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Unlabelled: Background Current information about numbers of other-sex partners, experiences of different heterosexual behaviours and the recent heterosexual experiences among a representative sample of Australian adults is needed. It is not known whether these practices have changed between 2001-02 and 2012-13. Methods: Computer-assisted telephone interviews were completed by a representative sample of 9963 men and 10131 women aged 16-69 years from all states and territories. The overall participation rate among eligible people was 66.2%. Results: Men reported more sexual partners than women, although the lifetime number of heterosexual partners reported by women increased significantly between 2001-02 and 2012-13. In 2012-13, 14.7% of men and 8.6% of women reported two or more sexual partners in the last year. Reporting multiple partners was significantly associated with being younger, being bisexual, living in major cities, having a lower income, having a blue-collar occupation and not being married. The proportion of respondents reporting ever having had oral sex or anal intercourse increased significantly since the last survey. At the last heterosexual encounter, 91.9% of men and 66.2% of women had an orgasm, oral sex was reported in only approximately one in four encounters and anal intercourse was uncommon. Conclusion: There were increases between 2001-02 and 2012-13 in partner numbers among women and in the lifetime experience of oral and anal sex. The patterns of heterosexual experience in Australia are similar to those found in studies of representative samples in other countries.
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Heterosexual experience and recent heterosexual
encounters among Australian adults: the Second Australian
Study of Health and Relationships
Chris Rissel
A,I
, Paul B. Badcock
B,C
, Anthony M. A. Smith
B,H
, Juliet Richters
D
,
Richard O. de Visser
E
, Andrew E. Grulich
F
and Judy M. Simpson
G
A
Sydney School of Public Health, Charles Perkins Centre (D17), University of Sydney, Sydney,
NSW 2006, Australia.
B
Australian Research Centre in Sex, Health and Society, La Trobe University, 215 Franklin Street,
Melbourne, Vic. 3000, Australia.
C
Centre for Youth Mental Health, University of Melbourne, Orygen Youth Health Research Centre,
35 Poplar Road, Parkville, Vic. 3052, Australia.
D
School of Public Health and Community Medicine, University of New South Wales, Sydney,
NSW 2052, Australia.
E
School of Psychology, Pevensey 1, University of Sussex, Falmer BN1 9QH, UK.
F
The Kirby Institute, Wallace Wurth Building, University of New South Wales, Sydney,
NSW 2052, Australia.
G
Sydney School of Public Health, Edward Ford Building (A27), University of Sydney, Sydney,
NSW 2006, Australia.
H
Deceased.
I
Corresponding author. Email: chris.rissel@sydney.edu.au
Abstract. Background:Current information about numbers of other-sex partners, experiences of different heterosexual
behaviours and the recent heterosexual experiences among a representative sample of Australian adults is needed. It is not
known whether these practices have changed between 200102 and 201213. Methods:Computer-assisted telephone
interviews were completed by a representative sample of 9963 men and 10 131 women aged 1669 years from all states and
territories. The overall participation rate among eligible people was 66.2%. Results:Men reported more sexual partners
than women, although the lifetime number of heterosexual partners reported by women increased signicantly between
200102 and 201213. In 201213, 14.7% of men and 8.6% of women reported two or more sexual partners in the
last year. Reporting multiple partners was signicantly associated with being younger, being bisexual, living in major
cities, having a lower income, having a blue-collar occupation and not being married. The proportion of respondents
reporting ever having had oral sex or anal intercourse increased signicantly since the last survey. At the last heterosexual
encounter, 91.9% of men and 66.2% of women had an orgasm, oral sex was reported in only approximately one in four
encounters and anal intercourse was uncommon. Conclusion:There were increases between 200102 and 201213 in
partner numbers among women and in the lifetime experience of oral and anal sex. The patterns of heterosexual experience
in Australia are similar to those found in studies of representative samples in other countries.
Additional keywords: anal intercourse, Australia, contraceptive behaviour, cunnilingus, fellatio, heterosexuality, national
survey, oral sex, orgasm, sexual behaviour, sexual practices.
Received 8 June 2014, accepted 19 August 2014, published online 7 November 2014
Introduction
Patterns of sexual behaviour are of considerable social and
medical interest. Human sexuality intersects with many aspects
of our lives, including entertainment, partner relationships,
families and housing. Images of sex and sexuality pervade our
communication media, but do not always reect actual sexual
behaviour. At a population level, to help prevent the spread of
HIV and other sexually transmissible infections (STIs), it is
important to have information about specic sexual behaviours
and numbers of partners. Population surveys have found
associations between a greater number of sexual partners and
the likelihood of acquiring STIs.
13
CSIRO PUBLISHING
Sexual Health, 2014, 11, 416426
http://dx.doi.org/10.1071/SH14105
Journal compilation CSIRO 2014 www.publish.csiro.au/journals/sh
Data (collected from 2001 to 2002) from the rst Australian
Study of Health and Relationships (ASHR1) from respondents
aged 1659 years showed that heterosexual men reported having
sex with more people over their lifetime, both in the last 5 years
and in the last year, than did heterosexual women.
4
In all, 15.1%
of heterosexual men and 8.5% of heterosexual women reported
having two or more sexual partners in the last year, although
these partnerships were not necessarily concurrent. People who
identied as homosexual or bisexual reported more partners than
did those who identied as heterosexual.
5
The study also reported that one person in four had not
had sex in the previous 4 weeks and most people had had sex
less than twice a week.
6
Those who were in heterosexual
relationships had had sex on average 1.84 times a week in
the past 4 weeks, with younger people having sex more
frequently.
7
Most sexual behaviours and experiences vary
substantially with age. Nearly all heterosexual encounters
(95%) involved vaginal intercourse and almost half (49%)
also involved manual stimulation of the genitals, with men
having an orgasm in 95% of encounters and women in 69%.
8
Findings from the later Australian Longitudinal Study of Health
and Relationships conducted in 200510 with respondents aged
1664 years revealed that, compared with a brief encounter,
longer sexual encounters were more likely to include the less-
common sexual practices of oral sex and self-stimulation.
9
In the three countries with large repeated national sexual
health studies (USA, UK and France), there is no clear pattern of
temporal changes in the number of recently reported other-sex
partners. In the US in the early 1990s, Laumann et al. surveyed
adults 1859 years and reported that 10% of men had no sexual
partners in the past 12 months, 67% had one and 23% had two or
more partners, with the median number of partners being six.
10
Chandra et al. reported on men aged 1544 years in the US in
200608 and found that 18% had had no partners, 63% had one
partner and 19% had two or more partners, with the median
number of partners being ve.
11
Furthermore, Chandra et al.
reported data from 2002 for adults aged 1544 years, which
clearly shows that there was a decrease in the proportion of
respondents with multiple partners in the past 12 months over the
period 200608, for both men and women.
For women in the US aged 1859 years, Laumann et al.
reported that in the 1990s, 13.6% of women had no sexual
partners in the past 12 months, 74.7% had one and 11.7% had
two or more partners, with the median number of partners
being two.
10
Chandra et al. found that, among women aged
1544 years in the US in 200608, 17.1% had had no partners in
the past 12 months, 69.0% had one partner and 13.0% had two or
more partners, with the median number of partners being 3.2.
11
In the UK, between the rst and second British National
Study of Sexual Attitudes and Lifestyles, Natsal-1 with
respondents aged 1659 years (1990) and Natsal-2 with
respondents aged 1644 years (2000), the mean number of
partners in the past 5 years increased for both men (from
2.6 to 3.8) and women (from 1.5 to 2.4).
12,13
For comparison
purposes, the Natsal-1 frequencies were re-run on informants
aged 1644 years. The increased sexual activity and diversity
reported in Natsal-2 in men was sustained in Natsal-3 (overall
respondents aged 1674 years, but compared with those aged
1644 years) for data collected from 2010 to 2012, but had
generally not risen further in men.
