An assessment of HIV/STI vulnerability and related sexual risk-taking in a nationally representative sample of young Croatian adults

The Role of Religiosity and Personal Faith in Young People's Sexual Debut and Sexual Risk Taking: A Bayesian Approach

Using a Bayesian statistical approach, this study aimed to provide a robust assessment of associations between religiosity and personal faith, timing of sexual initiation and sexual risk taking in young people. To produce posterior probability distribution of the estimation of associations, this study combined two population-based surveys of emerging Croatian adults and meta-analytical estimates pertaining to international studies published between 2000 and 2020. Regardless of the prior used, age at sexual debut was delayed by both religiosity (correlations ranged from 0.10 to 0.13) and personal faith (r = 0.09-0.13). Apart from delaying sexual debut, the findings suggest a very limited role of religiosity and personal faith in the protection of sexual and reproductive health among young people.

A meta-analytic exploration of associations between religious service attendance and sexual risk taking in adolescence and emerging adulthood

Findings since 2000 about the association between the frequency of religious service attendance (formal religiosity) and sexual risk taking in adolescents and emerging adults were explored. A systematic literature search (April 2020) focused on articles with data on religiosity and age at sexual debut, number of sexual partners, condom use at most recent sexual intercourse, and consistent condom use. A total of 27 studies with 37,430 participants (Mage = 18.4, range: 12-25, 43.5% male) were included. In random-effects meta-analysis, the link between formal religiosity and sexual risk taking was significant only for age at sexual debut (r = 0.09, 95% CI = 0.05, 0.13) and the number of sexual partners (r = -0.14, 95% CI = -0.19, -0.09). Weak associations between the constructs of interest indicate that formal religiosity is not sufficient to protect young people's sexual health.

Religious faith and sexual risk taking among adolescents and emerging adults: A meta-analytic review

RATIONALE

Although there is some evidence that religious faith may offer protection against sexual risk taking in adolescence and emerging adulthood, no attempts have been made to systematically quantify the association.

OBJECTIVE

Using data from studies conducted in the 2000-2020 period, this meta-analysis aimed to estimate the link between religious faith and four sexual risk-taking behaviors in samples of adolescents and emerging adults.

METHODS

Five different search systems were used to conduct a systematic literature search in April 2020. Studies that contained quantitative data on religious faith and at least one indicator of sexual risk taking (age at sexual debut, number of sexual partners, condom use at most recent sexual intercourse, and consistent condom use) were searched for. In total, 35 articles published in peer-reviewed journals, in English, were identified. Random-effects meta-analytic approach was used to assess target associations among 41,758 adolescents and emerging adults (M_age = 18.9 years, 37% male). To estimate the effect across the four risk indicators, we employed robust variance estimation (RVE) method.

RESULTS

We found small associations between religious faith on the one hand and age at sexual debut (r = 0.08, 95% CI = 0.03, 0.12) and the number of sexual partners on the other hand (r = -0.15, 95% CI = -0.21, -0.09). No association with condom use was observed. With all studies included, the overall effect size was 0.11 (95% CI = 0.06, 0.16), indicating a small (protective) role of religious faith in young people's sexual risk taking.

CONCLUSIONS

Considering the limited role of religious faith in young people's sexual and reproductive health, comprehensive sexuality education remains essential for risk-reduction, even among more religious young people.

Associations between adolescents' use of sexually explicit material and risky sexual behavior: A longitudinal assessment

The unprecedented accessibility and affordability of online sexually explicit material (SEM) has facilitated widespread use among adolescents and growing concerns over adverse reproductive health outcomes. Although SEM-induced risky sexual behavior is among key concerns, there is a paucity of longitudinal research addressing this issue. This study aimed to assess the longitudinal association between frequency of SEM use and risky sexual behavior among adolescents in two independent 5-wave panel samples of Croatian adolescents (n = 368; n = 247). The indicators of risky sexual behavior were: (1) not using a condom at most recent sexual intercourse, and (2) reporting two or more sexual partners. Multilevel logistic regression analysis with a lagged component was used to explore the associations of interest. Controlling for sociodemographic characteristics, pubertal timing and sensation seeking, frequency of SEM use was not associated with the two indicators of sexual risk taking. This study’s findings are relevant for health and educational experts, but also for concerned parents.

