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Socio-cultural and psychosocial dimensions of sexual risk taking
Abstract
Although the notion of sexual risk taking encompasses a number of potential problems related to human sexuality, it is most often used to describe the risks associated with acquiring sexually transmitted infections (STIs), including HIV. It has been well established that STIs often have negative consequences for reproductive and sexual health in both women and men from adolescence onward. An understanding of non-medical aspects of sexual risk taking is of crucial importance for the efficient prevention of STIs. The psychosocial dimension of sexual risks describes the individual and peerbased characteristics that influence sexual decision making and the probability of becoming infected with an STI. The socio-cultural dimension points to the existence of various ideological and moral expectations in a given society, which may increase or decrease vulnerability to sexual risk among different social groups or populations. Efficient prevention of STIs requires (a) knowledge of the medical aspects and a thorough understanding of non-medical aspects of sexual risks, (b) distinguishing between scientific facts and moralistic/ideological claims, and (c) interdisciplinary prevention programs, including the introduction of comprehensive sex education.
Seksualno eksplicitni materijal (SEM) je bilo koji materijal koji prikazuje spolne organe, a kojemu je cilj seksualno uzbuđenje ili poticanje mašte uz prikaze jasno eksplicitnih seksualnih radnji. Učestalost korištenja raznih vrsta SEM-a nerijetko se dovodi u vezu s različitim seksualnim ponašanjima (seksualni odnosi pod utjecajem psihoaktivnih supstanci, povremeni seksualni odnosi) i stavovima (permisivnost seksualnih stavova, stavovi o seksualnim aktivnostima i intimnim odnosima). Stoga je cilj ovog istraživanja bio ispitati odnos između korištenja seksualno eksplicitnog materijala i seksualno rizičnog ponašanja (rano seksualno iskustvo, korištenje kondoma u većini seksualnih veza, seksualna veza s nepoznatom osobom). Konačni uzorak bio je sastavljen od 58 muškaraca i 85 žena prosječne dobi 20,78 godina. Sudionici su ispunjavali Upitnik seksualno rizičnog ponašanja i Skalu stavova o seksualnosti te su im bila postavljena pitanja o upotrebi SEM-a. Rezultati su pokazali da postoji značajna razlika po spolu u čestini i vrsti korištenja SEM-a, odnosno muškarci upotrebljavaju SEM češće od žena, a također i više upotrebljavaju online videa i online fotografije. Muškarci su ranije bili prvi put izloženi SEM-u. Muškarci su pokazali tendenciju većeg seksualno rizičnog ponašanja i permisivnijih stavova prema seksualnosti u odnosu na žene. Utvrđena je i pozitivna povezanost između čestine korištenja SEM-a i seksualno rizičnog ponašanja u žena, odnosno što žene češće upotrebljavaju SEM, to se i ponašaju seksualno rizičnije. Između ostalog, utvrđena je i pozitivna povezanost između čestine korištenja SEM-a i permisivnosti stavova prema seksualnosti i u muškaraca i u žena, odnosno, što je veća čestina korištenja SEM-a, to su i stavovi prema seksualnosti permisivniji. Ključne riječi: seksualnost, seksualno eksplicitan materijal, seksualno rizično ponašanje, stavovi prema seksualnosti
U radu se opisuju postupci izradbe i provjere metrijskih svojstava višedimenzionalnog instrumenta za mjerenje zapreka uporabi muškoga kondoma. Konstrukcija i validacija provedena je na online uzorku osoba, poglavito studenata, između 18 i 30 godina (N=754). Provedene analize glavnih komponenata pokazale su postojanje pet međusobno povezanih dimenzija zapreka uporabi kondoma: (1) problemi vezani uz pregovaranje o uporabi kondoma i otpor partnera; (2) antierotski aspekti uporabe kondoma; (3) društvena (ne)poželjnost uporabe kondo-ma; (4) manjak samopouzdanja vezanog uz uporabu kondoma i (5) poteškoće vezane uz nabavku i nošenje kondoma. Višedi-menzionalnost skale testirana je i konfirmacijskom faktorskom analizom. Skalu prepreka uporabi kondoma (SPUK; k=27) i njezine komponente obilježava zadovoljavajuća pouzdanost, neovisna o spolu. Valjanost skale utvrđena je analizom povezanosti sa srodnim konstruktima. Autori vjeruju kako bi primjena skale mogla unaprijediti razumijevanje sporadične (nesustavne) upotrebe kondoma i tako poslužiti u izradbi programa prevencije HIV-a i drugih spolno prenosivih bolesti. Ključne riječi: kondom, zapreke uporabi kondoma, evaluacija instrumenta, mladi, odgovorno seksualno ponašanje Vanesa Benković, Hrvatsko društvo za farmakoekonomiku i ekonomiku zdravstva, Drage Stipca 10, 10 000 Zagreb, Hrvatska.
