title: Use of the Internet for Sexual Health Among Sexually Experienced Persons Aged 16 to 44 Years: Evidence from a Nationally Representative Survey of the British Population.
abstract: BACKGROUND
  Those who go online regarding their sexual health are potential users of new Internet-based sexual health interventions. Understanding the size and characteristics of this population is important in informing intervention design and delivery.
  
  
  OBJECTIVE
  We aimed to estimate the prevalence in Britain of recent use of the Internet for key sexual health reasons (for chlamydia testing, human immunodeficiency virus [HIV] testing, sexually transmitted infection [STI] treatment, condoms/contraceptives, and help/advice with one's sex life) and to identify associated sociodemographic and behavioral factors.
  
  
  METHODS
  Complex survey analysis of data from 8926 sexually experienced persons aged 16-44 years in a 2010-2012 probability survey of Britain's resident population. Prevalence of recent (past year) use of Internet sources for key sexual health reasons was estimated. Factors associated with use of information/support websites were identified using logistic regression to calculate age-adjusted odds ratios (AORs).
  
  
  RESULTS
  Recent Internet use for chlamydia/HIV testing or STI treatment (combined) was very low (men: 0.31%; women: 0.16%), whereas 2.35% of men and 0.51% of women reported obtaining condoms/contraceptives online. Additionally, 4.49% of men and 4.57% of women reported recent use of information/support websites for advice/help with their sex lives. Prevalence declined with age (men 16-24 years: 7.7%; 35-44 years: 1.84%, P<.001; women 16-24 years: 7.8%; 35-44 years: 1.84%, P<.001). Use of information/support websites was strongly associated with men's higher socioeconomic status (managerial/professional vs semiroutine/routine: AOR 1.93, 95% CI 1.27-2.93, P<.001). Despite no overall association with area-level deprivation, those in densely populated urban areas were more likely to report use of information/support websites than those living in rural areas (men: AOR 3.38, 95% CI 1.68-6.77, P<.001; women: AOR 2.51, 95% CI 1.34-4.70, P<.001). No statistically significant association was observed with number of sex partners reported after age adjustment, but use was more common among men reporting same-sex partners (last 5 years: AOR 2.44, 95% CI 1.27-4.70), women reporting sex with multiple partners without condoms (last year: AOR 1.90, 95% CI 1.11-3.26), and, among both sexes, reporting seeking sex online (last year, men: AOR 1.80, 95% CI 1.16-2.79; women: AOR 3.00, 95% CI 1.76-5.13). No association was observed with reporting STI diagnosis/es (last 5 years) or (after age adjustment) recent use of any STI service or non-Internet sexual health seeking.
  
  
  CONCLUSIONS
  A minority in Britain used the Internet for the sexual health reasons examined. Use of information/support websites was reported by those at greater STI risk, including younger people, indicating that demand for online STI services, and Internet-based sexual health interventions in general, may increase over time in this and subsequent cohorts. However, the impact on health inequalities needs addressing during design and evaluation of online sexual health interventions so that they maximize public health benefit.
authors.affiliation: Research Department of Infection and Population Health, Institute of Epidemiology and Healthcare, University College London, London, United Kingdom. c.aicken@ucl.ac.uk.
authors.forename: Catherine R H
authors.identifier: http://orcid.org/0000-0001-7515-3667
authors.initials: CR
authors.lastname: Aicken
authors.forename: Claudia S
authors.identifier: http://orcid.org/0000-0001-5523-5630
authors.initials: CS
authors.lastname: Estcourt
authors.forename: Anne M
authors.identifier: http://orcid.org/0000-0003-1330-7100
authors.initials: AM
authors.lastname: Johnson
authors.forename: Pam
authors.identifier: http://orcid.org/0000-0002-1067-1583
authors.initials: P
authors.lastname: Sonnenberg
authors.forename: Kaye
authors.identifier: http://orcid.org/0000-0003-1053-8640
authors.initials: K
authors.lastname: Wellings
authors.forename: Catherine H
authors.identifier: http://orcid.org/0000-0002-4220-5034
authors.initials: CH
authors.lastname: Mercer
mesh_terms: D000293:Adolescent; D000328:Adult; D002690:Chlamydia Infections / Q000175:diagnosis; D003273:Contraceptive Devices; D005260:Female; D015658:HIV Infections / Q000175:diagnosis; D006801:Humans; D020407:Internet; D016015:Logistic Models; D008297:Male; D060728:Reproductive Health; D012725:Sexual Behavior; D012747:Sexual Partners; D012749:Sexually Transmitted Diseases / Q000175:diagnosis; D011795:Surveys and Questionnaires; D006113:United Kingdom; D014505:Urban Population; D055815:Young Adult
keywords: Internet; contraception; eHealth; health care-seeking behavior; information-seeking behavior; sexual health; sexually transmitted diseases; surveys