Trends in testing of sexually transmissible infections (STIs), sexual health knowledge and behaviours, and pornography use in cross-sectional samples of young people in Victoria, Australia, 2015–21
Sarah Eddy A * , Caitlin Douglass A B , Michelle Raggatt A C , Alexander Thomas A and Megan Lim A B CA Burnet Institute, 85 Commercial Road, Melbourne, Vic. 3004, Australia.
B School of Population and Global Health, University of Melbourne, 235 Bouverie Street, Carlton, Vic. 3053, Australia.
C School of Public Health and Preventative Medicine, Monash University, 553 St Kilda Road, Melbourne, Vic. 3004, Australia.
Sexual Health 20(2) 164-172 https://doi.org/10.1071/SH22122
Submitted: 27 July 2022 Accepted: 4 March 2023 Published: 27 March 2023
© 2023 The Author(s) (or their employer(s)). Published by CSIRO Publishing
Abstract
Background: Sexually transmissible infections (STI) are prevalent and increasing among young Australians. This study examined trends in STI testing, sexual health knowledge/behaviours, and pornography use in young people aged 15–29 years in Victoria, Australia between 2015 and 2021.
Methods: Seven online cross-sectional surveys were conducted in a convenience sample of young people, recruiting a total of 7014 participants (67% female). Logistic regression analyses determined trends over time in binary outcomes.
Results: There was a decrease in reports of lifetime vaginal sex over time, while lifetime anal sex remained stable. Among those who had ever had vaginal sex, results showed an increase in the use of long-acting reversible contraceptives on the last occasion of vaginal sex. There was no change in STI testing or condom use with all partner types. Knowledge of STIs and sexual health changed over time: the proportion knowing that chlamydia can make women infertile decreased over time, while knowledge that taking the pill does not reduce fertility increased. There was no change in pornography use after adjusting for demographic variables.
Conclusions: Although uptake of long-acting contraceptives increased, STI knowledge and testing, as well as consistent condom use, remained low. Public health interventions should continue to address these critical components of STI prevention.
Keywords: anal sex, condom, contraceptive, pornography, sexual behaviours, sexual partner, STI knowledge, STI testing, vaginal sex, young people.
References
[1] World Health Organization (WHO). Defining sexual health: report of a technical consultation on sexual health, 28–31 January 2002, Geneva. Geneva: World Health Organization; 2006.[2] Burke L, Nic Gabhainn S, Young H. Student sex: more or less risky than other young adults? Sex Educ 2015; 15 31–47.
| Student sex: more or less risky than other young adults?Crossref | GoogleScholarGoogle Scholar |
[3] The Kirby Institute. National update on HIV, viral hepatitis and sexually transmissible infections in Australia: 2009–2018. Sydney: The Kirby Institute; 2020. Available at https://kirby.unsw.edu.au/sites/default/files/kirby/report/National-update-on-HIV-viral-hepatitis-and-STIs-2009-2018.pdf [accessed 21 December 2021]
[4] The Kirby Institute. Fourth national sexually transmissible infections strategy. Canberra: Department of Health; 2018. Available at https://www.health.gov.au/resources/publications/fourth-national-sexually-transmissible-infections-strategy-2018-2022?language=en [accessed 11 March 2022]
[5] Lyons HA. Heterosexual casual sex and STI diagnosis: a latent class analysis. Int J Sex Health 2017; 29 32–47.
| Heterosexual casual sex and STI diagnosis: a latent class analysis.Crossref | GoogleScholarGoogle Scholar |
[6] Kang M, Rochford A, Skinner SR, Mindel A, Webb M, Peat J, et al. Sexual behaviour, sexually transmitted infections and attitudes to chlamydia testing among a unique national sample of young Australians: baseline data from a randomised controlled trial. BMC Public Health 2014; 14 12
| Sexual behaviour, sexually transmitted infections and attitudes to chlamydia testing among a unique national sample of young Australians: baseline data from a randomised controlled trial.Crossref | GoogleScholarGoogle Scholar |
[7] The Kirby Institute. Tracking the progress 2020: national sexually transmissible infections strategy. Sydney: UNSW Sydney; 2021. Available at https://kirby.unsw.edu.au/sites/default/files/kirby/report/Tracking-the-progress-2020_National-STI-Strategy.pdf [accessed 21 December 2021]
[8] Douglass CH, Vella AM, Hellard ME, Lim MSC. Correlates of sexually transmissible infection testing among a sample of at-risk young Australians. Aust J Prim Health 2017; 23 272–7.
