Nicole Stone

Oral Sex and Condom Use Among Young People In the United Kingdom

CONTEXT The development of UK national targets to reduce the transmission of HIV and other STDs has focused health promotion efforts on advocating the use of condoms during penetrative vaginal and anal sex. However, other behaviors that can facilitate STD transmission-such as oral sex and, in particular, fellatio-have received limited attention. METHODS Between 2003 and 2005, a sample of 1,373 full- and part-time students, primarily aged 16-18, completed questionnaires about their knowledge, attitudes and experiences related to sexual behavior and health. Chi-square tests were used to assess differences by sexual experience and gender. Supplementary data were obtained from sexual event diaries completed by 108 young people. RESULTS Fifty-six percent of survey respondents had experienced fellatio or cunnilingus, including 22% of those who had not yet engaged in penetrative intercourse. Of young people who had had vaginal intercourse, 70% had previously had oral sex. Among those who had experienced fellatio once, 17% had used a condom, but only 2% of respondents who had engaged in fellatio more than once reported consistent use. Reduced pleasure and lack of motivation, desire and forethought were reasons given for not using condoms during fellatio; hygiene, avoidance of the dilemma of whether to spit or swallow ejaculate, and taste were commonly cited as triggers for use. CONCLUSION Greater efforts are needed to publicize the risk of exposure to STDs that many young people face because of unprotected noncoital sexual activities before, as well as after, they enter into relationships involving intercourse.

What Determines Geographical Variation in Rates of Acceptance onto Renal Replacement Therapy in England

Objective: To determine the independent effects of need and supply factors on the known geographical variation in acceptance rates onto renal replacement therapy (RRT) in England. Methods: Data were obtained from all renal units in England on the characteristics of all cases aged 16 years and over, resident in England, who were accepted onto RRT in 1991 and 1992. Of these, 5715 (94.5%) had a valid postcode that could be matched to a census ward. Multilevel modelling using Poisson regression was used. The number of acceptances in each census ward within age bands 16–34, 35–64 and 65+ was the dependent variable. Independent effects modelled were: (1) individual factors (age, sex); (2) census ward need factors — ethnicity (expressed as the percentage of the ward population that was Asian or African-Caribbean), socio-economic deprivation — and supply factors — ‘access’ to the nearest renal unit using crowfly and road travel time and distance, and services available to each ward expressed as number of haemodialysis stations per 100 000 catchment population of the nearest renal unit; (3) district health authority level effects. Results: Age was a major determinant of acceptance, with a 7-fold higher rate in males aged over 64 years compared with younger men. Acceptance rates were lower in females, with a negative age-sex interaction in females aged over 64 years. The percentage of both Asian and African-Caribbean populations per ward was a highly significant positive determinant. Deprivation was also a significant determinant, best represented by a customised index. There was an inverse relation of acceptance with distance, especially road travel time. Other supply side variables had a significant effect though there was no independent district effect. There was some variation in the strength of these relationships by type of area (Greater London, urban and non-urban). Conclusions: Need and supply factors influence service use as expressed as acceptance onto RRT. Pressure to expand RRT services needs to be aimed at areas with large minority ethnic populations and those living far from existing units.

Spatial variation in teenage conceptions in south and west England

Multilevel Poisson models are used to identify factors influencing variation in census ward level teenage conception rates. Multilevel logistic models are also employed to examine the outcome of these conceptions. Demographic and socioeconomic characteristics are accounted for as well as access to family planning services. The paper emphasizes the importance of customized deprivation indices that are specific to the health outcome in urban and rural areas.

How, not just if, condoms are used: the timing of condom application and removal during vaginal sex among young people in England.

Objective: To assess the prevalence of, and factors associated with, vaginal penetration before condom application and following condom removal among young people in education in England. Method: A large cross sectional survey (n = 1373) was conducted in educational establishments in England and sexual event diaries were completed by a subsample of young people over a 6 month period. Results: Of the 375 survey respondents who reported having used a condom on the most recent occasion of vaginal sex, 6% had applied the condom after penetration and 6% had continued penetration after condom removal. Of the 74 diary respondents, 31% applied a condom late and 9% removed a condom early at least once over a 6 month period. The odds of “imperfect” condom use were found to decrease with overall consistency of condom use, confidence in correct condom use, positive reported relationship with mother, non-use of other contraception, and desire to use a condom. Conclusion: Given that late application and early removal of condoms fail to maximise their effectiveness as a method of STI prevention, it is important to address “imperfect” condom use and the factors associated with such use in public health policies and programmes. It is essential that young people understand the importance of using condoms consistently and correctly, and are also equipped with the skills and knowledge to do so.

