Sex Differences in Awareness of Preventive Health Behaviors for Healthy Pregnancy Among Adolescents Using TPB

Purpose: Due to increased high risk pregnancies in Korea, comprehensive approaches to promote awareness on healthy pregnancy for both sexes should be established as early as possible in the developmental period. Raising awareness of adolescents’ knowledge of preventive measures of high-risk pregnancies could affect their behavior positively in the near future. In order to assess the awareness of healthy behaviors related pregnancy among male and female adolescents in Korea, the construct of Theory of Planned Behavior (TPB) variables were used in this study. The purpose of this study was to examine awareness of preventive health behaviors using TPB variables associated with healthy pregnancy in Korean adolescents by sex.

Methods: Utilizing a comparative descriptive design, a total of 429 male adolescents and 280 female adolescents were recruited. A questionnaire was designed to measure subcategories of the TPB related to preventive behavior for healthy pregnancy consisting of proper contraceptive practice, alcohol and tobacco use, and sexually transmitted infections(STIs). Participants’ socio-demographic characteristics, alcohol and tobacco use, nutritional behaviors, and sexual experience were also measured. Data was analyzed by descriptive statistics. Also, sex differences in main variables were analyzed using χ² test and Mann Whitney U test.

Results: There were significant differences by sex in subcategories of TPB variables.

1) Behavioral attitude

Female adolescents showed more favorable attitude toward proper contraceptive practice (Z=-4.86, p<0.001) and healthy pregnancy decisions (Z=-2.43, p=0.015) than male adolescents.

2) Subjective norms

Female adolescents had higher subjective norms of proper contraceptive practice (Z=-3.06, p=0.002) and cessation of tobacco use (Z=-2.21, p=0.027) than male adolescents.

3) Perceived behavior control (PBC)

Female adolescents had higher PBC of tobacco cessation than male adolescents (Z=-4.55, p<0.001). Male adolescents had higher PBC of proper condom usage than female adolescents (Z=-4.76, p<0.001).

4) Behavioral intentions

Female adolescents revealed higher intentions for abstinence (Z=-2.78, p=0.005), tobacco cessation (Z=-2.84, p=0.005), and healthy pregnancy practices (Z=-2.83, p=0.005) than male adolescents. Male adolescents revealed higher intentions for contraceptive use (Z=-2.31, p=0.021).

Also, there were significant differences by sex in academic achievement (χ²=20.71, p<0.001), tobacco usage(χ²=16.64, p<0.001), nutritional status(χ²=15.64, p<0.001).

Conclusion: This is the first study to examine sex differences in awareness of preventive health behaviors for healthy pregnancy among Korea adolescents. This report suggest that specifically female adolescents are less educated regarding proper condom use and have lower intentions for using them. Thus, education of condom using is to be required for female adolescents. On the other hand, male adolescents have shown more smoking experience. Not only they feel difficult to stop smoking, but have lower intention to stop smoking. Even they lacked positive attitude towards proper contraceptive practice and effort for healthy pregnancy. Therefore, education of smoking related pregnancy and other contraceptive methods is needed for male adolescents. Also, nursing intervention included improving awareness of preconception care for adolescents is needed. According to the most important predicting components in this study, educational intervention must be focused on considering sex differences in preventive behaviors in order to stop trending prevent from high risk pregnancy.

Acknowledgements: This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Science, ICT & Future Planning (Grant number: 2018R1A2B2001231).