| Correlates of sexually transmissible infection testing among a sample of at-risk young Australians.Crossref | GoogleScholarGoogle Scholar |
[9] World Association for Sexual Health (WAS). Achieve recognition of sexual pleasure as a component of well-being. Oaxaca Mexico; 2008. Available at https://worldsexualhealth.net/resources/millennium-declaration/ [accessed 20 January 2023]
[10] Ford JV, Corona Vargas E, Finotelli I, Fortenberry JD, Kismödi E, Philpott A, et al. Why pleasure matters: its global relevance for sexual health, sexual rights and wellbeing. Int J Sex Health 2019; 31 217–30.
| Why pleasure matters: its global relevance for sexual health, sexual rights and wellbeing.Crossref | GoogleScholarGoogle Scholar |
[11] Lim MSC, Carrotte ER, Hellard ME. The impact of pornography on gender-based violence, sexual health and well-being: what do we know? J Epidemiol Community Health 2016; 70 3–5.
| The impact of pornography on gender-based violence, sexual health and well-being: what do we know?Crossref | GoogleScholarGoogle Scholar |
[12] Lim MSC, Agius PA, Carrotte ER, Vella AM, Hellard ME. Young Australians’ use of pornography and associations with sexual risk behaviours. Aust N Z J Public Health 2017; 41 438–43.
| Young Australians’ use of pornography and associations with sexual risk behaviours.Crossref | GoogleScholarGoogle Scholar |
[13] Peter J, Valkenburg PM. Adolescents and pornography: a review of 20 years of research. J Sex Res 2016; 53 509–31.
| Adolescents and pornography: a review of 20 years of research.Crossref | GoogleScholarGoogle Scholar |
[14] Richters J, Badcock PB, Simpson JM, Shellard D, Rissel C, de Visser RO, et al. Design and methods of the second Australian study of health and relationships. Sex Health 2014; 11 383–96.
| Design and methods of the second Australian study of health and relationships.Crossref | GoogleScholarGoogle Scholar |
[15] Fisher C, Kauer S. National survey of Australian secondary students and sexual health 1992–2018: trends over time. La Trobe; 2019. Available at http://www.teenhealth.org.au/resources/Reports/Secondary%20Student%20Survey%20Report%20-%20Trends%20Over%20Time.pdf [accessed 13 December 2021]
[16] Richters J, Fitzadam S, Yeung A, Caruana T, Rissel C, Simpson JM, et al. Contraceptive practices among women: the second Australian study of health and relationships. Contraception 2016; 94 548–55.
| Contraceptive practices among women: the second Australian study of health and relationships.Crossref | GoogleScholarGoogle Scholar |
[17] Rissel C, Heywood W, de Visser RO, Simpson JM, Grulich AE, Badcock PB, et al. First vaginal intercourse and oral sex among a representative sample of Australian adults: the second Australian study of health and relationships. Sex Health 2014; 11 406–15.
| First vaginal intercourse and oral sex among a representative sample of Australian adults: the second Australian study of health and relationships.Crossref | GoogleScholarGoogle Scholar |
[18] Rissel C, Badcock PB, Smith AMA, Richters J, de Visser RO, Grulich AE, et al. Heterosexual experience and recent heterosexual encounters among Australian adults: the second Australian study of health and relationships. Sex Health 2014; 11 416–26.
| Heterosexual experience and recent heterosexual encounters among Australian adults: the second Australian study of health and relationships.Crossref | GoogleScholarGoogle Scholar |
[19] Lim MSC, Bowring AL, Gold J, Aitken CK, Hellard ME. Trends in sexual behavior, testing, and knowledge in young people; 2006–2011. Sex Transm Dis 2012; 39 831–4.
| Trends in sexual behavior, testing, and knowledge in young people; 2006–2011.Crossref | GoogleScholarGoogle Scholar |
[20] Döring NM. The Internet’s impact on sexuality: a critical review of 15years of research. Comput Hum Behav 2009; 25 1089–101.
| The Internet’s impact on sexuality: a critical review of 15years of research.Crossref | GoogleScholarGoogle Scholar |
[21] Masoudi M, Maasoumi R, Bragazzi NL. Effects of the COVID-19 pandemic on sexual functioning and activity: a systematic review and meta-analysis. BMC Public Health 2022; 22 189
| Effects of the COVID-19 pandemic on sexual functioning and activity: a systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar |
[22] Owens EW, Behun RJ, Manning JC, Reid RC. The impact of Internet pornography on adolescents: a review of the research. Sex Addict Compulsivity 2012; 19 99–122.
