Sexual health knowledge, attitudes and behaviours: variations among a religiously diverse sample of young people in London, UK

Applying the COM-B behaviour model to understand factors which impact 15-16 year old students' ability to protect themselves against acquirement of Human Papilloma virus (HPV) in Northern Ireland, UK

High-risk strains of Human Papillomavirus (HPV) can lead to the development of a number of cancers including cervical, vulvar, penile, anal and oropharyngeal. HPV vaccination programmes offer the HPV vaccine to males and females 12-13 years old in schools throughout the UK. However, knowledge of HPV remains low in post-primary schools. The aim of this study is to capture 15-16 year old students' perceptions regarding the current provision of HPV education, and whether providing HPV education to 15-16 year olds could influence their intention to be vaccinated and/or future sexual health decisions related to HPV. Between 5th November 2021 and 6th May 2022, seven focus groups were conducted with 34 students in post-primary schools in Northern Ireland, United Kingdom. The data was analysed using the COM-B behaviour model to explore the perceived facilitators and barriers impacting students' ability to protect themselves from acquirement of HPV. Students perceived their knowledge of HPV to be poor and supported the addition of comprehensive mandatory HPV education at 15-16 years old when many of them were becoming sexually active. They identified barriers including lack of parental education, school ethos and religion and insufficient education regarding their legal rights to self-consent to HPV vaccination. Students felt that removal of these barriers would lead to safer sexual practices, increased awareness of the importance of HPV screening and increased HPV vaccination uptake. The recommendations provided by students need to be supported by the Education Authority in conjunction with the Department of Health in order to be successfully implemented into the post-primary school curriculum.

Not Who You Are, But Who You Are With: Re-examining Women's Less Satisfying Sexual Debuts

Gender differences in appraisals of first intercourse are among the largest in sexuality research, with women indicating less satisfying "sexual debuts" than men. Dispositional or "actor-level" explanations for this gender gap are pervasive, yet research has largely examined heterosexual debuts in which actor gender and partner gender are confounded. We assessed whether women's less satisfying sexual debuts are better explained by actor gender or partner gender, comparing experiences of women who debuted with men (WDM) with those of men and women who debuted with women (MDW, WDW). Retrospective accounts of sexual debut were collected from 3033 adults. At first intercourse, we found that WDW had equal physical and emotional satisfaction to MDW, and more satisfaction than WDM, suggesting satisfaction gaps owing to partner gender, not actor gender. This pattern did not extend to a comparison event (first masturbation), where WDW and WDM had similar satisfaction, but less satisfaction than MDW, suggesting an actor gender gap. To identify sources of satisfaction gaps, we probed for corresponding differences in the circumstances of sexual debut. Sexual circumstances were more strongly implicated than nonsexual ones, with relative deprivation of glans stimulation explaining relative dissatisfaction at first intercourse, but not first masturbation, and orgasm explaining it at both. Findings challenge the view that the satisfaction gap at first intercourse reflects an inherent difference between genders. Indeed, they demonstrate similarities when partner gender does not differ and suggest strategies for ensuring equal sexual satisfaction-and equal sexual rights realization-at (hetero) sexual debut.

Sex, Sexuality, and Intimate Relationships Among Afghan Women and Men of Refugee Background Living in Melbourne, Australia: Experiences, Opportunities, and Transcultural Tensions

Over the last two decades, Afghanistan has been a leading country of origin for asylum seekers and refugees arriving in Australia. It is widely recognized that humanitarian migrants experience poorer sexual and reproductive health than the broader population. In turn, a body of research has emerged exploring the sexual and reproductive health of the local Afghan community. However, this has predominantly focused on youth or perinatal experiences, and less attention has been given to the broader relational and social dimensions of sexuality. Accordingly, this research aimed to explore the perspectives and experiences of married Afghan women and men as they navigate and negotiate sex, sexuality, and intimate relationships following settlement in Melbourne, Australia. A total of 57 Afghan women and men participated in six focus group discussions and 20 semi-structured interviews. Male participants described the ways that having increased access to sex and sexually explicit materials in Australia is creating opportunities for them to establish more fulfilling sex lives. Many women also described a growing awareness of sexuality, although often expressed difficulty prioritizing and claiming more pleasurable sexual encounters for themselves. However, concerns about sexual freedom are also creating new challenges for the Afghan community living in Australia in relation to sex and relationships. For example, men expressed fears about women exercising sexual liberties outside of the home, and this appeared to place women's everyday behavior under increased scrutiny. Women also voiced concerns about how easily men can access sex outside of marriage within Australia, and described how this amplified their sense of obligation to be sexually compliant and meet their husband's desires. This study provides new insights into the ways that Afghan community members are moving between societies, and how their understandings of sexual participation, pleasure, desire, health, consent, and capacity for self-determination are being challenged, reshaped, and reconstructed throughout this process.

