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PubMed2001

Repeatability of sexual history in longitudinal studies on HPV infection and cervical neoplasia: determinants of reporting error at follow-up interviews.

BACKGROUND: Misclassification of sexual history due to faulty recall or reporting bias may be the reason for variability in the association between sexual history and human papillomavirus (HPV) infection seen in studies conducted in different geographical areas. This study aimed to assess the repeatability of questionnaire information on sexual-history variables and their correlates, using information from repeat interviews by six international prospective cohort studies. METHODS: The pooled dataset included over 14 775 women interviewed on two separate occasions, of whom 5690 returned for a third interview. At each return visit women were re-asked questions on age at first intercourse and number of sexual partners. The six cohorts originated from studies in Denmark, Costa Rica. San Francisco, Toronto, Montreal and São Paulo. RESULTS: Exact agreement between age at first intercourse recalled on separate occasions ranged from 60-85%, whereas exact recall rates for number of sexual partners were substantially lower and more study-dependent, varying between 20% and 77%. The intraclass correlation coefficients gauging the degree of repeatability in responses ranged from 0.68 to 0.97 for age at first intercourse and 0.08 to 0.94 for number of sexual partners. Age, ethnicity, education and cohort membership were the strongest predictors of reporting error for both sexual history markers, although study design characteristics also seemed to play a role. HPV infection status seemed to influence recall of number of partners, but not age at first intercourse. CONCLUSIONS: Information on sexual behaviours is not reliably collected in epidemiological studies of sexually transmitted diseases, which may influence the magnitude of relative risk estimates.

Adolescent↗

PubMed2001

Ukrainian medical students' experiences, attitudes, and knowledge about reproductive health.

In a 1999 classroom survey of sexual behavior among 689 1st-year medical students at Donetsk State Medical University, Ukraine, 59% of the women and 83% of the men revealed they had "ever" had sexual intercourse. The mean age of first intercourse was 15.7 years for the men and 16.6 years for the women. Thirty-two percent of the students reported they did not use contraceptives at their first intercourse, and 19% said they used no contraceptives at their most recent coitus. Condoms were the most frequent means of contraception, followed by coitus interruptus. Less than 5% used oral contraceptives, and 73% of students reported being afraid to use them. About 6% of the students reported they had had sexually transmitted infections (STI) and 10% had had an abortion. Improving knowledge concerning unwanted pregnancies and STI among Ukraine's future health providers may contribute to improving reproductive health issues in general in Ukraine.

Abortion, Induced↗

PubMed1994

Sexual behaviour survey in a rural area of northwest Tanzania.

OBJECTIVE: Little is known about variations in patterns of sexual behaviour in different countries, cultures, and subpopulations that determine the spread of HIV-1. Quantitative studies are required to improve understanding. METHODS: To assess reported patterns of sexual behaviour, we administered a standardized questionnaire to 416 men and 498 women aged 15-49 years from a rural population in northwest Tanzania. RESULTS: Reported levels of sexual activity were highest in men and among younger age groups. The number of sexual partners and number of sex acts per unit of time were strongly correlated: men reported 10 times as many lifetime partners than women. Frequency of sexual partner exchange plateaued earlier in women (by age 25 years) than in men (by age 35 years). For the great majority, age of first intercourse was 15 years or younger; older subjects were older at first intercourse and had fewer lifetime partners than younger subjects. CONCLUSIONS: This age-related pattern suggests that more recent birth cohorts have behaviour patterns that increase the risk of sexually transmitted infectious agents such as HIV. Preventive education programmes should be targeted at young adults, who adopt higher risk profiles of frequent partner exchange linked with first intercourse at an early age.

Adolescent↗

PubMed2000

The determinants of sexual intercourse before age 16.

