Recalling sexual behavior: a methodological analysis of memory recall bias via interview using the diary as the gold standard

This study examined the effect of time lag on the validity of retrospective self-reports of sexual behavior. Seventy-five heterosexual students (44 women, 31 men) made daily recordings of sexual behavior, condom use, and alcohol or substance use for 1 month. Ability of respondents to recall sexual behavior recorded during this period was assessed at 1, 2, and 3 months after diary completion using recall interviews (25 interviewed at each interval). For vaginal intercourse, total recall error was significantly greater at 3 months than at 1 month post-diary. For all other variables assessed, the 2- and 3-month time intervals did not produce significant increase in total recall error. Higher frequency of vaginal intercourse, orgasm, and alcohol use prior to sexual activity were associated with total recall error for some but not all behaviors and outcomes. The results provide a partial validation of the diary-interview recall model as a method for studying recall error.     

High-risk sexual behavior among students of a minority-serving university in a community with a high HIV/AIDS prevalence

OBJECTIVE: The authors used a stratified cluster sampling design to inform campus sexually transmitted diseases prevention programs. PARTICIPANTS AND METHODS: They conducted a cross-sectional study of students (N = 1,130) at a large, urban, minority-serving university in South Florida using the 2004 National College Health Assessment Survey instrument. RESULTS: Of the 1,130 participants, 14.0% reported risky sexual behavior (having more than 1 sexual partner in 1 year and not using a condom the last time they had vaginal intercourse), and 11.9% reported consistent risky sexual behavior (having more than 1 partner in 1 year and not using condoms most or all of the time during the past 30 days). In multivariable analysis, past-month alcohol use had the strongest independent association with both risky and consistent risky sexual behavior. Illicit drug use was marginally significant in both models. CONCLUSIONS: Administrators should address the use of alcohol and other drugs on campus in planning interventions to promote safe sexual behavior.     

EFFECTS OF OVERWEIGHT ON RISKY SEXUAL BEHAVIOR OF ADOLESCENT GIRLS

We use data from the National Longitudinal Survey of Adolescent Health to estimate effects of adolescent girls' overweight on their propensity to engage in risky sexual behavior. We estimate single equation, two‐stage, and sibling fixed‐effects models. We consider both absolute weight and weight relative to other girls in the individual's school. We focus on vaginal intercourse without a condom, any type of sexual activity while under the influence of alcohol, and anal intercourse. Our findings confirm previous research indicating that overweight or obese girls are less likely than their recommended‐weight counterparts to be sexually active. As a result, they are less likely to have vaginal intercourse without a condom. However, overweight or obese girls are not less likely to have sex under the influence of alcohol, and once they have had vaginal intercourse, their consistency of condom use is no different from that of their recommended‐weight peers. The most striking finding is that overweight or obese girls are at least 15% more likely than their recommended‐weight peers to have ever had anal intercourse regardless of whether they have ever had vaginal sexual intercourse. The results from this study underscore the importance of using multifaceted and contemporary measures of risky sexual behavior and have implications for the health and well‐being of adolescent girls. (JEL I12, J13)     

Changing aids‐ and fertility‐related behavior: The effectiveness of sexual education

A questionnaire was used to access the effectiveness of a ten‐week university course on human sexuality in changing students' AIDS‐ and fertility‐related behavior. The students' knowledge and behavior were evaluated (1) early in the class before there were any discussions or readings about sexual behavior, AIDS, or birth control and (2) three months later—approximately one month after completing the class. A randomly selected control group of students who did not take the class on sexuality was given the questionnaire at the same two points in time. Compared to the control group, the experimental group showed significant increases in knowledge about the likelihood of contracting the virus from one act of vaginal intercourse. The experimental group also reported increased worry about contracting AIDS from their sexual activity, while the control group did not. Further, compared with the control group, the experimental group increased certain cautious behaviors, such as being more selective in their choice of sexual partners and asking their partners more questions about their AIDS‐related behavior. However, the course did not lead students to: 1) significantly increase their use of the condom or other forms of contraception, 2) decrease their number of sexual partners, or 3) spend a longer time getting to know new partners before engaging in sexual activity. Implications for sexual education are discussed.     

