Hanneke de Graaf

The Psychological Measurement of Childhood Sexual Development in Western Societies: Methodological Challenges

Children can display sexual behavior or have sexual experiences. Different psychological research methods are available for studying these kinds of behaviors and feelings, such as interviewing or observing children (direct methods), asking adolescents or adults to retrospectively report their childhood memories or using intermediaries to observe children (indirect methods). Each of these methods has its own advantages and limitations. Based on a review of the literature, this work answers three questions: (a) What research methods are generally used to study childhood sexual development? (b) What insight do these methods give into the sexual behaviors or feelings of children? and (c) What are the advantages and limitations of each of these research methods in this research domain? Almost all studies on childhood sexual behavior and feelings use either observational or retrospective methods. In both types of studies, only behavior that is considered to be sexual from an adult perspective is reported. To gain insight into the childs perspective, one has to rely on methods other than observations or retrospective research, such as interviews with children that match their developmental limitations and competencies.

Family Cohesion and Romantic and Sexual Initiation: A Three Wave Longitudinal Study

Although the relation between family relationships and the timing of sexual debut has been the focus of many studies, research on mediating factors is scarce. This study examines whether low levels of family cohesion result in an earlier onset of romantic and sexual experiences, and whether the link between family cohesion and an early sexual debut is mediated by early romantic initiation. A longitudinal sample of 314 adolescent girls and 222 boys, aged 12–17 at Wave 1, completed questionnaires at three measurement points with three year intervals. The results showed that sexual debut followed romantic initiation for 77% of the participants. For early adolescent females (aged 12–14), high levels of family cohesion resulted in a later sexual debut and this association was fully mediated by a delay of romantic initiation. Among boys and older girls, timing of romantic initiation did not mediate the link between family cohesion and timing of sexual initiation. Early adolescent girls who have negative relationships with their parents turn to romantic relationships for intimacy and support, which subsequently provide the opportunity for an early sexual debut. Low levels of family cohesion thus primarily precipitate romantic initiation and sexual initiation appears to be secondary to this process among girls in this age group.

Educational Differences in Adolescents' Sexual Health: A Pervasive Phenomenon in a National Dutch Sample

Educational level is strongly associated with age of first intercourse and risk of unintended pregnancies. This study examined these associations in a large representative sample of Dutch adolescents and also included associations of educational level with other sexual health aspects. Adolescents aged 12 to 25 (3,926 boys and 3,915 girls) completed an online questionnaire that included measures of romantic and sexual experience; the evaluation of their sexual debut; the risk of sexually transmitted infections (STIs) and pregnancy; and sexual attitudes, satisfaction, self-efficacy, knowledge, victimization, and functioning. The results showed that adolescents on a vocational track or who completed fewer years of education were more at risk of several adverse sexual health outcomes than adolescents on an academic track. They had their first sexual experiences at an earlier age; evaluated these experiences less favorably; had less sexual health knowledge and fewer refusal skills; and had a higher risk of unintended pregnancy, STIs, and victimization. Possible explanations for these consistent differences are discussed. Sex education and services should pay specific and targeted attention to less educated young people and tailor their efforts specifically to the needs, characteristics, and realities of this group.

Prevalence of non-volitional sex types and associated factors: a national sample of young people

Background Non-volitional sex (NVS) in young people continues to be a major public health problem with long-term negative health outcomes. For the first time, the prevalence of different types of NVS and associated factors are compared between young people with same-sex sexual activities and those who have not. Methods We obtained data from 10,401 young women and men (aged 12 to 25 years) who participated in a population study on sexual health, the Netherlands. We calculated and compared the prevalence of six types of NVS between women who had sex with men (yWSM) or women (yWSW), and men who had sex with women (yMSW) or men (yMSM). In sexually experienced participants (n = 5986) logistic regression analyses were applied to assess associations with NVS by assault or penetration. Analyses were weighted to represent the Dutch population. Results The prevalence of NVS ranged from 1% to 61%, depending on type. Prevalence was higher for young women (any: 40.6%) than men (any: 20.4%), and highest for yMSM and yWSW. Prevalence of NVS by assault or penetration was related to a range of socio-demographic, behavioral and social factors, which were largely similar regardless of sex or same-sex-experiences. The NVS perpetrators were in over 70% of cases known to the victim; 1 in 4 cases of NVS by penetration were accompanied by violence. Conclusion A substantial proportion of young people in the Netherlands have experienced NVS. Medical professionals, educators and caregivers should integrate services to continue to address NVS by targeting young people’s multifaceted risk profiles and evidenced based interventions for doing so are needed.

Comparing databases: determinants of sexually transmitted infections, HIV diagnoses, and lack of HIV testing among men who have sex with men

