Differences Between Landline and Mobile Phone Users in Sexual Behavior Research.

This study investigated differences between the demographic characteristics, participation rates (i.e., agreeing to respond to questions about sexual behavior), and sexual behaviors of landline and mobile phone samples in Australia. A nationally representative sample of Australians aged 18 years and over was recruited via random digit dialing in December 2011 to collect data via computer-assisted telephone interviews. A total of 1012 people (370 men, 642 women) completed a landline interview and 1002 (524 men, 478 women) completed a mobile phone interview. Results revealed that telephone user status was significantly related to all demographic variables: gender, age, educational attainment, area of residence, country of birth, household composition, and current ongoing relationship status. In unadjusted analyses, telephone status was also associated with women's participation rates, participants' number of other-sex sexual partners in the previous year, and women's lifetime sexual experience. However, after controlling for significant demographic factors, telephone status was only independently related to women's participation rates. Post hoc analyses showed that significant, between-group differences for all other sexual behavior outcomes could be explained by demographic covariates. Results also suggested that telephone status may be associated with participation bias in research on sexual behavior. Taken together, these findings highlight the importance of sampling both landline and mobile phone users to improve the representativeness of sexual behavior data collected via telephone interviews.

Associations between early first sexual intercourse and later sexual and reproductive outcomes: a systematic review of population-based data.

The assumption that early sexual debut leads to adverse outcomes has been used as justification for sexual health interventions and policies aimed at delaying sexual initiation, yet research in the area has been limited. This review identified and synthesized published literature on the association between early first sexual intercourse and later sexual/reproductive outcomes. Literature searches were conducted in Medline, Embase, PsycINFO, and Current Contents. In all, 65 citations met the selection criteria (industrialized, population-based studies). By far the most common sexual behavior to have been investigated has been sexual partners. Studies consistently reported early first intercourse to be associated with more recent, lifetime, and concurrent sexual partners. Early initiators were also more likely to participate in a wider range of sexual practices and report increased sexual satisfaction (among men). Furthermore, early first intercourse, in some studies, was shown to increase the risk of teen pregnancies, teen births, and having an abortion, while findings on STIs and contraceptive use have been mixed. These findings, however, must be interpreted with caution due to methodological problems and limitations present in the research, including a lack of consensus on what constitutes early sexual intercourse and inconsistencies and problems with analyses.

Design and methods of the Second Australian Study of Health and Relationships.

UNLABELLED: Background This paper describes the methods and process of the Second Australian Study of Health and Relationships. METHODS: A representative sample of the Australian population was contacted by landline and mobile phone modified random-digit dialling in 2012-13. Computer-assisted telephone interviews elicited sociodemographic and health details as well as sexual behaviour and attitudes. For analysis, the sample was weighted to reflect the study design and further weighted to reflect the location, age and sex distribution of the population at the 2011 Census. RESULTS: Interviews were completed with 9963 men and 10131 women aged 16-69 years from all states and territories. The overall participation rate among eligible people was 66.2% (63.9% for landline men, 67.9% for landline women and 66.5% for mobile respondents). Accounting for the survey design and adjusting to match the 2011 Census resulted in a weighted sample of 20094 people (10056 men and 10038 women). The sample was broadly representative of the Australian population, although as in most surveys, people with higher education and higher status occupations were over-represented. Data quality was high, with the great majority saying they were not at all or only slightly embarrassed by the questionnaire and almost all saying they were 90-100% honest in their answers. CONCLUSIONS: The combination of methods and design in the Second Australian Study of Health and Relationships, together with the high participation rate, strongly suggests that the results of the study are robust and broadly representative of the Australian population.

Attitudes toward sex and relationships: the Second Australian Study of Health and Relationships.