Associations Between Croatian Adolescents' Use of Sexually Explicit Material and Sexual Behavior: Does Parental Monitoring Play a Role?

The use of sexually explicit material (SEM) has become a part of adolescent sexual socialization, at least in the Western world. Adolescent and young people's SEM use has been associated with risky sexual behaviors, which has recently resulted in policy debates about restricting access to SEM. Such development seems to suggest a crisis of the preventive role of parental oversight. Based on the Differential Susceptibility to Media Effects Model, this study assessed the role of parental monitoring in the context of adolescent vulnerability to SEM-associated risky or potentially adverse outcomes (sexual activity, sexual aggressiveness, and sexting). Using an online sample of Croatian 16-year-olds (N = 1265) and structural equation modeling approach, parental monitoring was found consistently and negatively related to the problematic behavioral outcomes, regardless of participants' gender. While SEM use was related to sexual experience and sexting, higher levels of parental monitoring were associated with less frequent SEM use and lower acceptance of sexual permissiveness. Despite parents' fears about losing the ability to monitor their adolescent children's lives in the Internet era, there is evidence that parental engagement remains an important protective factor.

Prevalence and Frequency of Heterosexual Anal Intercourse Among Young People: A Systematic Review and Meta-analysis

We aim to assess if heterosexual anal intercourse (AI) is commonly practiced and how frequently it is practiced by young people. We searched PubMed for articles published 1975 to July 2014 reporting data on the proportion of young people (mean age <25) practicing heterosexual AI (AI prevalence) and on number of AI acts (AI frequency). Stratified random-effects meta-analysis and meta-regression were used to produce summary estimates and assess the influence of participant and study characteristics on AI prevalence. Eighty-three and thirteen of the 136 included articles reported data on lifetime AI prevalence and monthly AI frequency, respectively. Estimates were heterogenous. Overall summary estimates of lifetime AI prevalence were 22 % (95 % confidence interval 20-24) among sexually active young people, with no statistically significant differences by gender, continent or age. Prevalence increased significantly with confidentiality of interview method and, among males and in Europe, by survey year. Prevalence did not significantly differ by recall period. An estimated 3-24 % of all reported sex acts were AI. Reported heterosexual AI is common but variable among young people worldwide. To fully understand its impact on STI spread, more and better quality data on frequency of unprotected AI, and trends over time are required.

The influence of religion on sexual HIV risk

This systematic review examines the relationship between religion and sexual HIV risk behavior. It focuses primarily on how studies have conceptualized and defined religion, methodologies, and sexual risk outcomes. We also describe regions where studies were conducted and mechanisms by which religion may be associated with sexual risk. We included 137 studies in this review, classifying them as measuring: (1) only religious affiliation (n = 57), (2) only religiosity (n = 48), and (3) both religious affiliation and religiosity (n = 32). A number of studies identified lower levels of sexual HIV risk among Muslims, although many of these examined HIV prevalence rather than specific behavioral risk outcomes. Most studies identified increased religiosity to be associated with lower levels of sexual HIV risk. This finding persists but is weaker when the outcome considered is condom use. The paper reviews ways in which religion may contribute to increase and reduction in sexual HIV risk, gaps in research, and implications for future research on religion and HIV.

