Sexual Activity and Regret in Greek Student Population

1. Sexual activity, unwanted sexual behavior and regret for sexual intercourse in a Greek student population Dr. Philippe-Richard J. Domeyer, MD, MHA, MSc, PhD General Practitioner / Family Physician Academic Tutor of Health Management, Hellenic Open University

2. Sexual activity, unwanted sexual behavior and regret for sexual intercourse in a Greek student population Katsari V, Mariolis A, Souliotis K, Domeyer P. Dr. Philippe-Richard J. Domeyer, MD, MHA, MSc, PhD General Practitioner / Family Physician Academic Tutor of Health Management, Hellenic Open University

3. Introduction • Premarital sex & shift of the onset of sexual behavior towards a younger age is a universal behavioral pattern • Variations in age at first coitus between countries exist • Prevalence of unwanted adolescent pregnancies and STDs still increasing in some countries • Need for comprehensive research, education and multi-level action • Lloyd C, 2007 • WHO, 2011

4. Introduction • The epidemiological characteristics of sexual activity, sexual coercion and regret for first sexual intercourse have not been studied in detail in Greece so far. • Predictors have not been thoroughly investigated. • Students often exhibit a distinct behavioral pattern.

5. Aims and objectives Age at first sexual contact Number of sexual partners AIMS Assessment of young students’ sexual behavior, related parameters and their predictors Regret for first sexual contact Unwanted sexual behavior

6. 296 active students of Greek public Institutes of Vocational Training 287 students participated 13 invalid questionnaires 276 students18-30 yrs old(final study sample) Materials 2 students refused to participate 7 students >30 yrs old

7. Questionnaire • SHARE (Sexual Health and Relationships Education or Safe, Happy and Responsible) Study Questionnaire (UK) • Research-based teacher-led sex education programme • Subjected to RCT • Theory of planned behavior • Mostly Likert-type items

8. Theory of planned behavior Icek Azjen, 2006

9. Questionnaire structure (1) • Demographic characteristics • Communication with family/friends • Behavioral beliefs (using a condom could…) • Normative beliefs • Subjective norm (friends) • Descriptive norm (friends) • Anticipated approval (partner)

10. Questionnaire structure (2) • Ease of condom use • Intention of condom use • Regret of no condom use • Intention to buy, carry, discuss, suggest… condom • Knowledge (composite scale) • Regret, pressure, time to intercourse, partner, condom use: • First sexual relationship • Most recent sexual relationship • General sexual behavior (high risk?) and coercion

11. Questionnaire • Greek version of the validated SHARE StudyQuestionnaire, forth and back translated and culturally adapted. • Face and content validity assessed (from a sample of students and experts in the field, respectively)

12. Statistical analysis • Descriptive statistics • Cronbach’s alpha coefficients • Non-parametric statistical methods • Multiple regression & logistic regression analyses • Use of STATA 9.1 statistical software

13. Ethics • Anonymous self-administered questionnaires • Written permission from regulating authorities • Written permission from SHARE investigators • Written informed consent from participants • Study approved by the Institutional Review Board

14. Demographic characteristics • Age: 20.89±2.41 yrs • Sex: ♂ 58 (21.2%) ♀ 216 (78.8%)

15. Demographic characteristics

16. Communication † 1: very uncomfortable, 5: very comfortable; * Wilcoxon rank-sum test † 1: strongly agree, 5: strongly disagree; * Wilcoxon rank-sum test

17. Regret about timing of firstsexual intercourse with first partner Wilcoxon rank-sum test, p=0.0006

18. Regret about timing of first sexual intercourse with recent partner Wilcoxon rank-sum test, p=0.002

19. Pressure to first sexual intercourse with firstpartner Wilcoxon rank-sum test, p=0.001

20. Pressure to first sexual intercourse with recent partner Wilcoxon rank-sum test, p=0.029

21. Dating time till first sexual intercourse with first partner Wilcoxon rank-sum test, p=0.0001

22. Dating time till first sexual intercourse with recent partner Wilcoxon rank-sum test, p=0.0003

23. First and recent partner: comparisons *Wilcoxon rank-sum test, **Wilcoxon matched-pairs signed-rank test

24. Chi2 test for trend, p=0.001

25. Sexual coercion: descriptives & univariate analysis * Wilcoxon rank-sum test

26. Sexual coercion: multivariate analysis ** Stepwise backward logistic regression

27. Age at first sexual intercourse & predictors (age ≤16yrs vs older) * Wilcoxon rank-sum test ** Stepwise backward logistic regression

28. Number of sexual partnersever & predictors of having had >3 * Wilcoxon rank-sum test ** Stepwise backward logistic regression

29. Predictors of regret about timing of 1stsexual intercourse with 1stpartner * Stepwise backward ordinal logistic regression

30. Discussion & Conclusions • First study in the Greek literature and among the few in the international literature to provide a global perspective of sexuality-related issues of young students • Key messages • Important sex differences regarding: • Communication with family, friends and partners regarding sexual issues (women seem to be more uncomfortable with father – friends) • Regret about timing of first sexual intercourse (women more regretful) • Pressure to first sexual intercourse (women report increased pressure) • Dating time till first sexual intercourse (women declare more time)

31. Discussion & Conclusions • Shift of attitude of students from first to recent sexual relationship (become more “liberate”), concerning: • Regret about timing of first sexual intercourse • Pressure to first sexual intercourse • Dating time till first sexual intercourse • Use of effective contraceptive methods • Most popular contraceptive methods: condom, “withdrawal” • Ease of communication with parents emerged asconsistent predictors and are related to a more pronounced sexual activity, as documented by the age at first sexual intercourse and the number of sexual partners ever. • Sexual coercion and regret about timing of 1st sexual intercourse with 1st partner are prevalent (one out of four respondents) and both related to having received pressure from the first partner to first sexual intercourse.