| The impact of Internet pornography on adolescents: a review of the research.Crossref | GoogleScholarGoogle Scholar |
[23] Twenge JM, Sherman RA, Wells BE. Sexual inactivity during young adulthood is more common among U.S. Millennials and iGen: age, period, and cohort effects on having no sexual partners after age 18. Arch Sex Behav 2017; 46 433–40.
| Sexual inactivity during young adulthood is more common among U.S. Millennials and iGen: age, period, and cohort effects on having no sexual partners after age 18.Crossref | GoogleScholarGoogle Scholar |
[24] Beutel ME, Burghardt J, Tibubos AN, Klein EM, Schmutzer G, Brähler E. Declining sexual activity and desire in men – findings from representative German surveys, 2005 and 2016. J Sex Med 2018; 15 750–6.
| Declining sexual activity and desire in men – findings from representative German surveys, 2005 and 2016.Crossref | GoogleScholarGoogle Scholar |
[25] Wadham E, Green C, Debattista J, Somerset S, Sav A. New digital media interventions for sexual health promotion among young people: a systematic review. Sex Health 2019; 16 101–23.
| New digital media interventions for sexual health promotion among young people: a systematic review.Crossref | GoogleScholarGoogle Scholar |
[26] Lederer AM, Vertacnik AL. Correlates of sexually transmitted infection knowledge among late adolescents. Sex Health 2021; 18 303–10.
| Correlates of sexually transmitted infection knowledge among late adolescents.Crossref | GoogleScholarGoogle Scholar |
[27] Jenkinson R, Bowring A, Dietze P, Hellard M, Lim MSC. Young risk takers: alcohol, illicit drugs, and sexual practices among a sample of music festival attendees. J Sex Transm Dis 2014; 2014 357239
| Young risk takers: alcohol, illicit drugs, and sexual practices among a sample of music festival attendees.Crossref | GoogleScholarGoogle Scholar |
[28] Curtis TJ, Field N, Clifton S, Mercer CH. Household structure and its association with sexual risk behaviours and sexual health outcomes: evidence from a British probability sample survey. BMJ Open 2018; 8 e024255
| Household structure and its association with sexual risk behaviours and sexual health outcomes: evidence from a British probability sample survey.Crossref | GoogleScholarGoogle Scholar |
[29] Lewis R, Tanton C, Mercer CH, Mitchell KR, Palmer M, Macdowall W, et al. Heterosexual practices among young people in Britain: evidence from three national surveys of sexual attitudes and lifestyles. J Adolesc Health 2017; 61 694–702.
| Heterosexual practices among young people in Britain: evidence from three national surveys of sexual attitudes and lifestyles.Crossref | GoogleScholarGoogle Scholar |
[30] Herbenick D, Rosenberg M, Golzarri-Arroyo L, Fortenberry JD, Fu T-C. Changes in penile-vaginal intercourse frequency and sexual repertoire from 2009 to 2018: findings from the national survey of sexual health and behavior. Arch Sex Behav 2022; 51 1419–33.
| Changes in penile-vaginal intercourse frequency and sexual repertoire from 2009 to 2018: findings from the national survey of sexual health and behavior.Crossref | GoogleScholarGoogle Scholar |
[31] de Visser RO, Richters J, Rissel C, Badcock PB, Simpson JM, Smith AMA, et al. Change and stasis in sexual health and relationships: comparisons between the first and second Australian studies of health and relationships. Sex Health 2014; 11 505–9.
| Change and stasis in sexual health and relationships: comparisons between the first and second Australian studies of health and relationships.Crossref | GoogleScholarGoogle Scholar |
[32] Stavridou A, Samiakou C, Kourti A, Tsiorou S, Panagouli E, Thirios A, et al. Sexual activity in adolescents and young adults through COVID-19 pandemic. Children 2021; 8 577
| Sexual activity in adolescents and young adults through COVID-19 pandemic.Crossref | GoogleScholarGoogle Scholar |
[33] Coombe J, Kong FYS, Bittleston H, Williams H, Tomnay J, Vaisey A, et al. Love during lockdown: findings from an online survey examining the impact of COVID-19 on the sexual health of people living in Australia. Sex Transm Infect 2021; 97 357–62.
| Love during lockdown: findings from an online survey examining the impact of COVID-19 on the sexual health of people living in Australia.Crossref | GoogleScholarGoogle Scholar |
[34] Marston C, Lewis R. Anal heterosex among young people and implications for health promotion: a qualitative study in the UK. BMJ Open 2014; 4 e004996
| Anal heterosex among young people and implications for health promotion: a qualitative study in the UK.Crossref | GoogleScholarGoogle Scholar |
[35] Malhotra S. Impact of the sexual revolution: consequences of risky sexual behaviors. J Am Phys Surg 2008; 13 88–90.
