Management in Health, Vol 17, No 3 (2013)

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Claudia Andreea NISTOR1 , Septimiu Toader VOIDĂZAN2


1Service of Monitoring and Control of Nosocomial Infections, Mures County Hospital

2Department of Epidemiology, University of Medicine and Pharmacy of Tg. Mureş.



ABSTRACT: OBIECTIVUL THE OBJECTIVE of the study was focused on describing the perception of adolescents from an urban climate on their knowledge about sexually transmitted diseases, their sexual experiences, to identifying the level of knowledge regarding contraceptive methods and information sources.

MATERIAL AND METHODS: We used a cross-sectional study, by applying an evaluation questionnaire about education and sexual behaviour to 200 students. The data were collected during the period of 01.10.2012-15.12.2012 in high schools from Tg Mures city.

RESULTS: Boys were earlier to practice sex and had an earlier sexual debut compared to girls. At age of 17-18 years, we identified equal proportions between the sexes, with increasing numbers of girls who have had a sexual contact. Among questioned adolescents who had sexual contact 42.8 to 44.8% reported they had protected sex. Out of all the teenagers who have had sexual intercourse, 60% had received sexual education information. These were provided primarily by friends, and after by parents and physicians. Girls are more interested than boys to talk to their sexual partner about the risk of a possible pregnancy or methods of contraception.

In conclusion, our result can provide useful information on the sexual behaviour of Romanian teenagers in urban areas, which can be beneficial for starting health programs in schools, with the aim to assist the young population to avoid unwanted pregnancy or sexually transmitted diseases.


Keywords: sexually transmitted diseases, sexual behaviour, adolescent.





The starting of an information programme in sexual education, promotion of health and sexual behaviour for the young population are important debate topics in any civilized society, and have to involve state authorities, health and education professionals, researchers, organizations and social movements.

Sex education programs are important for young people and teenagers, these represent a population category which are vulnerable, easily influenced by a number of risky behaviours, including multiple sexual partners through unprotected sex or harmful behaviours (use of drug, alcohol, smoking) [1, 2].

Sexuality or reproductive health are issues much discussed in the scientific literature from the public health, covering topics such as how to become pregnant, abortion, contraception, sexually transmitted diseases, prevention of these diseases relations with health services, etc. [3].

In the context of the efforts to control transmission of sexually transmitted diseases (STDs), a complete understanding of unsafe sexual behaviour among adolescents and young in general is particularly necessary. This necessity results from the fact that, even though many studies with focus on risky sexual behaviour are published, many of them concentrate mainly on population groups with increased risk. [4]


GOAL study was to describe the perception of adolescents in urban areas, on the knowledge of sexually transmitted diseases, their sexual experiences, identify their level of knowledge concerning contraceptive methods and source of information.


MATERIAL AND METHODS: We used a cross-sectional study by applying an evaluation questionnaire about education and sexual behaviour to 200 students. Data were collected between 01.10.2012 to 15.12.2012 in some schools from the city of Tg Mures.

According to the data from County School Inspectorate of Mures County and the enrolment plan for 2012-2013, in classes IX-XII, were assigned 18 high schools around 9.000 students. 52% of the students were girls. Out of the 18 schools I received acceptance from the director to apply this questionnaire only from 5 schools with a high number of students, approximately 800 students per school, a total of 4000 students. It was included in the study persons in the age of 15-18, of both sexes, regardless whether or not they had started their sexual life or not. The study instrument was based on a standardized questionnaire, the most used method of data collection, from which I caught (firstly objective, but also subjective) conduct, via a number of 10 reference items of education and sexual behaviour.

The questionnaire included questions as follows:

         socio-demographic data (gender, age, family income, family size, etc.);

         sexual activity (age of first intercourse, number of partners, etc.);

         contraception (known means, use, etc.);

         sexually transmitted diseases;

         sexual education.