BackgroundEarly detection and treatment of STI/HIV are public health priorities. Our objective was to compare characteristics of men who have sex with men (MSM) in Dutch data available in 2010 from EMIS, an international internet survey, Schorer Monitor, a Dutch internet survey, and data from STI- clinic visits, since these might be subject to different and unknown biases.MethodsData from Dutch MSM Internet Surveys (EMISNLN = 3,787; Schorer Monitor, SMON N = 3,602), and 3,800 STI clinic visits (SOAP) were combined into one dataset. We included factors that were measured in all three databases. The socio-demographics included were age (at the time of the survey), zip code, and ethnicity. Behavioural variables included were the number of sexual partners, condom use with last sexual partner, drug use, being diagnosed with STI, being diagnosed with HIV, and HIV testing. Outcomes we investigated were being diagnosed with STI, HIV, and never been tested for HIV.ResultsLogistic regressions showed that determinants for being diagnosed with STI were having more sexual partners, drug use, and having had an HIV test (aORs 1.3 to 17.1) in EMIS and SMON. Determinants for being diagnosed with HIV in all three databases were older age, living in Amsterdam, and having more partners (aORs 1.8 to 4.4). In EMIS and SMON, drug use, non-condom use, and having STI were additional determinants (aORs 1.6 to 8.9). Finally, determinants associated with never been tested for HIV were being younger (only SOAP), living outside of Amsterdam, having fewer partners, no drug use, and no STI (aORs 0.2 to 0.8).ConclusionsRisk factors from internet surveys were largely similar, but differed from STI clinics, possibly because it involves self-reports rather than diagnoses or because of differences in timing. The difference between the internet surveys and STI clinic data is much less pronounced for having never been tested, suggesting both are appropriate for this outcome. These findings shed light on conclusions drawn from different data sources, as well as the comparability of recruitment strategies, the robustness of risk factors, consequences of phrasing questions differently, and on (policy) implications based on different data sources.

6 De seksuele levensloop

In dit hoofdstuk beschrijven we seksuele ontwikkeling vanuit een (contextueel) levensloopperspectief.

National prevalence estimates of chlamydia and gonorrhoea in the Netherlands

Objectives National prevalence estimates of Chlamydia trachomatis (chlamydia) and Neisseria gonorrhoeae (gonorrhoea) are important for providing insights in the occurrence and control of these STIs. The aim was to obtain national prevalence estimates for chlamydia and gonorrhoea and to investigate risk factors associated with infection. Methods Between November 2016 and January 2017, we performed a national population-based cross-sectional probability sample survey among men and women aged 18–34 years in the Netherlands. Individuals were invited to complete a questionnaire about sexual health. At the end of the questionnaire, sexually active individuals could request a home-based sampling kit. Samples were tested for chlamydia and gonorrhoea using nucleic acid amplification test (NAAT). Logistic regression analyses were performed for predictors of participation and chlamydia infection. Results Of the 17 222 invited individuals, 4447 (26%) participated. Of these, 3255 were eligible for prevalence survey participation and 550 (17%) returned a sample. Participation in the prevalence survey was associated with age (20+) and risk factors for STI. We did not detect any gonorrhoea. The overall weighted prevalence of chlamydia was 2.8% (95% CI 1.5% to 5.2%); 1.1% (0.1% to 7.2%) in men and 5.6% (3.3% to 9.5%) in women. Risk factors for chlamydia infections in women aged 18–24 years were low/medium education level, not having a relationship with the person you had most recent sex with and age at first sex older than 16. Conclusions Chlamydia and gonorrhoea prevalence were low in the general Dutch population, as was the participation rate. Repeated prevalence surveys are needed to analyse trends in STI prevalences and to evaluate control policies.

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

Sexually developing adolescents and emerging adults face sexual health risks as well as potentially negative outcomes of online sexual behaviors. The goal of this study was to describe three categories of sexual risk behavior: (1) behavior related to STI/HIV, (2) behavior related to unplanned pregnancy, and (3) online sexual risk behavior. In addition, we investigated whether these behaviors are actually related to negative (health) outcomes. For this purpose, we used data from a Dutch probability survey: “Sex under the age of 25.” Adolescents and emerging adults aged 12 through 24 (8,053 boys and 12,447 girls) completed a digital questionnaire, including measures of the risk of STI/HIV and pregnancy, online sexual behavior and non-consensual sex. Chi-square tests and logistic regressions were used to test for gender and age differences and compute associations between risk behavior and negative outcomes. The results showed that the risk of unplanned pregnancy is low in the Netherlands. It seems that adolescents and emerging adults are less aware of the risk of STI/HIV than of the risk of pregnancy. About 11% of the participants had had more than one partner in the last 6 months and had not used condoms consistently with their last partner, and these participants had a 3.56 times higher likelihood of ever being diagnosed with an STI. Although many young people stop using condoms with their partner after a while, most of them did not get tested for STIs. More emerging adults (aged 18–24) engage in sexting (sending personal nude pictures and sex videos to others), but the chance that these images are shared with other people than the intended recipient is higher among adolescents (aged 12–17). The results of this study can guide professionals working in sex education and sexual health services to focus their efforts on the risk behaviors in the Netherlands that deserve most attention.

Seks onder je 25e: Seksuele gezondheid van jongeren van 12 tot 25 jaar in Nederland

Er bestaat op dit moment geen reguliere registratie op het gebied van seksuele gezondheid van jongeren, maar in het veld is wel behoefte aan gegevens om beleid op te baseren. Daarom zijn onder de titel ‘Seks onder je 25e’ in 2005 en 2012 twee populatiestudies afgerond naar de seksuele gezondheid van jongeren van 12 tot 25 jaar. Beide studies zijn uitgevoerd door Rutgers WPF en Soa Aids Nederland en gefinancierd door ZonMw. Ze zijn een vervolg op de ‘Jeugd en Seks’ studies uit 1990 en 1995.AbstractSex under the age of 25: Sexual health of young people aged 12-25 in the NetherlandsCurrently, no regular registrations of Dutch young people’s sexual health exist in the Netherlands, although policy makers are in need of accurate figures. To provide this information, in 2005 and 2012 two representative studies were conducted among young people aged 12 to 25. Both used a participatory action approach to ensure that the results of the study will be relevant for the persons and organisations that aim to improve young people’s sexual health. The broad perspective on sexual health of these studies is unique and needs to be maintained in future sexual health monitoring.