Jennifer Downing

Early pubertal onset and its relationship with sexual risk taking, substance use and anti-social behaviour: a preliminary cross-sectional study

BackgroundIn many countries age at pubertal onset has declined substantially. Relatively little attention has been paid to how this decline may affect adolescent behaviours such as substance use, violence and unprotected sex and consequently impact on public health.MethodsIn the UK, two opportunistic samples (aged 16-45 years), paper-based (n = 976) and online (n = 1117), examined factors associated with earlier pubertal onset and whether earlier age of onset predicted sexual risk-taking, substance use and anti-social behaviours during early adolescence.ResultsOverall, 45.6% of females reported menarche ≤ 12 years and 53.3% of males were categorised as having pubertal onset ≤ 11 years. For both sexes earlier pubertal onset was associated with poorer parental socio-economic status. Other pre-pubertal predictors of early onset were being overweight, more childhood illnesses (females) and younger age at time of survey (males). For both sexes earlier puberty predicted having drunk alcohol, been drunk, smoked and used drugs <14 years as well as having a sexual debut and unprotected sex <16 years. Males with earlier pubertal onset were more likely to report fighting and aggressive responses to emotional upset during early adolescence while females were more likely to report being bullied and having taken more time off school.ConclusionResults provide sufficient evidence for changes in age of pubertal onset to be further explored as a potential influence on trends in adolescent risk behaviours. Further insight into the relationship between early puberty and both obesity and socio-economic status may help inform early interventions to tackle the development of risk behaviours and health inequalities during early adolescence.

Adults at 12? Trends in puberty and their public health consequences

Adults at 12? Over the past 150 years, the age of puberty onset has fallen substantially across many developed countries. Although trends are apparent in both sexes,1 the evidence in females (where biological markers are clearer) suggests that, for instance, in northern Europe the age at menarche (first menstruation) fell during the 1800s, then further reduced by up to 3 years over the last century (fig 1). Factors contributing to this fall include a combination of public health successes and changes in social structures. Thus, successes such as improved childhood nutrition and health status through reduction in childhood infections have been major factors accelerating the onset of puberty.7 Figure 1  Secular trends in menarcheal age.11,12,13,14,15 Socially, however, stress is also a puberty accelerator, with familial disruption, including father absenteeism, being one of the most effective stressors, and levels of divorce as well as single-parent families have rapidly escalated in many countries (eg, England, 2005).8,9 The sum effect of these changes has been relatively recent reductions in the age of puberty onset.7 However, these have not been matched by efforts to …

Factors associated with risky sexual behaviour: a comparison of British, Spanish and German holidaymakers to the Balearics

BACKGROUND Previous studies exploring risk-taking behaviour on holiday are typically limited to single nationalities, confounding comparisons among countries. Here we examine the sexual behaviour of holidaymakers of three nationalities visiting Ibiza and Majorca. METHODS A comparative cross-sectional study design was used focusing on British, Spanish and German holidaymakers in the age range of 16-35 years. Overall, 3003 questionnaires were gathered at airports in Majorca and Ibiza from holidaymakers returning home. RESULTS Of those surveyed, 71.1% were single (travelling without a current sexual partner) (Majorca, 74.3%; Ibiza, 68.0%). Overall, 34.1% of single holidaymakers had sex on holiday. Amongst single participants, factors associated with having sex on holiday were high levels of drunkenness, being Spanish and holidaying for over 2 weeks. Of those single and having sex on holiday, factors associated with multiple sexual partners were being male and age ≤19 years. Unprotected sex was predicted by being German and holidaying in Majorca, holidaying with members of the opposite sex and using four or more drugs on holiday. All sexual behaviours were predicted by a high number of sexual partners in the previous 12 months. Furthermore, single holidaymakers having sex abroad were more likely to prefer night-time venues facilitating casual sex and excessive alcohol consumption. CONCLUSIONS Casual sex encounters in youth holiday resorts may be commonplace and mediated through substance use. Further focused public health efforts, including in bars/nightclubs, are needed to prevent sexual risk-taking which can increase the likelihood of poor sexual health outcomes and associated factors such as regretted sex.

