Adverse Sexual Health Outcomes Research Articles

P04.19 Alcohol involvement in sexual behaviour and adverse sexual health outcomes in early middle age

Introduction Research on alcohol and sexual behaviour has focused on young adults or high-risk groups, showing alcohol use contributing to riskier sexual choices. Adults now in early midlife have been exposed to heavier drinking norms than previously, raising questions about effects on sexual well-being. We examined self-reported use and consequences of alcohol in sexual contexts, and its association with usual drinking pattern at age 38, and also associations of heavy drinking occasion (HDO) frequency with number of sexual partners, sexually transmitted infection (STI), and termination of pregnancy (TOP), from 26–32 and 32–38 years of age. Methods Members of the Dunedin Study birth cohort answered computer-presented questions about sexual behaviour and outcomes, and interviewer-administered alcohol consumption questions, at age 26, 32 and 38 years. Results Response level was >90% at each assessment. At 38, drinking before or during sex in the previous year was common (8.2% of men; 14.6% of women reported “usually/always”), and unwanted consequences were reported by 13.5% of men and 11.9% of women, including regretted sex or failure to use contraception or condoms. Frequent heavy drinkers were more likely to “use alcohol to make it easier to have sex” and regret partner choice, particularly women. Heavy drinking frequency was strongly associated with partner numbers for men and women at 32, but only for women at 38. Significantly higher odds of STIs amongst the heaviest drinking men, and TOPs amongst the heaviest drinking women were seen at 32–38. Conclusion Alcohol involvement in sex continues beyond young adulthood where it has been well documented, and is common at 38. Women appear to be more affected than men, and heavy drinking is associated with poorer outcomes for both. Improving sexual health and wellbeing throughout the life course needs to take account of the role of alcohol in sexual behaviour. Disclosure of interest statement This work was supported by the Health Research Council of New Zealand [12/1086]. The authors have no conflicts of interest.

Alcohol Involvement in Sexual Behaviour and Adverse Sexual Health Outcomes from 26 to 38 Years of Age.

BackgroundResearch on alcohol and sexual behaviour has focused on young adults or high-risk groups, showing alcohol use contributing to riskier sexual choices. Adults now in their late thirties have been exposed to heavier drinking norms than previously, raising questions about effects on sexual wellbeing. We examined self-reported use and consequences of alcohol in sexual contexts, and its association with usual drinking pattern at age 38, and also associations of heavy drinking occasion (HDO) frequency with number of sexual partners, sexually transmitted infections (STIs), and terminations of pregnancy (TOPs), from 26–32 and 32–38 years of age.MethodsMembers of the Dunedin Study birth cohort answered computer-presented questions about sexual behaviour and outcomes, and interviewer-administered alcohol consumption questions, at age 26, 32 and 38 years.ResultsResponse level was >90% at each assessment. At 38, drinking before or during sex in the previous year was common (8.2% of men; 14.6% of women reported “usually/always”), and unwanted consequences were reported by 13.5% of men and 11.9% of women, including regretted sex or failure to use contraception or condoms. Frequent heavy drinkers were more likely to “use alcohol to make it easier to have sex” and regret partner choice, particularly women. Heavy drinking frequency was strongly associated with partner numbers for men and women at 32, but only for women at 38. Significantly higher odds of STIs amongst the heaviest drinking men, and TOPs amongst the heaviest drinking women were seen at 32–38.ConclusionsAlcohol involvement in sex continues beyond young adulthood where it has been well documented, and is common at 38. Women appear to be more affected than men, and heavy drinking is associated with poorer outcomes for both. Improving sexual health and wellbeing throughout the life course needs to take account of the role of alcohol in sexual behaviour.

STD and Abortion Prevalence in Adolescent Mothers With Histories of Childhood Protection Involvement.