PURPOSE: To identify risk and protective factors for initiation of sexual intercourse before age 16 years at the level of the individual, family, and school. METHODS: A longitudinal study based on a cohort of 1020 people born in Dunedin, New Zealand in 1972/73 and followed up to age 21 years. Demographic characteristics of the sample were similar to the New Zealand population of that age, except that a smaller proportion (3%) were Maori or Pacific Island Polynesian. Information on individual, family and school factors was collected by interview with parents at ages 3, 5, 7 and 9 years and then by postal questionnaire two-yearly up to 15 years. Subjects were assessed two-yearly from age 3 years and interviewed about their behaviours and ambitions at ages 11, 13, and 15 years. Questions about age at first intercourse were asked by computer at age 21 years. Multivariate logistic regression was used to model associations with age of first intercourse less than 16 years. RESULTS: Data on age at first intercourse were available for 926/1020 (91%) of surviving members of the cohort assembled at age 3 years. Overall 27.5% of males and 31.7% of females reported sexual intercourse before age 16 years. In multivariate analyses the independent predictors for early sexual initiation for males were: not having outside home interests at age 13 years, no religious activity at age 11 years, not being attached to school at age 15 years, a low reading score, and a diagnosis of conduct disorder in early adolescence. For females, independent predictors were: socioeconomic status in the middle range, mother having her first child before age 20 years, IQ in the middle range, not being attached to school, being in trouble at school, planning to leave school early, cigarette smoking and higher self-esteem score. CONCLUSIONS: Individual and school factors appear to be more important than family composition or socioeconomic status in the decision to have sexual intercourse before age 16 years. The lowering of age at first intercourse may be partly a cohort effect related to high rates of teenage childbearing in the mothers' generation, and to changes in social acceptability of early sexual behaviour.

Adolescent↗

PubMed2002

[Sexual activity and contraception habits among adolescents over the last 14 years. An investigation among 9th grade pupils in the municipality of Viborg].

INTRODUCTION: The purpose of the investigation was to illustrate changes in sexual activity, the use of contraceptive methods, and age at the first coitus during the last fourteen years. MATERIAL AND METHODS: Twenty-one ninth grade classes in schools in the municipality of Viborg were asked to complete a questionnaire. Altogether 372 questionnaires were distributed and 344 pupils (92%) were entered in the investigation. Neither the teachers nor the pupils knew anything about the investigation before distribution. Identical questionnaires had been completed by the same age group in 1986 and 1993, which enabled us to compare the results and point out differences. RESULTS: We found no changes in age at the first coitus. One third of the pupils had had their first intercourse, 15% before the age of 15. Previously girls were sexually more active than boys, this difference was now equalised. Most (53%) of the experienced pupils had not had coitus in the preceding four weeks, but, compared with 1986, more of the pupils had been sexually active within the preceding week. As found in 1993, the use of condoms had increased, which was still unchanged. There was a continuing decline in the use of the pill at the first intercourse. However, the pupils changed the condoms for the pills as they became more experienced. Ten per cent of the pupils still did not use any contraception at the first intercourse. Occasional use of contraception was more common. In 1986, 75% used contraception at every intercourse, that proportion had fallen to 51% in the year 2000. DISCUSSION: Age at the first intercourse remained unchanged over the 14 years examined, and the change in contraceptional habits seen in 1993 had persisted, except that the proportion using contraception at every intercourse had decreased. The explanation for not using contraception was generally that the intercourse was unplanned. The girls were at a greater risk of unwanted pregnancies and sexually transmitted diseases, as they, more often than the boys, used unsafe methods of contraception.

Adolescent↗

PubMed1984

Sexual and contraceptive experience among teenagers in Uppsala.

A questionnaire was offered to 181 sixteen-year-old boys (n = 88) and girls (n = 93) in different schools in the city of Uppsala. The questionnaire was introduced to the students by a nurse midwife during a regular lesson and included over 100 questions dealing partly with sexual education, attitudes towards sex and own experience of sex and contraception. Of the girls, 47% and of the boys, 31% answered that they had had intercourse. Twenty-eight per cent of the girls and 21.5% of the boys had had their first intercourse before the age of 15. Contraception was used at the first intercourse by 59% of the girls and by 70% of the boys. At the very first intercourse, the condom was the most commonly used contraceptive method. Increasing sexual experience changed the contraceptive pattern and at their last intercourse 48% of the girls were on the pill and 33% of the boys said that their girl friend was on the pill.