Knowledge difference of sexually transmitted infections between Hong Kong undergraduates from local and international secondary schools: A cross-sectional study

Background

Since the delivery of sex education is not standardized across local and international secondary schools in Hong Kong, this study aims to assess and compare the knowledge level of sexually transmitted infections (STIs) between university students who attended local and international secondary schools in Hong Kong.

Methods

From January to March 2019, we conducted a cross-sectional survey among undergraduates at the University of Hong Kong. The primary outcome was STI knowledge as measured by a 29-item quiz. A higher quiz score meant a better STI knowledge level. Students' attitude toward sexual health and their sex education history was collected. Bivariate and multivariate analyses were conducted to evaluate the association factor with a better STI knowledge level.

Results

Three hundred and ninety six students were included in the analysis. Three hundred thirty three (85.35%) students attended local secondary schools and 58 (14.65%) students attended international secondary schools in Hong Kong; 200 (50.51%) students were male and 196 (49.49%) students were female. Compared with students from local secondary school, those from international secondary schools had a significantly higher STI quiz score (18.19 vs. 15.4, p = 0.003). The results of multiple linear regression revealed that students in a higher year of study (β = 1.07, p < 0.001), from medical faculties (β = 6.96, p < 0.001), and from international secondary schools (β = 2.27, p = 0.003) achieved a higher STI quiz score.

Conclusion

University students who attended international secondary schools in Hong Kong possess a significantly higher knowledge level of STIs compared with those who attended local secondary schools. Nonetheless, the overall STI awareness among university students is inadequate. The inadequacy of STI awareness calls for the need to plan and implement satisfactory, comprehensive, and standardized sex education across the overall education system in Hong Kong.

How Religion, Social Class, and Race Intersect in the Shaping of Young Women's Understandings of Sex, Reproduction, and Contraception

Using a complex religion framework, this study examines how and why three dimensions of religiosity-biblical literalism, personal religiosity, and religious service attendance-are related to young women's reproductive and contraceptive knowledge differently by social class and race. We triangulate the analysis of survey data from the Relationship Dynamics and Social Life study (RDSL) and semi-structured interview data from the National Study of Youth and Religion (NSYR) to identify and explain patterns. From the quantitative data, we find that all three dimensions of religiosity link to young women's understandings of sex, reproduction, and contraception in unique ways according to parental education and racial identity. There is a lack of knowledge about female reproductive biology for young women of higher SES with conservative Christian beliefs (regardless of race), but personal religiosity and religious service attendance are related to increased contraceptive knowledge for young black women and decreased knowledge for young white women. From the qualitative data, we find that class and race differences in the meaning of religion and how it informs sexual behavior help explain results from the quantitative data. Our results demonstrate the importance of taking a complex religion approach to studying religion and sex-related outcomes.

Sexually transmitted infection knowledge and attitudes among Muslim women worldwide: a systematic review

Extramarital sexual relations are forbidden in Islam, and sexual health information is not readily available in Islamic communities, especially for women. This review aimed to explore sexually transmitted infection (STI) knowledge and attitudes among Muslim women worldwide. A systematic review was conducted on seven electronic databases. We included qualitative and quantitative studies of female Muslim participants of reproductive age, focusing on STI knowledge and attitudes. A narrative synthesis approach was used with thematic analysis methods. Eighteen studies conducted in 13 countries were included. Three main themes were identified: poor knowledge and misconceptions; sources of sexual health information and information needs; and cultural influences on STI knowledge and attitudes. Generally, Muslim women had poor knowledge regarding STI signs and symptoms, prevention, diagnosis and treatment, in addition to many misconceptions. Negative attitudes towards people infected with HIV/AIDS were common, and attitudes were highly influenced by misconceptions and insufficient knowledge. Infected women tended to be subjected to more blame and judgement compared to men. While the review summarises knowledge and attitudes of Muslim women worldwide, we excluded studies that did not clearly state that the study participants were Muslim women, hence many countries with Muslim populations are not represented in this review. Negative attitudes towards STIs make it harder for women to access sexual health information, STI prevention and treatment. This review highlights the need for culturally sensitive sexual health education for Muslim women. Future sex education interventions would benefit from considering the wider personal and external barriers.