UNLABELLED: Background Attitudes towards sex and relationships influence laws about what is and is not permissible and social sanctions against behaviours considered unacceptable. They are an important focus for research given their links to sexual behaviour. The aim of the present study was to describe attitudes towards sex and relationships, to identify correlates of scores on a scale of sexual liberalism and to examine responses to jealousy-evoking scenarios among Australian adults. METHODS: Computer-assisted landline and mobile telephone interviews were completed by a population-representative sample of 20094 men and women aged 16-69 years. The overall participation rate among eligible people was 66.2%. Respondents expressed their agreement with 11 attitude statements, five of which formed a valid scale of liberalism, and also responded to a jealousy-evoking scenario. RESULTS: There was general agreement that premarital sex was acceptable (87%), that sex was important for wellbeing (83%) and that sex outside a committed relationship was unacceptable (83%). Respondents were accepting of homosexual behaviour and abortion and few believed that sex education encouraged earlier sexual activity. More liberal attitudes were associated with: being female; speaking English at home; homosexual or bisexual identity; not being religious; greater education; and higher incomes. Respondents who expressed more liberal attitudes had more diverse patterns of sexual experience. Predicted sex differences were found in response to the jealousy-evoking scenario - men were more jealous of a partner having sex with someone else and women were more jealous of a partner forming an emotional attachment - but responses varied with age. CONCLUSION: Sexual attitudes of Australians largely support a permissive but monogamous paradigm. Since 2002, there has been a shift to less tolerance of sex outside a committed relationship, but greater acceptance of homosexual behaviour.

First vaginal intercourse and oral sex among a representative sample of Australian adults: the Second Australian Study of Health and Relationships.

UNLABELLED: Background Current information about the characteristics of Australian adults' first vaginal intercourse and contraception or precautions used on that occasion is needed, as well as whether these characteristics have changed between 2001-02 and 2012-13. METHODS: Computer-assisted telephone interviews were completed by a representative sample of 20094 men and women aged 16-69 years. The overall participation rate among eligible people was 66.2%. Respondents indicated their age at first vaginal intercourse and first oral sex. Those who reported vaginal intercourse were asked the age of their partner, their relationship to their partner, the duration of this relationship, and what contraception or precautions (if any) were used. RESULTS: There was a significant decline in the median age of first vaginal intercourse for both men and women among those born between the 1940s and the 1960s, but no further decline since. There has also been a significant increase in the use of protection at first vaginal intercourse, from less than 20% of men and women in the 1950s to over 90% in the 2000s. For men and women, first vaginal sex before age 16 years was significantly associated with a greater number of lifetime and recent sexual partners, and a greater likelihood of having had a sexually transmitted infection. CONCLUSION: Given the earlier age at first vaginal intercourse, sex education should begin earlier so that all young people have information about contraception and disease prevention before they begin their sexual careers.

Heterosexual experience and recent heterosexual encounters among Australian adults: the Second Australian Study of Health and Relationships.

UNLABELLED: Background Current information about numbers of other-sex partners, experiences of different heterosexual behaviours and the recent heterosexual experiences among a representative sample of Australian adults is needed. It is not known whether these practices have changed between 2001-02 and 2012-13. METHODS: Computer-assisted telephone interviews were completed by a representative sample of 9963 men and 10131 women aged 16-69 years from all states and territories. The overall participation rate among eligible people was 66.2%. RESULTS: Men reported more sexual partners than women, although the lifetime number of heterosexual partners reported by women increased significantly between 2001-02 and 2012-13. In 2012-13, 14.7% of men and 8.6% of women reported two or more sexual partners in the last year. Reporting multiple partners was significantly associated with being younger, being bisexual, living in major cities, having a lower income, having a blue-collar occupation and not being married. The proportion of respondents reporting ever having had oral sex or anal intercourse increased significantly since the last survey. At the last heterosexual encounter, 91.9% of men and 66.2% of women had an orgasm, oral sex was reported in only approximately one in four encounters and anal intercourse was uncommon. CONCLUSION: There were increases between 2001-02 and 2012-13 in partner numbers among women and in the lifetime experience of oral and anal sex. The patterns of heterosexual experience in Australia are similar to those found in studies of representative samples in other countries.

Homosexual experience and recent homosexual encounters: the Second Australian Study of Health and Relationships.