Adolescent↗

PubMed2005

Religious differentials in the sexual and reproductive behaviors of young women in the United States.

PURPOSE: To examine whether religious involvement and affiliation during early adolescence is associated with reduced levels of sexual risk. METHODS: We used nationally representative data from the 1995 National Survey of Family Growth (NSFG) to examine the relationship between religious affiliation and frequency of attendance at religious services at age 14 years and a range of sexual behaviors among women aged 15-24 years, including age of first intercourse, contraceptive use, timing of first family planning visit, timing of birth, and number of sexual partners. The majority of young women had mothers with at least a high school education (79%) and had been living with both parents at age 14 (57%). Two-thirds of the sample was white, 12% Hispanic, and 15% black, and a substantial minority is poor (18%) or low-income (24%). We used bivariate analysis to describe variation in behavior according to religious affiliation and frequency of attendance. We used multivariate techniques to assess the role of religion once other factors are taken into account. RESULTS: Bivariate relationships suggest that both affiliation and attendance are associated with age of first sex, contraceptive use at first sex, teen births, and number of sexual partners. However, most of these associations disappear once we control for young women's demographic characteristics. Multivariate analyses show that religious affiliation shares few associations with sexual behaviors, though frequent attendance at religious services at age 14 years continues to have a strong delaying effect on the timing of first intercourse. CONCLUSION: Frequency of attendance and religious affiliation have little impact on sexual behaviors once intercourse occurs.

Adolescent↗

PubMedDate not supplied

Sexual behaviour related to the spread of sexually transmitted diseases--a population-based survey.

Behavioural patterns pertinent to the spread of sexually transmitted diseases (STD) were assessed in a random sample population study in Sweden. From a sample of 1150 individuals aged 16-31 years, 768 (68%) completed a questionnaire on past and present sexual contacts. Response rate was highest in youngest and oldest age groups. Median age at first intercourse was 16.4 years for women and 17.1 years for men; the woman's partner at first intercourse was a median of 2 years older; men chose partners of the same age for first intercourse. The time to second partner was a median of 2 years; number of lifetime partners increased with one new partner for 2.5 years. Condoms were more frequently used in younger age groups. In all age groups, 5-10% of individuals reported a high-risk behaviour for the spread of STDs.

Adolescent↗

PubMed1988

The effectiveness of cervical screening: a population-based case-control study.

The cervical smear histories of 36 women with invasive cervical cancer were compared to those of 120 age-matched controls, drawn from local registrar's offices. Of the cases 47% were screened at least once, while for the controls this figure was 68%. The relative risk of getting invasive cervical cancer for women screened at least once compared to women who were never screened was 0.32. The most important confounding factor was age at first intercourse. Contrary to other studies however, it was found that women who were younger when having first intercourse were screened more often. After correcting the relative risk of screened vs unscreened for age at first intercourse, the relative risk became 0.22. When the length of the interval since the last smear was considered, the relative risk was 0.18 when the smear was made between 2 and 5 years earlier and 0.30 when this smear was made more than 5 years earlier. These results support the assumption that screening is effective in the prevention of invasive cancer of the uterine cervix. Even a screening interval of more than 5 years provides considerable protection.

Adult↗

PubMed1991

Age at first experience of intercourse among Norwegian adolescents: a lifestyle perspective.

