title: Immaturity in puberty and negative attitudes toward reproductive health among Indonesian adolescents.
abstract: BACKGROUND
  Complex factors influence adolescents' attitudes. Secondary sexual development and emotional changes are markers of puberty and affect attitudes toward reproductive health (RH). This is especially evident in the society and culture of Indonesia. This study examined the presence of immaturity at puberty and factors associated with negative attitudes toward RH among Indonesian adolescents.
  
  
  METHODS
  We conducted a cross-sectional study with 1040 students (aged 11-16 years) selected using multistage random cluster sampling. Data were collected using a self-administered questionnaire that included the illustrative questionnaire for interview surveys with young people and the pubertal development scale (PDS), modified in accordance with the Indonesian context. Data analysis used descriptive and comparative statistics and logistic regression analyses.
  
  
  RESULTS
  Immature pubertal development was higher in boys [22.7%, 95% confidence interval (CI): 14.7%-30.7%] than girls (18.4%, 95% CI: 11%-25.7%). However, negative attitudes were higher in girls (40.6%, 95% CI: 34.3%-46.8%) than boys (37.1%, 95% CI: 29.9%-44.7%). Factors associated with negative attitudes toward RH in both boys and girls were age, RH communication with parents, and pubertal development. Smoking was an additional factor in boys, whereas living in an urban area was an additional factor in girls. High knowledge about RH was associated with less negative attitudes toward RH in both boys and girls.
  
  
  CONCLUSIONS
  Immaturity and factors that influence negative attitudes toward RH should be explored during puberty. Improving knowledge about RH may help to prevent negative attitudes toward RH, especially for girls in urban areas and boys with smoking habits.
authors.affiliation: Doctoral Course of Health Development Nursing, Division of Health Sciences, Graduate School of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kodatsuno,Kanazawa, Japan.|Family and Community Health Nursing Department, School of Nursing, University of Jember, Jl. Kalimantan 37 Jember, Jawa Timur, Indonesia68121, Phone/Fax +62331323450.
authors.forename: Tantut
authors.initials: T
authors.lastname: Susanto
authors.affiliation: Doctoral Course of Health Development Nursing, Division of Health Sciences, Graduate School of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kodatsuno,Kanazawa, Japan.
authors.forename: Ruka
authors.initials: R
authors.lastname: Saito
authors.affiliation: Doctoral Course of Health Development Nursing, Division of Health Sciences, Graduate School of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kodatsuno,Kanazawa, Japan.
authors.affiliation: Department of Health Development Nursing, Division of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kodatsuno,Kanazawa, Japan.
authors.forename: Rumiko
authors.initials: R
authors.lastname: Kimura
authors.affiliation: Department of Health Development Nursing, Division of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kodatsuno,Kanazawa, Japan.
authors.forename: Akiko
authors.initials: A
authors.lastname: Tsuda
authors.affiliation: Department of Health Development Nursing, Division of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kodatsuno,Kanazawa, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Tabuchi
authors.affiliation: Department of Clinical Nursing, Division of Health Sciences, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, Kodatsuno,Kanazawa, Japan.|Wellness Promotion Sciences Center, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 5-11-80, Kodatsuno, Kanazawa, 920-0942,Japan.|Division of Health Sciences, Graduate School of Kanazawa University, Kodatsuno,Kanazawa, Japan, Phone/Fax: +81-76-265-2555.
authors.forename: Junko
authors.initials: J
authors.lastname: Sugama
keywords: adolescent development; attitudes; reproductive health; sexual development