UNLABELLED: Background The aim of this study is to describe homosexual experience and characteristics of recent homosexual encounters among Australian adults and identify changes between 2001-02 and 2012-13. METHODS: Computer-assisted telephone interviews were completed by a representative sample of 20094 men and women aged 16-69 years and the participation rate among eligible people was 66.2%. Respondents indicated the number of same-sex partners they had had in their lifetime and in the last 12 months. Those who reported any homosexual experience were asked the age at which this first occurred and about characteristics of the first and most recent homosexual encounter. RESULTS: Reporting ever having same-sex experience was more common in women (13.5%) than in men (6.5%, P<0.001). Among these people, men reported more lifetime and recent same-sex partners than women (P<0.001). Same-sex experience was associated with some but not all indices of higher socioeconomic status. In men, it was associated with living in a major city (P=0.02) and in women, it was associated with younger (<30 years) age and with very low income (P<0.001). Men were younger than women at their first homosexual encounter (P=0.005). Women were more likely than men to have their first same-sex encounter with a regular partner. For women but not men, there was a significant increase in the proportion reporting same-sex experience since 2001-02. CONCLUSION: Same-sex experience is not uncommon and is increasing in prevalence in young Australian women. The high number of same-sex partners among homosexual and bisexual men places them at greater risk of sexually transmissible infection.

Characteristics of heterosexual regular relationships among a representative sample of adults: the Second Australian Study of Health and Relationships.

UNLABELLED: Background The aim of this study was to describe important characteristics of Australian adults' heterosexual regular sexual relationships and examine how these characteristics have changed since 2002. METHODS: Computer-assisted landline and mobile telephone interviews were completed by a representative sample of 20 094 Australian residents aged 16-69 years. The participation rate among eligible people was 66.2%. Data were collected on respondents' social and demographic characteristics, relationship status and duration, cohabitation status, partner's age, contraception use, expectations about sexual exclusivity, sexual partners in the previous year, actual and ideal frequencies of sex and levels of physical pleasure and emotional satisfaction in their relationships. RESULTS: Most sexually active respondents 89%; 74% of all respondents, were in a heterosexual regular relationship. Most (97%) expected sexual exclusivity in their relationships, with 3% reporting extradyadic sex in the previous year. Respondents reported an average frequency of sex of 1.44 times per week, with most reporting very high levels of physical pleasure (men, 88%; women, 76%) and emotional satisfaction (men, 86%; women, 84%) in their relationships. Comparisons with data from the First Australian Study of Health and Relationships revealed that significantly more sexually active men were in a relationship in the current survey; that respondents' average frequency of sex was significantly lower; and that women's reports of extreme emotional satisfaction had risen. Otherwise, results were consistent with those of the first study. CONCLUSIONS: In general, results suggested that the characteristics of Australians' heterosexual relationships changed little between 2002 and 2013. Despite a decline in respondents' average weekly frequency of sex, the majority of respondents reported being in a highly satisfying, sexually exclusive relationship.

Sexual identity, sexual attraction and sexual experience: the Second Australian Study of Health and Relationships.

UNLABELLED: Background Behavioural and other aspects of sexuality are not always consistent. This study describes the prevalence and overlap of same-sex and other-sex attraction and experience and of different sexual identities in Australia. METHODS: Computer-assisted telephone interviews were completed by a representative sample of 20094 men and women aged 16-69 years recruited by landline and mobile phone random-digit dialling with a response rate (participation rate among eligible people) of 66.2%. Respondents were asked about their sexual identity ('Do you think of yourself as' heterosexual/straight, homosexual/gay, bisexual, etc.) and the sex of people with whom they had ever had sexual contact and to whom they had felt sexually attracted. RESULTS: Men and women had different patterns of sexual identity. Although the majority of people identified as heterosexual (97% men, 96% women), women were more likely than men to identify as bisexual. Women were less likely than men to report exclusively other-sex or same-sex attraction and experience; 9% of men and 19% of women had some history of same-sex attraction and/or experience. Sexual attraction and experience did not necessarily correspond. Homosexual/gay identity was more common among men with tertiary education and living in cities and less common among men with blue-collar jobs. Many gay men (53%) and lesbians (76%) had some experience with an other-sex partner. More women identified as lesbian or bisexual than in 2001-02. Similarly, more women reported same-sex experience and same-sex attraction. CONCLUSION: In Australia, men are more likely than women to report exclusive same-sex attraction and experience, although women are more likely than men to report any non-heterosexual identity, experience and attraction. Whether this is a feature of the plasticity of female sexuality or due to lesser stigma than for men is unknown.