Predictors of sexual assertiveness: the role of sexual desire, arousal, attitudes, and partner abuse

This study was conducted to test interpersonal, attitudinal, and sexual predictors of sexual assertiveness in a Spanish sample of 1,619 men and 1,755 women aged 18-87 years. Participants completed measures of sexual assertiveness, solitary and dyadic sexual desire, sexual arousal, erectile function, sexual attitudes, and frequency of partner abuse. In men, higher sexual assertiveness was predicted by less non-physical abuse, more positive attitudes toward sexual fantasies and erotophilia, higher dyadic desire, and higher sexual arousal. In women, higher sexual assertiveness was predicted by less non-physical abuse, less solitary sexual desire and higher dyadic sexual desire, arousal, erotophilia, and positive attitudes towards sexual fantasies. Results were discussed in the light of prevention and educational programs that include training in sexual assertiveness skills.

Rising popularity of anal intercourse and sexual risk taking: findings from two national probability studies of young Croatian adults

This study examined the prevalence and correlates of heterosexual anal intercourse in two national probability samples of young Croatian adults aged 18–25 years, which were collected in 2005 and 2010. The lifetime prevalence of anal intercourse increased from 27% to 36%. In multivariate analysis, reporting four or more lifetime sexual partners was the only correlate of the experience of anal intercourse that was significant among both women (odds ratios [ORs] = 1.78–3.27, P < 0.05) and men (ORs = 3.14–4.63, P < 0.01). Information about condom use at most recent anal intercourse was collected in the 2010 study wave only. Age (OR = 0.80, P < 0.05), female gender (OR = 0.29, P < 0.01), holding more negative attitudes towards condoms (OR = 0.28–0.32, P < 0.05) and reporting condom use at most recent vaginal intercourse (OR = 11.45, 95% Confidence interval [CI] = 5.68–23.06) were associated with using a condom at most recent anal intercourse. Given the substantial prevalence of anal intercourse among young heterosexual adults and considerable sexually transmitted infection/HIV risks associated with the practice, sex education programmes should promote the discussion of health risks associated with anal eroticism.

Condom use errors and problems in a national sample of young Croatian adults

In this study, we examined the correlates of condom use errors and problems in a population-based study conducted in 2010 among young Croatian adults aged 18-25 years. Out of a total sample of 1,005 participants, 679 reported condom use in the preceding year. The analyses focused on four outcomes: condom breakage, condom slippage, condom-related erection loss, and delayed condom application. Eighteen percent of participants experienced breakage, 13% reported slippage, 17% reported erection loss, and 34% applied a condom after intercourse started. Multivariate logistic regression analyses were performed to examine the correlates of these condom use errors and problems. Condom breakage was less likely to be reported by women and older participants. The odds of breakage were increased for participants who reported being under the influence of drugs during sex and who reported other condom use errors and problems in the past year. Condom slippage was more likely to occur among younger participants and those who reported condom breakage and delayed condom application. Condom-related erection loss was positively associated with a higher number of sexual partners in the preceding year, condom breakage, and a higher score on the Anti-Erotic Obstacles to Condom Use Scale. Odds of delayed condom application were increased for participants who experienced condom breakage and for those who consumed alcohol before sex in the past year. Having used a condom at first sex significantly reduced the odds of applying a condom after intercourse started. In comparison to non-habitual condom users, habitual users were found less likely to report any of the assessed condom use errors and problems. Improving condom use skills remains an important task in Croatia, which is currently hampered by the absence of evidence-based sex education in schools.

Revisiting the association between pornography use and risky sexual behaviors: the role of early exposure to pornography and sexual sensation seeking

Among the suggested problems and harms associated with widespread pornography use among young people, risky sexual behaviors have been frequently mentioned. To further explore this public health concern, this article analyzed sexual sensation seeking (SSS) as a potential confounder of the association between pornography use and sexual risks using data collected in 2010 from a population-based sample of young Croatian adults aged 18 to 25 (n = 1,005). Significant, but small, correlations were found between the indicators of pornography use (age at first exposure, frequency of use in the past 12 months, and personal importance of pornography) and sexual risk taking. However, in a multivariate analysis, only age at first exposure to pornography remained a significant, albeit weak, predictor of sexual risk taking among both women and men. SSS, defined as the dispositional tendency toward the impulsive pursuit of sexual arousal and stimulation, neither confounded nor moderated this association. Overall, the findings do not support the notion that pornography use is substantially associated with sexual risk taking among young adults, but suggest that early exposure to sexually explicit material and high SSS are additive risk factors for sexual risk taking.

