National Sexual Health Survey Research Articles

Trauma Chronicity and the Long-Term Needs of Childhood Sexual Trauma Survivors

Research has linked childhood sexual trauma (CST) with adverse adult outcomes (AAOs) that span physical, psychological, and social domains of functioning. Differences in conceptualizing and measuring CST, however, have inhibited the examination of trauma-related variables hypothesized to impact adult outcomes. We used National Sexual Health Survey (NSHS; 1995–1996) data to examine trauma chronicity (i.e., duration) and AAOs (domains: physical and mental health, close relationships, and achievement). The NSHS (N = 6537, 18–70 years) assessed duration using perpetrator-specific CST reports. Adjusting for background characteristics, we examined CST duration in relation to AAOs and CST-related help-seeking. Approximately 8% of participants reported CST. Chronic (vs. single-exposure) CST survivors were at substantially higher risk of experiencing AAOs [i.e., mean AAOs and specific AAOs (e.g., physical and emotional health problems, divorce/separation, and poverty)]. CST had direct effects on sexual dysfunction and satisfaction, and on relationship stressors which may impact sexual relationship quality. Although 62% of CST survivors did not seek help, those with more chronic CST histories reported a higher prevalence of trauma-related help-seeking. Our work underscores the importance of examining CST chronicity in relation to long-term developmental outcomes. Chronicity assessment may be an important screening tool in the therapeutic context and in broader community screening efforts.

Knowledge of HIV/AIDS and Attitudes towards Condom Use among African American Men Ages 18 to 35

Background: Of all racial/ethnic groups in the United States young African Americans are the most impacted by HIV/AIDS, including rates of new infections and deaths. Purpose: To determine whether attitude towards condom use differed according to knowledge of HIV/AIDS and demographics such as age, education, income, length of relationships, and years sexually active. Methods: A cross-sectional quantitative study of 162 young African American men aged 18 to 35 years from an urban geographic area. Data collection: Demographic and survey data was collected from a metropolitan hospital in northern New Jersey and other local faith-based organizations where young African American men congregate or program network. A ten question paper and pencil survey tool was developed from the Multidimensional Condom Attitude scale; the HIV Knowledge Questionnaire scale; and, the National Sexual Health Survey. Data analysis: Three hypotheses were tested with correlation statistics. The fourth involved hierarchical multiple linear regression to investigate the ability of HIV/AIDS knowledge to predict attitude towards condoms, after controlling for age, income, years sexually active, education and length of relationship. Findings: Pearson r analyzed the relationship among the variables since it is sensitive to linear relationships. A positive relationship was found between attitude toward condom use scores with age (r=0.20, p=0.00), income (r=0.29, p=0.000), and knowledge of HIV/AIDS (r=0.39, p=0.000). Younger African American men with less years of sexual activity (r=-0.23, p=0.00) and less knowledge of HIV/AIDS were negatively related to condom use. An independentsample t-test also revealed a significant difference in attitude towards condom use based on the participants’ age group, t(160)=-2.58, p=0.011). The mean attitude score for the 18-24 age group was 19.42, (SD=4.54); for the 24-35 age group it was 21.53, (SD=5.80). Beta values were significant for HIV/AIDS (β=0.28, p=0.002), income (β=0.31, p<0.03), and number of years sexually active (β=-0.38, p=0.000). Implications: Educational programs and community outreach are needed for the younger African American male to prevent HIV/AIDS and other opportunistic infections by increasing their knowledge and improving their attitudes towards condom use.

Prevalence and risk factors of sexually transmitted infections among French service members.

IntroductionSexually Transmitted Infections (STIs) have always represented a public health concern in the military, yet most studies rely on self-reports among non-random samples of military populations. In addition, most of the studies exploring STI rates among the military focus on US service members. This paper assesses the prevalence and correlates of STIs in the French military using biomarkers and compares self-reported versus diagnosed STIs.MethodsData are drawn from the COSEMIL study, a national sexual health survey conducted in the French military in 2014 and 2015. A random sample of 784 men and 141 women aged 18–57 years completed a self-administered questionnaire and provided biological samples for STI testing. We used logistic regression modeling to identify the correlates of STI diagnosis and self-reports.ResultsThe prevalence of diagnosed STIs was 4.7% [3.8–5.9], mostly due to Chlamydia trachomatis. This rate was four times higher than the 12 months self-reported rate of 1.1% [0.6–2.3]. Reported STI rates were similar among men and women (1.1% versus 1.8%), but diagnosed STI rates were twice as high among females versus males (10.4% versus 4.1%, p = 0.007). There were significant differences in the determinants of reported versus diagnosed STIs. In particular, age and sexual orientation were associated with reported STIs, but not with diagnosed STIs. Conversely, STI counseling and depression were associated with STI diagnosis but not with STI reports.ConclusionThis study underlines the need to use biomarkers in population-based surveys, given the differential and substantial underreporting of STIs. Results also highlight the need for programmatic adaptation to address gender inequalities in STI rates, by developing women’s health services in the French military. Addressing such needs not only benefits women but could also serve as a strategy to reduce overall STI rates as most military women have military partners, increasing the risk of internal transmission.