Masturbation, paying for sex, and other sexual activities: the Second Australian Study of Health and Relationships.

UNLABELLED: Background This study describes the prevalence of (solo) masturbation, paying for sex and a range of other sexual practices among Australians. METHODS: A representative sample of 20094 men and women aged 16-69 years (participation rate among eligible people, 66.2%) were recruited by landline and mobile phone random-digit dialling and computer-assisted telephone interviews in 2012-13. RESULTS: Many respondents (men, 72%; women, 42%) had masturbated in the past year. Half (51%) of the men and 24% of women had masturbated in the past 4 weeks. In the past year, more than two-fifths of respondents (men, 63%; women, 20%) had looked at pornography in any medium. Approximately 15% of men and 21% of women had used a sex toy. Digital-anal stimulation with a partner was practised by 19% of men and 15% of women, and oral-anal stimulation by 7% of men and 4% of women. Sexual role playing or dressing up were engaged in by 7-8%. Online sex, swinging, group sex, BDSM (bondage and discipline, 'sadomasochism' or dominance and submission) and fisting (rectal or vaginal) were each engaged in by less than 3% of the sample. Seventeen per cent of men said they had ever paid for sex; 2% had done so in the past year. CONCLUSION: Most of the solo practices studied were engaged in by more men than women, but women were more likely to have used a sex toy. Autoerotic activities are both substitutes for partnered sex and additional sources of pleasure for people with sexual partners.

Knowledge about and experience of sexually transmissible infections in a representative sample of adults: the Second Australian Study of Health and Relationships.

UNLABELLED: Background Sexually transmissible infections (STIs) present a substantial public health burden, and are related to modifiable sexual behaviours. METHODS: Computer-assisted telephone interviews were completed by a population-representative sample of 20 094 men and women aged 16-69 years. The overall participation rate among eligible people was 66.2%. Respondents were asked questions regarding their knowledge about, self-reported history of, and testing for STIs. RESULTS: STI knowledge was better in women, the young, people of higher socioeconomic status, those with a variety of indicators of being at high STI risk and those with a history of receiving sex education in school. Approximately one in six men and women reported a lifetime history of an STI. A history of STI testing in the last year was reported by ~one in six (17%) women and one in eight men (13%) and higher rates of testing in women were reported in most high-risk groups. The highest rates of STI testing (61%) and HIV testing (89%) were reported in homosexual men. CONCLUSION: Knowledge of STI-related health consequences and transmission is improving in Australians, and rates of STI testing were relatively high but were higher in women than in men. Further increases in testing rates in both sexes will be required to facilitate the early diagnosis and treatment of STIs, which is a cornerstone of STI control.

Safer sex and condom use: findings from the Second Australian Study of Health and Relationships.

UNLABELLED: Background It is important to have current and reliable estimates of the frequency and correlates of condom use among Australian adults. METHODS: A representative sample of 20094 men and women aged 16-69 years, from all states and territories, completed computer-assisted telephone interviews. The overall participation rate among eligible people was 66.2%. RESULTS: Although most respondents had used a condom at some time in their lives, fewer than half of those who were sexually active in the year before being interviewed had used a condom in that year. Condom use in the last year was associated with youth, speaking a language other than English at home, bisexual identity, greater education, residence in major cities, lower income and having multiple sexual partners in the last year. One-quarter of respondents used a condom the last time they had vaginal intercourse and one-sixth of these were put on after genital contact. Condom use during most recent vaginal sex was associated with youth, lower income, having sex with a non-regular partner and not using another form of contraception. Condom use appears to have increased between 2001-02 and 2012-13. CONCLUSION: Consistent with other research, this study showed that condom use was strongly associated with partner type and use of other contraception. There may be a need to highlight among people with multiple sexual partners the fact that non-barrier methods of contraception do not offer protection against sexually transmissible infections. The finding that many condoms were applied after genital contact suggests a need to promote both use and correct use of condoms.

Experiences of sexual coercion in a representative sample of adults: the Second Australian Study of Health and Relationships.