Early sexual debut and unprotected sexual activity place adolescents at risk of adverse sexual health outcomes. Adolescents involved with child protective services (CPS) may be a particularly vulnerable population. California birth records for 86,946 adolescents who became first-time mothers in 2008-2010 were probabilistically linked to statewide CPS records from 1998 and later. The prevalence of STDs at birth and of abortion history were explored by preconception CPS involvement. Generalized linear models, adjusted for health, socioeconomic and demographic characteristics, were used to assess correlates of current STDs and history of abortion. At the time they gave birth, 1% of adolescents had a documented STD, and 5% reported a previous abortion. After adjustment for other characteristics, CPS involvement was associated with a significantly elevated prevalence both of STDs (relative risk, 1.2) and of previous abortion (1.4). Other characteristics also were associated with both outcomes, but not always in the same direction. For example, delaying prenatal care until after the first trimester or getting none at all was associated with an increased prevalence of STDs (1.3), but a reduced prevalence of abortion (0.8-0.9); having public insurance coverage for the birth was associated with a reduced STD prevalence (0.9) and an elevated abortion history prevalence (1.2). To assess whether adolescents with a history of CPS involvement need targeted sexual health interventions, further research is needed on the mechanisms that underlie associations between CPS involvement and adverse sexual health outcomes.

Characteristics of youth who report early sexual experiences in Sweden.

Early timing of first sex is a common risk factor for adverse sexual and reproductive health (SRH) outcomes. This study explored characteristics and circumstances associated with early sexual experience (at or below age 14) among Swedish youth. Data were drawn from UngKAB09, a national study of youth SRH in Sweden. 24,000 youth 16-28 years were randomly selected for a web-based survey with a response rate of 24%. Post-stratification weights were used to correct for over- and underrepresentation in response. Adjusted logistic regression was used to model associations with early sexual experience, by gender. In the final sample (N = 5,321, 49% girls), 9 in 10 were sexually experienced, of whom 21% reported early first sex. In multivariate analysis, early sex was significantly associated with 7 of the 9 predictor variables selected for the model among boys and 14 of 15 selected factors among girls. Early sex was positively associated with low educational attainment, early pubertal onset, bisexual identity and (girls only) rural residence. For girls, first generation immigrant status, greater religiosity, conservative sexual attitudes and low Chlamydia knowledge decreased the odds of early sex. Early experience was more common if youth had older partners and, among girls, felt that sex was expected. Being in love, feelings of intimacy, alcohol use at first sex, and (girls only) causal sexual partner and wantedness of first sex were inversely associated with early first sex. The findings and implications are discussed in relation to the European and global literature on early sexual experiences.

Let's talk about sex: gender norms and sexual health in English schools.

The sexual health of young people in England is an urgent public health concern. While interventions to address young people's sexual health have focussed on knowledge, skills and contraception access, amazingly none in the UK has explicitly addressed the effects of the social hierarchies of gender and gendered behavioural ideals that shape young people's sexual expectations, attitudes and behaviour. The lack of attention to gender is a persistent gap in health research, practice and policy. A rigorous evaluation of such an intervention package would go some way to building an evidence base for challenging gender norms, which appear to be strongly associated with adverse sexual health outcomes.

Educational Differences in Adolescents' Sexual Health: A Pervasive Phenomenon in a National Dutch Sample

Educational level is strongly associated with age of first intercourse and risk of unintended pregnancies. This study examined these associations in a large representative sample of Dutch adolescents and also included associations of educational level with other sexual health aspects. Adolescents aged 12 to 25 (3,926 boys and 3,915 girls) completed an online questionnaire that included measures of romantic and sexual experience; the evaluation of their sexual debut; the risk of sexually transmitted infections (STIs) and pregnancy; and sexual attitudes, satisfaction, self-efficacy, knowledge, victimization, and functioning. The results showed that adolescents on a vocational track or who completed fewer years of education were more at risk of several adverse sexual health outcomes than adolescents on an academic track. They had their first sexual experiences at an earlier age; evaluated these experiences less favorably; had less sexual health knowledge and fewer refusal skills; and had a higher risk of unintended pregnancy, STIs, and victimization. Possible explanations for these consistent differences are discussed. Sex education and services should pay specific and targeted attention to less educated young people and tailor their efforts specifically to the needs, characteristics, and realities of this group.

Systematic review of facility-based sexual and reproductive health services for female sex workers in Africa.

