Many adolescents do not have access to sexual and reproductive health education due to the lack of structural support specific to cultural formatting and overall negative attitude toward this type of education. Therefore, adolescents often use the internet as the main source of health information. The purpose of this study was to investigate specific internet websites associated with online searching for information about sex and sexually transmitted infections (STIs).
Methods:
A cross-sectional study was carried out on 702 high school students in Belgrade, the capital city of Serbia. Relevant data were obtained through an anonymous questionnaire. The questionnaire included socio-demographic characteristics, use of the internet and online platforms. Electronic health literacy was tested by the e-Health literacy scale.
Results:
All students used the internet. The prevalence of seeking online information about sex was 31.9% and 12.4% about STIs. Being a boy, having lower grades, attending the humanities-languages program, being younger when using the internet for the first time, using forums and social media, but not websites run by physicians, and browsing online information about STIs were associated with seeking online information about sex. Girls, who had lower grades, had higher family income, were older when they first started using the internet, used social media and websites run by physicians and searched for online information about sex were more likely to seek online information about STIs.
Conclusions:
Adolescents in this study sought online information about sex more often than STIs. Social media were used to search both topics online, suggesting that participatory media which offer engaging content could be the preferred manner of online learning about sex and STIs. These online resources could be used for information delivery about reproductive health for high school students.
United Nations. Lack of access to sexual, reproductive health education and rights results in harmful practices, impedes sustainable development, speakers tell Population Commission [Internet]. 2023 [cited 2023 April 27]. Available from: https://press.un.org/en/2023/pop1106.doc.htm
2.
ScheinfeldE.The role of shame, stigma, and family communication patterns in the decision to disclose STIs to parents in order to seek support. Int J Environ Res Public Health. 2023; 20: 1–12.
3.
HusseinJFergusonL.Eliminating stigma and discrimination in sexual and reproductive health care: a public health imperative. Sex Reprod Health Matters. 2019; 27: 1–5.
4.
BuziRSSmithPBBarreraC.Talk with Tiff: teen’s inquiries to a sexual health website. J Sex Marital Ther. 2015; 41: 126–133.
5.
KettingEBrockschmidtLIvanovaO.Investigating the ‘C’ in CSE: implementation | effectiveness of comprehensive sexuality education in the WHO European region. Sex Educ. 2021; 21: 133–147.
Jeremic StojkovicVCvjetkovicSMatejicBGazibaraT. Adolescents’ right to confidential health care: knowledge, attitudes and practice of pediatricians and gynecologists in the primary healthcare sector in Belgrade, Serbia. Int J Public Health. 2020; 65: 1235–1246.
9.
Terzic-SupicZSantric-MilicevicMMirkovicMKaricSSoldatovicI.Cross sectional study on attitudes of Serbian mothers with preschool children: should a HIV-positive female teacher be allowed to continue teaching in school?BMC Int Health Hum Rights. 2015; 15: 1–10.
10.
CousinsS.HIV in Serbia: stigma and a stagnant HIV response. Lancet HIV. 2018; 5: e343–e344.
11.
MladenovicA.A necessity or luxury: sexuality education in Serbia. Admin Public Policy. 2020; 2: 35–55. [in Serbian]
12.
JovanovićM.LGBT persons in Serbia: between formal acceptance and informal rejection. Teme. 2020; 44: 139–157 [in Serbian]
13.
DjordjevicGRadovanovicSDjonovicNRadevicSVasiljevicDMihailovicN.The factors that determine reproductive health characteristics of adolescents in Serbia. Serbian J Exp Clin Res. 2019; 20: 23–26.
14.
TomaševićTUkropinaSJovanovićVMKvrgićSČankovićSMilijaševićD.Self-efficacy and unwanted sexual intercourse: ‘Reproductive Health Education Programme for high-school students in Vojvodina’. Zdrav Var. 2022; 61: 93–100.
15.
StanojevićMStankovićLSelimiAKraljevićNPopovićIPopovićJ. Sexual activity, knowledge and the use of contraception among high-school students in Niš and Preševo. Acta Med Medianae.2019; 58: 40–48.
16.
ParkEKwonM.Health-related internet use by children and adolescents: systematic review. J Med Internet Res. 2018; 20: e120.
17.
HolstromAM.Sexuality education goes viral: what we know about online sexual health information. Am J Sex Educ. 2015; 10: 277–294.
18.
GazibaraTCakicJCakicMGrgurevicAPekmezovicT.Searching for online health information instead of seeing a physician: a cross-sectional study among high school students in Belgrade, Serbia. Int J Public Health. 2020; 65: 1269–1278.
19.
GilliamMChorJHillB.Digital media and sexually transmitted infections. Curr Opin Obstet Gynecol. 2014; 26: 381–385.