Understanding the decline in under-18 conception rates throughout England's local authorities between 1998 and 2017

We consider England's two-decade teenage conception decline in the context of societal changes: rising educational aspirations; growing second- and third-generation teenage ethnic minority populations; increased deprivation associated with economic recession and post-2008 Government austerity; and changing housing availability. Using England's Local Authority Districts (LAD) 1998-2017, we explore the role of area characteristics in explaining spatial differences in under-18 conception rates and how changing characteristics may explain temporal changes. Urban/rural distinctions in teenage conceptions are largely minimised after considering LAD characteristics. Area characteristics continue to partly explain teenage conception rates but are better at explaining area differences than variation over time.

Religiosity differences in the transition to first intercourse before age 18 among Polish students

Poland is a Catholic country and is one of a few countries in Europe where the percentage of people declaring themselves as non-believing remains rather low. Thus, most young Poles are brought up in Catholic families and receive religious instruction at school.

The purpose of this study is to estimate the effects of religiosity and gender on the risk of first intercourse before age 18 among university students in Poland. We analysed data from two comparative studies of affective life, sexual behaviour, and attitudes conducted among university students in 2001 and 2013. We used survival analysis techniques to test for relative differences in the effects of religiosity on the timing of first sexual intercourse. While the results confirm that religiosity was a significant differentiating factor in the sexual behaviours of students in Poland, they also show that religiosity was a significant predictor of sexual abstinence only if a young person regarded religion as very important. The unadjusted median age at first sex for the participants who attached no or little importance to religion was more than 2 years lower than the median age among those who considered religion very important and attended church services regularly. The findings also indicate that there were significant gender differences, with young males transitioning to sex earlier than young females, albeit only among the 2001 cohort. The multivariate analyses confirm the absence of significant gender differences in FSI before age 18 within religious groups (controlling for other factors) in the cohort of students born after 1990. The results for control variables are consistent with the literature indicating that growing up in a two-parent household has a protective effect, and that teenage lifestyles are significant. Our observation of a distinct polarity of students with respect to religiosity and the timing of sexual debut may be a starting point for further analyses of FSI determinants.

Factors influencing sexual and reproductive health of Muslim women: a systematic review

BACKGROUND

In Islamic societies, issues related to sexual and reproductive health (SRH) are rarely discussed and considered sensitive subjects. This review aimed to identify any personal, religious, cultural, or structural barriers to SRH service and education among Muslim women worldwide.

METHODS

A search for qualitative and quantitative studies was conducted on seven electronic databases. A narrative synthesis using thematic analysis was conducted.

RESULTS

Fifty-nine studies were included from 22 countries: 19 qualitative, 38 quantitative and two mixed methods. Many Muslim women have poor SRH knowledge, and negative attitudes which influence their access to, and use of SRH services. Barriers to contraception use among Muslim women included a lack of basic reproductive knowledge, insufficient knowledge about contraception, misconceptions, and negative attitudes. Women had negative attitudes towards family planning for limiting the number of children but not for child spacing, which reflected religious views towards family planning. Religious and cultural beliefs were barriers to contraception use and access to SRH services and information. Family and the community have a significant impact on women's contraceptive use and access to SRH services. Husband and family opposition played a significant role in contraception access and use. Fear of stigmatization and being labelled as having pre-marital sexual relations among unmarried women acted as the main barrier to accessing contraception and seeking SRH information and services.

CONCLUSION

The findings reveal that there are multiple levels of factors that influence Muslim women's SRH. Poor SRH knowledge and practices among Muslim women is complex matter that is affected by personal, community, cultural, religious factors and existing policies and regulations. All these factors overlap and are affected by each other. There is an urgent need for interventions addressing modifiable barriers to SRH education and services to improve knowledge, informed choice and access to services to facilitate better sexual and reproductive wellbeing for Muslim women. It is important to note that while this review aimed to report findings on Muslim women, we acknowledge that significant variations exist within every culture and religion.

