Offline and Online Sexual Risk Behavior among Youth in the Netherlands: Findings from "Sex under the Age of 25"

Patterns of Sexting by Youths: A Latent Class Analysis

Sexting (exchanging sexual correspondence in the online space) is considered a practice that expresses sexuality in the online space. Between adolescents, sexting can be part of a couple relationship or outside of it, and can be voluntary or coercive. Regardless of motives, sexting has been linked to various negative outcomes. Understanding the factors that influence sexting behavior is essential for developing effective prevention and intervention programs. The present study aimed to identify and compare different profiles of sexting behavior in adolescents using latent class analysis. Participants were 487 Israeli adolescents aged 14-19 (male N = 215, 44%, female N = 272, 56%) years who completed an online survey of demographic factors, online parental mediation, family and friend cohesion, and perception of sexting norms. Two distinct classes of individuals were identified: those who engage in sexting ("sexters") and those who do not ("non-sexters"). Sexters were more likely to be secular, and without a romantic partner. These findings may inform interventions aimed at preventing negative outcomes associated with adolescent sexting.

Effectiveness of a Theory-Based Digital Animated Video Intervention to Reduce Intention and Willingness to Sext Among Diploma Students: Cluster Randomized Controlled Trial

BACKGROUND

Sexting refers to the exchange of sexually explicit digital content in the form of texts, photos, or videos. In recent years, sexting has become a public health concern. Surveys in Malaysia show a high prevalence of young adults engaged in sexting. Given that sexting is associated with sexual risk behavior, cyberbullying, and mental health issues, this behavior needs intervention to alleviate the resulting public health burden. However, there is a scarcity of theory-based intervention programs on the prevention of intention and willingness to sext among young adults.

OBJECTIVE

This study aimed to develop and implement a sexting intervention module guided by the prototype willingness model (PWM), delivered using web-based animated video, and evaluate its effectiveness among diploma students from a public higher educational institution. The primary outcomes were intention and willingness to sext, while the secondary outcomes were knowledge, attitude, perceived norms, and prototype perceptions of sexting.

METHODS

This 2-armed, parallel, single-blinded cluster randomized controlled trial was conducted in a public higher educational institution in the state of Melaka, Malaysia. Diploma students from 12 programs were randomly allocated into intervention and control groups. Both groups answered a self-administered web-based questionnaire assessing the outcomes at the baseline. The intervention group received a newly developed intervention module based on the PWM in the form of 5 animated videos posted on a private YouTube platform, while the control group was put on the waitlist. The intervention group was encouraged to discuss any issues raised with the researchers via WhatsApp private chat after viewing the videos. All participants were observed immediately and 3 months postintervention. Data analysis was performed with SPSS (version 26; IBM Corp). A generalized linear mixed model was used to determine the effectiveness of the intervention.

RESULTS

There were a total of 300 participants with an attrition rate of 8.3% (n=25). After adjusting for age, sex, relationship status, and the amount of time spent on the web, there were significant differences in the intention to sext (β=-.12; P=.002; Cohen d=0.23), willingness to sext (β=-.16; P<.001; Cohen d=0.40), knowledge (β=.12; P<.001; Cohen d=0.39), attitude (β=-.11; P=.001; Cohen d=0.31), perceived norms (β=-.06; P=.04; Cohen d=0.18), and prototype perceptions (β=-.11; P<.001; Cohen d=0.35) between the intervention and control groups over 3 months.

CONCLUSIONS

In this study, the sexting intervention module using the PWM that was delivered via web-based animated videos was effective in reducing intention and willingness to sext as well as in improving knowledge of sexting, attitudes, perceived norms, and prototype perceptions. Therefore, relevant agencies involved in the promotion of sexual and reproductive health among young adults in Malaysia can consider the implementation of this module.

TRIAL REGISTRATION

Thai Clinical Trial Registry TCTR20201010002; https://www.thaiclinicaltrials.org/show/TCTR20201002001.

Changes in sexually transmitted infections-related sexual risk-taking among young Croatian adults: a 2005-2021 three-wave population-based study

AIM

To assess the prevalence and dynamics of risky sexual behaviors among Croatian emerging adults in the 2005-2021 period.

METHODS

Three surveys were conducted on large-scale national samples of young adults aged 18-24 in 2005 (N=1092) and 18-25 in 2010 and 2021 (N=1005 and N=1210, respectively). The 2005 and 2010 studies were conducted with face-to-face interviews on stratified probabilistic samples. The 2021 study was conducted by computer-assisted web-interviewing on a quota-based random sample from the largest national online panel.