20.
SteinerRJPampatiSRasberryCNLiddonN.“Is it really confidential?” A content analysis of online information about sexual and reproductive health services for adolescents. J Adolesc Health. 2019; 64: 725–731.
21.
GazibaraTCakicMCakicJGrgurevicAPekmezovicT.Familiarity with the internet and health apps, and specific topic needs are amongst the factors that influence how online health information is used for health decisions amongst adolescents. Health Info Libr J. 2024; 41: 283–297.
22.
NikkelenSWCvan OostenJMFvan den BorneMMJJ. Sexuality education in the digital era: intrinsic and extrinsic predictors of online sexual information seeking among youth. J Sex Res. 2020; 57: 189–199.
23.
EttelG3rdNathansonIEttelDWilsonCMeolaP.How do adolescents access health information? And do they ask their physicians?Perm J. 2012; 16: 35–38.
24.
SebelefskyCKarnerDVoitlJKleinFVoitlPBöckA.Internet health seeking behaviour of parents attending a general paediatric outpatient clinic: a cross-sectional observational study. J Telemed Telecare. 2015; 21: 400–407.
25.
KimSUSynSY.Research trends in teens’ health information behaviour: a review of the literature. Health Info Libr J. 2014; 31: 4–19.
26.
KanugaMRosenfeldWD.Adolescent sexuality and the internet: the good, the bad, and the URL. J Pediatr Adolesc Gynecol. 2004; 17: 117–124.
27.
NormanCDSkinnerHA.eHEALS: The eHealth Literacy Scale. J Med Internet Res. 2006; 8: e27.
28.
NormanCDSkinnerHA.eHealth literacy: essential skills for consumer health in a networked world. J Med Internet Res. 2006; 8: e9.
29.
GazibaraTCakicJCakicMPekmezovicTGrgurevicA.eHealth and adolescents in Serbia: psychometric properties of eHeals questionnaire and contributing factors to better online health literacy. Health Promot Int. 2019; 34: 770–778.
30.
MitchellKJYbarraMLKorchmarosJDKosciwJG.Accessing sexual health information online: use, motivations and consequences for youth with different sexual orientations. Health Educ Res. 2014; 29: 147–157.
31.
IbegbulamIJAkpomCCEnemFNOnyamDI.Use of the Internet as a source for reproductive health information seeking among adolescent girls in secondary schools in Enugu, Nigeria. Health Info Libr J. 2018; 35: 298–308.
32.
ShakirSMMWongLPAbdullahKLAdamP. Online STI information seeking behaviour and condom use intentions among young Facebook users in Malaysia. Health Promot Int. 2020; 35: 1116–1124.
33.
FlinnCKoretsidouCNearchouF.Accessing sexual health information online: content, reasons and practical barriers in emerging adults. Youth. 2023; 3: 107–124.
34.
McKellarKLittleLSmithMASillenceE.Seeking sexual health information? Professionals’ novel experiences of the barriers that prevent female adolescents seeking sexual health information. Int J Adolesc Med Health. 2020; 32(1): 1–11.
35.
JayasundaraCC.Sexual health information seeking behaviour of adolescents and their satisfaction with the information outcome: an application of the theory of motivated information management. J Acad Libr. 2021; 47: 102383.
36.
WhitfieldCJomeenJHayterMGardinerE.Sexual health information seeking: a survey of adolescent practices. J Clin Nurs. 2013; 22: 3259–3269.
37.
Centers for Disease Control and Prevention. About Sexually Transmitted Infections (STIs) [Internet]. 2024 [cited 2020 August 20]. Available from: https://www.cdc.gov/sti/about/index.html
38.
InthavongKHaLTHAnhLTKSychareunV.Knowledge of safe sex and sexually transmitted infections among high school students, Vientiane Prefecture, Lao PDR. Glob Health Action. 2020; 13(Suppl 2): 1785159.
39.
BogaleEKAnagawTFTirunehMGFentaETEndeshawDDelieAM, et al. Prevalence of sexually transmitted infections, and its associated factors among students in Ethiopia: a systematic review and meta-analysis study. BMC Public Health. 2024; 24: 1976.
40.
FrimpongJBBuduEAduCMohammedATettehJKSeiduAA, et al. Comprehensive HIV/AIDS knowledge and safer sex negotiation among adolescent girls and young women in sub-Saharan Africa. J Biosoc Sci. 2022;54:991–1003.
41.
PattersonSPHiltonSFlowersPMcDaidLM.What are the barriers and challenges faced by adolescents when searching for sexual health information on the internet? Implications for policy and practice from a qualitative study. Sex Transm Infect. 2019; 95: 462–467.
42.