Without claiming to represent a national or even local level, however, the study however aims to include similar subjects from the 5 schools with different profiles (humanities, real, technical, services, sports). I wanted both boys and girls to have equal representation in the two age groups (15-16 years and 17-18 years respectively). The sample volume was largely determined by available resources. The principal technical criteria that stood as base for the sample size were:

         minimize sampling error ( considered an error of 7% acceptable);

         a significance threshold of 0.05;

         sampling step of 20 (In every school I questioned every 20th student, 3 students from the two classes, with a medium of 7 classes/school/academic year).

Both sample size calculations and empirical rules recommended in statistics indicated a sample of 200 students (100 boys and 100 girls).

The students were informed about the objectives of the study. Adolescents were asked to participate in the study, and those who were willing to answer to the questionnaire was included to be the studies data.

Statistical analysis: Data received through the questionnaire was centralized in a data base in Excel, and the statistical analysis was performed by using the informatics program GraphPad Prism Software (San Diego, California, USA). It was used students t-test to evaluate the differences between the papa metric variables (expressed through medium and range), respectively chi-square test for variables expressed in numbers (%). All the tests I interpreted with a significance threshold p=0.05, and statistical significance was considered for p-values ​​less than this threshold.



Demographic and socioeconomic characteristics of the sample by gender

I interviewed 200 adolescent students, 100 female and 100 male, the male age was 16.5 years for the whole sample, 16.4 years for girls and 16.7 years for boys. We didnt identify any significant difference in age (p=0.84), family income (p=0.76) and family structure (p=0.43).  Instead we had significant differences between the group of girls and boys in terms of education level of the mother (p=0.04) and father (p=0 002) (Table 1).


Table I - Demographic and socio-economic participants in the study



TOTAL (N = 200)

BOYS (N = 100)

FEMALES (N = 100)



Age (mean SD)





Family income (%)


Low (<500)





Medium (500-1500)




High (> 1500)




Family structure (%)


Only child





Two brothers




> 2 brothers and




Mother's education (%)


≤ 8 years





high school




post secondary univ




Education of father (%)


≤ 8 years





high school




post secondary univ




*-Student test

**-Chi-square test


Sexual behaviour

Boys were more tolerant towards sex and sexual debut occurred earlier than girls. Approximately 24% of boys in the age 15-16 years have had a sexual contact compared with only 14% of girls. At the age of 17-18 we identified unequal percent between the sexes, with a rising of percent of girls who had a sexual contact.

Among the questioned adolescents who had had sexual contact, between 42.8- 44.8% reported they had had protected sex.

Regarding the age of sexual debut, the boys were earlier; one fifth of them had had sexual intercourse before 14 years of age compared with only 7% of the girls. Among the ones who had their first sexual contact between the ages of 15-17 years of age most of them were boys, while in the group that starter their sexual life after the age of 17 the percent of girls rose (Table 2).


Table 2 - Characteristics of participants in the study of sexual behaviour




(N = 200)


(N = 100)


(N = 100)



Sex (15-16 years), no (%)



18 (18.7)

11 (23.9)

7 (14.0)

0.29 **


78 (81.3)

35 (76.1)

43 (86.0)

Sex (17-18 years old), no (%)



39 (37.5)

18 (March 3. 3)

21 (42.0)

0. 42 **


65 (62.5)

June 3 (June 6. 7)

29 (58.0)

Protection during intercourse Number (%)



25 (43.8)

13 (44.8)

12 (42.8)

0.94 **


32 (56.2)

16 (55.2)

16 (57.2)

Age at first intercourse, number (%)


≤ 14 years

8 (14.1)

6 (20.6)

2 (7.1)

0.05 **

15-17 years

19 (33.3)

11 (37.9)

8 (28.6)

≥ 17 years

30 (52.6)

12 (41.3)

18 (64.3)

**-Chi-square test




Information on sex education

From the total adolescent who had started their sexual life, up to 60% had received sexual education information. From table 3 can be seen that girls were more involved in the process of sexual information, than was the boys (girls: 75% vs. boys: 48.3%, p=0. 05).  Information was provided mainly by friends, and after that by parents and medics. Also from table 3 can be seen that girls are more interested in discussing with sexual partner about the risk of pregnancy (girls: 75% vs. boys: 44.8%, p=0.03), or to have a discussion before the sexual act about contraception methods, especially regarding the use of condoms (girls: 75% vs. boys: 41.4%, p=0.01). The percent between the sexes are similar and smaller when I analysed the answers regarding the risk of getting a venereal disease during sexual contact. 


