Minna Nikula

Sexual health among young adults in Finland: Assessing risk and protective behaviour through a general health survey

Objective: To describe the extent of sexual risk and protective behaviours and reproductive health outcomes comparing men and women of 18—29 and assess the demographic correlates of these indicators within genders. Design: A module of questions on sexual behaviour and reproductive health outcomes was integrated into a population-based general health survey in Finland. Methods: A representative sample of people over 17, including 1,894 individuals between 18 and 29 years, was drawn from the population registry in 2001. Individual interviews and self-administered questionnaires were used with a response rate of 79% for the interview and 68% for the questionnaire. Results: It was more common for younger men to stay single and have multiple partners while women of the same age were cohabiting or married and chose a regular sex partner. The mean number of sexual partner for men was 5.0 (SD 5.1) and for women 3.4 (SD 2.1). Besides higher prevalence of multiple partners, men reported also casual sex contacts more often than women, 33% vs. 20%. Both genders reported relatively high and concordant rates of contraception use. However, in casual sex contacts a condom was used consistently only by less than half of both sexes. Marital status was the strongest predictor for behaviour and health outcomes. Conclusions: Casual sex is common among young adults in Finland and often occurs without a condom. This study shows that it is feasible to incorporate sexual behaviour questions as part of a larger health survey offering an option for monitoring sexual behaviour when funding for large-scale HIV surveys is decreasing.

Contraceptive use and abortion among women of reproductive age in st. Petersburg, Russia

CONTEXT: Although the characteristics associated with contraceptive use among Russian women have been studied no large-scale research has been conducted on womens use of different contraceptive methods and abortion. METHODS: A random sample of 1147 women aged 18-44 completed questionnaires at local womens clinics in St. Petersburg in 2003-2004. Chi-square tests were used to examine differences in selected characteristics among age-groups and logistic regression was used to assess associations between these characteristics and the use of contraceptive methods at last intercourse and abortion history. RESULTS: Among women at risk of unintended pregnancy six in 10 had used reliable contraceptives (the pill the IUD or condoms) at last intercourse; 42% had used condoms. Women in the middle income level were more likely than women with lower income to have used the pill (odds ratio 2.1); cohabiting women and those who had had children had lowered odds of using condoms (0.6 and 0.3-0.5 respectively). More than half of those surveyed reported having had an abortion. Characteristics associated with increased odds of having had an abortion included being 25 or older (2.2-3.5) cohabiting (2.9) having high income (1.7) having experienced first intercourse before turning 18 (2.2) and having used no contraceptive method at first sex (1.5). The factor that was most strongly associated with abortion was a womans number of births (4.9-5.7). CONCLUSIONS: Educational programs that promote the consistent use of condoms especially among young women and family planning programs that reduce financial barriers to contraceptive use are critically needed in Russia.

Risk factors for induced abortions in St Petersburg, Estonia and Finland. Results from surveys among women of reproductive age

Objectives To compare the risk factors of self-reported abortion in St Petersburg, Estonia and Finland, which are neighbouring areas having different abortion rates. Methods Data from four population-based questionnaire surveys (Finland 1992 and 1999; St Petersburg 2003; Estonia 2004) were used. With the exception of the 1992 Finnish survey (based on interviews) all were postal surveys. There were 1070 respondents in Finland (78% and 52% response rates), 1147 (68%) in St Petersburg, and 5190 (54%) in Estonia. Results The prevalence of self-reported abortions was highest among women in St Petersburg and among the two oldest age groups of Russian-speaking Estonians. In all areas women with a history of abortion were more likely to have low education, children, a history of multiple partners and to have had their first intercourse when younger than 18 years. Insufficient use of reliable contraception, both at first and last intercourse, was the only risk factor that was more common in St Petersburg and in Estonia than in Finland. In Estonia, more Estonian than Russian-speaking women used reliable contraceptives. Conclusion The comparison of three areas suggests that high abortion rates are related to low contraceptive use and not to other risky sexual behaviour.