14
However, in women, there
were increases from Natsal-2 to Natsal-3 in the number of
male sexual partners over the lifetime, the proportion
reporting ever having had a sexual experience with genital
contact with another woman, and the proportion reporting at
least one female sexual partner in the past 5 years was higher in
Natsal-3 than in Natsal-2.
14
In France, among respondents aged
1869 years, the lifetime number of sexual partners increased for
women (3.3 in 1992 to 4.4 in 2006), but less so for men (from
11.0 to 11.6).
15
Heterosexual experience and number of heterosexual
partners
While there have been reported increases in the number of
heterosexual sexual partners among women (e.g. in France,
the UK and US), it is not known if this increase has also
occurred in Australia. In 2001, 45% of Australian men and
18% of Australian women reported 10 or more sexual partners.
4
In the year before the interview, approximately 90% of
respondents reported heterosexual activity, and approximately
three-quarters of respondents had had sex with only one partner,
and 8% of men and 2.9% of women reported having had more
than two sexual partners.
4
Heterosexual behaviour
Internationally, most adults (>90%), both men and women, have
had vaginal intercourse,
4,11,14
and there is wide variation in the
experience of oral sex and anal intercourse. In the UK, the
experience of oral sex in the past year increased between 1990
and 2000 for both men and women, but did not continue to
increase at Natsal-3, with approximately three-quarters of
respondents reporting it. Reports of anal sex in the past year
in the UK increased steadily from approximately 7% at Natsal-1
to 16% at Natsal-3.
14
Most recent heterosexual experiences
As sexual practices change, it is important to understand what
behaviours are engaged in for estimating levels of risky
behaviour and for providing information to guide the
development of interventions to promote safer sex. While
most (>90%) recent heterosexual encounters reported in
ASHR1 involved a regular sexual partner, a substantial
minority did not.
4
In their most recent sexual encounters,
95% had vaginal intercourse, approximately 30% had oral
sex, fewer than 1% had anal intercourse and approximately
84% used contraception where there was a risk of pregnancy.
4
The aim of this paper is to describe numbers of other-sex
partners, experiences of different heterosexual behaviours and
most recent heterosexual experiences among a representative
national sample of Australian adults, and identify changes
between 200102 and 201213.
Methods
The methodology used in the Second Australian Study of
Health and Relationships (ASHR2) is described elsewhere in
this issue.
16
Briey, between October 2012 and November
2013, computer-assisted telephone interviews were completed
by a representative sample of 20 094 Australian residents aged
Heterosexual experience and recent encounters Sexual Health 417
1669 years from all states and territories. Ethical approval was
obtained from the researchershost universities. Respondents
were selected using dual-frame modied random-digit dialling
(RDD), combining directory-assisted landline-based RDD with
RDD of mobile telephones. The overall participation rate
among people contacted who were identied as eligible was
66.2%.
To maximise the number of interviews with people who had
engaged in less common and/or more risky sexual behaviours, all
respondents who had had no sexual partners in the previous year,
who had had more than one partner in the previous year, and/or
who reported homosexual experience completed a long form
of the survey instrument, which collected detailed data on
their sexual attitudes, relationships and behaviours. Of the
larger proportion of respondents who reported having had one
partner in the previous year and no homosexual experience, 20%
were randomly selected to complete the long-form interview
and the remaining 80% completed a short-form interview. As
a consequence, 8577 completed the long-form interview, and
11 517 completed the short-form. Answers to questions that
occurred only in the long-form interview are reported after
weighting to reect the sample as a whole.
Respondents who indicated that they had had some
heterosexual experience were asked to recall how many
other-sex partners they had had sex with: (1) in their lifetime;
and (2) in the 12 months before being interviewed. Respondents
were asked about the total number of people with whom they had
had vaginal or anal intercourse and any additional people with
whom they had had oral sex (fellatio or cunnilingus) or manual
sex (stimulation of the genitals) but not intercourse. Respondents
were also asked a series of questions about their rst sexual
experiences with a partner of the other sex. Responses to three
separate items made it possible to identify whether respondents
had ever had vaginal intercourse, oral sex and anal intercourse
(see Boxes 1, 2). The word partneris used in this paper to mean
anyone with whom the respondent had had intercourse or oral or
manual sex.
Respondents could report on details of up to ve most recent
sexual experiences with different partners of the other sex that
had occurred within the last 12 months. The 12-month recall
period was chosen to reduce demands on memory and, therefore,
the distorting inuence of recall biases. This paper reports data
relating to respondentsmost recent heterosexual experiences
rather than usualbehaviour. With a large sample, the
Box 2. Ascertainment of the number of male sexual partners of women
The questions were asked in relation to the womens lifetime and the last year.
In your whole life, how many men have you had vaginal or anal intercourse with? Thats the mans penis in the womans vagina or
anus. Please include your current partner, if you have one.
[If asked whether sex work is included,interviewer says: Yes, we ask more about that later.]
[If respondent asks re sexual contact with adults as a child,interviewer says: You dont need to count anything that happened when
you were very young.]
Are there any more men that you had oral sex with? Thats the mans penis in your mouth, or his mouth on your vaginal area.
[If respondent asks re sexual contact with adults as a child,interviewer says: You dont need to count anything that happened when
you were very young.]
In your whole lifetime, how many men have you had oral sex with? Thats the mans penis in your mouth, or his mouth on your
vaginal area.
Are there any men that you had some form of sexual contact with that involved stimulating the penis or vaginal area?
In the last 12 monthsthat is, since [insert date]how many men have you had vaginal or anal intercourse with?
Box 1. Ascertainment of the number of female sexual partners of men
The questions were asked in relation to the mens lifetime and the last year.
In your whole life, how many women have you had vaginal or anal intercourse with? Thats your penis in the womans vagina or
anus. Please include your current partner, if you have one.
[If asked whether sex work is included,interviewer says: Yes, we ask more about that later.]
[If respondent asks re sexual contact with adults as a child,interviewer says: You dont need to count anything that happened when
you were very young.]
Are there any more women that you had oral sex with? Thats your penis in the womans mouth, or your mouth on the womans
vaginal area?
[If respondent asks re sexual contact with adults as a child,interviewer says: You dont need to count anything that happened when
you were very young.]
Are there any more women that you had some form of sexual contact with that involved stimulating the penis or vaginal area?
In the last 12 monthsthat is, since [insert date]how many women have you had vaginal or anal intercourse with?
418 Sexual Health C. Rissel et al.
aggregation of the most recent activity effectively represents usual
behaviour.
Respondents indicated the age of their partner and their
relationship to their partner (live-in partner, steady partner but
not live-in, occasional, casual/one-night stand, and other).
They also indicated whether any contraception was used.
Respondents indicated whether they engaged in the following
sexual practices during their most recent heterosexual
encounters: vaginal intercourse, anal intercourse, oral sex,
masturbation (manual stimulation) of themselves by their
partner, masturbation of their partner. They also indicated
whether they had had an orgasm. Respondents who reported
vaginal or anal intercourse also indicated whether a condom
was used (see Boxes 3, 4).
The correlates of the heterosexual behaviours examined in
this paper included a range of demographic characteristics,
which were recoded to facilitate analysis. Respondentsages
were recoded into six groups (1619, 2029, 3039, 4049,
Box 3. Ascertainment of the characteristics of the most recent heterosexual encounter of men
I am now going to ask about sex with the woman that you most recently had sex with.
When was the last time you had sex with this woman? Interviewer states that by sexwe mean any kind of contact with another
person that you felt was sexual. It could be kissing or touching, or intercourse, or any other form of sex.
What was your relationship to her? Interviewer waits and prompts if necessary.If client in sex work, response is coded as 5 other.
How old was she?
How long had you known her before you had sex for the rst time? Interviewer prompts with known counts from when rst met
in person.
How long ago was the rst time you had sex with her? Interviewer is careful to use only one eld,tries to get respondents best
guess rather than use code 88,dont remember.
How many times had you had sex with her in the past 4 weeks?
Did you use any contraception?