[36] Grzeskowiak LE, Calabretto H, Amos N, Mazza D, Ilomaki J. Changes in use of hormonal long-acting reversible contraceptive methods in Australia between 2006 and 2018: a population-based study. Aust N Z J Obstet Gynaecol 2021; 61 128–34.
| Changes in use of hormonal long-acting reversible contraceptive methods in Australia between 2006 and 2018: a population-based study.Crossref | GoogleScholarGoogle Scholar |
[37] Mazza D, Bateson D, Frearson M, Goldstone P, Kovacs G, Baber R. Current barriers and potential strategies to increase the use of long-acting reversible contraception (LARC) to reduce the rate of unintended pregnancies in Australia: an expert roundtable discussion. Aust N Z J Obstet Gynaecol 2017; 57 206–12.
| Current barriers and potential strategies to increase the use of long-acting reversible contraception (LARC) to reduce the rate of unintended pregnancies in Australia: an expert roundtable discussion.Crossref | GoogleScholarGoogle Scholar |
[38] Garrett CC, Keogh LA, Kavanagh A, Tomnay J, Hocking JS. Understanding the low uptake of long-acting reversible contraception by young women in Australia: a qualitative study. BMC Womens Health 2015; 15 72
| Understanding the low uptake of long-acting reversible contraception by young women in Australia: a qualitative study.Crossref | GoogleScholarGoogle Scholar |
[39] Chow EPF, Hocking JS, Ong JJ, Phillips TR, Fairley CK. Sexually transmitted infection diagnoses and access to a sexual health service before and after the national lockdown for COVID-19 in Melbourne, Australia. Open Forum Infect Dis 2021; 8 ofaa536
| Sexually transmitted infection diagnoses and access to a sexual health service before and after the national lockdown for COVID-19 in Melbourne, Australia.Crossref | GoogleScholarGoogle Scholar |
[40] Hocking JS, Temple-Smith M, Guy R, Donovan B, Braat S, Law M, et al. Population effectiveness of opportunistic chlamydia testing in primary care in Australia: a cluster-randomised controlled trial. Lancet 2018; 392 1413–22.
| Population effectiveness of opportunistic chlamydia testing in primary care in Australia: a cluster-randomised controlled trial.Crossref | GoogleScholarGoogle Scholar |
[41] Zaneva M, Philpott A, Singh A, Larsson G, Gonsalves L. What is the added value of incorporating pleasure in sexual health interventions? A systematic review and meta-analysis. PLoS ONE 2022; 17 e0261034
| What is the added value of incorporating pleasure in sexual health interventions? A systematic review and meta-analysis.Crossref | GoogleScholarGoogle Scholar |
[42] Kurkowski JP, Hsieh G, Sokkary N, Santos X, Bercaw-Pratt JL, Dietrich JE. Knowledge of sexually transmitted infections among adolescents in the houston area presenting for reproductive healthcare at Texas children’s hospital. J Pediatr Adolesc Gynecol 2012; 25 213–7.
| Knowledge of sexually transmitted infections among adolescents in the houston area presenting for reproductive healthcare at Texas children’s hospital.Crossref | GoogleScholarGoogle Scholar |
[43] Keizur EM, Bristow CC, Baik Y, Klausner JD. Knowledge and testing preferences for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis infections among female undergraduate students. J Am Coll Health 2020; 68 754–61.
| Knowledge and testing preferences for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis infections among female undergraduate students.Crossref | GoogleScholarGoogle Scholar |
[44] Helmer J, Senior K, Davison B, Vodic A. Improving sexual health for young people: making sexuality education a priority. Sex Educ 2015; 15 158–71.
| Improving sexual health for young people: making sexuality education a priority.Crossref | GoogleScholarGoogle Scholar |
[45] Prendergast LE, Toumbourou JW, McMorris BJ, Catalano RF. Outcomes of early adolescent sexual behavior in Australia: longitudinal findings in young adulthood. J Adolesc Health 2019; 64 516–22.
| Outcomes of early adolescent sexual behavior in Australia: longitudinal findings in young adulthood.Crossref | GoogleScholarGoogle Scholar |
[46] Australian Bureau of Statistics. Education and work, Australia. 2021. Available at https://www.abs.gov.au/statistics/people/education/education-and-work-australia/latest-release [accessed 17 February 2022]