Table 3 - Characteristics of sexual behaviour at adolescents who had sexual contact




(N = 57)


(N = 29)


(N = 28)



Have you received sexual education information?

 Number (%)



35 (61.4)

14 (48.3)

21 (75.0)



22 (38.6)

15 (51.7)

7 (25.0)

Who provided the information?

No. (% of those with information received)



8 (22.8)

2 (14.4)

6 (28.6)





12 (34.4)

6 (42.8)

6 (28.6)

Teachers, school

2 (5,7)

1 (7.2)

1 (4.8)

Doctors and specialists

10 (28.5)

3 (22.2)

7 (33.2)


3 (8.6)

2 (14.4)

1 (4.8)

Have you discussed with your partner

about the risk of pregnancy, Number (%)



34 (59.6)

13 (44.8)

21 (75.0)



23 (40.4)

16 (55.2)

7 (25.0)

Have you discussed with your partner

about the risk of STDs, No (%)



17 (29.8)

9 (31.1)

8 (28.6)



40 (70.2)

20 (68.9)

20 (71.4)

Have you talked to your partner about contraception, No (%)



33 (57.9)

12 (41.4)

21 (75.0)



24 (42.1)

17 (58.6)

7 (25.0)

**-Chi-square test



The study follows the attitude of adolescents in urban areas regarding the sexual education information, reflected by their sexual experiences, knowledge of contraceptive methods or by knowledge about sexual transmissible diseases.

Sexual behaviour was analysed according to two age groups, 15-16 which included young students and 17-18 with students who were getting close to their adulthood. Because of their wish to win experience, the boys had much earlier sexual contact compared to girls, noted by the percentage of 24% in the age group of 15-16 years. The boys preferred a transient relationship, while the girls preferred a stabile one, after much discussion and persuasion. The percent show us that there exist a gap of one year and only at 17-18 years of age the number of girls with sexual contact is similar to the number of boys. The fact that boys start their sexual life earlier than girls can be noticed from the question about the age of their first sexual relationship.

In Romania, the onset of sexual life among the young population is not that early, a fact underlined also from a national study from data from up to 4.400 subjects, from which almost 2.500 were from urban areas. It is noted from that study that only 2.8% of the women and 13.2% of the men have had their first sexual contact before 15 years of age [5].

In studies from other countries we identified 48% from the adolescents in USA (age 10-24) had started their sexual life [2]. In Italy 38% (14-19 years of age) [6], in South Africa 17-46% (13-17 years of age) [7] and 5.1-56.6% of the Turkish adolescents (16-20 years of age) [8]. The differences in the studies are caused by the characteristic of the included material, cultures or socio-economic conditions in these countries.

From the data we can affirm that even in our case, the sexual behaviour and the level of education concerning sexual health are influenced by the grade of urban development, cultural elements, the geographical position, the family income, the level of education of the parents and by the adolescents own attitude. For sexes, natural stimulation, erotic literature, pornography, excessive audiovisual preoccupation of sex and the access of contraceptive methods lead, in some cases, to an earlier debut of the sexual life (13-15 years).

This study gives evidence of an increased non-use of contraceptive methods during sex, especially condoms (55.2% girls vs 57.2 boys), a higher number than what have been found in other studies [9, 10].