Sexual behaviour in aids‐related research: Reliability and validity of recall and diary measures

In order to assess the reliability and validity of two data collection instruments for measuring sexual practices in homosexual men, we administered a recall data collection instrument to 30 sexually active men, and a diary instrument to a subset of 19 participants. Each instrument covered a period of one month. For the recall instrument, the correlation coefficients between the test‐retest showed a good level of reliability for a number of infrequent sexual practices but was poor for frequent sexual practices. Correlation coefficients were calculated for sexual practices recorded in the first two and the second two weeks for both the recall and the diary. Generally, the level of agreement between the first and second two weeks for sexual practice data recorded in the diary was lower than the recall questionnaire. While the reliability of the recall method was found to be limited to certain sexual practices, it was concluded to be the most reliable and efficient method presently available for the collection of important high‐risk AIDS‐related sexual activities for a one‐month period.     

High-Risk Sexual Behavior Among Students of a Minority-Serving University in a Community With a High HIV/AIDS Prevalence

Objective: The authors used a stratified cluster sampling design to inform campus sexually transmitted diseases prevention programs. Participants and Methods: They conducted a cross-sectional study of students (N = 1,130) at a large, urban, minority-serving university in South Florida using the 2004 National College Health Assessment Survey instrument. Results: Of the 1,130 participants, 14.0% reported risky sexual behavior (having more than 1 sexual partner in 1 year and not using a condom the last time they had vaginal intercourse), and 11.9% reported consistent risky sexual behavior (having more than 1 partner in 1 year and not using condoms most or all of the time during the past 30 days). In multivariable analysis, past-month alcohol use had the strongest independent association with both risky and consistent risky sexual behavior. Illicit drug use was marginally significant in both models. Conclusions: Administrators should address the use of alcohol and other drugs on campus in planning interventions to promote safe sexual behavior.     

Sexual practices and the duration of last heterosexual encounter: findings from the Australian longitudinal study of health and relationships

This study investigated the association between sexual practices and duration of a sexual encounter. Using data from a population-based computer-assisted telephone survey of 8,656 Australians aged 16 to 64 years, four distinct patterns of sexual practices among respondents were found: "basic sexual encounter" (involving mainly kissing, cuddling, stroking one's partner and being stroked, and vaginal intercourse), "basic sexual encounter plus oral sex," "all assessed sexual practices" (all sexual behaviors included in the survey), and "mainly vaginal intercourse" (characterized by lower levels of kissing, cuddling, and stroking). For both men and women, respondents classified in the basic sexual encounter plus oral sex, and all assessed sexual practices clusters reported significantly longer durations than those in the basic sexual encounter group, whereas respondents in the mainly vaginal intercourse cluster reported shorter durations. These differences were found even after allowing for demographic differences in sexual duration-specifically, age and partner type of the most recent opposite-sex partner. These findings add to the understanding of what typically happens in a sexual encounter. Overall, longer sexual encounters appear to be associated with the inclusion of the least common sexual practices-namely, oral sex and self-stimulation.     

Sexual Practices and the Duration of Last Heterosexual Encounter: Findings from the Australian Longitudinal Study of Health and Relationships

This study investigated the association between sexual practices and duration of a sexual encounter. Using data from a population-based computer-assisted telephone survey of 8,656 Australians aged 16 to 64 years, four distinct patterns of sexual practices among respondents were found: “basic sexual encounter” (involving mainly kissing, cuddling, stroking one's partner and being stroked, and vaginal intercourse), “basic sexual encounter plus oral sex,” “all assessed sexual practices” (all sexual behaviors included in the survey), and “mainly vaginal intercourse” (characterized by lower levels of kissing, cuddling, and stroking). For both men and women, respondents classified in the basic sexual encounter plus oral sex, and all assessed sexual practices clusters reported significantly longer durations than those in the basic sexual encounter group, whereas respondents in the mainly vaginal intercourse cluster reported shorter durations. These differences were found even after allowing for demographic differences in sexual duration—specifically, age and partner type of the most recent opposite-sex partner. These findings add to the understanding of what typically happens in a sexual encounter. Overall, longer sexual encounters appear to be associated with the inclusion of the least common sexual practices—namely, oral sex and self-stimulation.     

The Impact of Pregnancy and Childbirth on Sexual Behaviors: A Systematic Review

The purpose of this review was to examine and synthesize the available quality evidence to provide researchers, educators, and clinicians an overview of what is known about sexual behaviors during pregnancy and the year after childbirth. Search engines were used to identify peer-reviewed, English-language articles that met the inclusion criteria. A total of 56 prospective, retrospective, and qualitative studies published after 1996 were reviewed. A gradual decline in vaginal intercourse from prepregnancy to first trimester to third trimester was found. Most couples resume vaginal intercourse by eight weeks after childbirth, but this behavior does not occur at prepregnancy frequencies until closer to 12 months postchildbirth. Future studies should consider assessing sexual behaviors beyond vaginal intercourse and increase efforts in recruitment of diverse samples including non-White, nonheterosexual pregnant individuals, and partners of pregnant individuals.     