Needs assessment for sexual health services development in a small European Union member state

Introduction

Awareness of sexual health in Malta – a small European Union member state started to gain momentum in the new millennium. Taboos and norms about sexuality pose strong barriers for the provision of information, and reproductive health services. A major contributor is the strong influence of the Roman Catholic Church, which holds fast to its prohibitions of sexual behaviours, albeit counterbalanced by the liberal standpoint adopted by the State in recent years.

Methods

Survey data were collected from 269 students aged 16–21 (response rate 89.7%) in a state post-secondary school. The sample was selected through convenience sampling within the school grounds.

Results

Women were more knowledgeable in relation to available services and risks when compared to men. No geographical differences were found. School was the most common source for information, while health professionals, namely general practitioners were considered trusted resources for their needs. Confidentiality was deemed to be the most requested and crucial feature of sexual health services.

Conclusions

Three important multisectoral needs emerged, namely adequate dissemination system of sexual health information, scientifically based sexual health education for professionals in contact with young people, and well-designed and accessible sexual health services. Implications for management include updating health sexual education and promotion strategies, as well as designing better services. Young people should be able to make informed choices regarding their sexual health, in line with contemporary needs.

American Political-Party Affiliation as a Predictor of Usage of an Adultery Website

The more politically conservative Americans are, the more restrictive their sexual attitudes are. A natural follow-up question is how this difference in attitudes relates to actual behavior. But self-reports of sexual behavior may be compromised by a social desirability bias that is influenced by the very sexual attitudes at issue. We employed a non-self-reported measure of sexual behavior: usage of the adultery-focused dating website Ashley Madison. Linking an August 2015 leak of user data from Ashley Madison to 2012 voter registration rolls from five U.S. states, we found 80,000 matches between 200,000 Ashley Madison user accounts and 50 million voters. According to simple rates in the sample, and also to predictively validated regression models controlling for state, gender, and age, we found that Democrats were least likely to use Ashley Madison, Libertarians were most likely, and Republicans, Greens, and unaffiliated voters were in between. Our results provide support for theories arguing that people with stricter sexual attitudes are paradoxically more likely to engage in deviant sexual behavior.

Sociodemographic characteristics associated with the use of effective and less effective contraceptive methods: findings from the Understanding Fertility Management in Contemporary Australia survey

OBJECTIVE

Unintended pregnancy and abortion may, in part, result from suboptimal use of effective contraception. This study aimed to identify sociodemographic factors associated with the use of effective and less effective methods among women and men of reproductive age living in Australia.

METHODS

In a cross-sectional national survey, 1544 women and men aged 18-51 were identified as being at risk of pregnancy. Chi-square and logistic regression analyses were used to assess the sociodemographic factors related to contraceptive use.

RESULTS

Most respondents (n = 1307, 84.7%) reported using a method of contraception. Use of any contraceptive was associated with being born in Australia (Odds Ratio [OR] 1.89; 95% Confidence Interval [CI]1.186, 3.01; p = .008), having English as a first language (OR 1.81; 95% CI: 1.07, 3.04; p = .026), having private health insurance (OR 2.25; 95% CI 1.66, 3.04; p < .001), and not considering religion important to fertility choices (OR 0.43; 95%CI 0.31, 0.60; p < .001). A third used effective contraceptive methods (n = 534, 34.6%; permanent methods: 23.1%, and long-acting reversible contraception (LARC): 11.4%). Permanent methods were more likely to be used in rural areas (OR 0.62; 95%CI 0.46, 0.84; p = .002). Use of the least effective, short-term methods was reported by nearly half (condoms: 25.6%, withdrawal: 12.5%, and fertility-awareness-based methods: 2.8%). Those who relied on withdrawal were more likely to live in a metropolitan area (OR 2.85; 95% CI 1.95, 4.18; p < .001), and not have private health insurance (OR 0.52; 95% CI 0.38, 0.71; p < .001).

CONCLUSIONS

Targeted promotion of the broad range of available contraceptives may raise awareness and uptake of more effective methods and improve reproductive autonomy in certain population groups.

