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Sex education, first sex and sexual health outcomes in adulthood: Findings from a nationally representative survey.

There has been significant investment in sexual health research in Ireland over the last decade. Researchers at the Royal College of Surgeons in Ireland (RCSI) have been involved in the three national, cross-sectional, general sexual health surveys, involving 13,000 adults, that have been conducted in Ireland since 2003*. The first was The Irish Contraception and Crisis Pregnancy (ICCP) Study 2003 (ICCP-2003)1, which was designed to establish nationally-representative data on current atti­tudes, knowledge and experience of contraception, crisis pregnancy and related services in Ireland. This was followed, in 2006, by The Irish Study of Sexual Health and Relationships (ISSHR)2, which was designed to build a representative and reli­able picture of sex and sexual behaviour in Ireland, including levels of sexual knowledge. Most recently, The Irish Contracep­tion and Crisis Pregnancy Study 2010 (ICCP-2010)3, was a repeat of the earlier ICCP study, providing an important opportunity to explore trends over time. This brief is based on a research project conducted in 2012 entitled: ‘Exploring trends in sexual activity, contraceptive use, and pregnancy experiences in Ireland: a secondary analysis of national survey data from the last decade’ which was designed to review the state of current knowledge in the area of sexual health, with the aim of informing policy and identifying future research directions. Four main research questions were explored: Who is talking to their children about sex? Does sex education have an impact on age and contraception use at first sex? Who has experienced a crisis pregnancy in Ireland? Who has ever had an STI and/or HIV test? Suitable participants and variables across datasets were identified and extracted for analysis. All participants were younger adults aged 18-45 years. Further methodological details are available on request from carolinekelleher@rcsi.ie *RCSI also completed a separate, related national survey of sexual violence in 2001 (SAVI: Sexual Abuse & Violence in Ireland)4

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Background: Notifiable STI rates are increasing. Research has identified risky sexual behaviours as the most significant predictor of attendance for sexually transmitted infections (STI) screening. There are no similar data on predictors of attendance for STI/HIV testing in Ireland. We aim to identify socio-demographic characteristics and the sexual health history of Irish people who have ever had an STI/HIV test.\ud Methods: Data were from two nationally representative sexual health surveys, carried out in Ireland in 2006 and 2010. Adults aged 18 to 45 years who had ever had sexual intercourse were included (N=7348). Descriptive analyses and a binary logistic regression investigated the socio-demographic characteristics and sexual health history of respondents with a history of STI/HIV testing compared to those without this history.\ud Findings: 25 per cent (N=1831) of respondents reported a history of a STI/HIV test. Increased likelihood of testing was associated with: being female (OR=1.51, 95 per cent CI 1.34–1.70); being homosexual/lesbian (OR=3.71, 95 per cent CI 1.47–9.37) or bisexual (OR=2.21, 95 per cent CI 1.43–3.42); younger age at the time of first heterosexual experience (OR=1.71, 95 per cent CI 1.48–1.97)); and not using contraception on this occasion (OR=1.29, 95 per cent CI 1.11–1.49).\ud Discussion: Increased STI/HIV testing in certain demographic groups may reflect more health conscious health seeking behaviour or increased risk behaviour. Attention needs to be paid to the context of first sex (age and contraception use) in both the policy and service delivery arenas.

Two main questions we aim to answer... \ud 1. Is sex education effective in delaying first sexual \ud intercourse and encouraging contraception use on this \ud occasion? \ud 2. Is receiving sex education related to sexual health \ud outcomes/behaviours in later life and does the context \ud of first sex have any role in this relationship?

This multi-stage mixed methods study was designed to assess the impact and experience of sexual violence (SV) in a sample of Irish women with a history of rape/sexual assault. A secondary aim was to explore the appropriateness of the trauma response model as a means of contextualising and explaining women’s post-rape experiences. Stage One involved a series of one-to-one interviews with a selection of stakeholders (n=18) who were providing services to Irish victims of SV. Several important themes were identified from the analysis of these data including: barriers to services, current gaps in service provision; and the perceived impact of SV. Stage Two comprised a detailed quantitative assessment of a sample of Irish women with an experience of SV (n=65). Participants completed a battery of measures in order to assess a number of key constructs/aspects of their life including: experience of trauma symptoms, recent psychological distress; recent life stress; social support; overall Quality of Life (QoL); and alcohol and drug use. A frequency distributionmatched sample of women (COM group) without a history of SV (n=57) also completed these measures (with the exception of the trauma symptoms measure). The average length of time since the incident of SV was almost 13 years) (M=12 years, 9 months) and approximately one third of the sample had also experienced SV under the age of 16. More than eight women in every ten knew the perpetrator, to a greater or lesser degree. The SV sample was characterised by significantly higher rates of recent psychological distress and negative life events than their comparison group counterparts as well as significantly worse QoL, and lower rates of social support. They also obtained significantly higher scores on all scales of the trauma symptoms measure when compared to the norm group. The relationship of the victim to the perpetrator emerged as a significant factor in relation to current marital status, histoiy of a mental health diagnosis and age at the time of the incident. Women who were older at the time of the sexual assault were found to have significantly lower rates of QoL and were experiencing more psychological distress than younger women. A number of significant and interesting correlations were also found between various subscales of the measures. Stage Three explored the impact and experience of SV in more detail by means of a series of one-to-one interviews with a reduced sub-sample of women selected from Stage Two (n=14). These qualitative data supplemented and amplified the findings from the previous two stages of the study. A number of key superordinate themes and subthemes were identified including: reactions to the experience of SV; impact of the experience of SV; service utilisation; disclosure; recovery and healing; and experiences of participation in the research. The findings from this study have highlighted a number of important issues in the area of SV in Ireland whilst also adding to the small, but growing pool of literature that is beginning to question the utility of the widely accepted trauma response model as a means of comprehensively and accurately contextualising and explaining women’s post-rape experiences. Collectively, the findings demonstrate the often ‘hidden’ impact of SV and, in particular, the pervasive and long-term effects on both self-esteem and sexual and intimate relationships. Future understanding of the effects of SV would be enhanced by allowing for the possibility for growth and recovery in rape victims as evidenced by the high level of education attainment in the SV sample. The results suggest that current medico-legal responses to SV in Ireland should incorporate appropriate training and awareness-raising initiatives in relation to victims of SV. It is hoped that improvements such as these would result in a measurable increase in, for example, the uptake of formal mental health services by these women. Furthermore, well co-ordinated public education campaigns are urgently required to dismantle the prevailing ‘rape supportive’ culture. Future research that includes, for example, men, and minority groups is needed while the role of alcohol misuse in the management or exacerbation of PTSD symptoms and factors moderating engagement in sexual risktaking behaviours post-assault are two additional areas worthy of further investigation.

Of those surveyed at a major airline in Ireland, more than half of the flight attendants believed that there was an unsatisfactory ‘fit’ between their skills and their jobs, and three-quarters said that they typically felt conflict between their employer’s expectations and their own desires.