Review of HIV vulnerability and condom use in central and eastern Europe

The epidemiological trend of increasing HIV incidence rates due to sexual transmission in central and eastern Europe has been documented. The current review analysed research articles that report on a wide spectrum of vulnerable populations from this world region. Studies of injection drug users, commercial sex workers, men who have sex with men, adolescents and young adults all reported inconsistent condom use. However, these patterns varied across populations and geographic areas. Populations in former Soviet countries - the most affected by HIV - also often appeared to have lower condom use rates. Intensified, comprehensive and locally tailored measures to curb sexual HIV transmission are urgently needed. Social development programs need to incorporate HIV prevention.

Changes in human immunodeficiency virus and sexually transmitted infections-related sexual risk taking among young Croatian adults: 2005 and 2010 population-based surveys

AIM

To determine changes in sexual behaviors and other relevant characteristics related to human immunodeficiency virus (HIV) and sexually transmitted infection (STI) risks among young Croatian adults.

METHOD

We surveyed adults aged 18-24 in 2005 (n=1092) and 18-25 in 2010 (n=1005). Both samples were probabilistic and stratified by county, settlement size, age, and gender. The samples were non-matched. Trained interviewers conducted structured face-to-face interviews in participants' households. The part of the questionnaire assessing sensitive information was self-administered.

RESULTS

A majority of participants at both survey points (85.2%-86.2%) were sexually active. Median age at sexual debut (17 years) remained unchanged. Lifetime number of sexual partners was also stable. More women than men reported only one lifetime sexual partner. The prevalence of condom use at first intercourse increased (from 62.6 to 70%, P=0.002), while the prevalence of condom use at most recent sexual intercourse remained stable (54% in 2005 and 54.7% in 2010). Consistent condom use also remained unchanged. Consistent condom use in the past year was reported by 19.2% participants in 2005 nad 20% in 2010.. At both survey points for both genders, consistent condom use was associated with age (odds ratio [OR] W2005=0.74, P=0.004; ORW2010=0.72, P<0.001; ORM2005=0.73, P<0.001; ORM2010=0.80,P=0.006), negative attitudes toward condom use (ORW2005=0.84, P=0.001; ORW2010=0.90, P=0.026; ORM2005=0.92, P=0.032; ORM2010=0.90, P=0.011)), and condom use at first intercourse (ORW2005=3.87, P<0.001; ORW2010=4.64, P<0.001; ORM2005=5.85, P<0.001; ORM2010=4.03, P<0.001). In the observed period, HIV/AIDS knowledge was stable.

CONCLUSION

Risky sexual practices remain common among young Croatian adults. Given the recently reported STI prevalence rates in this age cohort, introduction of school-based sex education that would focus on protective behavioral and communication skills seems to be of crucial epidemiological importance.

Urine-based testing for Chlamydia trachomatis among young adults in a population-based survey in Croatia: feasibility and prevalence

Background

We assessed the feasibility of collecting urine samples for testing on genital Chlamydia trachomatis infection in a population-based survey, and prevalence of this infection among young people aged 18-25 in Croatia. In Croatia, as in the other countries of Eastern Europe, there is a lack of data on prevalence of C trachomatis in the general population, including young adults.

Methods

We sampled participants using a nationally representative, multi-stage stratified probability sample of young men and women. Detection of C trachomatis DNA in urine samples was performed by using a real-time PCR assay COBAS^® TaqMan^® CT Test, v2.0.