BackgroundSeveral biological, behavioural, and structural risk factors place female sex workers (FSWs) at heightened risk of HIV, sexually transmitted infections (STIs), and other adverse sexual and reproductive health (SRH) outcomes. FSW projects in many settings have demonstrated effective ways of altering this risk, improving the health and wellbeing of these women. Yet the optimum delivery model of FSW projects in Africa is unclear. This systematic review describes intervention packages, service-delivery models, and extent of government involvement in these services in Africa.MethodsOn 22 November 2012, we searched Web of Science and MEDLINE, without date restrictions, for studies describing clinical and non-clinical facility-based SRH prevention and care services for FSWs in low- and middle-income countries in Africa. We also identified articles in key non-indexed journals and on websites of international organizations. A single reviewer screened titles and abstracts, and extracted data from articles using standardised tools.ResultsWe located 149 articles, which described 54 projects. Most were localised and small-scale; focused on research activities (rather than on large-scale service delivery); operated with little coordination, either nationally or regionally; and had scanty government support (instead a range of international donors generally funded services). Almost all sites only addressed HIV prevention and STIs. Most services distributed male condoms, but only 10% provided female condoms. HIV services mainly encompassed HIV counselling and testing; few offered HIV care and treatment such as CD4 testing or antiretroviral therapy (ART). While STI services were more comprehensive, periodic presumptive treatment was only provided in 11 instances. Services often ignored broader SRH needs such as family planning, cervical cancer screening, and gender-based violence services.ConclusionsSex work programmes in Africa have limited coverage and a narrow scope of services and are poorly coordinated with broader HIV and SRH services. To improve FSWs’ health and reduce onward HIV transmission, access to ART needs to be addressed urgently. Nevertheless, HIV prevention should remain the mainstay of services. Service delivery models that integrate broader SRH services and address structural risk factors are much needed. Government-led FSW services of high quality and scale would markedly reduce SRH vulnerabilities of FSWs in Africa.

Advancing Adolescent Sexual and Reproductive Health by Promoting Healthy Relationships

The field of public health faces a challenge in preventing adverse sexual and reproductive health outcomes such as sexually transmitted diseases, unintended pregnancy, and dating and sexual violence among adolescents. Innovative approaches are needed to better address these issues. Focusing on healthy relationships is an emerging approach that may be used to promote adolescent sexual and reproductive health. In this report, we discuss the need for innovative and efficient strategies for adolescent sexual and reproductive health, the benefits of a healthy relationships approach, describe the need for a science-based conceptual framework on healthy relationships, and provide some considerations for developing a conceptual framework of healthy relationships in order to move the field of public health forward.

Age-related variation in sexual behaviours among heterosexual men residing in Brazil, Mexico and the USA

ObjectiveTo compare the prevalence of demographic characteristics and sexual behaviours across age groups and to estimate their significance in predicting sexual risk factors by age cohort.MethodsThis cohort study examined sexually...

Sexual risk behavior and STI health literacy among ethnic minority adolescent women

Although information is available for prevention of sexually transmitted infection (STI/HIV), adolescents continue to engage in high risk sexual behavior particularly ethnic minority adolescent women with histories of STI or abuse. A description therefore of STI/HIV knowledge and sexual risk behavior among these women is indicated for modification of prevention efforts for sexual health promotion. African-American (n=94) and Mexican-American (n=465) adolescent women 14–18years of age were included in the study. Assessments of sexual risk behavior and STI/HIV knowledge among these adolescent women described Mexican-American women as at higher risk of STI, pregnancy, substance use and abuse with lower levels of STI/HIV knowledge, previous HIV testing and perceptions of risk than African-American women. A focus on Mexican-American adolescent women with histories of STI and abuse is indicated for translation of community-based health promotion interventions for amelioration of potential adverse sexual health outcomes among ethnic minority adolescent women.

Unequal sexual health – Differences between detained youth and their same aged peers

To describe sexual health risks in an understudied group, youth in detention, and compare these to sexual health risks among non-detained youth. In addition, variables predicting adverse sexual health outcomes are sought and compared. In 2009, a self-administered questionnaire on sexuality was conducted amongst youth in Sweden. In 2010, the same Internet-based questionnaire was applied in a study at Swedish detention centres. In this article, sexually active youth aged 15-20 years in the two groups are compared and bivariate logistic regression analyses are conducted in order to find predictors of adverse sexual health outcomes, among detainees and non-detainees respectively. Major differences between the detained and the non-detained concerning a majority of risk-taking variables exist. Although detained youth display several risky sexual behaviors, no specific risk factors are found in a logistic regression analysis. However, this is a vulnerable group. The mere fact that an adolescent is placed at a detention centre should be an imperative for professionals to address the subject of sexual health and safer sex. Furthermore, the results will be used in a forthcoming sex education curriculum tailored especially at detained youth. This is one, but by far not the only way to minimize the health inequalities that are presented in this study.