Reliability of self-reported contraceptive use and sexual behaviors among adolescent girls

This study examines two issues relevant to adolescents' self-reported sexual and contraceptive use behaviors: reliability of partner-referent reports versus 3 and 6 month reports, and test-retest reliability of reports completed over a 2 week period. Data are from 196 13 to 18 year old girls recruited into this study while they south reproductive care from health clinics in a metropolitan area. All participants reported having had sexual intercourse during the past 6 months. Twice over a 2 week interval, participants completed the same paper and pencil surveys. The survey presented questions about sexual behavior and contraceptive use using 3 sequential frames of reference: within the past 6 months, within the past 3 months, and by specific sexual partners in the past 6 months. Findings demonstrate that adolescent girls can reliably report sexual behavior and contraceptive use over a 6 month interval. Study findings have implications for future research utilizing adolescents' self-reported sexual and contraceptive use behaviors.     

Some aspects of prostitution

This study was based on data collected from 87 men during and immediately following participation in a counseling program aimed at assisting them to reduce sexual behaviors associated with high HIV risk. All the men reported having engaged in same‐gender anal or oral sex without condoms during the year prior to enrollment. Three‐month retrospective reports of sexual behavior, solicited just after participation, were compared with reports collected weekly during the same three‐month period. Accuracy of recall over an ensemble of 10 behavior items was quite low, with amount of error positively associated with behavior frequency. In general, exaggerated reports were associated with low‐frequency behavior and underreports with high‐frequency behavior. Because of observed differences in the average frequency of occurrence of the various specific types of sexual behavior, adjustment for event frequency was required to provide adequate analysis of between‐behavior differences in memory error. Estimated functional relationships between behavior frequency and average memory error illustrated that for sexual activity occurring between 1 and 20 times in the three‐month period, there was a significant association between the HTV‐risk level of a behavior and the average extent to which the behavior was forgotten (i.e., underreported). After event‐frequency adjustment, anal activity without condoms—the behavior believed to entail the highest level of risk for HIV transmission, and the behavior about which the counseling program provided the least ambiguous cues regarding risk—was associated with the greatest underreporting error, and the ensemble of unprotected behaviors (i.e., those unaccompanied by condom usage) involved significantly greater underreporting than did protected behaviors. Error rates over the ensemble of behaviors were strikingly low for zero‐frequency events, suggesting the utility of dichotomous ever/never measures in research evaluating activity levels and behavior change. Other analysis techniques for reducing potential recall bias, allowing finer evaluations of behavior frequency and change, were also discussed.     

Adaptive training for existing male transsexual gender role: A case history

The development of AIDS interventions for adolescents is hindered by the lack of data on the conditions that influence high‐risk sexual behavior. We examined psychosocial correlates of condom use and multiple partner sex for a sample of sexually‐active heterosexual adolescent women. Respondents reported higher levels of vaginal intercourse than the “average” adolescent. A minority were engaging in anal intercourse. Condom use was associated with perceived enjoyment of condoms and communication skills. Number of sexual partners was associated with susceptibility beliefs, social norms, and sexual communication skills. The findings support the general observation that AIDS interventions with adolescents should build sexual communication skills, address motivational issues, and teach people how to enjoy safe‐sex activities.     

Patterns of Sexual Experience Among Urban Latino and African American Ninth Grade Students

This analysis assessed patterns of sexual experience, the order in which behaviors were initiated, and associated factors, among Latino and African American ninth grade students (average age 15.2) who self-administered audio-computer-assisted surveys on netbooks in classes at 10 Los Angeles–area public high schools. Lifetime experiences with vaginal and oral sex were most common (19% and 16%, respectively); fewer reported anal sex (6%). Of the 23% reporting any sex, 91% fell into four categories: 36% reporting both oral and vaginal sex; 23% vaginal only; 18% all three; and 13% oral only. Most sexually experienced students (88%) initiated with vaginal or oral sex (46% vaginal, 33% oral, 9% both same day). No dominant pathway of sexual onset emerged for those reporting all three types of sex. We found no evidence that oral or anal sex substituted for or delayed vaginal sex. Males, those with a current partner, and those reporting multiple partners were more likely than others to report all three sexual behaviors versus vaginal only (odds ratios [ORs] 2.0, 1.5, 3.0; p = .02, .06, < .01, respectively). Although vaginal intercourse dominated their early sexual behavior, one-fifth of sexually experienced students reported anal intercourse, highlighting the need for specific prevention messages surrounding this higher-risk behavior.     