To determine the average age of sexarche in young people in the territory of Bosnia and Herzegovina (BandH) in relation to their sex, place and life-style and religion.
A survey (anonymous questionnaire) about sexual behavior of young people in the period 2007-2009 on the sample of 6000 individuals (experimental group of 5000 students and control group of 1000 non-students) has been conducted in four major university cities in BandH: Sarajevo, Tuzla, Mostar, Banja Luka.
A total of 3.659 (out of 6000, 61%) sexually active youth of which 1871 (51.1%) males, and 1788 (48.9%) females were observed. Among student population there were 3001 (82%), and among non-students 658 (18%) sexually active individuals. The mean (average) age of sexarche in sexually active youth as a whole was 17.34 (SD ± 1.77) in males and 18.20 (SD ± 1.84) in females (p<0.001), and among students and non-students, 17.72 (SD ± 1.81), and 17.92 (SD ± 2.04) (p=0.02), respectively (p=0.01). There was a significant difference of the average values of sexarche among members of different religions, in males ( p<0.001) as well as in females (p=0.004) in both groups.
Results of this study do not present a descending trend of the average age of first coitus in youth in BiH, which is contrary to the results of other countries.
The worldwide epidemic of human immunodeficiency virus (HIV) has affected different populations in different countries. Yet, every country has recognized the particular vulnerability of its young people to possible infection. This vulnerability is commonly thought to relate in the main to young people's assumed universal interest in sexual experimentation.Various studies have demonstrated not only both worrying levels of sexual risk-taking among some young people, but also significant care being taken by others in relation to HIV/AIDS risk. Young people are clearly not a singularity, but rather live their lives in varying social and cultural circumstances that have a bearing on their sexual activities and their ideas about sex. This paper reports on a comparative study of the social and contextual factors affecting young people's risk-related sexual behaviour in seven developing countries. The study was commissioned by the World Health Organization's former Global Programme on AIDS and overseen to completion by the Joint United Nations Programme on AIDS (UNAIDS). The paper outlines the study's cross-cultural design and qualitative methodology, and in particular reports its major findings on gender relations among young people. The findings argue strongly for a reconceptualization of young people's sexuality and for different kinds of research needed to obtain more subtle, detailed social and cultural data for use in designing educational interventions for young people in relation to HIV/AIDS.
The paper analyzes socio-cultural and psychosocial factors affecting sexual activities and related risk-taking behaviors in Croatian high-school students. It attempts to determine the correlates of sexual activity, early sexual initiation, the number of sexual partners, and the use of contraceptives and condoms. Due to the gender-specific trajectories of sexual socialization and initiation, all the analyses were carried out separately for female and male students. The results point out gender-specific structure of adolescent sexual risk-taking, clustering of risk-taking activities, and the habitual character of sexual risk-taking. These findings should be instrumental for the development of a comprehensive school-based sex education curriculum that Croatia lacks.
This study examined the relationship between self-esteem in adolescence and later risky sexual behavior and pregnancy in late adolescence and early adulthood. The investigation analyzed data from a birth cohort of over 1,000 New Zealand young adults studied to the age of 25. Lower levels of self-esteem at age 15 were associated with greater risks of engaging in unprotected sex (sexual intercourse with either an opposite- or same-sex partner without using a condom), a greater number of sexual partners, and a greater risk of pregnancy at ages 15-25. Adjustment for potentially confounding factors, including family socioeconomic background, family functioning, child abuse, and individual characteristics and behavior, reduced the strength of these associations to statistically non-significant levels. It was concluded that the effects of self-esteem during adolescence on later risky sexual behavior and pregnancy were weak and largely explained by the psychosocial context within which self-esteem develops.