What form of contraception did you use? Interviewer reads out codes:
1. Contraceptive pill
2. IUD (intrauterine device)
3. Depo injection (Provera or Ralovera)
4. Implant (Implanon)
5. I have had a vasectomy
6. Partner has had tubal ligation
7. Condom
8. Safe period/natural family planning (rhythm method, Billings method, symptothermic, periodic abstinence, We only do it
when its safe)
9. Withdrawal (coitus interruptus, pulling out)
10. Nuva-Ring
11. Diaphragm/cervical cap
12. Spermicide foam or jelly
13. Other non-prescribed (incl. Femidom, douching, sponge; type in next page)
14. Partner breastfeeding
The last time you had sex, did you put your penis into her vagina?
Was a condom used?
Was the condom put on before your penis touched her vagina?
Did you ejaculate inside her? If respondent states Yesand condom was used, interviewer claries whether ejaculation occurred
in the condom.
The last time you had sex, did you put your penis into her anus?
Was a condom used when you did this?
Was the condom put on before your penis touched her anus?
Did you ejaculate inside her rectum? If respondent states Yesand condom was used, interviewer claries whether ejaculation
occurred in the condom.
The last time you had sex, did you have oral sex with your penis in her mouth?
Did you have oral sex with your mouth on her vaginal area?
Did she stimulate your penis with her hand?
Did you stimulate her clitoris or vaginal area with your hand?
And the last time you had sex with her, did you have an orgasm?
Heterosexual experience and recent encounters Sexual Health 419
5059, and 6069 years). Languages spoken at home were
recoded as English or a language other than English. Sexual
identity (in answer to the question Do you think of yourself
as ...) was coded as heterosexual, homosexual or bisexual;
too few respondents stated that they were queer,other,or
undecidedto allow analysis of these groups. Respondents
reported highest completed level of education was recoded
to distinguish between those who had not (yet) completed
secondary school, those who had completed secondary
school, and those who had completed post-secondary
education. Respondentspostcodes were used with the
Accessibility/Remoteness Index of Australia (ARIA)
17
to
determine whether respondents lived in a major city, a
regional area or a remote area (i.e. areas with relatively
unrestricted, restricted and very restricted access to goods,
services and opportunities for social interaction respectively).
To approximate the gross annual household income, quintiles
reported by the Australian Bureau of Statistics,
18
respondents
Box 4. Ascertainment of the characteristics of the most recent heterosexual encounter of women
I am now going to ask about sex with the man that you most recently had sex with.
When was the last time you had sex with this man? Interviewer states that by sexwe mean any kind of contact with another person
that you felt was sexual. It could be kissing or touching, or intercourse, or any other form of sex.
What was your relationship to him? Interviewer waits and prompts if necessary.If client in sex work, response is coded as 5 other.
How old was he?
How long had you known him before you had sex for the rst time? Interviewer prompts with known counts from when rst met
in person.
How long ago was the rst time you had sex with him?
How many times had you had sex with him in the past 4 weeks?
Did you use any contraception?
What form of contraception did you use? Interviewer reads out codes:
1. Contraceptive pill
2. IUD (intrauterine device)
3. Depo injection (Provera or Ralovera)
4. Implant (Implanon)
5. Partner had a vasectomy
6. Have had tubal ligation
7. Condom
8. Safe period/natural family planning (rhythm method, Billings method, symptothermic, periodic abstinence, We only do it
when its safe)
9. Withdrawal (coitus interruptus, pulling out)
10. Nuva-Ring
11. Diaphragm/cervical cap
12. Spermicide foam or jelly
13. Other non-prescribed (incl. Femidom, douching, sponge; type in next page)
14. Breastfeeding
The last time you had sex, did he put his penis into your vagina?
Was a condom used?
Was the condom put on before his penis touched your vagina?
Did he ejaculate inside you? If respondent states Yesand condom was used, interviewer claries whether ejaculation occurred in
the condom.
The last time you had sex, did he put his penis into your anus?
Was a condom used when you did this?
Was the condom put on before his penis touched your anus?
Did he ejaculate inside your rectum? If respondent states Yesand condom was used, interviewer claries whether ejaculation
occurred in the condom.
The last time you had sex, did you have oral sex with your mouth on his penis?
Did you have oral sex with his mouth on your vaginal area?
Did you stimulate his penis with your hand?
Did he stimulate your clitoris or vaginal area with his hand?
And the last time you had sex with him, did you have an orgasm?
420 Sexual Health C. Rissel et al.
reported annual income was grouped into ve categories: less than
$28 000, $28 001$52 000, $52 001$83 000, $83 001$125000
and more than $125000. Respondentsreported occupation
was coded into the nine major categories of the Australian
Standard Classication of Occupations,
19
and then recoded to
distinguish between managerial/professional occupations, white-
collar occupations and blue-collar occupations. Finally, the main
outcome variables were compared with those of ASHR1 to
identify signicant changes over time.
Data were weighted to adjust for the probability of each
respondent being selected for a landline or mobile phone
interview, a long-form interview and (for landline
participants), the number of in-scope adults in the household.
Data were then weighted to match the Australian population on
the basis of age, gender, area of residence (i.e. state by ARIA
category) and telephone ownership (i.e. mobile telephone only
vs other), resulting in an adjusted sample of 10 056 men and
10 038 women (total 20 094). The data were thus weighted to
account for the specics of our sample design and the fact
that particular types of people were slightly over- or under-
represented. The data presented therefore describe the Australian
population aged 1669 years, subject to the biases noted
elsewhere in this issue.
16
Weighted data were analysed using the survey estimation
commands in Stata Version 11.2.
20
Data were analysed using
univariate logistic regression for dichotomous outcomes,
including comparisons of ASHR1 and ASHR2. Percentages
are presented in this article without standard errors or 95%
condence intervals (CI). This decision was made to maximise
both readability and brevity, and is in keeping with the style
of other studies of a similar scope and intent.
14,21
Due to the
number of participants in ASHR2, it is important to recognise
that often there is the statistical power to detect even small
changes as statistically signicant, but these do not necessarily
correspond to signicant differences in a public health sense.
Further information about the precision of estimates is found
elsewhere in this issue.
16
Results
Heterosexual experience and number
of heterosexual partners
Information about the numbers of heterosexual partners
reported by respondents is displayed in Tables 1and 2.
Overall, men reported signicantly more other-sex partners
than women over their lifetimes and in the last year (both
P<0.001). Among heterosexually identied respondents, men
reported signicantly more other-sex partners than women
over their lifetimes (P<0.001), and in the last year (both
P<0.001). Homosexually identied men and women reported
similar mean numbers of other-sex partners over their lifetimes
(P= 0.09), and in the last year (P= 0.12). Bisexually identied
men and women reported similar mean numbers of other-sex
partners over their lifetimes (P= 0.97) and in the last year
(P= 0.23).
For men (Table 1), reports of partner numbers were
signicantly related to sexual identity in each time period
(both P<0.001). Heterosexually identied men and
bisexually identied men reported similar mean numbers of
Table 1. Number of other-sex partners for lifetime and in the last year
reported by men
Data show the percentage of respondents in each group
Period and no. Sexual identity Total
A
of partners Heterosexual
(n= 9547)
Homosexual
(n= 189)
Bisexual
(n= 109)
(n= 9862)
Lifetime
0 3.7 52.9 8.1 5.7
1 12.6 11.5 4.0 15.5
2 6.8 9.0 12.8 8.2
39 32.3 17.9 29.7 33.2
1049 36.9 8.1 36.4 32.0
50 + 7.8 0.6 9.1 5.5
Mean 17.9 4.0 21.5 17.7
95% CI 17.118.7 1.46.5 13.829.2 16.918.5
Median 8 0 7 7
Maximum 1110 209 500 1110
In the last year
0 13.1 96.1 39.3 15.9
1 74.3 2.9 42.2 72.9
2 4.7 1.0 6.1 4.7
39 6.6 0.0 8.7 5.6
1049 1.3 0.0 3.8 0.9
50 + 0.1 0.0 0.0 0.0
Mean 1.4 0.1 1.5 1.3
95% CI 1.31.4 0.00.9 0.92.1 1.31.4
Median 1 0 1 1
Maximum 75 2 20 75
A
Includes Otherand Not sure.