Determinants and Correlates of Preventive Behaviors at First Sex With a First Partner and Second Partner: Analysis of the FECOND Study

PurposeThis study explores transitions in contraceptive use in early sexual life in France and has three objectives: describe predictors of contraceptive use at first sex with first and second partners, describe contraceptive trajectories in these partnerships, and test associations between use at first sex and switching in first partnership on use with second partner. MethodsOur analyses include 1,823 participants, aged 15–29 years, of the 2010 French national sexual health survey who reported at least two lifetime sexual partners and a subset of 1,593 people who report contraceptive use throughout their first partnership. We use logistic regression and generalized estimating equation models to investigate the three objectives. ResultsOur results reveal a decline in contraceptive use between first and second partner, driven primarily by decreases in condom use, from 87.9% to 79.5% between first and second partner. This is partially offset by an increase in use of effective methods (from 7.8% to 38.1%), particularly by women. Any method use and discontinuation with first partner were predictors of patterns with second partner. ConclusionsAnalysis of early transitions in contraceptive use of adolescents in early sexual life reveals shifts from sexually transmitted infection to pregnancy prevention and an increase in unprotected sex.

Salud sexual y reproductiva, y crisis económica en España. Informe SESPAS 2014

Sexual and reproductive health (SRH) is protected by the public authorities to ensure that people enjoy a free, satisfying, and safe sexual life. Despite the approval of the National Sexual and Reproductive Health Strategy in 2011, the progress achieved may be jeopardized by recent proposals for legislative changes affecting this area (abortion Law and 16/2012 Law) and by the impact of the current economic crisis. This article aims to describe the current situation of sexual and reproductive health in the Spanish population and to identify the potential impact of the economic crisis. To this end, we used the following information sources: the National Sexual Health Survey, the DAPHNE surveys, births and fetal deaths statistics from the Spanish National Institute of Statistics, the Registry of Voluntary Pregnancy Interruptions, reports from the National Epidemiology Center, and the National AIDS Registry. Sexual health and the availability of information are rated as good by the Spanish population. Among young people, schools and health services have become less important as information sources and the internet has become more important. Since the beginning of the crisis, contraceptive use and fertility have declined and maternity has been delayed. The economic crisis seems to have affected some indicators of sexual and reproductive health. However, the potential effects on other indicators should continue to be monitored because insufficient time may have passed for accurate determination of the full effect of the crisis.

Recruitment using mobile telephones in an Irish general population sexual health survey: challenges and practical solutions

BackgroundNon-coverage of households without a landline telephone is a major concern of telephone survey researchers. Sampling mobile telephone users in national surveys is vital in order to gain access to the growing proportion of households that use mobile telephones extensively or exclusively. The complex logistics of conducting surveys with mobile telephones have been discussed in the literature. This paper outlines the actual challenges encountered during a recent national sexual health survey in Ireland, which utilized a mobile telephone sampling frame to recruit approximately half of the sample.MethodThe 2010 Irish Contraception and Crisis Pregnancy Survey (ICCP-2010) is a nationally representative sample of adults aged 18-45 years living in Ireland (n = 3002; 1416 recruited by landline telephone and 1586 recruited by mobile telephone). The overall response rate for the survey was 69% (79% for the landline telephone strand; 61% for the mobile telephone strand). All interviews were conducted using computer-assisting telephone interviewing.ResultsDuring the 18-week fieldwork period, five main challenges relating to the use of mobile telephones were encountered: (1) explaining to respondents how random digit dialling works in relation to mobile telephones; (2) establishing the respondent's eligibility; (3) calling the respondent with the Caller ID blocked or withheld; (4) calling the respondent when they are in any number of locations or situations; and (5) explaining to respondents the importance of refusal conversion calls for the response rate calculation. Details of how the survey protocols and procedures were monitored and adapted throughout the study to ensure a high response rate are outlined.ConclusionIt is undeniably more challenging to recruit respondents using mobile telephones as opposed to landline telephones. Respondents are generally not familiar with being contacted on their personal mobile telephone for the purposes of being recruited for a research study. The main challenge for survey methodologists and interviewers is to devise simple protocols to explain to respondents why they are being contacted on a mobile telephone. Recommendations for survey researchers interested in using this methodological approach in the future are discussed.