Translational Research Applications for the Study of Adolescent Sexual Decision Making

Although the initiation of sexual behaviors in adolescence is normative, adverse sexual health outcomes disproportionately affect adolescents relative to adults. Efforts to improve sexual health and increase health promotion behaviors in adolescent populations have not been fully successful. In this paper, we propose that translational research that integrates insights from neuroscience, ecological systems theory, and decision science with adolescent sexual behavior research can lead to advances in our understanding of the etiology and prevention of sexual risk behaviors among adolescents. Moreover, these insights can be further translated to the design and implementation of clinical interventions that improve sexual health.

What’s Age Got to Do With It? Partner Age Difference, Power, Intimate Partner Violence, and Sexual Risk in Urban Adolescents

Adolescent girls with older male main partners are at greater risk for adverse sexual health outcomes than other adolescent girls. One explanation for this finding is that low relationship power occurs with partner age difference. Using a cross-sectional, descriptive design, we investigated the effect of partner age difference between an adolescent girl and her male partner on sexual risk behavior through the mediators of sexual relationship power, and physical intimate partner violence (IPV), and psychological IPV severity. We chose Blanc's framework to guide this study as it depicts the links among demographic, social, economic, relationship, family and community characteristics, and reproductive health outcomes with gender-based relationship power and violence. Urban adolescent girls (N = 155) completed an anonymous computer-assisted self-interview survey to examine partner and relationship factors' effect on consistent condom use. Our sample had an average age of 16.1 years with a mean partner age of 17.8 years. Partners were predominantly African American (75%), non-Hispanic (74%), and low-income (81%); 24% of participants reported consistent condom use in the last 3 months. Descriptive, correlation, and multiple mediation analyses were conducted. Partner age difference was negatively associated with consistent condom use (-.4292, p < .01); however, the indirect effects through three proposed mediators (relationship power, physical IPV, or psychological IPV severity) were not statistically significant. Further studies are needed to explore alternative rationale explaining the relationship between partner age differences and sexual risk factors within adolescent sexual relationships. Nonetheless, for clinicians and researchers, these findings underscore the heightened risk associated with partner age differences and impact of relationship dynamics on sexual risk behavior.

Intimate partner violence and sexual health outcomes: a population-based study among 16-44-year-old women in Estonia

Violence against women as a public issue and health burden has only recently been acknowledged in Estonia. The aim of this study was to outline the prevalence and to explore the associations of intimate partner violence (IPV) and selected sexual health outcomes. Data from the population based cross-sectional survey among representative sample of 16-44-year-old non-pregnant women (n = 1966) were analysed using multivariate logistic regression. Of 1966 respondents, 362 (18.4%) reported IPV during 12 months preceding the survey. Physical IPV was reported by 339 (17.2%), sexual by 80 (4.1%) and both physical and sexual by 35 (1.8%) of respondents. After controlling for significant confounding socio-demographic factors, exposure to IPV was found to be associated with contraception non-use [adjusted odds ratio (AOR) = 2.02, 95% confidence interval (CI) 1.44-2.82] or the use of unreliable contraceptive methods (AOR = 1.54, CI 1.16-2.04) during the most recent sexual intercourse, having never used a condom (AOR = 1.53, CI 1.12-2.10), repeat induced abortion (AOR = 1.72, CI 1.24-2.37), lifetime sexually transmitted infections (AOR = 2.05, CI 1.56-2.68) and dyspareunia (AOR = 2.14, CI 1.65-2.77). The exposure of IPV was an important contributor to sexual risk behaviour and adverse sexual health outcomes among women of reproductive age in Estonia. Any strategy to promote sexual health should include prevention of IPV and other forms of violence against women with the strengthening of women's sexual and reproductive rights.

Joining and leaving sex work: experiences of women in Kigali, Rwanda

Although sex work can bring significant economic benefit there are serious downsides, not least vulnerability to adverse sexual health outcomes. Focus-groups discussions and in-depth interviews were conducted with 70 female sex workers to explore the context in which they started sex work, their motivations to leave, and their experiences of trying to leave. The pathway to becoming a sex worker was underscored by poverty, with disruptive events leading to increasing vulnerability and increasingly difficult life choices. A sizeable minority of women became sex workers while working as house-girls, a position associated with financial, physical and sexual vulnerability. The majority of participants were still working as sex workers, citing financial reasons for not leaving. Motivations to leave sex work included experiencing a frightening incident, peer pressure and concerns about dependent children. Those who left often described a change in their financial circumstances that enabled them to leave. Some had left but had returned to sex work following a financial crisis or because they found their new life too hard. House-girls are particularly vulnerable and therefore an appropriate focus for prevention. Programmes assisting women to leave need to include financial safety nets so that a time of financial difficulty does not necessitate a return to sex work.