Table 2. Number of other-sex partners for lifetime and in the last year
reported by women
Data show the percentage of respondents in each group
Period and no. Sexual identity Total
A
of partners Heterosexual
(n= 9588)
Homosexual
(n= 121)
Bisexual
(n= 222)
(n= 9931)
Lifetime
0 4.4 25.2 4.4 5.9
1 20.1 18.1 5.6 23.2
2 10.6 7.8 7.0 10.9
39 41.3 36.0 39.4 39.9
1049 21.9 9.9 34.7 18.6
50 + 1.8 1.9 9.0 1.5
Mean 8.1 6.5 21.6 8.4
95% CI 7.78.5 2.610.3 10.632.5 7.98.9
Median 4 2 8 4
Maximum 1002 100 1100 1100
In the last year
0 17.5 91.7 19.3 19.2
1 76.0 6.7 52.2 74.8
2 3.4 1.6 12.4 3.3
39 2.9 0.0 12.4 2.5
1049 0.2 0.0 3.6 0.2
50 + 0.0 0.0 0.0 0.0
Mean 0.98 0.1 1.9 1.0
95% CI 0.951.00 0.00.2 1.32.5 0.91.0
Median 1 0 1 1
Maximum 37 2 15 37
A
Includes Otherand Not sure.
Heterosexual experience and recent encounters Sexual Health 421
partners, but homosexually identied men reported signicantly
fewer other-sex partners in each time period.
For women (Table 2), mean partner numbers were
signicantly related to sexual identity in each time period.
Bisexually identied women reported signicantly more
other-sex partners over their lifetimes (P= 0.03) and in
the year before being interviewed (P<0.001) than
heterosexually identied women. Homosexually identied
women reported signicantly fewer other-sex partners over
their lifetimes (P= 0.003) and in the year before being
interviewed (P<0.001) than heterosexually identied women,
and bisexually identied women reported signicantly more
other-sex partners in both of these time frames.
There were signicant associations between age group and
lifetime number of other-sex partners, with men and women
in the youngest age group reporting signicantly fewer
heterosexual partners (P<0.001 for men and women). The
mean lifetime number of heterosexual partners was 7.0 for
men aged 1619 years, 14.0 for men aged 2029 years, 18.7
for men aged 3039 years, 21.8 for men aged 4049 years, 21.0
for men aged 5059 years, and 18.6 for men aged 6069 years.
The mean lifetime number of heterosexual partners was 2.1 for
women aged 1619 years, 4.9 for women aged 2029 years, 5.8
for women aged 3039 years, 5.7 for women aged 4049 years,
4.6 for women aged 5059 years, and 3.4 for women aged
6069 years.
There were also signicant associations between age and
number of other-sex partners in the year before being
interviewed (P<0.001 for men and women); the number
decreased with age after 2029 yearsfor both sexes. The
mean number of other-sex partners in the year before being
interviewed was 1.4 for men aged 1619 years, 1.4 for men aged
2029 years, 1.2 for men aged 3039 years, 1.1 for men aged
4049 years, 1.0 for men aged 5059 years, and 0.9 for men
aged 6069 years. The mean number of other-sex partners in
the year before being interviewed was 1.0 for women aged
1619 years, 1.1 for women aged 2029 years, 1.0 for women
aged 3039 years, 0.9 for women aged 4049 years, 0.8
for women aged 5059 years, and 0.6 for women aged
6069 years.
Among respondents who reported heterosexual activity in
the year before being interviewed, women were signicantly
less likely than men to report that they had sex with more than
one partner (8.6% vs 14.7%; OR = 0.55, 95% CI = 0.480.62,
P<0.001). Table 3displays correlates of having multiple
sexual partners in the year before being interviewed. Very
few married men (2.5%) and women (1.0%) reported having
sex with more than one partner in the year before being
interviewed.
Among men, increasing age was associated with signicantly
lower odds of reporting multiple sexual partners in the past year
(P<0.001). Multiple partners were signicantly more likely to
be reported by bisexually identied men (P<0.001), men with
lower levels of education (P<0.001), men with lower incomes
(P<0.001), men with blue-collar occupations (P<0.001), men
living in remote locations (P= 0.008) and men who were not
in live-in relationships (P<0.001). Reporting multiple partners
was not signicantly related to speaking a language other than
English at home (P= 0.29).
Among women, the odds of reporting multiple sexual
partners was signicantly greater among younger women
(P<0.001), bisexually identied women (P<0.001), women
whose highest level of education was secondary school
(P= 0.01), women with lower incomes (P<0.001), women
with blue-collar occupations (P<0.001) and women who
were not in live-in relationships (P<0.001). Women living in
regional locations were less likely to report multiple sexual
partners in the last year (P= 0.01). For women, reporting
multiple sexual partners was not signicantly related to
speaking a language other than English at home (P= 0.10).
Lifetime heterosexual behaviour
The data in Table 4show that over 94% of respondents
had engaged in vaginal intercourse, over 80% of respondents
reported lifetime experience of oral sex, and approximately one
in ve respondents reported lifetime experience of heterosexual
anal intercourse. Although men were no more likely than women
to report experience of vaginal intercourse (P= 0.71), they
were more likely to report experience of oral sex (85.8% vs
80.1%, P<0.001) and anal intercourse (24.9% vs 19.3%,
P<0.001).
There was a signicant association between age and
experience of vaginal intercourse (P<0.001 for men and
women). Respondents in the youngest age group were the
least likely to have had vaginal intercourse, but among those
aged 20 years or over there was little variation with increasing
age. Although there were signicant associations with age
for both oral sex (P<0.001 for men and women) and anal
intercourse (P<0.001 for men and women), the patterns of
association with age were different from those for vaginal
intercourse. For both oral and anal sex, the youngest
respondents were the least likely to report experience of these
behaviours, and respondents aged 60 years and over were less
likely than those aged 2059 years to report experience of these
behaviours.
Most recent heterosexual encounter
The data in Table 5describe the relationship between
the respondent and his/her most recent heterosexual partner.
Men were signicantly more likely than women to report that
their most recent sexual partner was someone other than a
regular partner (P<0.001). It is worth noting that this
difference is driven by more men reporting occasionalor
casualpartners and that there was no difference between
men and women for regular not live inand otherpartners
(Table 5). There was also a signicant association between
gender and partner age (P<0.001). Men were less likely than
women to report that their partner was older than them, and more
likely to report that they were older than their partner.
Approximately half of the respondents reported using some
form of contraception at their last heterosexual encounter,
with no signicant difference between men and women
(P= 0.28).
The sexual behaviours reported by respondents during their
most recent heterosexual sexual encounters are also reported
in Table 5in order of decreasing frequency. In nearly all of the
sexual encounters, respondents had vaginal intercourse. Men
422 Sexual Health C. Rissel et al.
were more likely than women to report that during their last
sexual encounter they engaged in vaginal intercourse (P= 0.05),
cunnilingus (P<0.001) and anal intercourse (P<0.001), but
there was no difference between men and women in reporting
manual stimulation of the male partner by the female partner
(P= 0.46) and fellatio (P= 0.10). However, women were less
likely to report manual stimulation by the male partner
(P<0.001). Although the majority of men and women had an
orgasm during their most recent heterosexual encounter, women
were signicantly less likely than men to report that they had an
orgasm (P<0.001).
Condom use for vaginal intercourse was reported by 23.3%
of respondents, with men signicantly more likely than women
to report condom use (P= 0.01). Condoms were used in 22.3%
of the instances of anal intercourse, with no difference in
the proportions of men and women reporting condom use
(P= 0.52).