The sexual behaviour of British backpackers in Australia.

Objectives: To explore sexual behaviour and risk-taking among British backpackers in Australia and to investigate the influence of substance use and social settings on sexual behaviour abroad. Methods: A cross-sectional design was used. The questionnaire gathered information on sexual and substance use behaviour in the 12 months prior to leaving the UK and during backpackers’ stays in Australia. A total of 1008 backpackers, recruited in hostels in Sydney and Cairns, were included in the study. Results: In total, 73.2% had sex during their stay in Australia, including 68.9% of those who arrived without a partner. Across all backpackers, mean number of sexual partners increased from 0.3 per 4-week period in the UK in the 12 months prior to the trip to 1.0 per 4-week period spent in Australia. Over a third (39.7%) had multiple partners in Australia, increasing to 45.7% in those arriving single. Of those arriving single and having sex, 40.9% reported inconsistent condom use and 24.0% had unprotected sex with multiple partners. Number of sexual partners in the UK, length of stay in Australia at time of interview, planned length of stay, frequent visits to bars/clubs, high frequency of alcohol intake and use of illicit substances in Australia were indicators for risky sexual behaviour. Conclusions: Backpackers are at high risk of sexually transmitted infections and other negative sexual health outcomes. Multi-agency sexual health promotion strategies that address the relationship between sex, drugs and alcohol should be targeted at backpackers prior to, and during, their travels.

Wellbeing, alcohol use and sexual activity in young teenagers: findings from a cross-sectional survey in school children in North West England.

BackgroundAdolescent health is a growing concern. High rates of binge drinking and teenage pregnancies, documented in the UK, are two measures defining poor wellbeing. Improving wellbeing through schools is a priority but information on the impact of wellbeing on alcohol use, and on sexual activity among schoolchildren is limited.MethodsA cross-sectional survey using self-completed questionnaires was conducted among 3,641 schoolchildren aged 11-14 years due to participate in a sex and relationships education pilot programme in 15 high schools in North West England. Bivariate and multivariate analyses were conducted to examine the relationship between wellbeing and alcohol use, and wellbeing and sexual activity.ResultsA third of 11 year olds, rising to two-thirds of 14 year olds, had drunk alcohol. Children with positive school wellbeing had lower odds of ever drinking alcohol, drinking often, engaging in any sexual activity, and of having sex. General wellbeing had a smaller effect. The strength of the association between alcohol use and the prevalence of sexual activity in 13-14 year olds, increased incrementally with the higher frequency of alcohol use. Children drinking once a week or more had 12-fold higher odds of any sexual activity, and 10-fold higher odds of having sex. Rare and occasional drinkers had a significantly higher odds compared with non-drinkers.ConclusionsThe relationship between wellbeing and alcohol use, and wellbeing and sexual activity reinforces the importance of initiatives that enhance positive wellbeing in schoolchildren. The association between alcohol use and sexual activity highlights the need for integrated public health programmes. Policies restricting alcohol use may help reduce sexual exposure among young teenagers.

A cross-sectional survey of compliance with national guidance for alcohol consumption by children: measuring risk factors, protective factors and social norms for excessive and unsupervised drinking

