Assess Puberty Health Needs Among 10-15-year-old Boys

Background: According to the studies conducted, teenage period and its related health issues are one of the most signicant issues. This study aimed to investigate the health needs of 10–15-year-old teen boys about puberty. Methods: This cross-sectional descriptive-correlational study was performed on boy’s teen (10-15 year-old) through stratied-cluster sampling in Ardabil city. The data gathering tool was a self-reported researcher-designed questionnaire consisting of 10 demographic questions, 35 questions in 5 categories; Awareness of puberty changes, sexual orientation, mood swings, health behavior, self-condence and 5 questions about educational demands. Descriptive statistics and chi-square test, correlation coecient and regression were used to analyze the quantitative data. Results: The mean age of the teen boys was 11.38 ± 4.37. There was a signicant relationship between the father and mother’s level of education and teen boys’ awareness of puberty changes (p < 0.001). The results of this study showed that 69.8% of teen boys were not well aware of puberty (change of puberty and health behavior)and about 87% teen boys in this study did not have access to the required educational resources and 82% percent of the families did not talk about the change of puberty and hygiene practices related to their teenagers also Correlation test between teen boys’ health behavior and awareness of puberty changes (r = 0.12 p < 0.007) and between self-condence and health behaviors (r = 0.14, p < 0.001) revealed signicant and positive relationships. Conclusion: There is a need among teen boys for information about puberty changes and related health behaviors also the role of families is the most important source of information for teen boys.

understanding of gender diversity [6]. It is important to remember that teens may not always be direct in their questions for the doctor. For example, teens worried about their development may express this through general complaints or indirect questions about body function [7]. In one study conducted by the Iranian Ministry of Health and Medical Education in Tehran showed that more than half of adolescents do not know about the symptoms of puberty or information is incomplete about symptom of puberty [8,9]. Teaching puberty in schools can help learners better understand themselves and deal with the changes they are experiencing, and hence gain the self-esteem to overcome daily challenges they may face with teachers and peers in school. Adolescents also become more conscious of socially-constructed myths and taboos built around puberty, such as negative perceptions of menstruation or dismissal of emotion as un-masculine [10,11]. A better understanding of puberty and life skills helps young people to make independent decisions and better cope with pressure from peers, family, community and media messages [9]. According to the cited issues and the importance of this period in the life of the future and the beginning of physical, mental and sexual changes we intended to carry out a research aimed at determining the health needs of teen boys' in Ardebil, to make a step towards raising the level of consciousness and culture of father of future of our country and helps to health authorities for develop educational programs to raise teen boys' awareness of issues related to puberty and health behaviors.

Study design
This correlation-Cross-sectional descriptive study was conducted on 452 teen boys (12-15 years -old) in Ardabil (Ardabil is an ancient city in northwestern Iran, and the capital of Ardabil Province). The city was rst divided into ve regions: north, south, east, west and central, and then randomly selected a number of clusters proportional to the population of each region. The sample size was determined based on inclusion criteria and 95% con dence level and 80% test power. Inclusion criteria include: 12-15 years old, residence in Ardebil city, would like to participate in the study. And exclusion criteria, including those under 12 and over 15 years old and not wanting to take part in the study. For this study, a self-care puberty researcher-made questionnaire was used. The validity of questionnaire was determined by two methods of face validity and content validity, which con rmed by experts of health education, psychology, urologist. The total content validity index (CVI) in the "relevancy", "simplicity", and "clarity" respectively equals 86.6, 92.9, and 91.7. The reliability of the questionnaire further evaluated. Through internal consistency (α = 0. 81) and test retest (r = 0.84).
This questionnaire consisted of three parts. The rst part consisted of 10 questions on demographic and family information, the second part consisted of 35 questions in 5 categories; Awareness of puberty changes, sexual orientation, mood swings, health behavior, self-con dence and the three part 5 questions about educational demands study group.
The questions in the second part of the questionnaire were divided into 5 categories: Questions 1-14 were related awareness of puberty changes. In this section, each correct answer was scored with 1 and the score of the wrong answer with zero points. Maximum awareness score was set at 14 and the minimum score was zero.
Questions 15-17 assessed adolescents' self-con dence (judging and believing in their ability to perform tasks and activities) related on their ability to perform health behaviors. The questions were rated on a 4point Likert scale of 4 I'm quite sure. From teen boys were asked to rate their con dence by choosing one of the options for adherence of health behaviors. Each correct answer had 4 points, with a maximum score of 12 and a minimum score of 4.
Questions 18-19 assessed teen boys 'sexual orientation (Sexual orientation refers to whether a person's physical and emotional arousal is to people of the same or opposite sex). The questions were rated on a 4-point Likert scale. From teen boys were asked to rate sexual orientation in three sub-categories (communicate with girls, mental ambiguity about the opposite sex and sexual matters) The maximum score in this section was set at 8 and at least 4.
Questions 20-23 assessed teen boys' mood swings (Mood swings during adolescence are partially due to biology. Hormonal shifts that occur during puberty play a major role in the way teens think and feel.). The questions were rated on a 4-point Likert scale. The maximum score in this section was set at 16 and at least 4.
Questions 24-35 about health behavior teen boys about puberty with two-choice questions with yes-andno answer. In this section, each correct answer was scored with 1 and the score of the wrong answer with zero points. Maximum awareness score was set at 12 and the minimum score was zero. The last 5 questions assessed the educational needs of teen boys.

data analysis
The data were analyzed by SPSS software version 19 and analyzed using chi-square, correlation coe cient and regression tests.