Age at first intercourse among Norwegian adolescents was studied by means of survival analysis. The data stemmed from a nation-wide survey of 3000 Norwegian adolescents aged 17-19, yielding a response rate of 61.8%. Median age at first intercourse was 17.3 years among girls and 18.0 years among boys. By means of Cox regression analysis associations between age at onset of intercourse and some correlates were estimated. Age at first intercourse was significantly associated with educational aspirations, smoking behaviour, alcohol consumption, peer affiliation, and frequency of visiting a discotheque. These inter-relationships confirm that age at onset of intercourse comprise an important indicator of the lifestyle of an individual. In order to influence sexual behaviour of adolescents it may thus be appropriate to employ health promotion activities focusing upon environmental and structural factors, as a supplement to traditional methods of sex education.

Adolescent↗

PubMedDate not supplied

Adolescents' reports of reproductive health education, 1988 and 1995.

CONTEXT: Reproductive health education is a key strategy for promoting safe sexual behavior among teenagers. In the last decade, new initiatives in response to AIDS and growing interest in abstinence education may have changed the prevalence, content or timing of the reproductive health education provided by schools and parents. METHODS: Formal reproductive health education and communication with parents about reproductive health among males aged 15-19 were analyzed using data from the 1988 and 1995 National Surveys of Adolescent Males. Young men's reports of formal instruction were compared with reports by adolescent females from the 1995 National Survey of Family Growth. RESULTS: Between 1988 and 1995, formal reproductive health education became nearly universal among adolescent males: In 1988, 93% of teenage males received some formal instruction, compared with 98% in 1995. The percentage of teenage males who received instruction about AIDS increased from 73% to 97% and the proportion who received instruction about how to say no to sex increased from 58% to 75%. Adolescent males who had dropped out of school received significantly less reproductive health education than those who had stayed in school, however. In addition, the median age at initial instruction decreased from age 14 to 13. Many males did not receive instruction prior to first intercourse, with non-Hispanic blacks being significantly less likely than other males to receive education prior to first intercourse. In 1995, 54% of black males had received reproductive health education before they first had sex, compared with 68% of Hispanic males and 76% of non-Hispanic white males. A smaller share of adolescent males than females received reproductive health education, and males were less likely than females to receive instruction prior to first intercourse. CONCLUSIONS: During the last decade, many types of formal reproductive health education for adolescents expanded. Further efforts should focus on assuring access to timely, comprehensive and high-quality reproductive health education for all teenagers and reducing gaps in access related to race, gender and school attendance.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Sexual activity, condom use and AIDS awareness among adolescent males.

New data from the 1988 National Survey of Adolescent Males indicate that 60 percent of never-married young men ages 15-19 are sexually active. Among 17-19-year-old males living in metropolitan areas, the rate of sexual activity reported in 1988 was 15 percent higher than that reported in 1979. This increase encompasses a rise of 23 percent among black males and 13 percent among nonblack males. Slightly more than half of the sexually active males in the 1988 survey reported that they had used a condom the last time they had had intercourse. Among both black and nonblack youths aged 17-19 living in metropolitan areas, rates of reported condom use at last intercourse more than doubled between 1979 and 1988. Conversely, reported reliance on ineffective methods of contraception or use of no method at last intercourse was 60 percent lower. When first intercourse occurred within two years of the 1988 survey, the odds of using a condom were increased by 110 percent over the odds when intercourse occurred between 1975 and 1982, after controlling for the effects of age at first intercourse, race and ethnicity. The young men in the sample were very knowledgeable about how the human immunodeficiency virus is transmitted, and over three-quarters of the sample did not dismiss the disease as uncommon, nor did they think that using condoms to prevent the spread of AIDS was too much trouble. The rates of condom use were significantly lower than average, however, among young men who had ever used drugs intravenously or whose partners had done so, young men who had ever had sex with a prostitute and those who had had five sexual partners or more in the past year.

Acquired Immunodeficiency Syndrome↗

PubMed2002

The association between female genital cutting and correlates of sexual and gynaecological morbidity in Edo State, Nigeria.