The socioeconomic characteristics of risky sexual behaviour among reproductive-age women in St Petersburg

Aims: To examine the sexual behaviour of reproductive age women in St Petersburg and its variation according to socio-demographic characteristics. Methods: A cross-sectional survey with a self-administered questionnaire. A random sample of women aged 18—44 in two districts in St Petersburg in 2004 were invited to a womans clinic to complete a questionnaire. Of those women who were contacted (n=1719), 67% completed the anonymous questionnaire either in a clinic or at home. Results were analyzed according to three age-groups (18—24, 25—34, 35—44 years). Predictive characteristics were studied by use of multivariate models. Results: Younger respondents had on average started sexual life much earlier than the oldest (mean age 17.6 and 19.7 years respectively). The use of contraception at first coitus had become more common for each consecutive generation, though 25% of women aged 18—25 used no contraception, and only 45% used reliable contraception at first intercourse. Around 16% of the women had had two or more sex partners during the previous year, 55% of the youngest and 43% of the oldest had used reliable contraceptive methods. Older women were less likely to use contraceptives in last intercourse. High personal income, having children and low education were related to early age at first intercourse. Being single (women over 24 years) or having high income (women in all ages) was correlated with having had multiple sexual partners. Conclusions: In addition to youth, sexual education should be targeted to older women, many of whom practice risky sexual behaviour.

Sexual behaviour and lifestyles of young men in Finland, 1998–2005. Cross-sectional survey of military conscripts

Objective To reveal sexual risk behaviour over time and to explore the associations of sexual risk behaviour, HIV-testing and socio-demographic and lifestyle characteristics, including alcohol and drug use among young men. Methods Cross-sectional, structured health and lifestyle survey carried out during the beginning of the mandatory military service. Data were collected from 10,446 randomized conscripts in 1998–2005, with a response rate of 95%. Results There was a minor increase in the prevalence of those reporting early sexual intercourse and multiple lifetime partners between 1998 and 2005 (age adjusted odds ratios [ORs] 0.68 [95% confidence interval (CI) 0.54–0.87] and 0.83 [0.70–0.99]), and a minor decrease in multiple partners over the past 12 months or engaging in high risk sex between 2000 and 2005 (ORs: 1.20 [95% CI: 1.08–1.41] and 1.45 [1.13–1.86]). No significant differences were observed in non-condom use and HIV-testing over the study period. Alcohol consumption had an independent, strong dose-contingent relationship with sexual risk behaviour. Illegal drug use showed a trend for similar but weaker association with risky sex as alcohol use. Conclusions This study shows minor change in the risk indicators over time, yet the prevalence of sexually transmitted infections has risen. More in-depth research to identify groups with risky sexual behaviour and multiple risk factors related to sex, alcohol and drugs is a matter of public health importance.

The socio-demographic patterning of sexual risk behaviour: a survey of young men in Finland and Estonia

BackgroundSexually transmitted infections (STIs) among the youth are an increasing challenge for public health in Europe. This study provided estimates of mens (18–25 years) sexual risk behaviour and self-reported STIs and their socio-demographic patterning in Finland and Estonia; two countries that are geographically close, but have very different STI epidemics.MethodNationally representative cross-sectional population surveys with comparable survey questions were used. Data from self-administered questionnaires for 1765 men aged 18–25 years in Finland (85% of the age cohort was included in the sampling frame, 95% of the sample responded) and 748 in Estonia, with a response rate of 43% respectively, were analysed. Socio-demographic patterning of multiple partners, condom use and self-reported STIs are presented was studied using multiple logistic regression analysis.ResultsThe main findings focus on associations found within each country. In Finland, higher age, low education and to a lesser extent relationship with a non-steady partner increased the likelihood of reporting multiple lifetime-partners, while in Estonia only higher age and low education revealed this effect. In relation to unprotected intercourse, in Finland, higher age, low education and relationship status with a steady partner increased the likelihood of reporting unprotected intercourse. In Estonia, the same was observed only for relationship status. In Finland the likelihood of self-reported STIs increased by older age and lower education and decreased by being with a non-steady partner, while in Estonia, a non-significant increase in self-reported STIs was observed only in the older age group.ConclusionA clear socio-demographic patterning for sexual behaviour and self-reported STIs was revealed in Finland, but a less consistent trend was seen in Estonia. The findings of this study suggest that prevention strategies should focus in Finland on less educated singles and in Estonia on young men generally.