Table 6shows the differences in major variables between
ASHR1 and ASHR2 for Australians aged 1659 years. Since
2002, there has been a statistically signicant increase in the
lifetime number of partners reported by women, but not men,
and there have been statistically signicant increases in the
proportion of both men and women who have ever had
vaginal, oral and anal sex. The most marked increases were
for ever having had oral sex, particularly for women, where the
proportion increased by 15 percentage points. Ever having had
Table 3. Correlates of reporting multiple other-sex partners in the last year
Respondents who reported heterosexual activity in the last year. Unless indicated otherwise, data show the percentage of
respondents in each category reporting behaviour. Unadjusted odds ratios (OR) and 95% condence intervals (CI) are for
reporting multiple other-sex partners in the last year
Correlate Men
(n= 8530)
OR (95% CI) Women
(n= 8124)
OR (95% CI)
Total 14.7 8.6
Age (years)
1619 43.2 1.70 (1.272.28) 32.9 2.16 (1.543.00)
2029 30.9 1 18.6 1
3039 10.3 0.26 (0.200.33) 5.9 0.28 (0.210.37)
4049 8.2 0.20 (0.160.25) 3.8 0.17 (0.130.23)
5059 7.6 0.19 (0.150.23) 2.3 0.10 (0.070.14)
6069 5.7 0.13 (0.100.17) 1.4 0.06 (0.040.10)
Language at home
English 14.8 1 8.8 1
Other 12.8 0.84 (0.621.15) 5.8 0.65 (0.381.09)
Sexual identity
Heterosexual 14.5 1 7.9 1
Homosexual 25.8 2.05 (0.3412.1) 19.4 2.79 (0.3423.09)
Bisexual 30.6 2.59 (1.474.57) 35.3 6.33 (4.109.78)
Other/Refused 13.2
A
19.0
A
Education
Lower secondary 14.6 1 8.7 1
Secondary 17.9 1.27 (1.021.59) 12.5 1.50 (1.102.04)
Post-secondary 12.4 0.82 (0.661.03) 7.0 0.79 (0.591.06)
Region of residence
Major city 15.3 1 9.3 1
Regional 12.5 0.79 (0.670.94) 6.5 0.68 (0.540.85)
Remote 20.8 1.46 (0.902.37) 13.3 1.51 (0.683.35)
Household income group
Very low (<$28 000) 27.2 1 22.2 1
Low ($28 000$52 000) 22.2 0.76 (0.581.00) 14.3 0.58 (0.430.78)
Middle ($52 001$83 000) 15.6 0.49 (0.380.64) 7.0 0.26 (0.190.36)
High ($83 001$125 000) 10.5 0.31 (0.240.41) 4.4 0.16 (0.110.23)
Very high (>$125 000) 9.3 0.27 (0.210.36) 4.0 0.15 (0.100.21)
Occupational category
Blue collar 18.0 1 9.8 1
White collar 18.5 1.04 (0.851.26) 10.2 1.05 (0.761.45)
Manager/professional 10.0 0.50 (0.420.60) 5.8 0.57 (0.400.81)
Relationship
Live-in 12.6 1 5.0 1
Regular 71.6 17.57 (13.2023.39) 52.2 20.88 (14.8429.39)
Occasional 87.5 48.86 (26.7089.43) 60.0 76.51 (39.32148.85)
Casual 91.2 71.88 (43.36119.14) 73.3 52.59 (29.4793.84)
Other 49.3 30.31 (13.8166.52) 21.0 5.08 (1.9213.47)
A
OR not calculated because there were too few observations to allow reliable estimation of OR.
Heterosexual experience and recent encounters Sexual Health 423
anal sex increased for both men and women by 5 percentage
points.
Discussion
Although current patterns of heterosexual behaviour in Australia
are broadly similar to those found in Australia in 200102,
7
there
has been an increase in the lifetime number of partners
reported by women. This increase among women has
also been observed in the UK and US.
11,14
Nonetheless,
heterosexual men still reported more sexual partners than
women, which internationally is a common nding. This may
be related to women using more accurate methods for calculating
their number of partners than men,
22
as well as men over-
estimating, and women under-estimating their number of
sexual partners.
23
Differences between men and women may
also be attributable to men using female sex workers, who are
less likely to be sampled, and men being more likely to
experience sex abroad.
Among respondents who were sexually active in the year
before being interviewed, 14.7% of men and 8.4% of women
reported multiple sexual partners in the last year. This group of
respondents included very few married men or women. As has
been found previously, younger respondents were the most
likely to report having sex with more than one partner in the
recent past.
24
Bisexual respondents were more likely than
heterosexual respondents to report multiple other-sex partners.
Multiple partners were also more likely to be reported by men
and women living in cities, those with lower incomes, and those
with blue-collar occupations.
Relative to ASHR1, the proportions of men and women who
reported experience of oral sex or anal intercourse had increased
signicantly. This is consistent with increases in the lifetime
experience of oral and anal sex in other countries.
11,14,25
The
reasons for these increases are unclear, but they may be due to
increased experimenting associated with liberal societies and
the sexualisationof the popular media and advertising. The
increased availability of pornography via the Internet, which
frequently depicts oral and anal sex, may also have contributed
to increased experimentation. Despite increases in reports of
ever having had heterosexual anal intercourse (25.3% of men
and 19.3% of women), only 1% of men and 0.4% of women had
anal intercourse the last time they had sex with a partner of the
other sex, and this proportion has not changed in Australia.
24
Table 4. Lifetime experience of heterosexual behaviours among men
and women
Unless indicated otherwise, data show the percentage of category reporting
behaviour. Unadjusted odds ratios (OR) and condence intervals (CI) are
given for women versus men
Behaviour and age
group (years)
Men
(n= 9897)
Women
(n= 10 028)
OR (95% CI)
Vaginal intercourse
Total 94.1 94.2 0.97 (0.821.14)
1619 65.0 60.0
2029 90.4 89.1
3039 98.2 98.8
4049 99.0 99.0
5059 99.0 99.4
6069 98.8 99.5
Oral intercourse
Total 85.8 80.1 0.76 (0.690.83)
1619 63.7 57.1
2029 84.9 81.2
3039 90.8 88.2
4049 91.9 86.9
5059 89.9 81.8
6069 80.0 65.2
Anal intercourse
Total 24.9 19.3 0.78 (0.720.84)
1619 6.5 6.6
2029 22.9 17.7
3039 33.7 27.0
4049 31.2 22.1
5059 25.9 17.6
6069 17.2 14.7
Table 5. Characteristics of most recent heterosexual encounters
among men and women
Unless indicated otherwise, data show the percentage in each category.
Unadjusted odds ratio (OR) and condence interval (CI) are given for
women versus men
Characteristic Men
(n= 7923)
Women
(n= 7698)
OR (95% CI)
Relationship to partner
Regular partner 71.7 75.0 1
Regular but not live-in 17.4 17.1 0.94 (0.771.15)
Occasional 3.5 2.6 0.72 (0.461.11)
Casual/one-night stand 5.3 2.7 0.49 (0.340.70)
Other 1.2 1.2 0.92 (0.511.66)
Relationship to partner
Regular partner 89.1 92.1 1
Other 10.0 6.5 0.70 (0.550.89)
Relative age of respondent
More than 5 years younger 2.9 16.8 4.79 (3.466.62)
15 years younger 18.0 46.6 2.19 (1.742.75)
Same age as partner 12.7 14.1 1
15 years older 46.8 16.7 0.36 (0.280.45)
More than 5 years older 18.2 4.4 0.23 (0.180.31)
Used contraception
No need
A
39.4 33.6 0.89 (0.681.18)
No 10.4 9.9 1
Yes 49.8 55.4 1.17 (0.881.54)
Vaginal intercourse
Yes 95.4 92.4 0.66 (0.440.99)
Condom used 25.5 21.1 0.78 (0.640.94)
Manual stimulation of woman by man
Yes 81.8 73.3 0.67 (0.550.82)
Manual stimulation of man by women
Yes 70.8 69.6 1.07 (0.901.27)
Oral sex: cunnilingus
Yes 31.2 22.9 0.67 (0.570.79)
Oral sex: fellatio
Yes 27.2 24.0 0.87 (0.731.03)
Anal intercourse
Yes 1.2 0.4 0.32 (0.160.63)
Condom used 24.3 16.1 0.60 (0.122.99)
Orgasm
Yes 91.9 66.2 0.15 (0.110.20)
A
Respondent or partner wants a baby, is pregnant, infertile or past
menopause.
