ArticlesEthnic variations in sexual behaviour in Great Britain and risk of sexually transmitted infections: a probability survey
Introduction
Variations in the frequency of diagnosed sexually transmitted infections (STIs) by ethnic origin have been recorded in many western industrialised countries and are a major public-health concern.1, 2, 3 In Great Britain, much of the evidence has arisen from studies based on data from genitourinary medicine (GUM) clinics and, more recently, HIV and STI surveillance.4, 5, 6, 7, 8 Findings seem consistent across settings and over time, with generally higher rates of bacterial STIs being reported in black ethnic groups4, 5, 6 and lower rates in Asian groups than in white groups.7, 8 However, studies investigating the relation between ethnic origin and sexual health are often limited by definitions and use of race and ethnic origin as explanatory variables; non-collection of, and adjustment for, data on high-risk sexual behaviour; and failure to take into account the wider socioeconomic determinants of sexual ill-health.9, 10 Concerns have also been raised about the generalisability of data from GUM clinics and the inherent difficulties in extrapolating findings to individuals or groups in the wider community.10
Transmission of STIs is determined by sexual behaviour patterns.11 However, few behavioural studies have been done that have improved our understanding of ethnic variations in sexual health.12, 13 Factors contributing to the variation in frequency of STIs between population subgroups include sexual behaviour, background prevalence of untreated disease, and health-seeking behaviour—especially for STI treatment and screening services. Mathematical models and empirical data indicate that patterns of sexual mixing by ethnic origin, age, country, or sexual activity could be additional complex determinants of STI transmission.14, 15, 16, 17 These factors in turn are affected by educational level and social class (upstream factors) in the socioeconomic and cultural environment.18, 19, 20 Here, we use data from the second British National Survey of Sexual Attitudes and Lifestyles (Natsal 2000),21 to investigate ethnic variations in high-risk sexual behaviour and sexual health outcomes in Britain and their associations with key demographic and behavioural factors.
Section snippets
Participants
Natsal 200021 is a stratified probability sample survey of 11161 men and women aged 16–44 years, resident in Great Britain, undertaken between May 1, 1999, and Feb 28, 2001. The method is described in detail elsewhere.21, 22, 23 Briefly, a sample of 40 523 addresses was selected from the small-user postcode address file for Great Britain with a multistage probability cluster design, with over-sampling in London. Interviewers visited all selected addresses and recorded the number of residents
Results
The response rate for the ethnic minority boost was 63% with CASRO (code of standards and ethics for survey research)28 rules—ie, excluding respondents who were ill, away from home, or unable to speak English, and using the observed proportion of ineligible households to adjust the denominator of eligible households. Data from the ethnic minority boost added a further 949 observations to the 11161 sampled in the main survey. 389 participants from the main survey sample did not belong to one of
Discussion
In this national probability survey, we have shown striking variations across ethnic groups in the patterns and distribution of sexual behaviours and in the frequency of reported sexual health outcomes. Our findings also confirm the higher prevalence of adverse sexual health outcomes experienced by black Caribbean and black African communities in Britain, as shown in previous clinic and community-based studies.4, 5, 6 Our results for black Caribbean and black African communities are also
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