Results
In this study, 452 teen boys 10-15 years were studied with a mean age of 11.38 ± 4.37years, 62.83% of participants were rst and second children, and their mean the onset of puberty age was 11.36 ± 1.68. 33.1% of teen boys were obese or overweight. Other demographic and social characteristics of the samples under study are shown in Table 1.
Chi-square test showed a statistically signi cant relationship between parent's education level (p = 0.001) and teen boys' awareness of puberty changes.
Also, between parent age (p = 0.002) and teen boys' health behaviors and sexual orientation (p = 0.003). 88% of teen boys and 87.9% of parent's teen boys were interested in attending adolescents' special education classes ( Table 2).
The results of this study showed that 69.8% of teen boys had poor and incomplete knowledge about puberty changes and health behavior.
According to prioritizing questions 5,3,9,10 and 7about awareness of rst sign and change of puberty, genital changes and when to start, wet of dream, healthy diet during puberty, behavioral reaction to puberty changes, had the lowest score and were ranked the top 5 educational priorities in the awareness domain ( Table 2).
Results showed that 64.3% of the teen boys had poor self-con dence and based on 30, 29, 28 prioritizations, three priorities of educational intervention were self-con dence. In regular daily behavioral reaction to puberty changes, genital changes and sexual orientation ( Table 3).
Results showed that 78.3% of the teen boys had heterosexual desire and they couldn't manage that.
According to prioritizing sexual orientation management and communication with girls the most important educational priority was this section.
Teen mood swings are most volatile in early adolescence and tend to stabilize as teens get older, mood swings during adolescence are partially due to biology in this study 51% of teens have experienced mood swings (happiness, anger, sadness, and anxiety) in the past three weeks also 82% did not know how to manage mood swings and they needed training.
In this study, health behavior was 73.4% of teen boys had moderate, Interventions and priorities for health behaviors improvement include: Health behaviors in puberty, healthy diet and physical activity.
According to the ndings, promoting self-con dence was the most important educational priority in the formation of health behavior in in teen boys. According to the correlation test between the health behavior of teen boys and awareness (r = 0.13, P < 0.007) and between health behavior and self-con dence) (r = 0.12, P < 0.001) among teen boys were signi cant and positive, and based on linear regression by backward elimination among the variables with positive correlation with self-con dence behavior was the most important predictor of adolescent behavior in this study.
Analyze 5 questions related to educational demand showed some educational priorities; reproductive health educating parents and teachers to understand puberty, educating adolescents themselves about changes during the puberty in schools.
The results of the study showed that in the overall scoring, Intervention on adolescent self-con dence is rst priority and sexual orientation and mood swing was in the second and third priority. Results are shown in the Fig. 1.

Discussion
The results showed that teen boys in this study should have educational needs and information about puberty and its changes, sexual orientation, mood swings, health behavior and more importantly strengthening self-con dence was the most important item for improving health behaviors. also despite the tendency of teen boys to become aware of puberty, the majority of teen boys still did not know the full meaning of puberty and its changes.
The teen boys also had untrue scienti c and physiological awareness of the phenomenon of puberty and its Changes. In this study, most teenagers had expressed the need for education on the reproductive health in order to resolve their problems. According to the recommendations of World Health organization (WHO), informing teenagers about reproductive health is one of the main elements in starting national plans for improving teenagers' health situation [12,13]. On the other hand, according to the reproductive rights in the national law which accepts the international documents related to human rights and United Nations, access to the highest standards of reproductive and sexual health and decision-making about reproduction without any discrimination, pressure and violence is among teenagers' basic rights [14].
Although some educational programs for topics such as puberty, family life, acquired immune de ciency syndrome (AIDS) and live skills are also available for teenagers, these programs are incomplete and curriculum doesn't encompass sexual education and reproductive [15].
Self-con dence in teenager continued regular daily exercise, balanced diet, and health behaviors during puberty were poor in this study [16]. People with higher self-con dence are more likely to nd themselves more motivated to continue to behave in the face of obstacles [17]. On the other hand, constant selfcon dence personality traits are dynamic and changeable beliefs and may be enhanced by behavioral interventions. Successful interventions in puberty health self-con dence are also associated with increased self-care behaviors [18]. Therefore, self-con dence seems to be an important and effective precondition for successful self-care behaviors in adolescents [19].
In this study sexual orientation was one of the most important things that teenage boys faced. Teens have a sexual orientation even if they aren't sexually active yet [9,20]. In most cases, they were not familiar with its management. Teens should be given the opportunity to discuss issues of sexual attraction and orientation, mental health, substance and alcohol use, safer sex, school, family and friends. In fact, education should be available to all teenagers [21][22][23][24].
Mood swings are most volatile in early adolescence [15]. Which was observed in the current study in adolescents participating in the study. A study involving 12-to 15-year-olds showed results Forty percent of these adolescents were at high risk for externalizing behaviors (e.g., aggressive or delinquent behavior) at age 12 [25]. Using Internet diaries, the teens rated their daily moods in terms of happiness, anger, sadness, and anxiety during three weeks of the school year for ve years [29]. Effective communication is essential tool for connecting with the teenager's boy [26]. It is important to start with nonthreatening questions and progress to more sensitive areas So that we can plan according to its demands [27,28].

Conclusion
Page 8/11 The health of teenager's boy is an important issue. Health need in teenage boy is a big challenge to the health providers, but also important opportunities to connect with they, teach how their bodies changes, and intervene early in teenagers with psychosocial problems such as mood swings, body image or. health providers must be knowledgeable about their common health concerns so that they can anticipate which issues may be important to them and the important and practical point is that the needs are extracted from the adolescents themselves. The health provider's success with teenage boys depends on their ability to take the time to ask the teen about their lives and their skill in communicating with them. Puberty intervention priorities in adolescent boys