Understanding the sexuality and sexual health of Muslim young people in Canada and other Western countries: A scoping review of research literature

Muslim communities comprise one of the fastest growing populations in Canada and other Western countries. Healthcare providers and educators point to the lack of relevant and inclusive sexual health information as a major barrier in promoting Muslim young people's sexual health. Since evidence-based knowledge is critical to the development of relevant sexual health resources, we undertook a scoping review of primary and secondary research literature on sexuality and sexual health of Muslim young people. For the purpose of identifying relevant literature, we include studies of youth and young adults aged 12 to 30. We searched nine electronic databases encompassing multiple disciplines to identify recent peer-reviewed journal articles and grey literature published in English between 2005 and 2015. The search yielded 1187 articles; 306 duplicated articles were removed; 859 did not meet the inclusion criteria of Muslim young people and sexuality or sexual health; and a total of 22 articles were included in this review. This paper reports on the major themes identified through the review: (1) sexual health knowledge and perspectives on sex education; (2) socialization and conflicting values about sexuality; (3) gender, risks and sexual practices; and (4) sexual health information and service needs. We conclude that the lack of research on sexuality and sexual health of Muslim young people poses a challenge for policy-makers, service providers, sex educators and other stakeholders to gain sufficient understanding to guide the development of effective and inclusive sexual health programming for Muslim young people in Canada and other Western countries.

Ready, Willing, and Able: Contraceptive Use Patterns Across Europe

An "East-West" divide in contraceptive use patterns has been identified across Europe, with Western European countries characterized by the widespread use of modern contraception, and Central and Eastern European countries characterized by a high prevalence of withdrawal, the rhythm method, or abortion. Building on the Ready-Willing-Able framework, this study aims to gain more insight into the micro- and macro-level socioeconomic, cultural, and technological determinants underlying contraceptive use. Data from the Generations and Gender Survey (2004-2011) covering four Western and seven Central and Eastern European countries are used, and multinomial multilevel analyses are performed. Results reveal that individuals who intend to delay parenthood are more likely to use any contraceptive method, whereas holding more traditional values and having a lower socioeconomic status are associated with a higher likelihood of using no or only traditional methods. Regional reproductive rights and gender equality interact in complex ways with these associations. At minimum, our results underline the complexity of the processes underlying the persistent difference in contraceptive use across Europe.

Project YOURLIFE (What Young People Think and Feel about Relationships, Love, Sexuality, and Related Risk Behavior): Cross-sectional and Longitudinal Protocol

Introduction

Sexually transmitted infections and unplanned pregnancies affect adolescent sexual health and are serious public health concerns. They result from sexual intercourse in adolescence, which is usually associated with multiple partners, unprotected sex, and condom misuse. This behavior is related to socio-ecological factors that influence lifestyles. The YOURLIFE project aims to find out what young people think and feel about relationships, love, and sexuality, and to assess the associations between these thoughts and attitudes, adolescents’ social factors, and sexual health.

Materials and equipment

An international school-based study with a cross-sectional and optional subsequent longitudinal design. Three online questionnaires designed for adolescents aged 13/14, 15/16, and 17/18, respectively, will be used. A matching coding system will allow longitudinal follow-up when adolescents reply to follow-up surveys. Questionnaires will include questions related to sociodemographic data; information/communication technologies; leisure time; parental supervision; influences of parents/friends; information sources; messages perceived; and sexuality-related knowledge, attitudes, and opinions. The second and third questionnaires for participants aged 15/16 and 17/18 will also contain variables concerning sexual behavior. Schools will be able to use their results to tailor educational approaches targeting the needs of their students. Multivariate analyses will be performed using the larger international dataset.

Expected impact of the study on public health

The YOURLIFE project will collect comprehensive information about the socio-ecological determinants of the sexual risk-taking of schooled adolescents worldwide. Effective preventive programs could be subsequently designed and tailored to the specific determinants of adolescents from different schools and settings, and also, when analyzed globally, to public health professionals.

Culture and religious beliefs in relation to reproductive health

An increasing number of contemporary research publications acknowledge the influence of religion and culture on sexual and reproductive behavior and health-care utilization. It is currently hypothesized that religious influences can partly explain disparities in sexual and reproductive health outcomes. In this paper, we will pay particular attention to Muslims in sexual and reproductive health care. This review reveals that knowledge about devout Muslims' own experience of sexual and reproductive health-care matters is limited, thus providing weak evidence for modeling of efficient practical guidelines for sexual and reproductive health care directed at Muslim patients. Successful outcomes in sexual and reproductive health of Muslims require both researchers and practitioners to acknowledge religious heterogeneity and variability, and individuals' possibilities to negotiate Islamic edicts. Failure to do so could lead to inadequate health-care provision and, in the worst case, to suboptimal encounters between migrants with Muslim background and the health-care providers in the receiving country.