‘Where do babies come from?’ Barriers to early sexuality communication between parents and young children

‘Where do babies come from?’ ‘Why do boys have willies?’ ‘What does gay mean?’ Probably all parents have faced such ‘innocent’ questions from young children, and many have found them challenging to answer. Access to sexuality education at an early age is frequently considered controversial; however, there are strong indications that early and open communication can impact positively in terms of sexual safety and outcomes. Using focus group discussions with parents of 3–7 year olds in the UK, this study explores some of the challenges parents report in dealing with early sexual socialisation as well as the reasons they cite for restricting young childrens sexual awareness and access to knowledge. Thematic analysis reveals a number of barriers to communication: the need to protect childhood ‘innocence’, suitable timing and age appropriateness of explanations, personal discomfort, and fear of criticism and judgement.

Who presents more than once? Repeat abortion among women in Britain

Background and methodology Around one in three sexually active women in Britain will have an abortion during their lifetime and a third of those women will experience more than one. Using data collected during the second National Survey of Sexual Attitudes and Lifestyles the characteristics of women who have presented for a second or subsequent abortion are compared to those women who have obtained only one. Results Results indicate that increased age and parity are key characteristics distinguishing between women who have experienced only one abortion and those women who have had more. Findings also reveal that those who have sought abortion on more than one occasion are more likely (than those who have had one abortion) to be Black, have left school at an earlier age, be living in rented accommodation, report an earlier age at first sexual experience, be less likely to have used a reliable method of contraception at sexual debut and report a greater number of sexual partners. Discussion and conclusions It is well recognised that attendance at abortion services presents an important opportunity for the provision of individually tailored information regarding contraception to assist women avoid the need for subsequent procedures. However, differential use of abortion services may also indicate variations in knowledge levels, attitudes to risk, attitudes towards abortion, partner communication, gender power and differential access to services. Further research is required to clarify these potential relationships so that suitable health promotion activities can be developed.

Parental interpretations of “childhood innocence”: Implications for early sexuality education

Purpose Despite general recognition of the benefits of talking openly about sexuality with children, parents encounter and/or create barriers to such communication. One of the key barriers is a desire to protect childhood innocence. The purpose of this paper is to explore parental interpretations of childhood innocence and the influence this has on their reported practices relating to sexuality-relevant communication with young children. Design/methodology/approach In all, 110 UK parents and carers of children aged between four and seven years were involved in focus group discussions. The discussions were transcribed and thematic network analysis was subsequently applied to the data. Following the reading and re-reading of the transcripts for meaning, context and content, individual comments and statements were identified within the data set and grouped to generate themes. Findings Childhood innocence was commonly equated with non-sexuality in children and sexual ignorance. Parents displayed ambiguity around the conceptualisation of non-innocence in children. Parents desire to prolong the state of childhood innocence led them to withhold certain sexual knowledge from their children; however, the majority also desired an open relationship whereby their child could approach them for information. Originality/value UK parents have a strong desire to maintain the social construction of their children as inherently innocent. This discourse is affecting the way in which they communicate about sexually relevant information with their children.

Does attractiveness influence condom use intentions in heterosexual men? An experimental study

Objectives Judgements of attractiveness have been shown to influence the character of social interactions. The present study sought to better understand the relationship between perceived attractiveness, perceived sexual health status and condom use intentions in a heterosexual male population. Setting The study employed an electronic questionnaire to collect all data, during face-to-face sessions. Participants 51 heterosexual, English-speaking men aged between 18 and 69 years. Outcome measures Men were asked to rate the attractiveness of 20 women on the basis of facial photographs, to estimate the likelihood that each woman had a sexually transmitted infection (STI) and to indicate their willingness to have sex with or without a condom with each woman. Results The more attractive a woman was judged to be on average, the more likely participants would be willing to have sex with her (p<0.0001) and the less likely they were to intend to use a condom during sex (p<0.0001). Multivariate analysis revealed that higher condom use intentions towards a particular woman were associated with lower ratings of her attractiveness (p<0.0005), higher ratings of her STI likelihood (p<0.0001), the participant being in an exclusive relationship (p=0.002), having a less satisfactory sex life (p=0.015), lower age (p=0.001), higher number of sexual partners (p=0.001), higher age at first intercourse (p=0.002), higher rates of condomless sex in the last 12 months (p<0.043) and lower confidence in their ability to assess whether or not a woman had an STI (p=0.001). The more attractive a participant judged himself to be, the more he believed that other men like him would engage in condomless sex (p=0.001) and the less likely he was to intend to use a condom himself (p=0.02). Conclusions Male perceptions of attractiveness influence their condom use intentions; such risk biases could profitably be discussed during sex education sessions and in condom use promotion interventions.