BackgroundThe Chief Medical Officer for England has developed the first guidance in England and some of the first internationally on alcohol consumption by children. Using the most recent iteration of a large biennial survey of schoolchildren we measure the extent to which young peoples drinking fell within the guidelines just prior to their introduction and the characteristics of individuals whose drinking does not; how alcohol related harms relate to compliance; and risk factors associated with behaving outside of the guidance.MethodsA cross-sectional survey was conducted utilising a self-completed questionnaire with closed questions. A total of 11,879 schoolchildren, aged 15-16 years, from secondary schools in North West England participated in the study. Data were analysed using chi square and conditional logistic regression.ResultsAlcohol consumption is an established norm by age 15 years (81.3%). Acute alcohol related violence, regretted sex and forgetfulness were experienced by significantly fewer children drinking within the guidance (than outside of it). Over half of drinkers (54.7%) reported routinely drinking more heavily than guidance suggests (here ≥5 drinks/session ≥1 month), or typically drinking unsupervised at home or at a friends home when parents were absent (57.4%). Both behaviours were common across all deprivation strata. Children with greater expendable incomes were less likely to consume within guidance and reported higher measures for unsupervised, frequent and heavy drinking. Although drinking due to peer pressure was associated with some measures of unsupervised drinking, those reporting that they drank out of boredom were more likely to report risk-related drinking behaviours outside of the guidance.ConclusionsSuccessful implementation of guidance on alcohol consumption for children could result in substantial reductions in existing levels of alcohol related harms to young people. However, prolonged social marketing, educational and parental interventions will be required to challenge established social norms in heavy and unsupervised child drinking across all social strata. Policy measures to establish a minimum price for alcohol and provide children with entertaining alternatives to alcohol should also increase compliance with guidance.

Access to HIV community services by vulnerable populations: Evidence from an enhanced HIV/AIDS surveillance system

Abstract HIV disproportionately affects vulnerable populations such as black and minority ethnic groups, men who have sex with men (MSM) and migrants, in many countries including those in the UK. Community organisations in the UK are charitable non-governmental organisations with a proportion of the workforce who volunteer, and provide invaluable additional support for people living with HIV (PLWHIV). Information on their contribution to HIV care in vulnerable groups is relatively sparse. Data generated from an enhanced HIV surveillance system in North West England, UK, was utilised for this study. We aimed to determine the characteristics of individuals who chose to access community services in addition to clinical services (1375 out of 4195 records of PLWHIV in clinical services). Demographic information, risk factors including residency status, uniquely gathered in this region, and deprivation scores were examined. Multivariate logistic regression modelling was conducted to predict the relative effect of patient characteristics on attendance at community services. Attendance at community services was highest in those living in the most, compared with least, deprived areas (p<0.001), and was most evident in MSM and heterosexuals. Compared to white UK nationals attendance was significantly higher in non-UK nationals of uncertain residency status (Adjusted odds ratio [AOR] = 21.91, 95% confidence interval [CI] 10.48–45.83; p<0.001), refugees (AOR = 5.75, 95% CI 3.3–10.03; p<0.001), migrant workers (AOR = 5.48, 95% CI 2.22–13.51; p<0.001) and temporary visitors (AOR = 3.44, 95% CI 1.68–7.05; p<0.001). Community services, initially established predominantly to support MSM, have responded to the changing demography of HIV and reach the most vulnerable members of society. Consequent to their support of migrant populations, community services are vital for the management of HIV in black and minority groups. Paradoxically, this coincides with increasing funding pressures on these services.

Treatment and care of HIV positive asylum seekers

Background: Enhanced regional surveillance in north west England suggests that the proportion of HIV positive people who are asylum seekers (AS) is increasing. Nationally, there is no empirical evidence that HIV positive AS use HIV services to a greater or lesser extent than HIV positive non-AS. This report compares stage of disease and use of services between HIV positive non-AS and AS. Methods: Data on those accessing HIV treatment and care (from hospitals and non-governmental organisations (NGOs)) in the north west of England for the first time January 2001–June 2004 (total 2204; AS 409) were extracted from the regional enhanced surveillance system. Results: Compared with non-AS, AS did not differ in stage of HIV disease on first contact (p>0.05), were no more likely to stay overnight in hospital (p>0.05), but had an average of one extra outpatient appointment per year (median seven compared with six, p = 0.014). AS were much more likely to have accessed NGOs for support (43% compared with 27%: p<0.001). Conclusions: Use of specialist hospital services by HIV positive AS differs little from HIV positive persons who are not AS. However, HIV positive AS rely more on NGOs at a time when such voluntary services are under increasing financial pressures.