Religion in sexual health: a staff perspective

This paper reports data on the complexities of delivering religious/spiritual care in sexual health from a staff perspective. A learning needs analysis, in survey format, was conducted with the nursing staff of a leading London, sexual health clinic. Recruitment took place in May 2011 over a period of 2 weeks. The sample consisted of 25 members of staff which included service support workers and registered nurses. The 25 question survey was conducted and reviewed using Survey Monkey™. The survey was divided into three sections, being population demographics, clinical experience and understanding and education. This article will explore the second section of being clinical experience and understanding. This section used six open-ended questions to investigate participant's experience of common clinical episodes where religion was an influential part of the patient experience and decision-making. A range of contemporary sexual health and religious issues were extrapolated from the survey findings ranging from homosexuality to termination of pregnancy. Four main areas of complexity identified from participants responses were sexual dysfunction, treatment issues, sexual health knowledge and high-risk behaviour. Findings from the study highlight the diversity of influence of religion has on the sexual health of patients.

Religiosity, religious affiliation, and patterns of sexual activity and contraceptive use in France

OBJECTIVE

To examine the association between religiosity and sexual and contraceptive behaviours in France.

METHODS

Data were drawn from the 2005 Health Barometer survey, a random sample of 7495 women and 5634 men aged 15 to 44. We used logistic regression models to study the associations between religiosity and sexual and contraceptive behaviours, by gender and religious denomination.

RESULTS

Three quarters of respondents (73%) reported no religious practice, 20% practised occasionally, and 7% regularly. Regular practice was associated with later sexual debut, regardless of religious denomination. Among participants less than 30 years old, religious respondents were less likely to have used a condom at first sexual intercourse (odds ratio [OR] = 0.2 for women, OR = 0.4 for men) or any form of contraception (OR = 0.2 for women). At the time of the survey, sexually experienced adolescents who reported regular religious practice were less likely to use contraception (84.7% vs. 98.1%, p < 0.001). Regular practice was associated with a 50% decrease in the odds of using very effective methods for Catholics, but had no effect among Muslims.

CONCLUSION

This study, conducted in the French secularised context, shows a complex relationship between religiosity and sexual behaviours, which varies by gender, religious affiliation and during the life course.

Is religiosity a barrier to sexual and reproductive health? Results from a population-based study of young Croatian adults

Following the demise of socialism in 1989, religious identification substantially increased in most countries of Central, East, and Southeast Europe. Considering that there is evidence that religiosity is associated with reduced sexual risk taking among young people, this study explored associations between religiosity--assessed at three different levels (religious upbringing, personal religiosity, and social network religiosity)--and sexual risks among young Croatian adults. In addition, we examined whether religiosity predicted chlamydial infection among women and men aged 18-25. The data were collected in a national probability survey carried out in 2010 (n = 1,005). Overall, the effects of religiosity were sporadic, present primarily among women, and of small size. This lack of a sizeable impact of religiosity on young adults' sexuality was likely related to a particular type of religiosity, characterized by individualized morality, found among young people in the country. Although Croatia seems to be one of the most religious countries in Europe, our findings suggest that promoting religious morality--as recently attempted by an abstinence-based educational program--may not be an efficient tool in reducing sexual risks.

Religion versus ethnicity as predictors of unprotected vaginal intercourse among young adults

BACKGROUND

Young adults in North America are at increasing risk for contracting HIV and sexually transmissible infections (STI). Racial differences in HIV or STI risk are well documented, but other cultural and demographic factors contributing to HIV or STI risk are poorly understood. Although religion may play an important role in sexual behaviour, little research has explored its association with sexual attitudes, beliefs and practices. The present study examined how ethnicity, religion, HIV knowledge and attitudes, and other demographic factors are associated with engaging in unprotected vaginal intercourse (UVI) in a diverse sample of unmarried young adults.

METHODS

A cross-sectional study of 666 unmarried university students was conducted from 2005 to 2007, with participants completing an anonymous questionnaire on sexual attitudes and health for course credit.

RESULTS

Approximately 50% of the respondents had engaged in any vaginal intercourse and 32.2% had engaged in UVI in the past 6 months. Multivariable analyses showed that increasing age, being in a relationship for more than 6 months, greater HIV knowledge, stronger attitudes supporting the use of condoms, and religion (but not ethnicity) were associated with engaging in UVI. Among the sexually active subset of the sample (n=332), religion was the only predictor of engaging in UVI.