424 Sexual Health C. Rissel et al.
Respondentsreports of behaviours engaged in during their
most recent sexual encounters were similar to the results of
surveys of representative samples in other countries.
26,27
Nearly
all sexual encounters involved vaginal intercourse, although
this may not be the most sexually satisfying script
28
for
women, with only two-thirds of women reporting an orgasm
on their last heterosexual encounter compared with 90% of men.
The concept of sexual scriptrefers to traditional expectations
of sequences of sexual behaviour during a sexual encounter.
Our report from ASHR1 of sexual practices associated with
orgasm found that women were more likely to reach an orgasm
in sexual encounters that include more practices, especially
cunnilingus.
29
Condoms were used in ~23% of the most recent sexual
encounters. However, it is important to note that the majority
of these sexual encounters involved a regular sexual partner,
and that the majority also involved the use of some form of
contraception. Therefore, these encounters may not have
represented a situation of high risk of an STI. As described
by Grulich et al. multiple condomless partners over a specic
time period is the main risk factor for STIs,
30
and this
group should remain the priority focus for public health
interventions.
This study revealed that most heterosexual activity occurs
within the context of a regular relationship and that most
people report having sex with only one other-sex partner in
the past year. However, one in 10 respondents had sex with more
than one partner in the last year, and condom use was not
common in respondentsmost recent sexual encounters,
31
highlighting the continued need for interventions targeted at
people with multiple sexual partners, to promote safer sexual
behaviour to reduce the risk of unintended pregnancy and
transmission of STIs including HIV.
Conicts of interest
None declared.
Acknowledgements
This study was funded by the National Health and Medical Research Council
(grant no. 1002174). We are indebted to David Shellard and the staff of
the Hunter Valley Research Foundation for managing data collection and
undertaking the interviews for this study; and to the Social Research Centre
for producing weights for the data. We also thank the 21 139 Australians who
took part in the two phases of the project and so freely shared the sometimes
intimate aspects of their lives. Professor Anthony Smith died during the
course of this project and we intend this work to be a tribute to, and further
example of, the extraordinary contribution his work has made to the sexual
health and wellbeing of Australians.
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www.publish.csiro.au/journals/sh
... Both processes (stability and change) would thus be suitable for contributing to health inequalities, provided that their social stratification could be further substantiated. To our knowledge, however, there is no consistent evidence on this assumption (see the contradictory results in Kupek, 2001;Rissel et al., 2014;Tanfer et al., 1995). More clearly, separations or divorces 2 are regarded in the literature as a health risk because of an observed increase in risky behaviors (e.g., alcohol, promiscuity) and psychological stress (e.g., reduced well-being, increase in depression; Leopold, 2018). ...
Chapter
Full-text available
Thanks to improvements in living standards and health behavior as well as medical progress since the second half of the twentieth century, old age has become a life phase in its own right. This phase usually begins by the transition from working life to retirement (Kohli, 2000). Both the chance of reaching retirement and the life expectancy after retirement have increased significantly (Eisenmenger & Emmerling, 2011). The post-work phase spans several decades for many people now. In addition, people who retire are considerably healthier and more independent than their peers of earlier birth cohorts (Crimmins, 2004). The expansion of this phase of life has been accompanied by a differentiation of older people in terms of health and independence: healthy and active people experience this phase, as do people in need of help and care. This fact is considered by distinguishing between old and very old people (Baltes, 2007). Characteristics of old age are absence of non-compensable health restrictions, self-determination of various activities (e.g., traveling, hobbies, voluntary work), and strong social integration. Overall, the demands of old age can be coped well in this phase. Very old age is characterized by an increase in physical and cognitive losses and diseases, and a decrease in the abilities and possibilities of compensating for deficits (Baltes, 1997; Baltes & Smith, 2003).
... Both processes (stability and change) would thus be suitable for contributing to health inequalities, provided that their social stratification could be further substantiated. To our knowledge, however, there is no consistent evidence on this assumption (see the contradictory results in Kupek, 2001;Rissel et al., 2014;Tanfer et al., 1995). More clearly, separations or divorces 2 are regarded in the literature as a health risk because of an observed increase in risky behaviors (e.g., alcohol, promiscuity) and psychological stress (e.g., reduced well-being, increase in depression; Leopold, 2018). ...
... Both processes (stability and change) would thus be suitable for contributing to health inequalities, provided that their social stratification could be further substantiated. To our knowledge, however, there is no consistent evidence on this assumption (see the contradictory results in Kupek, 2001;Rissel et al., 2014;Tanfer et al., 1995). More clearly, separations or divorces 2 are regarded in the literature as a health risk because of an observed increase in risky behaviors (e.g., alcohol, promiscuity) and psychological stress (e.g., reduced well-being, increase in depression; Leopold, 2018). ...
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“Tell me how much your friends earn and I’ll tell you whether you smoke, what diseases you have and how old you’re going to become!” Part of this statement should be familiar to those who are interested in the connection between social inequality and health. People of comparatively lower socioeconomic status are at higher risk of health problems and are more likely to fall ill and die earlier than those who have a higher income etc. However, the sentence does not ask about your own income, but about the income of your friends. Is this information really meaningful? Does it really make a difference to your own health which friends you have, who you surround yourself with in your everyday life and what social position these people have?
... Both processes (stability and change) would thus be suitable for contributing to health inequalities, provided that their social stratification could be further substantiated. To our knowledge, however, there is no consistent evidence on this assumption (see the contradictory results in Kupek, 2001;Rissel et al., 2014;Tanfer et al., 1995). More clearly, separations or divorces 2 are regarded in the literature as a health risk because of an observed increase in risky behaviors (e.g., alcohol, promiscuity) and psychological stress (e.g., reduced well-being, increase in depression; Leopold, 2018). ...
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The loss of employment is an event that interferes with the lives of everyone affected, causes stress, and can have a negative impact on their health. Meta-analyses show that unemployed people have a worse state of health and a mortality risk that is at least 1.6 times higher than those who are employed. Unemployment is associated with a lower mental and physical health status and, in some cases, with riskier health behavior (particularly tobacco consumption). There are two important theses on the role of social networks in this context: (1) Unemployment changes social networks so that they no longer fulfill their positive function for health (mediator thesis); (2) Unemployment leaves social networks unchanged and persons with resource-rich networks suffer less from health losses due to unemployment (moderator thesis). This article provides an overview of empirical analyses on the topic of networks and unemployment.
... Both processes (stability and change) would thus be suitable for contributing to health inequalities, provided that their social stratification could be further substantiated. To our knowledge, however, there is no consistent evidence on this assumption (see the contradictory results in Kupek, 2001;Rissel et al., 2014;Tanfer et al., 1995). More clearly, separations or divorces 2 are regarded in the literature as a health risk because of an observed increase in risky behaviors (e.g., alcohol, promiscuity) and psychological stress (e.g., reduced well-being, increase in depression; Leopold, 2018). ...
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The influence and significance of social networks in health research are becoming widely discussed. Sociological network research meets the demand for a stronger consideration of “contexts” or the “environment” that influences health and care. Social networks are conceived as a mediating meso-level, which mediates between social macro-structures (e.g., healthcare systems, institutions, and organizations) and individual (not always) rationally acting actors. This perspective offers the possibility to analyze a variety of psychosocial mechanisms. These mechanisms can influence individual health in different ways, including (health) behavior, psyche, or physiology. In this chapter we present some central theoretical concepts, as well as empirical results, on network effects under the headings of “social support,” “social integration,” “social influence,” and “social contagion.”