RESULTS

Compared with 2005 and 2010, the age at coital debut increased for both genders in 2021 (by a median of one year, to 18 years, and by a mean of half a year, to 17.5 years, in men and to 17.9 in women). In the 2005-2021 period, condom use increased by about 15% both at first intercourse (to 80%) and in consistent use (to 40% in women and 50% in men). When we controlled for basic socio-demographics, Cox and logistic regressions indicated that, for both genders, in 2005 and 2010 compared with 2021, the risks/odds were significantly higher for reporting an earlier sexual debut (adjusted hazard ratio 1.25-1.37), multiple sexual partners (adjusted odds ratio [AOR] 1.62-3.31), and concurrent relationships (AOR 3.36-4.64), while the odds were lower for condom use at first sexual intercourse (AOR 0.24-0.46) and consistently (AOR 0.51-0.64).

CONCLUSION

Risky sexual behaviors decreased in the 2021 survey compared with the previous two waves, in both genders. Nonetheless, sexual risk-taking is still frequent among young Croatian adults. The introduction of sexuality education and other national-level public health interventions to reduce sexual risk-taking thus remains a public health imperative.

Effectiveness of a School-Based Pregnancy Prevention Intervention for Female Teenagers and Their Boyfriends: A Randomized Controlled Trial

PURPOSE

This study examined the effectiveness of a school-based pregnancy prevention intervention.

METHODS

73 female and male teenagers were recruited from an urban secondary school and randomly assigned to the intervention and control groups. The females were aged 13-15 years, and the boyfriends were aged 13-18 years. The intervention was implemented in six sessions over six weeks. Sessions 1-4 were conducted at the school, and sessions 5-6 were delivered via a smartphone messaging application. The outcomes included sexual health literacy, pregnancy prevention behaviors, and sexual risk behaviors. They were measured three times: at baseline (week 0, T1), immediately post-intervention (week 6, T2), and follow-up (week 10, T3). Two-way mixed repeated measure ANOVA was used to determine the differences of the outcomes.

RESULTS

After completion of the intervention, participants in the intervention group had significantly higher sexual health literacy both at T2 and T3 and better pregnancy prevention behavior. They had lower sexual risk behaviors at T3 than the control group.

DISCUSSION

The results indicate that the school-based pregnancy prevention intervention is effective. It improved the outcomes in female teenagers and their boyfriends at six weeks and 10 weeks post-intervention.

Routine universal testing versus selective or incidental testing for oropharyngeal Chlamydia trachomatis in women in the Netherlands: a retrospective cohort study

BACKGROUND

Pharyngeal Chlamydia trachomatis in women might contribute to autoinoculation and transmission to sexual partners. Data for effectiveness of different testing practices for pharyngeal C trachomatis are scarce. We therefore aimed to assess the prevalence of pharyngeal C trachomatis, determinants, and effectiveness of different testing practices in women.

METHODS

We did a retrospective cohort study, in which surveillance data for all women visiting sexually transmitted infection clinics in all regions in the Netherlands between Jan 1, 2008, and Dec 31, 2017, were used. We collected consultation-level data and individual-level data from 2016 onwards for sociodemographic characteristics, sexual behaviour in the past 6 months, self-reported symptoms, and STI diagnoses. The primary outcome was the positivity rate of pharyngeal C trachomatis infection compared between routine universal testing (>85% tested pharyngeally per clinic year), selective testing (5-85% tested pharyngeally per clinic year), and incidental testing (<5% pharyngeally tested per clinic year). We calculated the number of missed infections by extrapolating the positivity rate assessed by routine universal testing to all selectively tested women. We used multivariable generalised estimating equations logistic regression analyses to assess independent risk factors for pharyngeal C trachomatis and used the assessed risk factors as testing indicators for comparing alternative testing scenarios.