A pragmatic randomised controlled trial on routine iron prophylaxis during pregnancy in Maputo, Mozambique (PROFEG): rationale, design, and success

The effects of prophylactic iron during pregnancy on maternal and child health in developing settings with endemic malaria and high prevalence of HIV remain unclear. This paper describes the rationale, implementation and success of a pragmatic randomised controlled trial comparing routine iron supplementation vs. screening and treatment for anaemia during pregnancy. The setting was two health centres in Maputo, Mozambique. Pregnant women (≥ 12-week gestation; ≥ 18 years old; and not with a high-risk pregnancy, n=4326) were recruited. The main outcomes are preterm delivery and low birthweight. The women were randomly assigned to one of two iron administration policies: a routine iron group (n=2184) received 60 mg of ferrous sulphate plus 400 μg of folic acid daily while a selective iron group (n=2142) had screening and treatment for anaemia and a daily intake of 1 mg of folic acid. The recruitment, follow-up, and collection of follow-up data were successful; both groups were similar to each other in all the trial stages. Collection of delivery data was challenging and data on about 40% of births is missing. These are currently being traced through different hospitals and health centres. The compliance of the study personnel and the women with regard to regular measurement of haemoglobin and intake of the iron and folic acid tablets was high and similar in both trial arms. Taking into account the various constraints encountered, the stages of the present trial prior to delivery were carried out well.

The determinants of sexually transmitted infections among reproductive age women in St. Petersburg, Estonia and Finland

ObjectivesSexually transmitted infections’ (STIs) rate vary in St. Petersburg, Estonia and Finland; the aim was to compare the determinants of self-reported sexually transmitted infections in these areas.MethodsData from four population-based questionnaire surveys were used (Finland in 1992 and 1999; St. Petersburg in 2003; Estonia in 2004). With the exception of the 1992 Finnish survey (interview) all were postal surveys, with 1,070 respondents in Finland (78 and 52% response rates), 1,147 (68%) in St. Petersburg, and 5,190 (54%) in Estonia.ResultsRisky sexual behaviours were equally common in the three areas and the determinants were the same. Women with an STIs history more often had had their first sexual intercourse when aged under 18, had not used condom during first intercourse, had a high number of lifetime or previous year sexual partners. However, marital status and education were not similar determinants. Cohabiting and well-educated women in Finland were more likely to have STIs while in other areas the associations found were not statistically significant.ConclusionsRisky behaviour predicts STIs, but does not explain the varying rates of STIs between areas.

Is HIV testing normal or special? Opinions of health professionals in four European countries in 2008

The special norms in testing for HIV infection are not typical of testing or screening for other diseases. In four European countries, we studied health professionals’ views on HIV testing This study is based on cross-sectional surveys of two groups of health professionals: presidents of selected health professional societies and head physicians and nurses of selected hospital clinics in Belgium, Estonia, Finland, and Portugal in 2008. A common structured semi-anonymous questionnaire was used in the four countries. The number of societies responding varied from five to 10 and for hospital clinics from six to 18; the response rates were from 32% to 100% and 41% to 100%, respectively. Opinions on whether HIV testing is like any other test and on the value of specific approaches in HIV testing varied both within and between countries. Some professionals thought that HIV testing is different from the testing of other infectious diseases; others thought that such an exceptional approach may be a disservice to people and to the health system. Many professionals thought that HIV testing should not be thought of only from the point of view of the individual to be tested, but also from that of other people (potential patients). Obligatory testing was considered appropriate in certain circumstances. Generally, more HIV testing in health care was called for. Normalization of HIV testing, i.e., considering it like any other diagnostic test, is unlikely to meet much opposition from health professionals. Larger surveys are needed to confirm the results.