intercourse before the age of 20 years. Majority of

SWs. (83.1%) has joined the profession before the age of 25 years; 60.5% were having 3-

5 sexual partners on an average; 94.4% reported using condom all the time during a

sexual encounter; 91.9% of them had suggested the use of condom to their client

themselves, and 79.8% of them made it sure by helping the client to put on the condom.

Out of 29 SWs who had regular partners, 44.8% use condom all the times with their

regular partner, 92% had never seen female condom; 85 to 90% were aware about

various symptoms/diseases transmitted by unsafe sexual practice in male and female;

23.4% took treatment from the health workers for such problems; 87.9% SWs were

aware that HIV is transmitted by unprotected sex with an infected partner and 88.7%

were aware that consistent use of condom could protect her from HIV infection.

However, they did not know other measures, 65.3% don't perceive the risk of getting HIV
infection. Out of those 39 who perceived this risk, 48.7% attributed it to having many

clients, 30.8% to irregular use of condom and only 2.6% to non-treatment Sexually

Transmitted Diseases. Fifty-eight per cent are not aware about any behavioural change

needed to reduce the risk.28

A cross sectional study was conducted in Goa on Gender, sexual abuse and risk

behaviors in adolescents. It aims to study the gender, sexual abuse and risk behavior

among adolescents. The samples for the study were adolescents who belong to the age

group of 12-17years. The samples were selected by random sampling method. 811

adolescents were selected, out of which males accounted 53% and females 47%. The

result showed that one-third (266 adolescents) of the population had experienced at least

one type of sexual abuse among whom 47% experienced sexual abuse more than one

times and some experienced other kinds of physical and verbal violence in the previous

12months period. The risk behavior or perpetrators were older students who accounted

53%, relatives for 8%, teachers for 4% and miscellaneous 27%. The major findings of

this study indicate that sexual abuse and violence are common among this population and

statistical difference between males and females in overall prevalence of sexual abuse.

(19)

A study was designed to ascertain the prevalence and nature of sexual abuse in

childhood for a community sample of women. Two-stage design, using questionnaires

and face-to-face interviews, was employed, providing information on prevalence rates,

types of abuse, ages of victims, relationship to the abuser, and cohort effects.. A

significant number of these experiences (70%) involved genital contact or more severe

abuse, and 12% of those abused were subjected to sexual intercourse. The abusers were
usually known to the victim, being family members in 38.3% of cases and acquaintances

in another 46.3% Stranger abuse accounted for 15% of all abuse experiences. Most of the

abusers were young men, disclosure of the abuse was infrequent, and only 7% of all

abuse was ever officially reported. Thus the study concludes one woman in three reported

having one or more unwanted sexual experiences before age 16 years. Preadolescent girls

are at greatest risk.(20)

A study conducted on Sleep Related Disorders and Abnormal Sexual Behaviors

and Experiences. The main aim of this objective is to formulate the first classification of

sleep related disorders and abnormal sexual behaviors and experiences. The results

showed that A full range of sleep related sexual behaviors with self and/or bed partners or

others were reported, including masturbation, sexual vocalizations, fondling, sexual

intercourse with climax, sexual assault/rape, ictal sexual hyperarousal, ictal orgasm, and

ictal automatism. Adverse physical and/or psychosocial effects from the sleep sex were

present in all parasomnia and sleep related seizure cases, but pleasurable effects were

reported by 5 bed partners and by 3 patients with sleep related seizures. Forensic

consequences were common, occurring in 35.5% (11/31) of parasomnia cases, with most

(9/11) involving minors. All parasomnias cases reported amnesia for the sleep-sex, in

contrast to 28.6% (2/7) of sleep related seizure cases. Confusional arousals (CAs) were

diagnosed as the cause of “sleepsex” (“sexsomnia”) in 26 cases (with obstructive sleep

apnea [OSA] comorbidity in 4 cases), and sleepwalking in 2 cases, totaling 90.3%

(28/31) of cases being NREM sleep parasomnias. REM behavior disorder was the

presumed cause in the other 3 cases. Bedtime clonazepam therapy was effective in 90%

(9/10) of treated parasomnia cases; nasal continuous positive airway pressure therapy was
effective in controlling comorbid OSA and CAs in both treated cases. All five treated

patients with sleep related sexual seizures responded to anticonvulsant therapy. The

hypersexuality in KLS, which was twice as common in males compared to females, had

no reported effective therapy. It concludes that a broad range of sleep related disorders

associated with abnormal sexual behaviors and experiences exists, with major clinical

and forensic consequences.

To update a previous systematic review about the benefits and harms of sexual

risk-reduction counseling to prevent STIs for the U.S. Preventive Services Task Force.To

update a previous systematic review about the benefits and harms of sexual risk-reduction

counseling to prevent STIs for the U.S. Preventive Services Task Force. Results Thirty-

one trials (8–10, 14–41), reported in 57 publications (8–10, 14–67), were selected from

our review of 3241 abstracts and 218 full-text articles (Appendix Figure 2). Of the 31

included trials (n = 70 324), 16 were newly published and not included in the previous

review (n = 56 110). Most evidence comes from trials in women and nonwhite or

minority populations. Most trials targeted high-risk groups based on demographic

characteristics, high-risk behaviors, or presence of a recent STI. Study details (including

target populations) are presented in Appendix Tables 2 and 3 for adolescents and adults,

respectively, and Supplements 1 and 2. Results Thirty-one trials (8–10, 14–41), reported

in 57 publications (8–10, 14–67), were selected from our review of 3241 abstracts and

218 full-text articles (Appendix Figure 2). Of the 31 included trials (n = 70 324), 16 were

newly published and not included in the previous review (n = 56 110). Most evidence

comes from trials in women and nonwhite or minority populations. Most trials targeted

high-risk groups based on demographic characteristics, high-risk behaviors, or presence

of a recent STI. Study details (including target populations) are presented in Appendix

Tables 2 and 3 for adolescents and adults, respectively, and Supplements 1 and 2.Results

Thirty-one trials (8–10, 14–41), reported in 57 publications (8–10, 14–67), were selected

from our review of 3241 abstracts and 218 full-text articles (Appendix Figure 2). Of the

31 included trials (n = 70 324), 16 were newly published and not included in the previous

review (n = 56 110). Most evidence comes from trials in women and nonwhite or

minority populations. Most trials targeted high-risk groups based on demographic

characteristics, high-risk behaviors, or presence of a recent STI. Study details (including

target populations) are presented in Appendix Tables 2 and 3 for adolescents and adults,

respectively, and Supplements 1 and 2.55