FINDINGS

Between Jan 1, 2008, and Dec 31, 2017, a total of 550 615 consultations with at least one C trachomatis test was recorded, of which 541 945 (98·4%) consultations (including repeat visits) were included in this analysis. Pharyngeal C trachomatis positivity was lower in the routine universal testing group than in the selective testing group (1081 [2·4%; 95% CI 2·2-2·5] of 45 774 vs 3473 [2·9%; 2·8-3·0] of 121 262; p<0·0001). The positivity rate was also higher among consultations done in the incidental testing group (44 [4·1%; 95% CI 3·1-5·5] of 1073; p<0·0001) than in the routine universal testing group. Based on extrapolation, selective testing would have hypothetically missed 64·4% (95% CI 63·5-65·3; 6363 of 9879) of the estimated total of C trachomatis infections. The proportion of pharyngeal-only C trachomatis was comparable between routinely universally tested women (22·9%) and selectively tested women (20·4%), resulting in a difference of 2·5% (95% CI -0·3 to 5·3; p=0·07). When using risk factors for pharyngeal C trachomatis as testing indicators, 15 484 (79·6%) of 19 459 women would be tested to detect 398 (80·6%) of 494 infections.

INTERPRETATION

No optimal testing scenario was available for pharyngeal C trachomatis, in which only a selection of high-risk women needs to be tested to find most pharyngeal C trachomatis infections. The relative low prevalence of pharyngeal-only C trachomatis (0·5%) and probably limited clinical and public health effect do not provide support for routine universal testing.

FUNDING

Public Health Service South Limburg.

Are Youth Sexting Rates Still on the Rise? A Meta-analytic Update

A meta-analysis of 39 studies (110,380 participants) from 2009 to 2015 indicated that youth sexting increased over time. To inform current practice and policy initiatives, this meta-analytic update of studies since 2016 examined if rates of youth sexting have continued to rise and whether youth sexting differs by age, sex, sexting methods, and geographical location. Electronic searches were conducted in March 2020 in Embase, PsycINFO, MEDLINE, and Web of Science, yielding 1,101 nonduplicate records. Studies were included if they provided prevalence of youth sexting and data collection occurred ≥2016. Literature review and data extraction were conducted by following established PRISMA guidelines. All relevant data were extracted by two independent reviewers. To calculate mean prevalence rates, random-effects meta-analyses were conducted. Twenty-eight studies (N = 48,024) met inclusion criteria. The estimated pooled prevalence rates were as follows: (1) sending (19.3%), (2) receiving (34.8%), and (3) forwarding sexts without consent (14.5%). These prevalence rates are statistically similar to studies with data collected before 2016. In recent studies, females receive sexts at a higher rate than males, older youth are more likely to send sexts, and younger and older adolescents receive sexts at similar rates. Youth sexting rates have likely plateaued. Sexting education initiatives should begin early and encourage safe, ethical, and respectful online behavior.

Prevalence and Correlates of Sext-Sharing Among a Representative Sample of Youth in the Netherlands

Many adolescents use their electronic devices to send each other sexually explicit texts, photos, and videos of themselves-commonly known as sexting. This can be fun and is not usually problematic. However, if the intended recipient decides to share these sexts with a broader audience, the consequences for the depicted can be detrimental. The purpose of this study was to investigate the prevalence of (non-consensual) sext-sharing among Dutch adolescents and explore the characteristics of those who do, to gain a better understanding of factors involved in dissemination. We used data from "Sex under the age of 25," a representative national survey on sexual health among a sample of 20,834 Dutch 12-24-year-olds. The prevalence of sext-sharing was estimated using Complex Samples. Logistic regressions were used to assess associations between demographics, school-based sexting education, sexual- and online behavior, and mental health and sext-sharing. About 4% of the adolescents reported having shared someone else's sext in the last six months. Being male, aged 12-14 years, frequent social media usage, watching online porn, sexual experience, and being subjected to sext-sharing themselves associated most strongly with sext-sharing. Our findings show that the likelihood of sext-sharing is lower in older adolescents and that it associates with the extent of adolescents' sexual curiosity and online activity. The overlap between sharing sexts of others and having one's own sext shared suggests that dissemination of personal sexual content might be normalized or used as an act of retribution. Further research could be helpful to explain the mechanisms underlying this overlap. The results of this study illustrate the importance of exposing adolescents to evidence based preventive educational interventions on sexting from 12 years onwards and not just within the context of traditional school-based sex education, but also as a part of the (online) media-literacy curriculum.