OBJECTIVE: To examine the association between female genital cutting and frequency of sexual and gynaecological symptoms among a cohort of cut versus uncut women in Edo State of Nigeria. DESIGN: Cross sectional study. SETTING: Women attending family planning and antenatal clinics at three hospitals in Edo State, South-south Nigeria. POPULATION: 1836 healthy premenopausal women. METHODS: The sample included 1836 women. Information about type of female genital cutting was based on medical exams while a structured questionnaire was used to elicit information on the women's sociodemographic characteristics, their ages of first menstruation (menarche), first intercourse, marriage and pregnancy, sexual history and experiences of symptoms of reproductive tract infections. Associations between female genital cutting and these correlates of sexual and gynaecologic morbidity were analysed using univariate and multivariate logistic regression and Cox models. MAIN OUTCOME MEASURES: Frequency of self-reported orgasm achieved during sexual intercourse and symptoms of reproductive tract infections. RESULTS: Forty-five percent were circumcised and 71% had type 1, while 24% had type 2 female genital cutting. No significant differences between cut and uncut women were observed in the frequency of reports of sexual intercourse in the preceding week or month, the frequency of reports of early arousal during intercourse and the proportions reporting experience of orgasm during intercourse. There was also no difference between cut and uncut women in their reported ages of menarche, first intercourse or first marriage in the multivariate models controlling for the effects of socio-economic factors. In contrast, cut women were 1.25 times more likely to get pregnant at a given age than uncut women. Uncut women were significantly more likely to report that the clitoris is the most sexually sensitive part of their body (OR = 0.35, 95% CI = 0.26-0.47), while cut women were more likely to report that their breasts are their most sexually sensitive body parts (OR = 1.91; 95% CI = 1.51-2.42). Cut women were significantly more likely than uncut women to report having lower abdominal pain (OR = 1.54, 95% CI = 1.11-2.14), yellow bad-smelling vaginal discharge (OR = 2.81, 95% CI = 1.54-5.09), white vaginal discharge (OR = 1.65, 95% CI = 1.09-2.49) and genital ulcers (OR = 4.38, 95% CI 1.13-17.00). CONCLUSION: Female genital cutting in this group of women did not attenuate sexual feelings. However, female genital cutting may predispose women to adverse sexuality outcomes including early pregnancy and reproductive tract infections. Therefore, female genital cutting cannot be justified by arguments that suggest that it reduces sexual activity in women and prevents adverse outcomes of sexuality.

Adolescent↗

PubMed1996

The association of age and sexual history with the severity of the histological findings in women with cervical intraepithelial neoplasia.

We examined the demographic and behavioral data of 203 patients with histological diagnosis of cervical intraepithelial neoplasia (CIN) to assess putative predictors of the most severe alterations (CIN grade III). The variables significantly associated with the histological diagnosis of CIN III were time since first intercourse (odds ratio 5.33, 95% CI 1.80-16.15), time since menarche (odds ratio 4.62, 95% CI 1.39-16.05) and age (odds ratio 2.48, 95% CI 1.32-4.67). After multivariate analysis, the only independent variable still associated with CIN III was the time since first intercourse (odds ratio 6.11, p < 0.05). It is concluded that, in patients with recently diagnosed CIN, the time since first intercourse-rather than age, age at first intercourse or lifetime number of sex partners-is the information best associated with the severity of the disease.

Adult↗

PubMedDate not supplied

The consistency of self-reported initiation of sexual activity.

In an analysis of the consistency of self-reported age at first intercourse using longitudinal data from the National Youth Survey, 28-32% of adolescents reported an age at first intercourse inconsistent with the information they provided up to seven years later as adults. Overall, while females were the most likely to offer consistent responses (70%), while black males were the least likely to do so (27%). Multivariate analyses indicated that in addition to race and gender, some social and economic factors were significantly associated with inconsistent reporting. For example, those who lived in a two-parent household were less likely than those from a one-parent family to report an earlier age at first intercourse as adolescents than they reported as adults. After controlling for these inconsistencies, overall predictors of adolescent sexual behavior remained unchanged. Although the analysis could not determine which time period reflected more accurate data, it does suggest limitations to using self-reported data to construct estimates of adolescent sexual activity and to evaluate programs designed to alter adolescent sexual behavior.