Sexuality among Spanish adults with diabetes: A population-based case control study

ObjectivesTo describe and compare sexuality between subjects with diabetes with matched non-diabetic controls. MethodsPopulation based case control study using individual data from the Spanish National Sexual Health Survey. Diabetes status was self reported, we selected type 2 patients. We identified 461 diabetes sufferers. Two controls were matched by age, sex and sexual partner for each diabetic case.Sexuality measures included: sexual activity, importance of sex, satisfaction with partner, bothersome with one's sexual life and self-rated sexual health. Independent variables included: socio-demographics, physical health, chronic diseases and medications use. ResultsNo differences were found in “Sexually activity”, “Importance of sex” or “Bothersome” between those with and without diabetes. Dissatisfaction with partner was 25% in women with diabetes and 12.9% in non-diabetic controls (Adjusted-OR 1.82 95%CI 1.02–4.85).Diabetes sufferers reported sexual health as “fair/poor/very poor” more than their non-diabetic control, 58.1% vs. 45.1% for women (Adjusted-OR 1.74 95%CI 1.15–2.63) and 54.3% vs. 38% for men (Adjusted-OR 1.88 95%CI 1.29–2.75).Among diabetes sufferers “fair/poor/very poor” sexual health was associated with poorer physical health, not having a sexual partner and among men taking heart medications. ConclusionsWomen and men with diabetes have significantly worse sexuality measures than non diabetic controls.

Sexual Behaviors among Older Adults in Spain: Results from a Population‐Based National Sexual Health Survey

The Spanish National Sexual Health Survey (SNSHS) is designed to examine sexual activity, sexual behaviors, and sexual health among the Spanish population. To describe sexual activity and behaviors of Spaniards aged ≥ 65 years old focusing on gender differences. A population-based descriptive study was conducted using individual data from the SNSHS. The number of subjects aged ≥ 65 years included was 1,939 (1,118 women, 821 men). Sexual activity, frequency, sexual behaviors, sexual practices, and reasons for lack of sexual activity were assessed from questions included in the survey. Subjects who reported having any sexual practice including giving or receiving kissing and hugging, vaginal intercourse, oral sex, or masturbation, with at least one partner in the previous 12 months were considered as sexually active. We analyzed sociodemographic characteristics, self-rated physical and sexual health, comorbid conditions, and medications using multivariate logistic regression models. Overall, 62.3% of men and 37.4% of elderly women were sexually active (P < 0.01). The prevalence of sexual inactivity significantly increased with age (P < 0.01, odds ratio [OR] 5.8, 95% confidence interval 3.8-9.05 men; 6.37, 3.9-10.4 women). Not having a partner was a predictor of sexual inactivity (OR 5.79, 3.98-8.42 men; OR 12.0, 8.4-17.2 women). Worse self-rated sexual health, suffering ≥ 2 comorbid conditions, and taking ≥ 2 medications were associated with higher probability of reporting no sexual activity in both men and women. The most common sexual practices were kissing, hugging, and vaginal intercourse. The most common reasons for sexual inactivity were: partner was physically ill (23%), lack of interest (21%), and the man was a widower (23%). This study provided data on sexual activity in older Spanish adults and has identified potential factors that appear to influence sexuality in the elderly with some gender differences. Current results can have implications for healthcare providers for addressing these concerns in an effective manner.

