title: Can psychosocial and socio-demographic questions help identify sexual risk among heterosexually-active women of reproductive age? Evidence from Britain's third National Survey of Sexual Attitudes and Lifestyles (Natsal-3).
abstract: Contraceptive advice and supply (CAS) and sexually transmitted infection (STI) testing are increasingly provided in primary care. Most risk assessment tools are based on sexual risk behaviours and socio-demographics, for use online or in specialist services. Combining socio-demographic and psychosocial questions (e.g. religious belief and formative experience) may generate an acceptable tool for targeting women in primary care who would benefit from intervention. We aimed to identify psychosocial and socio-demographic factors associated with reporting key sexual risk behaviours among women in the British general population.
  
  
  
  We undertook complex survey analysis of data from 4911 hetero-sexually active women aged 16-44 years, who participated in Britain's third National Survey of Sexual Attitudes and Lifestyles (Natsal-3), a national probability sample survey undertaken 2010-2012. We used multivariable regression to examine associations between the available psychosocial and socio-demographic variables in Natsal-3 and reports of three key sexual behaviours: a) 2+ partners in the last year (2PP); b) non-use of condoms with 2+ partners in the last year (2PPNC); c) non-use of condoms at first sex with most recent sexual partner (FSNC). We adjusted for key socio-demographic factors: age, ethnicity and socio-economic status (measured by housing tenure).
  
  
  
  Weekly binge drinking (6+ units on one occasion), and first sex before age 16 were each positively associated with all three sexual behaviours after adjustment. Current relationship status, reporting drug use (ever), younger age and living in rented accommodation were also associated with 2+ partners and 2 + partners without condoms after adjustment. Currently being a smoker, older age and respondent ethnicity were associated with FSNC after adjustment for all other variables. Current smoking status, treatment for depression (last year), and living at home with both parents until the age of 14 were each associated with one or more of the behaviours.
  
  
  
  Reported weekly binge drinking, early sexual debut, and age group may help target STI testing and/or CAS among women. Further research is needed to examine the proportion of sexual risk explained by these factors, the acceptability of these questions to women in primary care and the need to customise them for community and other settings.
authors.affiliation: Brighton & Sussex Medical School, 318b Mayfield House, Village Way, Brighton, Falmer, BN1 9PH, UK.|University of Brighton, Brighton, UK.
authors.forename: Natalie
authors.initials: N
authors.lastname: Edelman
authors.affiliation: Brighton & Sussex Medical School, 318b Mayfield House, Village Way, Brighton, Falmer, BN1 9PH, UK.
authors.forename: Jackie A
authors.initials: JA
authors.lastname: Cassell
authors.affiliation: School of Psychology, Room 1C12 Pevensey1, University of Sussex, Brighton, BN1 9RH, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: de Visser
authors.affiliation: Centre for Sexual Health and HIV Research, University College London, 3rd Floor Mortimer Market Centre off Capper Street, London, WC1E 6JB, UK.
authors.forename: Philip
authors.initials: P
authors.lastname: Prah
authors.affiliation: Centre for Sexual Health and HIV Research, University College London, 3rd Floor Mortimer Market Centre off Capper Street, London, WC1E 6JB, UK. c.mercer@ucl.ac.uk.
authors.forename: Catherine H
authors.initials: CH
authors.lastname: Mercer
mesh_terms: D000328:Adult; D001290:Attitude; D003270:Contraceptive Agents; D005260:Female; D020010:Heterosexuality / Q000706:statistics & numerical data*; D006801:Humans; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D012747:Sexual Partners; D012749:Sexually Transmitted Diseases / Q000453:epidemiology; D006113:United Kingdom; D055815:Young Adult
chemical_list: D003270:Contraceptive Agents
keywords: Psychosocial; Sexual risk; Socio-demographic; Survey; Women