Seeking Safer Sexual Spaces: Queer and Trans Young People Labeled with Intellectual Disabilities and the Paradoxical Risks of Restriction

Young lesbian, gay, bisexual, and transgender (LGBT) people labeled with intellectual disabilities have unique sexual health needs that are not being met. Denial by others of their right to pleasure and the exercise of heightened external control over their sexuality are commonplace. Current research indicates that these youth are at heightened risk for compromised sexual health. This study aimed to explore the ways in which social and environmental conditions influence vulnerability to adverse sexual health outcomes for this population. We used a community-based research approach to conduct qualitative interviews and focus groups with 10 young LGBT people (aged 17–26) labeled with intellectual disabilities. Participants reported multiple limitations on their autonomy that resulted in having sex in places where they did not feel comfortable and were unlikely to practice safer sex. Attempts by authority figures to protect youth through limits on their autonomy may be unintentionally leading to negative sexual health outcomes.

Sexual health in women reporting a history of child sexual abuse

ObjectiveThe present study examined the association between child sexual abuse (CSA) and sexual health outcomes in young adult women. Maladaptive coping strategies and optimism were investigated as possible mediators and moderators of this relationship. MethodData regarding sexual abuse, coping, optimism and various sexual health outcomes were collected using self-report and computerized questionnaires with a sample of 889 young adult women from the province of Quebec aged 20–23 years old. ResultsA total of 31% of adult women reported a history of CSA. Women reporting a severe CSA were more likely to report more adverse sexual health outcomes including suffering from sexual problems and engaging in more high-risk sexual behaviors. CSA survivors involving touching only were at greater risk of reporting more negative sexual self-concept such as experiencing negative feelings during sex than were non-abused participants. Results indicated that emotion-oriented coping mediated outcomes related to negative sexual self-concept while optimism mediated outcomes related to both, negative sexual self-concept and high-risk sexual behaviors. No support was found for any of the proposed moderation models. ConclusionsSurvivors of more severe CSA are more likely to engage in high-risk sexual behaviors that are potentially harmful to their health as well as to experience more sexual problems than women without a history of sexual victimization. Personal factors, namely emotion-oriented coping and optimism, mediated some sexual health outcomes in sexually abused women. The results suggest that maladaptive coping strategies and optimism regarding the future may be important targets for interventions optimizing sexual health and sexual well-being in CSA survivors.

“It's a touchy subject”: Latino adolescent sexual risk behaviors in the school context

Adverse sexual health outcomes remain disproportionately high for Latino adolescents. To examine sexual risk behaviors in Latino adolescents, we conducted in-depth interviews with 18 Latino parents and 13 school staff members and carried out 1 year of fieldwork in the school and community. “It's a touchy subject [sex] here” exemplified the reluctance of addressing sexual risk behaviors. Community- and systems-level strategies are recommended.

P2-S6.06 Prevalence, incidence and predictors of sexual assault in the community-based HIM cohort of Sydney homosexual men

BackgroundSexual assault (SA) is commonly reported in cross-sectional studies of men who have sex with men (MSM) worldwide, but there are few community-based longitudinal data.MethodsParticipants in the Health in Men...

Chronic kidney disease in cats: An ounce of prevention is worth a pound of cure

Although information is available for prevention of sexually transmitted infection (STI/HIV), adolescents continue to engage in high risk sexual behavior particularly ethnic minority adolescent women with histories of STI or abuse. A description therefore of STI/HIV knowledge and sexual risk behavior among these women is indicated for modification of prevention efforts for sexual health promotion. African-American (n = 94) and Mexican-American (n = 465) adolescent women 14–18 years of age were included in the study. Assessments of sexual risk behavior and STI/HIV knowledge among these adolescent women described Mexican-American women as at higher risk of STI, pregnancy, substance use and abuse with lower levels of STI/HIV knowledge, previous HIV testing and perceptions of risk than African-American women. A focus on Mexican-American adolescent women with histories of STI and abuse is indicated for translation of community-based health promotion interventions for amelioration of potential adverse sexual health outcomes among ethnic minority adolescent women.