Results

Overall, 1005 young adults participated in the behavioural part of the survey, and 27.9% men and 37.5% women who were sexually experienced agreed to provide urine samples for testing on C trachomatis. Using multivariate analysis, women were significantly more likely to provide urine samples than men (aOR = 1.53, 95% CI 1.14-2.06) as were those who reported no condom use at last intercourse (aOR = 1.95, 95% CI 1.44-2.62). Prevalence of C trachomatis infection among those who were sexually experienced was 7.3% in men and 5.3% in women.

Conclusions

Population-based surveys that use probabilistic sampling are a feasible way to obtain population estimates of C trachomatis prevalence among young adults in Croatia, but it is challenging to obtain an adequate response rate. The prevalence of C trachomatis among young adults in Croatia found in this study was higher than that found in other European countries with similar survey response rates.

Is anal sex a marker for sexual risk-taking? Results from a population-based study of young Croatian adults

Background There is evidence that anal sex is becoming increasingly popular among heterosexual women and men. Several studies carried out in especially vulnerable populations (e.g. sex workers and low-income youth) suggested that anal sex may indicate a more general propensity to sexual risk-taking. Methods: To assess whether this epidemiologically important finding holds in the case of young adults from the general population, we analysed data from a cross-sectional probability survey carried out in 2010 on 1005 Croatian women and men aged 18–25. Results: Anal intercourse was reported by 36.5% of 861 sexually experienced participants (42.7% of men and 29.8% of women). About one-third of them (34%) used a condom at most recent anal intercourse. The experience of anal sex was significantly associated (P < 0.001) with all four indicators of sexual risk-taking (condom use at most recent vaginal intercourse, number of sexual partners in the past year, concurrent sexual relationships and anonymous sex in the past year), as well as with negative attitudes and beliefs about condom use (P < 0.01). Sexual sensation-seeking mediated the relationship between anal sex and some of the sexual risk-taking behaviours. Conclusion: According to the findings, heterosexual anal sex is directly and indirectly associated with increased behavioural risks of acquiring HIV and other sexually transmissible infections (STI). Sex education and STI prevention programs should focus on the importance of using protection when practicing anal sex.

Should we take anodyspareunia seriously? A descriptive analysis of pain during receptive anal intercourse in young heterosexual women

Anal sex is becoming increasingly prevalent among heterosexual women and men. Although pain related to receptive anal intercourse is not uncommon, little is known about its phenomenology. This article aims to assess the prevalence and correlates of pain during anoreceptive intercourse, including anodyspareunia, its most severe form, among young women. An online survey focusing on anal eroticism was carried out in March and April 2010 on a convenience sample of 2,002 women 18-30 years of age. Participants who reported 2 or more episodes of anal intercourse in the past year were asked about the level and frequency of pain at anoreceptive penetration; those who reported unbearable (too painful to continue) or strong pain at every such occasion were classified as anodyspareunic. The experience of receptive anal intercourse was reported by 63.2% (n = 1,265) of participants. Although almost half (48.8%) had to discontinue their first anoreceptive intercourse because of pain or discomfort, a majority of women (62.3%; n = 788) continued anal sex. Of the 505 participants who reported 2 or more episodes of anal intercourse in the past year, the women (8.7%; n = 44) who reported severe pain during every anoreceptive penetration were classified as anodyspareunic; all others were classified as non-anodyspareunic. For more than two thirds of women with anodyspareunia, the current pain level remained unchanged from their first experience with anal sex. Inability to relax was the most frequent self-hypothesized cause of pain among the anodyspareunic and nonanodyspareunic groups. Compared with other women, those with anodyspareunia reported substantially lower levels of sexual satisfaction (odds ratio = .95; p < .001) and were less sexually assertive (odds ratio = .80; p < .01). The findings that a substantial proportion of women reported pain at first and subsequent anoreceptive intercourse highlight a need for more information and education about anal eroticism.