... Both processes (stability and change) would thus be suitable for contributing to health inequalities, provided that their social stratification could be further substantiated. To our knowledge, however, there is no consistent evidence on this assumption (see the contradictory results in Kupek, 2001;Rissel et al., 2014;Tanfer et al., 1995). More clearly, separations or divorces 2 are regarded in the literature as a health risk because of an observed increase in risky behaviors (e.g., alcohol, promiscuity) and psychological stress (e.g., reduced well-being, increase in depression; Leopold, 2018). ...
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“Tell me how much your friends earn, and I’ll tell you if you smoke, what diseases you have and how long your life will be!” With this somewhat pointed statement, we wanted to shed light on the empirically well-confirmed connection between social and health inequalities from the perspective of network research at the beginning of this book (see chapter “Social networks and health inequalities: a new perspective for research”). Social networks are understood here as mediating entities at an intermediate or meso-level, whose structure and function mediate between vertical (income, education, occupational status, etc.) as well as horizontal (e.g., age, gender, ethnic origin) inequalities and health inequalities (e.g., life expectancy, morbidity rates). Besides this mediating influence a moderating relationship wherein social networks amplify or diminish vertical and horizontal inequalities seems to be reasonable.
... Both processes (stability and change) would thus be suitable for contributing to health inequalities, provided that their social stratification could be further substantiated. To our knowledge, however, there is no consistent evidence on this assumption (see the contradictory results in Kupek, 2001;Rissel et al., 2014;Tanfer et al., 1995). More clearly, separations or divorces 2 are regarded in the literature as a health risk because of an observed increase in risky behaviors (e.g., alcohol, promiscuity) and psychological stress (e.g., reduced well-being, increase in depression; Leopold, 2018). ...
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There are significant differences in morbidity (incidence of disease) and mortality (death rate) between men and women. By puberty, male adolescents are more likely to have health problems. During puberty, girls suffer from chronic and mental illnesses and male adolescents are more likely to suffer from acute and life-threatening diseases. Boys and men have riskier health behavior. The field of research mainly relates to the binarity of the sexes—men and women. Studies on trans and queer persons are rare in this field. Networks have a gender-specific effect on risk behavior. Women provide more and more time-consuming social support, even in case of illness. After widowhood, networks have both negative and positive effects, which are gender-specific.
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In this chapter we deal with the health and inequality aspects of networks from a psychological and sociological life span perspective. In doing so, we pay attention to the mutual interactions between health, social inequality, and networks in the context of biographical transitions that decisively shape the life course of adults. We focus exclusively on young and middle adulthood—here roughly defined as the age span between 20 and 60 years. We introduce the disciplinary perspectives and paradigms that deal with the topic of networks and health inequalities in different phases of life. We present theories that describe interactions between these concepts, and we summarize the state of research on the relationships between social and health inequalities, networks and health, and inequalities, networks, and health. We conclude with a summary and some desiderata for future research.
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The Australian Study of Health and Relationships is a large national population-representative survey of sexual behavior and attitudes conducted every decade. We describe experiences of sexual difficulties lasting at least a month among Australians surveyed in 2012-2013 and identify changes since the previous survey in 2001-2002. Computer-assisted telephone interviews were completed by 20,091 people aged 16-69 (participation rate 66%) of whom 16,897 people had had sex with a partner in the previous year. We asked how long each difficulty lasted, whether it was a problem and whether they sought treatment. Half (48%) the men and 68% of women reported at least one difficulty. Lack of interest in having sex was common (28% men, 52% women); 21% of men reported coming to orgasm "too quickly," and women reported inability to reach orgasm (25%) and trouble with vaginal dryness (22%). Women were more likely than men not to find sex pleasurable and to have physical pain during intercourse. Some differences by age group were also apparent. Many difficulties were not seen as problems, especially lacking interest and reaching orgasm too quickly. People with erection/dryness problems, or with pain in intercourse, were more likely to seek treatment, as were people with multiple difficulties. Between 2001-2002 and 2012-2013 there was little change for men, but among women rates of all sexual difficulties fell by 4-10 percentage points. This change accompanied a drop in frequency of sex among people in ongoing relationships and an increase in masturbation and use of pornography. One explanation might be that, over time, fewer women were agreeing to "service sex" when they were not in the mood. Overall, the drop in prevalence of women's sexual difficulties since a decade earlier suggests a change towards more egalitarian sexual relations.
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Unlabelled: Background Sexually transmissible infections (STIs) present a substantial public health burden, and are related to modifiable sexual behaviours. Methods: Computer-assisted telephone interviews were completed by a population-representative sample of 20 094 men and women aged 16-69 years. The overall participation rate among eligible people was 66.2%. Respondents were asked questions regarding their knowledge about, self-reported history of, and testing for STIs. Results: STI knowledge was better in women, the young, people of higher socioeconomic status, those with a variety of indicators of being at high STI risk and those with a history of receiving sex education in school. Approximately one in six men and women reported a lifetime history of an STI. A history of STI testing in the last year was reported by ~one in six (17%) women and one in eight men (13%) and higher rates of testing in women were reported in most high-risk groups. The highest rates of STI testing (61%) and HIV testing (89%) were reported in homosexual men. Conclusion: Knowledge of STI-related health consequences and transmission is improving in Australians, and rates of STI testing were relatively high but were higher in women than in men. Further increases in testing rates in both sexes will be required to facilitate the early diagnosis and treatment of STIs, which is a cornerstone of STI control.
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Unlabelled: Background This paper describes the methods and process of the Second Australian Study of Health and Relationships. Methods: A representative sample of the Australian population was contacted by landline and mobile phone modified random-digit dialling in 2012-13. Computer-assisted telephone interviews elicited sociodemographic and health details as well as sexual behaviour and attitudes. For analysis, the sample was weighted to reflect the study design and further weighted to reflect the location, age and sex distribution of the population at the 2011 Census. Results: Interviews were completed with 9963 men and 10131 women aged 16-69 years from all states and territories. The overall participation rate among eligible people was 66.2% (63.9% for landline men, 67.9% for landline women and 66.5% for mobile respondents). Accounting for the survey design and adjusting to match the 2011 Census resulted in a weighted sample of 20094 people (10056 men and 10038 women). The sample was broadly representative of the Australian population, although as in most surveys, people with higher education and higher status occupations were over-represented. Data quality was high, with the great majority saying they were not at all or only slightly embarrassed by the questionnaire and almost all saying they were 90-100% honest in their answers. Conclusions: The combination of methods and design in the Second Australian Study of Health and Relationships, together with the high participation rate, strongly suggests that the results of the study are robust and broadly representative of the Australian population.