CONCLUSION

Ethnicity, which is often considered an important variable in sexual health research, does not appear to be associated with UVI when taking into account other demographic variables, particularly religion. Consideration of religion may be important in devising HIV prevention interventions, in order to implement them in accordance with particular religious beliefs.

Attitudes and first heterosexual experiences among Indians and Pakistanis in Britain: evidence from a national probability survey

We compare attitudes, experiences of learning about sex and first intercourse among Indians (n = 393) and Pakistanis (n = 365) using a probability survey of Britain's general population aged 16-44 years conducted during 1999-2001 (n = 12,110). Higher proportions of Pakistanis (64.6%) and Indians (28.1%) reported religion as 'very important' versus 6.2% of other ethnicities. Pakistanis were more conservative in their attitudes, e.g. reporting premarital sex as wrong (adjusted odds ratios [AORs] for sociodemographic differences, 4.71 [men] and 6.59 [women]). Pakistanis were more likely to be married at first sex (AORs 6.2 [men] and 9.53 [women]), yet men were more likely than women to be in non-marital relationships at this time (69.4% versus 25.2%). Pakistani men and women and Indian women were more likely to report not using reliable contraception at first sex relative to others (AORs 2.33, 3.16 and 1.90, respectively). Pakistani and Indian women were more likely than others to report school lessons as their main source of sex education (AORs 2.23 and 1.77) and not discussing sex with their parents during adolescence (AORs 2.04 and 2.62). These unique data have implications for ensuring that sex and relationship education and health promotion messages are appropriately planned, targeted and delivered to benefit Pakistanis and Indians.

Young people of Chinese origin in western countries: a systematic review of their sexual attitudes and behaviour

People of Chinese origin are a growing population group in western countries. The community is seen to be marginalised, under-researched and neglected, in fact the least understood ethnic minority. This paper reports on a systematic review of sexual attitudes and behaviour among ethnic Chinese young people (mainly aged 13-25 years) living in western countries. An extensive literature search was conducted to cover the period of 1989 and 2009 using Medline, CINAHL, PsycINFO and ScienceDirect databases. There has been a dearth of literature in this area. However, results from existing literature show that ethnic Chinese youth reported poorer sexual health knowledge than white young people in their host countries, while they were found to be more likely to disapprove of uncommitted sex, be virgins, lose their virginity at a later age and have fewer sexual partners. Factors associated with their sexual attitudes and behaviour have also been identified. Countries like the United Kingdom, United States and Canada have become multicultural societies with many diverse ethnic groups. Without doubt educators and sexual health professionals need to provide sex education and services which should be culturally appropriate to people from diverse ethnic backgrounds. An understanding of their sexual values, sexual behaviour and associated factors is the first step towards achieving this goal.

Cervical, endometrial and ovarian cancers among immigrants in Sweden: importance of age at migration and duration of residence

In order to compare the risk of gynaecologic cancer among foreign-born women to the risk among those born in Sweden and to elucidate risk of cancer in relation to age at migration and duration of residence, we followed a cohort of 5.3 million women between 1969 and 2004 in Sweden. Through linkage with the national cancer register, we estimated cancer risk as rate ratios (RRs) with 95% confidence intervals (CIs) using Poisson regression. We reported RRs adjusted for age, calendar year of follow-up and years of education. Overall, 18,247 cases of cervical, 35,290 cases of endometrial and 32,227 cases of ovarian cancers occurred during 117 million person-years of follow-up. We found that adjusted RRs of all the three cancers were lower or the same among foreign-born women compared to those born in Sweden. As for cervical cancer, women aged 35-49 years born in Poland and Bosnia and women aged 50 years or more born in South America showed an increased risk, which was related to increasing age at migration. The risk was lowest among women born in Iran, Iraq, Organisation for Economic Cooperation & Development (OECD) and Finland, and highest among women born in Bosnia and Eastern Europe during their first 5 years since immigration. RRs for endometrial and ovarian cancers did not vary by duration of residence or by age at migration. Health care providers should be aware of the higher risk of cervical cancer among immigrants from high-risk areas, especially among those who immigrate at older ages. On the other hand, protective factors for ovarian and endometrial cancers seem to be retained upon migration.