To highlight the importance of medical service and educational support in the education for the health of the students, I looked up the principal sources of information regarding sexual education (reproduction health, STD) (Table III). The main source of information, the most frequently mention was identified as friends, to whom boys turned with confidence. After that, the second most common source of information was represented by parents and medical specialists, the source most preferred by girls. From our study can be seen that the school or mass media (TV, radio, newspapers) have a much lower impact on the level of sexual education. From the questions given to the adolescents who have had sex, it seems that girls are more concentrated on discussion with their sexual partner, about avoiding an unwanted pregnancy, or regarding the use of preventive methods. To avoid STD, the discussion between sexual partners does not reach more than 30% in the adolescents asked. Regarding BTS, the sex partners do not discuss about, in more of the 30% of adolescents, and in order to inform the young about diseases should be involved specialists.


CONCLUSION: In conclusion, the result from our observation can provide useful information regarding the sexual behaviour of the adolescents in urban areas. The boys have a more tolerant attitude regarding early sexual relations, compared to girls. Up to half of the adolescents included in this study do not use contraceptive protection during the sexual act, which induce a risky sexual behaviour. For girls, the source of information is predominantly medics and parents, compared to boys, who get it more often from friends and acquaintances. Girls are more attentive on avoiding an unwanted pregnancy and taking into account a contraceptive method.

It is necessary to promote and perform, more frequent, in schools a sexual education hour, with the goal to inform and promote a correct healthy and decent sexual behaviour among the young, in order to know all the risks they are exposed to, as the extern influences of any kind are much bigger now compared to earlier years.




1.       CAMINIS, A., HENRICH, C., RUCHKIN, V., SCHWAB-STONE, M., MARTIN, A., - Psychosocial predictors of sexual initiation and high-risk sexual behaviors in early adolescence. Child Adolesc Psychiatry Ment Health, 1:14, 2007;

2.       EATON, D.K., KANN, L., KINCHEN, S., SHANKLIN, S., ROSS, J., HAWKINS, J., - Centers for Disease Control and Prevention (CDC). Youth risk behavior surveillance United States, 2007.MMWR Surveillance Summaries, 57:1131., 2008;

3.       CAMPO-ARIAS, A., CEBALLO, G.A., HERAZO, E., -Prevalence of pattern of risky behaviors for reproductive and sexual health among middle-and high-school students.Rev Lat Am Enfermagem, 18:170174, 2010;

4.       ROMERO, E.G., TEPLIN, L.A., McCLELLAND, G.M., ABRAM, K.M., WELTY, L.J., WASHBURN, J.J., -A longitudinal study of the prevalence, development, and persistence of HIV/sexually transmitted infection risk behaviors in delinquent youth: implications for health care in the community. Pediatrics 2007, 119:e1126-e1141., 2007;

5.       SSSR-Ro 2004, -Studiul Sanatatii Reproducerii Romania 2004, raport sintetic, mai 2005, Ministerul Sanatatii, Banca Mondiala, UNFPA, USAID, UNICEF, Buzau, Editura Alpha MDN, 2005;

6.       GIANNOTTA, F., CIAIRANO, S., SPRUIJT, R., SPRUIJT-METZ, D., -Meanings of sexual intercourse for Italian adolescents. J Adolesc 32:157-169, 2009;

7.       PALEN, L.A., SMITH, E.A., CALDWELL, L.L., FLISHER, A.J., WEGNER, L., VERGNANI, T., -Inconsistent reports of sexual intercourse among South African high school students. J Adolesc Health 42:221-227., 2008;

8.       ARAS, S., SEMIN, S., GUNAY, T., ORCIN, E., OZAN, S., -Sexual attitudes and risk-taking behaviors of high school students in Turkey. J Sch Health, 77:359-366., 2007;

9.       ARAS, S., ORCIN, E., OZAN, S., SEMIN, S., -Sexual behaviors and contraception among university students in Turkey. J Biosoc Sci , , 39:121-135., 2007;

10.    HAGGSTROM-NORDIN, E., HANSON, U., TYDEN, T., -Sex behavior among high school students in Sweden: improvement in contraceptive use over time. J Adolesc Health 30:288-295., 2002.






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