Human papillomavirus (HPV) infection is the most common sexually transmitted infection, especially among young, sexually active individuals. As persistent infection with oncogenic types may lead to cervical cancer, HPV testing is a useful tool to screen for women at risk for subsequent development of cervical cancer. The aim of the study was to determine the prevalence of high-risk HPV (hrHPV) infection in different age groups of cytologically selected women from the Zagreb region, and to evaluate the frequency and results of repeat hrHPV testing. During a one-year study period (November 2005 to November 2006), a total of 3,440 cervical samples from women attending gynecological services of public and private health care systems were received. They were tested for 13 hrHPV genotypes by the polymerase chain reaction based AMPLICOR HPV test (Roche Molecular Systems). The overall prevalence of hrHPV was 34.6%. Most samples were obtained from women aged 21-30 years (44.2%), followed by the 31-40 (27.6%), 41-50 (15.7%), 51-60 (5.3%) and 261 (2.4%) age groups. Out of 3,227 cervical samples obtained from women of known age, 4.9% were obtained from the group of girls younger than 21, in which the highest prevalence of hrHPV (49.4%) was found. A similar prevalence was observed in women aged 21-30 (45.1%). The prevalence gradually decreased with age. During the study period, repeat hrHPV testing was performed in samples from 66 women at different intervals. Out of 28 women that were hrHPV negative on initial testing, only five women turned positive on repeat testing. Out of 38 women that were positive on initial testing, in one-third hrHPV could not be detected on repeat testing. As expected, hrHPV infection was highly prevalent in female adolescents and young women. Further investigation on repeat hrHPV testing is needed to assess virus clearance and rate of newly acquired infection.
Two waves of a cross-sectional research study focusing on HIV-related risks in a population of migrant workers were carried out in 2004 and 2006. The research focused on changes in HIV knowledge, beliefs about condom use and risk-taking behaviours. The study included 552 migrant workers in 2004 and 671 in 2006. Using a self-administered questionnaire, data was collected in occupational health offices in nine cities during the process of medical examination required for licensing. Three major changes were observed in the 2004-2006 period. HIV knowledge improved and an increase in condom use at last sexual intercourse with casual partner and at last anal sex was reported. The changes in condom use were observed only among participants who were married or in a relationship. No significant change was recorded in the rates of HIV testing. In 2006, marital status, occupation, beliefs about condom use and personal HIV concerns were found significant predictors of HIV-related behavioural change. Overall, the findings suggest a small reduction in HIV-related sexual risks among migrant workers in Croatia.
The paper examines theoretical concepts of adolescent sexual risk-taking and related methodological questions. In the first part, three models of risk-taking behavior are discussed: epidemological or the risk group model, the personality trait (risk seeking actor) model, and the model of risk factors. Discussing their shortcomings, the author proposes ct reconceptualization which includes rationality, commonness and sequential (path-dependent) organization of the sexual risk-taking in adolescence. In the second part of the paper the author presents a preliminary testing of these extensions using data from a pilot study carried out in 1998 on 417 high-school students. The concluding part offers a brief discussion of the much needed preventive and educational programs in Croatia.
The paper examines the extent and structural characteristics of sexual risk-taking (SRT) in student population. The introductory section offers a definition of SRT, the age specific contributing factors, and a brief overview of related bihevioral research - including all the studies carried out in Croatia (1973-1998). Four hypotheses regarding SRT in late adolescence are tested in the empirical part of the paper, which is based on data collected in the 1998 survey on sexual knowledge, attitudes and behavior carried out on 1355 freshmen at the University of Zagreb. The results confirm the first three hypotheses (regarding the normalcy or omnipresence of SRT, gender specific and sequentially organized structure of SRT), but offer only partial support for the contextual rationality thesis, suggesting instead a complex interplay of rational and irrational (habitual) elements as the psychological background of SRT. The concluding section discusses also more pragmatic, i. e. the applied aspects of the research on SRT, calling for SRT prevention in Croatia through comprehensive school-based sexual education.
A structural model for prediction of AIDS-relevant behavioral changes in young people was developed and evaluated by using full information maximum likelihood estimates obtained from LISREL VII computer program. Exogenous variables in the model are: socio-economic status, demographic status, and age. The model holds that these variables determine AIDS-relevant knowledge and attitudes, which in turn cause perception of personal susceptibility to harm. The latter variable causes AIDS-preventive behavioral changes. The model was tested on four independent samples, each consisting of N=200 young individuals. Six out of seven goodness-of-fit indices suggest acceptable fit of the model. Implications for AIDS-prevention programs are discussed.