UNLABELLED: Background It is important to have current reliable estimates of the prevalence, correlates and consequences of sexual coercion among a representative sample of Australian adults and to identify changes over time in prevalence and consequences. METHODS: Computer-assisted telephone interviews were completed by a representative sample of 20094 Australian men and women aged 16-69 years. The participation rate among eligible people was 66.2%. RESULTS: Sexual coercion (i.e. being forced or frightened into sexual activity) was reported by 4.2% of men and 22.4% of women. Sexual coercion when aged ≤16 years was reported by 2.0% of men and 11.5% of women. Correlates of sexual coercion were similar for men and women. Those who had been coerced reported greater psychosocial distress, were more likely to smoke, were more anxious about sex and more likely to have acquired a sexually transmissible infection. Few people had talked to others about their experiences of sexual coercion and fewer had talked to a professional. There were no significant differences between the First and Second Australian Study of Health and Relationships in whether men or women had experienced coercion, talked to anyone about this or talked to a counsellor or psychologist. CONCLUSION: Sexual coercion has detrimental effects on various aspects of people's lives. It usually occurs at the ages at which people become sexually active. There is a need to reduce the incidence of sexual coercion, better identify experiences of sexual coercion, and provide accessible services to minimise the detrimental effects of sexual coercion.

Who's cheating? Agreements about sexual exclusivity and subsequent concurrent partnering in Australian heterosexual couples.

UNLABELLED: Background Concurrent relationships are a driver of generalised epidemics of sexually transmissible infections (STIs). In Australia, explicit negotiation of agreements about sex outside regular relationships has been recommended in health promotion for gay men but not for heterosexuals. OBJECTIVE: To ascertain the annual incidence of concurrency among people in ongoing male-female relationships according to their reported expectations of exclusivity. METHODS: In a national cohort recruited by household random digit dialling in 2004-05, people aged 16-64 years completed computer-assisted telephone interviews including questions about expectations of sexual exclusivity, discussion and agreements. A year later, those in ongoing sexual relationships (5323 people) were asked about sexual partner numbers in the past year. RESULTS: The huge majority (96%) expected sexual exclusivity of themselves and their partner. However, only 48% of men and 64% of women had discussed the matter and explicitly agreed. Older respondents were less likely to report discussion. Only 1% reported mutually nonexclusive ('open') relationships. A year later, 93% of respondents were still in the same relationship, among whom 4% of men and 2% of women had had sex outside the relationship. Those with agreements that one or both partners could have sex with others were more likely to do so, but the majority of respondents who had sex with someone else were in relationships that were explicitly or implicitly expected to be exclusive. CONCLUSIONS: Sexual health promotion should stress the importance of STI testing and establishing agreements about exclusivity before condoms are abandoned in new relationships.

Heterosexual partner acquisition rates in the Australian population.

The rate of partner acquisition in a population is an important parameter when constructing epidemiological models of sexually transmissible infections. We have analysed the results of a survey of the sexual behaviour of the Australian population to estimate how many people have acquired no new partner, one, two or at least three new partners in the past year, and hence estimated heterosexual partner acquisition rates for the population by gender and age band. Partner acquisition rates are ~0.5 new partners per year for 16- to 19-year-olds, peak at ~0.7 in the 20- to 24-year-old age band, and then decline steadily with age to ~0.2 per year. In all age bands, there are more male respondents reporting three or more new partners in the last year than what is consistent with the rest of the data, which could be interpreted as evidence of an additional population stratum characterised by higher partner acquisition rates.

Population movement can sustain STI prevalence in remote Australian indigenous communities.

BACKGROUND: For almost two decades, chlamydia and gonorrhoea diagnosis rates in remote Indigenous communities have been up to 30 times higher than for non-Indigenous Australians. The high levels of population movement known to occur between remote communities may contribute to these high rates. METHODS: We developed an individual-based computer simulation model to study the relationship between population movement and the persistence of gonorrhoea and chlamydia transmission within hypothetical remote communities. RESULTS: Results from our model suggest that short-term population movement can facilitate gonorrhoea and chlamydia persistence in small populations. By fixing the number of short-term travellers in accordance with census data, we found that these STIs can persist if at least 20% of individuals in the population seek additional partners while away from home and if the time away from home is less than 21 days. Periodic variations in travel patterns can contribute to increased sustainable levels of infection. Expanding existing STI testing and treatment programs to cater for short-term travellers is shown to be ineffective due to their short duration of stay. Testing and treatment strategies tailored to movement patterns, such as encouraging travellers to seek testing and treatment upon return from travel, will likely be more effective. CONCLUSION: High population mobility is likely to contribute to the high levels of STIs observed in remote Indigenous communities of Australia. More detailed data on mobility patterns and sexual behaviour of travellers will be invaluable for designing and assessing STI control programs in highly mobile communities.