GravningenKFurbergA-SSkov SimonsenGWilsgaardT.Early sexual behaviour and Chlamydia trachomatis infection - a population based cross-sectional study on gender differences among adolescents in Norway. BMC Infect Dis. 2012; 12: 319.
43.
PanchaudCSinghSFeivelsonDDarrochJE.Sexually transmitted diseases among adolescents in developed countries. Fam Plann Perspect. 2000; 32: 24–32.
44.
RelićMSRelićNGPfićer-KuzmanovićJMRelićGV.Awareness, knowledge and behavior of highschool students con-cerning sexually transmitted infections. Med Pregl. 2018; 71: 284–294.
45.
Samkange-ZeebFNSpallekLZeebH.Awareness and knowledge of sexually transmitted diseases (STDs) among school-going adolescents in Europe: a systematic review of published literature. BMC Public Health. 2011; 11: 727.
46.
GottliebSLNewmanLMAminATemmermanMBroutetN.Sexually transmitted infections and women’s sexual and reproductive health. Int J Gynaecol Obstet. 2013; 123: 183–184.
47.
CunninghamSDTschannJGurveyJEFortenberryJDEllenJM.Attitudes about sexual disclosure and perceptions of stigma and shame. Sex Transm Infect. 2002; 78: 334–338.
48.
ReynoldsCSutherlandMAPalaciosI.Exploring the use of technology for sexual health risk-reduction among Ecuadorean adolescents. Ann Glob Health. 2019; 85: 57.
49.
AtkinsRSulikMJHartDAyresCReadN.The effects of school poverty on adolescents’ sexual health knowledge. Res Nurs Health. 2012; 35: 231–241.
50.
HarlingGSubramanianSBärnighausenTKawachiI.Socioeconomic disparities in sexually transmitted infections among young adults in the United States: examining the interaction between income and race/ethnicity. Sex Transm Dis. 2013; 40: 575–581.
51.
GuettoRVignoliDLachiA.Higher parental socioeconomic status accelerates sexual debut: evidence from university students in Italy. Adv Life Course Res. 2022; 51: 100461.
52.
Dagnachew AdamNDemissieGDGelagayAA.Parent-adolescent communication on sexual and reproductive health issues and associated factors among preparatory and secondary school students of Dabat Town, Northwest Ethiopia. J Environ Public Health. 2020; 2020: 4708091.
53.
BettingerJACelentanoDDCurrieroFCAdlerNEMillsteinSGEllenJM.Does parental involvement predict new sexually transmitted diseases in female adolescents?Arch Pediatr Adolesc Med. 2004; 158: 666–670.
54.
MertalaPLópez-PernasSVartiainenHSaqrMTedreM.Digital natives in the scientific literature: a topic modeling approach. Comput Human Behav. 2024; 152: 108076.
55.
JuhaňákLZounekJZáleskáKBártaOVlčkováK.The relationship between the age at first computer use and students’ perceived competence and autonomy in ICT usage: a mediation analysis. Comput Educ. 2019; 141: 103614.
56.
LivingstoneSMascheroniGStoilovaM.The outcomes of gaining digital skills for young people’s lives and wellbeing: a systematic evidence review. New Media Soc. 2023; 25: 1176–1202.
57.
NakayamaHUenoFMiharaSKitayuguchiTHiguchiS.Relationship between problematic Internet use and age at initial weekly Internet use. J Behav Addict. 2020; 9: 129–139.
58.
JonesKWilliamsJSipsmaHPatilC.Adolescent and emerging adults’ evaluation of a Facebook site providing sexual health education. Public Health Nurs. 2019; 36: 11–17.
59.
GoodyearVAArmourKMWoodH.Young people and their engagement with health-related social media: new perspectives. Sport Educ Soc. 2018; 24: 673–688.
60.
von RosenAJvon RosenFTTinnemannPMüller-RiemenschneiderF.Sexual health and the Internet: cross-sectional study of online preferences among adolescents. J Med Internet Res. 2017; 19: e379.
61.
KalamarAMBayerAMHindinMJ.Interventions to prevent sexually transmitted infections, including HIV, among young people in low- and middle-income countries: a systematic review of the published and gray literature. J Adolesc Health. 2016; 59(3 Suppl): S22–S31.
62.
Mohd TohitNFHaqueM.Forbidden conversations: a comprehensive exploration of taboos in sexual and reproductive health. Cureus. 2024; 16: e66723.
KeoghSCStillmanMAwusabo-AsareKSidzeEMonzónASMottaA, et al. Challenges to implementing national comprehensive sexuality education curricula in low- and middle-income countries: case studies of Ghana, Kenya, Peru and Guatemala. PLoS One. 2018; 13: e0200513.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