Talking relationships, babies and bodies with young children: the experiences of parents in England

Abstract Parents often find themselves ill-prepared for the moment at which questions of a sexual nature arise, or when children display signs of playful behaviour that can be interpreted as sexual. How these behaviours and questions are dealt with establishes the foundations on which children begin to interpret relationships, their bodies, those of others and the sexual world in which they live. In this study, the views and experiences of dealing with early childhood sexuality education, along with the ways in which communication had occurred, were collected from 110 parents in London and southern England during focus group discussions and analysed using thematic analysis. Parents who had chosen to communicate with their children reported a range of justifications as to why childhood sexuality communication was considered necessary and had, indeed, occurred. Six key themes were identified: communication prompts, the need for truth, the threat of ignorance, exposure, healthy and positive relationships and openness. Findings reveal that many parents are making strategic decisions about how to discuss relationships and sexuality with their young children. By highlighting the central trigger points for early parent-child sexuality communication, findings can be used to aid the development of relevant practice responses to support less confident parents to communicate effectively.

Feasibility and Preliminary Effectiveness of the Homework Intervention Strategy (eHIS) Program to Enhance Male Condom Use: Research Protocol.

Background Although condoms are effective in reducing the risk of sexually transmitted infections (STIs) and unintended pregnancy, they are still often not used consistently and correctly. Negative impact on sensation and pleasure, ruining the mood, causing problems with maintaining erection, and condom slippage or breakage are some of the reasons given by men explaining why they do not want to use condoms. Although many interventions promoting condom use exist, some of them delivered online are complex and time- and resource-intensive. The Homework Intervention Strategy (eHIS) program, adapted from the existing face-to-face Kinsey Institute Homework Intervention Strategy (KIHIS) program, aims to address these issues by encouraging men to focus on sensation and pleasure when trying different types of condoms and lubricants in a low-pressure situation (on their own, without a partner present). Objective The objectives of this study are to assess the feasibility, acceptability, and users’ engagement with the eHIS program, its preliminary effectiveness in increasing condom use frequency and consistency, as well as the feasibility of the programs evaluation approach, including choice of measures and participant recruitment and retaining strategies (primary outcomes). Secondary outcomes include condom use experience, condom use attitudes, condom use self-efficacy, condom use errors and problems, and condom fit-and-feel. All of these will be analyzed in the context of participants’ demographics, sexual history, and previous condom use. Methods The study has a pre-post-test, within-subjects design. Men aged 18 to 69 and living in the United Kingdom are recruited through posters, leaflets, social media, and emails. Study participants are asked to complete T1 (baseline) measures before entering the eHIS website. After completing the T1 measures, they can order a free condoms and lubricants kit and have access to the eHIS website for 4 weeks. During that time they are asked to practice using different types of condoms and lubricants on their own in a no-pressure situation. Following T1, participants are asked to complete the T2 and T3 measures at 4 and 10 weeks, respectively. Results Data collection for the study is completed. Data analysis is in progress and is expected to be completed by February 2018. Conclusions This brief, home-based, self-guided program may lead to increased consistent and correct condom use. Online delivery can make the program an easily accessible and low-cost health promotion intervention, which has the potential to reach a wide and diverse audience. If results of the current study show the program’s feasibility and preliminary effectiveness in changing condom use related outcomes, a larger scale randomized controlled trial (RCT) will be conducted. Trial Registration Research Registry: researchregistry2325; http://www.researchregistry.com/browse-the-registry.html# home/registrationdetails/58da6cad1d7ab0314337d076/ (Archived by WebCite at http://www.webcitation.org/6vXs6S9XW)