Adolescent↗

PubMed2026

Assessing the Association Between Age at First Sexual Intercourse and HIV Infection Risk Using A Two-sample Mendelian Randomization Framework.

This study applied a two-sample Mendelian randomization framework to investigate the potential association between age at first sexual intercourse (AFS) and the risk of Human Immunodeficiency Virus (HIV) infection. Summary-level Genome-Wide Association Study (GWAS) data from European populations were analyzed, including 214,547 individuals for AFS and 357 HIV cases with 218,435 controls from the FinnGen R5 dataset. Independent single-nucleotide polymorphisms significantly associated with AFS were selected as instrumental variables following linkage disequilibrium clumping and instrument-strength assessment. Causal estimates were evaluated using inverse-variance weighting (IVW), MR-Egger regression, weighted median, weighted mode, and simple mode. Cochran's Q test, MR-Egger intercept analysis, MR-PRESSO assessment, and leave-one-out sensitivity analyses were performed to evaluate heterogeneity, pleiotropy, and robustness. The IVW analysis suggested that genetically predicted later AFS was associated with reduced HIV infection risk (OR = 0.192, 95% CI = 0.062-0.592, P = 0.004), whereas earlier sexual debut corresponded to increased HIV susceptibility. Directionally consistent findings across multiple Mendelian randomization methods supported the stability of the observed association. However, the findings should be interpreted cautiously because the HIV outcome analysis relied on a single dataset with a limited number of HIV cases. These results support a potential association between earlier sexual debut and HIV susceptibility and demonstrate the utility of Mendelian randomization for investigating behavioral risk factors associated with infectious disease outcomes.

Humans↗

PubMedDate not supplied

Employment and the sexual and reproductive behavior of female adolescents.

CONTEXT: Women's employment opportunities may reduce the risk of early intercourse and pregnancy, but some evidence has linked adolescent employment and problem behaviors with early intercourse. METHODS: Hazard regression analyses of data from the National Longitudinal Survey of Youth were used to examine the relationship between employment and the risk of first intercourse before age 20 among women who were aged 14-16 in 1979. The relationship between employment and the risk of a first, nonmarital pregnancy among sexually experienced young women was also assessed. RESULTS: Current employment and cumulative months of past employment are associated with increased hazards of first intercourse (hazard ratios, 1.20 and 1.01, respectively); this association is particularly strong for white young women. Adolescents who work more than 120 hours a month are significantly more likely than nonworking adolescents to experience first intercourse (1.4). Although current employment has no effect on the likelihood of a first, nonmarital pregnancy among white adolescents, it is associated with an increased risk of pregnancy among blacks and with a reduced risk of pregnancy among Hispanics. CONCLUSIONS: Program planners and policymakers should be aware of the potential association between adolescent employment, particularly intense employment, and the likelihood of initiating intercourse and experiencing pregnancy, even if causality is still unclear.

Adolescent↗

PubMedDate not supplied

Levels of sexual activity among adolescent males in the United States.

Although three-fifths of adolescent males aged 15-19 say they have had sexual intercourse, analyses of data from the 1988 National Survey of Adolescent Males indicate that their level of sexual activity is relatively moderate. The data show that among sexually experienced young men the mean number of partners in the last 12 months is 1.9, and the mean frequency of intercourse in the last four weeks is 2.7 times. Black males have had more partners than white or Hispanic males; however, after the number of years since first intercourse are controlled for, these differences disappear. On average, sexually experienced youth spent six out of the last 12 months with no sexual partner, and only 21 percent of sexually active males had more than one partner in any month in the last year. Comparisons with 1979 data suggest that proportionately more adolescents were sexually experienced in 1988, but fewer non-black males had first intercourse before their 15th birthday. The number of partners since first intercourse and in the past four weeks appears to have decreased, as has the frequency of intercourse in the last four weeks.

Adolescent↗