Predictors of Contraceptive Methods among Adolescents and Young Women Residing in Spain

Preventing unwanted pregnancy is considered one of the main preventive measures of a developed health system. The aim of the study were to determine the prevalence of contraceptive methods and identify factors associated with the use of contraception by adolescents and young women residents in Spain. Descriptive cross-sectional epidemiologic study on the factors determining use of a contraceptive method among sexually active adolescents and young women aged 16-29 years, living in Spain. As the dependent variable, we took the answer to the questions "During the last 12 months, what contraceptive method have you generally used in your sexual relations?" Independent variables were socio-demographic factors, sexual habits, and variables associated with perception of sexual health. Using logistic multivariate regression models, we have estimated the independent effect of each of these variables on the contraceptive methods use. We used secondary individualized data drawn from the first National Sexual Health Survey conducted in Spain. The male condom seems to be the most widely used (56.7%). The likelihood of using a condom is greater to those who have more than two sexual partners (adjusted odds ratio [AOR]=3.11; 95% confidence interval [CI], 1.72-5.60). Predictors of use of oral contraceptives as the only method are age and having a positive view of one's sexual health (AOR=2.65; 95% CI, 1.28-5.45). Young women with two or more sexual partners were three times likelier to use the double method (AOR=3.83; 95% CI, 1.52-9.65). The number of sexual partners, information on and importance of sexuality in one's life predicted the use of the condom as the only method. The factors associated with use of oral contraceptives were having a stable sexual partner and good perception of sexual health. The variable most strongly associated with use of the double method was number of sexual partners.

Long-Term Health Correlates of Timing of Sexual Debut: Results From a National US Study

We explored long-term health consequences of age at sexual initiation and of abstinence until marriage to evaluate empirical support for the claim that postponing sexual initiation has beneficial health effects. We analyzed data from the 1996 National Sexual Health Survey, a cross-sectional study of the US adult population. We compared sexual health outcomes among individuals who had initiated sexual activity at an early or late age versus a normative age. We also compared individuals whose first sexual intercourse had occurred before versus after marriage. Early initiation of sexual intercourse was associated with various sexual risk factors, including increased numbers of sexual partners and recent sexual intercourse under the influence of alcohol, whereas late initiation was associated with fewer risk factors. However, both early and late initiation were associated with sexual problems such as problems with arousal and orgasm, primarily among men. Relationship solidity and sexual relationship satisfaction were not associated with early or late initiation. Early sexual debut is associated with certain long-term negative sexual health outcomes, including increased sexual risk behaviors and problems in sexual functioning. Late initiation was also associated with sexual problems, especially among men. Further research is needed to understand how sexual initiation patterns affect later health outcomes.

Sexually transmitted infection health-care seeking behaviour in the Netherlands: general practitioner attends to the majority of sexually transmitted infection consultations

Health-care seeking behaviour for sexually transmitted infection (STI)-related symptoms is not well known in the Netherlands. Within the framework of a large representative study, the second National Survey of General Practice (NIVEL 2001), 9687 persons aged 18 years and older were interviewed about their STI and STI-related health-care seeking behaviour. In total, 1.2% of the interviewees reported STI-related symptoms in the past year (18-24 years: 5%). A (lifetime) history of STI was reported by 2.7% (18-44 years: 4%). In all, 63% of interviewees visited their general practitioner (GP) for these complaints; 20% went to an STI-clinic and/or municipal public health services and 8% to a different care-provider. A total of 9% did not undertake any action. The majority of persons with STI-related symptoms in the Netherlands visit the GP. Reported history of STI-related symptoms was twice lower in the Netherlands compared with the UK National Sexual Health Survey. Appropriate attention for sexual health in primary care is needed.

Biases in internet sexual health samples: Comparison of an internet sexuality survey and a national sexual health survey in Sweden

The internet is becoming a favored technology for carrying out survey research, and particularly sexual health research. However, its utility is limited by unresolved sampling questions such as how biased internet samples may be. This paper addresses this issue through comparison of a ‘gold standard’ random selection population-based sexual survey (The Swedish Sexual Life Survey) with an internet-based survey in Sweden which used identical demographic, sexual and relationship questions, to ascertain the biases and degree of comparability between the recruitment methods. On the internet questionnaire, there were significant differences between males and females on all the measured indices. There were no significant differences in proportions of males and females, or nationality, between the two samples. However, the internet samples for both males and females were significantly more likely to be younger, originally from and currently living in a major city, better educated, and more likely to be students and less likely to be retired. Relationship variables were less likely to be significantly different between samples: there were no differences for males or females between the SSS and the internet samples on having been in a committed relationship, and how they met their present partner, nor for males in having discussed separation in the past year. However, there was a higher proportion of people attracted to the same sex, and higher numbers of sex partners (as well as a higher proportion of people reporting no sex) in the past year, in the internet sample. These data suggest that apart from the demographics of age, location, and education, currently being in a committed relationship, and the number of sex partners in the past year, internet samples are comparable for relationship characteristics and history with a national sexual life survey. Comparison of internet data with random survey data in other western countries should occur to determine if these patterns are replicated.