Sexual health in the United Kingdom has deteriorated in recent years with further increases in HIV and other sexually transmitted infections (STIs) reported in 2002. This paper describes results from the available surveillance data in the United Kingdom from the Health Protection Agency and its national collaborators. The data sources range from voluntary reports of HIV/AIDS from clinicians, CD4 cell count monitoring, a national census of individuals living with HIV, and the Unlinked Anonymous Programme, to statutory reports of STIs from genitourinary medicine (GUM) clinics and enhanced STI surveillance systems. In 2002, an estimated 49 500 adults aged over 15 years were living with HIV in the United Kingdom, of whom 31% were unaware of their infection. Diagnoses of new HIV infections have doubled from 1997 to 2002, mainly driven by heterosexuals who acquired their infection abroad. HIV transmission also continues within the United Kingdom, particularly among homo/bisexual men who, in 2002, accounted for 80% of all newly diagnosed HIV infections acquired in the United Kingdom. New diagnoses of syphilis have increased eightfold, and diagnoses of chlamydia and gonorrhoea have doubled from 1997 to 2002 overall; STI rates disproportionately affect homo/bisexual men and young people. Effective surveillance is essential in the provision of timely information on the changing epidemiology of HIV and other STIs; this information is necessary for the targeting of prevention efforts and through providing baseline information against which progress towards targets can be monitored.
The relationship between sensation seeking and a number of health behaviours was studied using a Norwegian 18-item version
of the Sensation Seeking Scale (SSS), which was included in a postal survey of a nationwide sample of 3000 Norwegian adolescents
aged 17–19 years, out of whom 1841 responded yielding a response rate of 62.8%. In both sexes sensation seeking was associated
with coital experience, number of sex partners and experience of casual sex. However, sensation seeking was not associated
with contraception use as measured in terms of observations of single acts on single occasions. Sensation seeking was significantly
associated with smoking and alcohol behaviour. The empirical data appear to support the construct validity of the sensation
seeking trait by confirming the expected associations between the trait and certain health behaviours in a Norwegian setting.
Furthermore, these expected associations were revealed using an 18-item SSS instrument only, which appears to demonstrate
the adequacy of a short SSS instrument, being preferable in many survey settings.
In a sample of 163 low-income African American women, we used logistic regression analyses to test for associations between (a) 5 operationalized constructs theorized in the Sexual Health Model to impact one's overall sexual health (barriers to healthy sexuality, sexual anatomy and functioning, positive sexuality, sexual health care, and cultural identity) and (b) several measures of risky sexual behavior (consistent condom use, multiple concurrent partnerships, and overall sexual risk). No significant relationship was found between acculturation and risky sexual behaviors. Having sexual difficulties was positively associated with overall sexual risk and multiple concurrent partnerships. Favorable attitudes toward condoms were positively associated with consistent condom use. Desiring or intending pregnancy was positively associated with inconsistent condom use and overall sexual risk behavior This is only the second study linking sexual difficulties and risky sexual behavior The exact nature of this correlational relationship needs to be studied and replicated in different and more heterogeneous populations.
During the past 20 years, both researchers and program developers made great progress in their efforts to reduce adolescent unprotected sex and prevent teen pregnancy. Research studies are now more likely to employ experimental designs with random assignments, to have large sample sizes with adequate statistical power, to measure actual sexual and contraceptive behaviors, to measure longer term effects, to employ proper statistical methods, and to report results in an unbiased manner. As a result of this body of research, large advances have occurred in our understanding of: 1) the incidence of teen pregnancy, and its consequences; 2) the effects of improving adolescent knowledge, increasing access to contraception, and improving parent/child communication; and 3) the characteristics of effective programs. The on-going evaluation of sex and HIV education programs coupled with creativity and perseverance on the part of program developers led to two groups of effective programs--sex and HIV education programs that reduce sexual risk-taking behavior, and youth development programs that reduce teen-age pregnancy and childbearing.
This study examined two potential mechanisms linking violence exposure and health risk behavior among adolescents in psychiatric care: sensation seeking and coping with stress through escape behavior.
Male (59%) and female adolescents (N = 251), ages 12 to 19 years, from diverse ethnic backgrounds (61% African American, 19% white, 12% Latino, 8% biracial or other ethnicity) completed a computer-administered survey assessing study variables from 1999-2004. Overall clinic consent rate was 41%. Age and gender were included in all analyses.
Consistent with the literature on nonpsychiatric samples, violence exposure was associated with both increased substance use and sexual risk taking. Violence exposure was not associated with motivation to engage in risk behavior as a means of escape, although motivation to cope through escape was associated with a greater likelihood of substance use. Sensation seeking was related to substance use and sexual risk taking among all adolescents and with violence exposure primarily within male adolescents.
Clinical interventions should promote adaptive coping strategies that emphasize maintaining healthy behavior, effective problem solving skills, and stress management techniques.