Incidence and persistence/recurrence of men's sexual difficulties: findings from the Australian Longitudinal Study of Health and Relationships.

This study presents data on the prevalence, incidence, and persistence/recurrence of 8 sexual difficulties among men. Participants were 3,157 Australian men who were administered 2 computer-assisted interviews approximately 12 months apart. Analyses were based on a weighted sample of 2,158 men who were 20-64 years of age, sexually active in the past 12 months, and in the same heterosexual relationship at both interviews. Upon recruitment, a third of men (34%) reported having 1 or more sexual difficulties. At follow-up, 21% reported a new sexual difficulty. The 2 highest incident difficulties were "lacking interest in having sex" (11%) and "reaching orgasm too quickly" (7%). In addition, 51% of men with 1 or more sexual difficulties at recruitment reported having at least 1 of these difficulties again at follow-up. While "trouble keeping an erection" had the highest persistence/recurrence (48%), "taking too long to orgasm" had the lowest (24%). Logistic regression modeling revealed a greater incidence of orgasmic difficulties among older and less educated men. There were few sociodemographic predictors of persistence/recurrence. These data should assist clinicians and other health service providers in identifying the potential challenges faced by men who experience sexual difficulties.

Penile implants among prisoners-a cause for concern?

BACKGROUND: We report the prevalence of penile implants among prisoners and determine the independent predictors for having penile implants. Questions on penile implants were included in the Sexual Health and Attitudes of Australian Prisoners (SHAAP) survey following concerns raised by prison health staff that increasing numbers of prisoners reported having penile implants while in prison. METHODS: Computer-Assisted Telephone Interviewing (CATI) of a random sample of prisoners was carried out in 41 prisons in New South Wales and Queensland (Australia). Men were asked, "Have you ever inserted or implanted an object under the skin of your penis?" If they responded Yes: "Have you ever done so while you were in prison?" Univariate logistic regression and logistic regression were used to determine the factors associated with penile implants. RESULTS: A total of 2,018 male prisoners were surveyed, aged between 18 and 65 years, and 118 (5.8%) reported that they had inserted or implanted an object under the skin of their penis. Of these men, 87 (73%) had this done while they were in prison. In the multivariate analysis, a younger age, birth in an Asian country, and prior incarceration were all significantly associated with penile implants (p<0.001). Men with penile implants were also more likely to report being paid for sex (p<0.001), to have had body piercings (p<0.001) or tattoos in prison (p<0.001), and to have taken non-prescription drugs while in prison (p<0.05). CONCLUSIONS: Penile implants appear to be fairly common among prisoners and are associated with risky sexual and drug use practices. As most of these penile implants are inserted in prison, these men are at risk of blood borne viruses and wound infection. Harm reduction and infection control strategies need to be developed to address this potential risk.

Fixed sized samples for type-specific surveillance of human papillomavirus in genital warts.

Surveillance data suggest that human papillomavirus (HPV) vaccination in Australia is reducing the incidence of genital warts. However, existing surveillance measures do not assess the proportion of the remaining cases of warts that are caused by HPV types other than 6 or 11, against which the vaccine has no demonstrated effectiveness. Using computer simulation rather than sample size formulae, we established that genotyping at least 60 warts can accurately test whether the proportion of warts due to HPV types not targeted by the vaccine has increased (Type I error probability ≤ 0.05, Type II error probability <0.07). Standard formulae for calculating sample size, in contrast, suggest that a sample size of more than 130 would be required for this task, but using these formulae entails making several strong assumptions. Our methods require fewer assumptions and demonstrate that a smaller sample size than anticipated could be used to address the question of what proportion of post-vaccination cases of warts are due to nonvaccine types. In conjunction with indications of incidence and prevalence provided by existing surveillance measures, this could indicate the number of cases of post-vaccination warts due to nonvaccine types and hence whether type replacement is occurring.