Longitudinal Associations Between Sexual Communication With Friends and Sexual Behaviors Through Perceived Sexual Peer Norms

The role of peers in adolescents' sexual behaviors is not yet fully understood. We investigated the association between sexual communication with friends (at T1) and subsequent changes in adolescents' experience with sexual behaviors (between T1-T3), and examined whether this association was explained by adolescents' perceptions of three sexual peer norms (at T2): (1) peers' sexual behaviors (descriptive norms), (2) peers' approval of sexual behaviors (injunctive norms), and (3) peer pressure to have sex. The data source was Project STARS, a longitudinal study on adolescent sexual development in the Netherlands, collected via online self-report questionnaires from 1,116 adolescents (11.5-17.9 years). Adolescents who communicated more frequently with their friends about sexuality-related topics at T1 reported significantly larger increases in their experience with different sexual behaviors between T1-T3. More sexual communication with friends also predicted adolescents subsequently perceiving more 1) peer sexual behaviors, 2) peer approval of sex, and 3) peer pressure to have sex. These stronger perceptions, in turn, predicted larger increases in their sexual behaviors between T1-T3. After adjusting for the three norms simultaneously, the main association between sexual communication with friends and sexual behavior change weakened but remained significant. Inspection of specific indirect effects showed this link was explained by injunctive norms only. No gender differences were found.

Birth control knowledge among freshmen of four Italian universities

Since sexual health education (SHE) is not mandatory in Italian schools, we conducted a survey on freshmen of four Italian university campuses in 2012 to investigate the respective level of sexual health knowledge (SHK) in relation to birth control, with the aim to inform public health policy makers. A convenience strategy was employed to sample 4,552 freshmen registered with various undergraduate courses at four Italian universities: Padua university (Veneto Region); university of Milan (Lombardy Region); university of Bergamo (Lombardy Region); university of Palermo (Sicily Region). We investigated the level of SHK on birth control using 6 proxy indicators: (1) the average length of a woman’s period [outcome with 3 levels: wrong (base) vs. acceptable vs. correct]; (2) the most fertile interval within a woman’s period (binary outcome: correct vs. wrong answer); (3) the event between the end of a period and the beginning of the next cycle (binary outcome: correct vs. wrong answer); (4) the average survival of spermatozoa in the womb (binary outcome: correct vs. wrong answer); (5) the concept of contraception (binary outcome: correct vs. wrong answer); (6) the efficacy of various contraceptives to prevent unintended pregnancies (linear score: 0–17). We fitted 6 separate models of multiple regression: multinomial for outcome 1; logistic for outcomes 2, 3, 4, 6; linear for outcome 6. Statistical estimates were adjusted for a number of socio-demographic factors. Results were expressed as odds ratios (OR) for the 4 multiple logistic regression models, linear coefficients (RC) for the linear regression model and relative risk ratio (RRR) for the multinomial logistic regression model. The level of significance of each risk estimate was set at 0.05. The level of SHK of freshmen sampled was rather low, as 60% interviewees did not know the average length of a woman’s period, the average survival of spermatozoa in the womb and the concept of contraception, whilst the most fertile interval within a woman’s period was known only to 55% of interviewees. The mean score of SHK on the efficacy of various contraceptive methods was only 5 (scale 0–17). Some categories of students were consistently and significantly less knowledgeable on birth control at multivariable analysis: males; students from the university of Palermo; those with vocational secondary school education and those not in a romantic relationship at the time the survey was conducted. The results of this survey clearly call for the introduction of SHE programs in Italian schools, as already done in several European countries. School SHE should start as early as possible, ideally even before secondary school. SHE should be holistic and delivered with a multiple agency coordinated approach involving the Ministry of Health, the Ministry of Education, University and Scientific Research (MIUR), families, schools, public health departments, primary health care providers, pharmacists, media, other.

Changes in young women’s contraceptive use in the Netherlands: findings from three sex under the age of 25 surveys

Prevention of unintended pregnancy among adolescents and young adults under 25 years is pivotal from an individual as well as societal perspective. In the USA, the use of long-acting reversible contraceptive (LARC) has been shown to increase, with no or little change in the use of short-acting reversible contraceptive (SARC). We assessed trends in no contraceptive, SARC, and LARC use by young women, aged between 12 and 25 years, and differences in trends within demographic groups (age, religion, ethnic background, and educational level) among these young women in the Netherlands. Data of sexually active young women aged 12–25 years from three cross-sectional representative surveys, 2005, 2012, and 2017, were used for this study. In total, 11,229 Dutch young women were included with a median age of 20 years (interquartile range 18–23 years). Overall, the proportion of young women using SARC decreased significantly between 2005 and 2017 from 88 to 76%. LARC use increased significantly between 2005 and 2017 from 3 to 16%. These trends varied by religious groups and educational level, emphasizing potential for tailored preventative measures for these groups. A shift towards LARC use might eventually lead to a further decrease in unwanted pregnancy and potentially abortion because of the lower risk of user errors.