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Population-based estimates of prevalence, risk distribution, and intervention uptake inform delivery of control programmes for sexually transmitted infections (STIs). We undertook the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3) after implementation of national sexual health strategies, and describe the epidemiology of four STIs in Britain (England, Scotland, and Wales) and the uptake of interventions. Between Sept 6, 2010 and Aug 31, 2012, we did a probability sample survey of 15 162 women and men aged 16-74 years in Britain. Participants were interviewed with computer-assisted face-to-face and self-completion questionnaires. Urine from a sample of participants aged 16-44 years who reported at least one sexual partner over the lifetime was tested for the presence of Chlamydia trachomatis, type-specific human papillomavirus (HPV), Neisseria gonorrhoeae, and HIV antibody. We describe age-specific and sex-specific prevalences of infection and intervention uptake, in relation to demographic and behavioural factors, and explore changes since Natsal-1 (1990-91) and Natsal-2 (1999-2001). Of 8047 eligible participants invited to provide a urine sample, 4828 (60%) agreed. We excluded 278 samples, leaving 4550 (94%) participants with STI test results. Chlamydia prevalence was 1·5% (95% CI 1·1-2·0) in women and 1·1% (0·7-1·6) in men. Prevalences in individuals aged 16-24 years were 3·1% (2·2-4·3) in women and 2·3% (1·5-3·4) in men. Area-level deprivation and higher numbers of partners, especially without use of condoms, were risk factors. However, 60·4% (45·5-73·7) of chlamydia in women and 43·3% (25·9-62·5) in men was in individuals who had had one partner in the past year. Among sexually active 16-24-year-olds, 54·2% (51·4-56·9) of women and 34·6% (31·8-37·4) of men reported testing for chlamydia in the past year, with testing higher in those with more partners. High-risk HPV was detected in 15·9% (14·4-17·5) of women, similar to in Natsal-2. Coverage of HPV catch-up vaccination was 61·5% (58·2-64·7). Prevalence of HPV types 16 and 18 in women aged 18-20 years was lower in Natsal-3 than Natsal-2 (5·8% [3·9-8·6] vs 11·3% [6·8-18·2]; age-adjusted odds ratio 0·44 [0·21-0·94]). Gonorrhoea (<0·1% prevalence in women and men) and HIV (0·1% prevalence in women and 0·2% in men) were uncommon and restricted to participants with recognised high-risk factors. Since Natsal-2, substantial increases were noted in attendance at sexual health clinics (from 6·7% to 21·4% in women and from 7·7% to 19·6% in men) and HIV testing (from 8·7% to 27·6% in women and from 9·2% to 16·9% in men) in the past 5 years. STIs were distributed heterogeneously, requiring general and infection-specific interventions. Increases in testing and attendance at sexual health clinics, especially in people at highest risk, are encouraging. However, STIs persist both in individuals accessing and those not accessing services. Our findings provide empirical evidence to inform future sexual health interventions and services. Grants from the UK Medical Research Council and the Wellcome Trust, with support from the Economic and Social Research Council and the Department of Health.
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Sexual behaviour and relationships are key components of wellbeing and are affected by social norms, attitudes, and health. We present data on sexual behaviours and attitudes in Britain (England, Scotland, and Wales) from the three National Surveys of Sexual Attitudes and Lifestyles (Natsal). We used a multistage, clustered, and stratified probability sample design. Within each of the 1727 sampled postcode sectors for Natsal-3, 30 or 36 addresses were randomly selected and then assigned to interviewers. To oversample individuals aged 16-34 years, we randomly allocated addresses to either the core sample (in which individuals aged 16-74 years were eligible) or the boost sample (in which only individuals aged 16-34 years were eligible). Interviewers visited all sampled addresses between Sept 6, 2010, and Aug 31, 2012, and randomly selected one eligible individual from each household to be invited to participate. Participants completed the survey in their own homes through computer-assisted face-to-face interviews and self-interview. We analysed data from this survey, weighted to account for unequal selection probabilities and non-response to correct for differences in sex, age group, and region according to 2011 Census figures. We then compared data from participants aged 16-44 years from Natsal-1 (1990-91), Natsal-2 (1999-2001), and Natsal-3. Interviews were completed with 15 162 participants (6293 men, 8869 women) from 26 274 eligible addresses (57·7%). 82·1% (95% CI 81·0-83·1%) of men and 77·7% (76·7-78·7%) of women reported at least one sexual partner of the opposite sex in the past year. The proportion generally decreased with age, as did the range of sexual practices with partners of the opposite sex, especially in women. The increased sexual activity and diversity reported in Natsal-2 in individuals aged 16-44 years when compared with Natsal-1 has generally been sustained in Natsal-3, but in men has generally not risen further. However, in women, the number of male sexual partners over the lifetime (age-adjusted odds ratio 1·18, 95% CI 1·08-1·28), proportion reporting ever having had a sexual experience with genital contact with another woman (1·69, 1·43-2·00), and proportion reporting at least one female sexual partner in the past 5 years (2·00, 1·59-2·51) increased in Natsal-3 compared with Natsal-2. While reported number of occasions of heterosexual intercourse in the past 4 weeks had reduced since Natsal-2, we recorded an expansion of heterosexual repertoires-particularly in oral and anal sex-over time. Acceptance of same-sex partnerships and intolerance of non-exclusivity in marriage increased in men and women in Natsal-3. Sexual lifestyles in Britain have changed substantially in the past 60 years, with changes in behaviour seeming greater in women than men. The continuation of sexual activity into later life-albeit reduced in range and frequency-emphasises that attention to sexual health and wellbeing is needed throughout the life course. Grants from the UK Medical Research Council and the Wellcome Trust, with support from the Economic and Social Research Council and the Department of Health.
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On surveys, men report two to four times as many lifetime opposite‐sex sexual partners (SPs) as women. However, these estimates should be equivalent because each new sexual partner for a man is also a new sexual partner for a woman. The source of this discrepancy was investigated in this study. Participants reported number of lifetime and past‐year SPs and estimation strategies. The pattern of lifetime estimates replicated. The lifetime protocols indicated that people used different estimation strategies, that people who used the same strategy produced similar estimates, that some strategies were associated with large estimates and others with small ones, and that men were more likely to use the former and women the latter. No sex differences in estimates or strategies were apparent in the past‐year protocols. Our findings suggest that discrepant lifetime partner reports occur because men and women rely on different estimation strategies, not because they intentionally misrepresent their sexual histories.
Article
Objective: To describe numbers of opposite-sex partners, experiences of different heterosexual behaviours, and recent heterosexual experiences among a representative sample of Australian adults. Methods: Computer-assisted telephone interviews were completed by a representative sample of 10,173 men and 9,134 women aged 16-59 years from all States and Territories. The response rate was 73.1% (69.4% among men and 77.6% among women). Results: Men reported more sexual partners than women over their lifetime, in the past five years and in the past year. 15.1% of men and 8.5% of women reported multiple sexual partners in the past year. Reporting multiple opposite-sex partners was significantly associated with being younger, identifying as bisexual, living in major cities, having a lower income, having a blue-collar occupation, and not being married. All but a handful of respondents' most recent heterosexual encounters involved vaginal intercourse and condoms were used in one-fifth of these sexual encounters. Anal intercourse was very uncommon during respondents' most recent heterosexual encounters. Conclusion: Patterns of heterosexual experience in Australia are similar to those found in studies of representative samples in other countries. Implications: There may be a need for interventions targeted at people with multiple sexual partners to promote safer sexual behaviour and to reduce the likelihood of transmission of HIV and other sexually transmitted infections.
Article
Sexual behaviour is a major determinant of sexual and reproductive health. We did a National Survey of Sexual Attitudes and Lifestyles (Natsal 2000) in 1999-2001 to provide population estimates of behaviour patterns and to compare them with estimates from 1990-91 (Natsal 1990). Methods We did a probability sample survey of men and women aged 16-44 years who were resident in Britain, using computer-assisted interviews. Results were compared with data from respondents in Natsal 1990. Findings We interviewed 11 161 respondents (4762 men, 6399 women). Patterns of heterosexual and homosexual partnership varied substantially by age, residence in Greater London, and marital status. In the past 5 years, mean numbers of heterosexual partners were 3.8 (SD 8.2) for men, and 2.4 (SD 4.6) for women; 2.6% (95% CI 2.2-3.1) of both men and women reported homosexual partnerships; and 4.3% (95% CI 3.7-5.0) of men reported paying for sex. In the past year, mean number of new partners varied from 2.04 (SD 8.4) for single men aged 25- 34 years to 0.05 (SD 0.3) for married women aged 35-44 years. Prevalence of many reported behaviours had risen compared with data from Natsal 1990. Benefits of greater condom use were offset by increases in reported partners. Changes between surveys were generally greater for women than men and for respondents outside London. Interpretation Our study provides updated estimates of sexual behaviour patterns. The increased reporting of risky sexual behaviours is consistent with changing cohabitation patterns and rising incidence of sexually transmitted infections. Observed differences between Natsal 1990 and Natsal 2000 are likely to result from a combination of true change and greater willingness to report sensitive behaviours in Natsal 2000 due to Improved survey methodology and more tolerant social attitudes.