Cycle-Related Changes in Mood,Sexual Desire,and Sexual Activity in Oral Contraception-Using and Nonhormonal-Contraception-Using Couples

Findings on women's sexuality across the menstrual cycle are inconsistent. One relatively consistent finding is a midcycle and premenstrual peak in sexual desire in freely cycling women. Results on the cycle-related effects on sexual behavior are less clear. Large proportions of reproductive-aged women use combined oral contraception (COC), but studies on potential cycle-related shifts in sexual desire and behavior are sparse. A prospective diary study assessed sexual desire, sexual behavior, and mood in 89 heterosexual couples. Women were using one of four contraceptive methods: (1) nonhormonal contraception, (2) low-dose COC containing 20 mcg ethinylestradiol and 75 mcg gestoden or desogestrel, (3) COC containing 35 mcg ethinylestradiol and 2 mg cyproteronacetate, and (4) COC containing 30 mcg ethinylestradiol and 3 mg drospirenone. No cycle effects of sexual desire were established in the COC group, but frequency of sexual intercourse declined in the last days of active pill taking. These results were similar in both female and male partners. Negative affect did not covary with sexual desire.     

The lesbian dyad

Little is known regarding how respondents interpret terms that are commonly used in sexual behavior surveys. The present study assessed the impact of four factors on respondents’ judgments of whether the hypothetical actors “Jim” and “Susie “ would consider a particular behavior that they had engaged in to be “sex.” The four factors were respondent's gender, actor's gender, type of act (vaginal, anal, or oral intercourse), and who achieved orgasm (neither, Jim only, Susie only, or both). Two hundred twenty‐three undergraduates (22.2 ± 2.2 years; 65% female) were asked to read 16 scenarios featuring Jim and Susie and to judge whether each actor would consider the described behavior to be sex. Results indicated that vaginal and anal intercourse were considered sex under most circumstances. Whether oral intercourse was labeled as sex depended on the gender and viewpoint of the actor, and whether orgasm occurred. Findings suggest that items in sexual behavior surveys need to be clearly delineated to avoid subjective interpretations by respondents.     

Sexual behavior of resident street prostitutes with their clients in Camden,New Jersey

This paper describes a prospective study of the sexual behaviors of 20 resident street prostitutes and their clients. Prostitutes were long‐term residents of and practiced street prostitution in their community. They worked full‐time and reported averages of four clients per workday, four to five workdays per week, in an eight‐year career. Sexual behaviors with clients on five to eight workdays were recorded over a seven‐month period. Forty‐nine percent of contacts were with repeat clients. A regular client was defined by prostitutes as one who visited at least once a week. The results of the present study indicate that long‐term sexual relationships exist between some clients and prostitutes. Typically, a regular client had one to three sexual encounters per week with the prostitute, spent several hours with her at a motel (or one of their homes), and was more likely (than the occasional client) to engage in vaginal intercourse. Reported condom use was in the range of 39 to 74 percent.     

Human immunodeficiency virus (HIV) seropositive homeless men: Behavioral and social characteristics

Homeless persons living in U.S. innercities are at risk for human immunodeficiency virus (HIV) infection, but few studies have examined the continued risk behaviors of HIV infected homeless men. We investigated the sexual behavior of 32 homeless men who had tested HIV seropositive. Twenty-five percent of HIV positive men reported a history of injection drug use, 34% had sex with men, over 40% had participated in commercial sex, and 59% had been treated for a non-HIV sexually transmitted disease. HIV seropositive men also reported recent sexual behavior, with 62% having sex in the previous month and 50% currently sexually active. Condom use was inconsistent among seropositive men; 44% of vaginal and 50% of anal intercourse occasions in the preceding three months did not involve condoms, and 28% of HIV seropositive men did not use a condom during their most recent sexual encounter. Substance use was frequently associated with unprotected sexual behavior among HIV seropositive men. Finally, measures of life satisfaction showed that HIV seropositive men were most satisfied with their relationships, mental health, and spiritual well being. These data suggest a need for intensive behavioral interventions tailored for homeless HIV infected men and we recommend that existing substance use treatment and holistic care be incorporated into behavioral interventions for HIV infected men.     

Adolescent Girls' Alcohol Use as a Risk Factor for Relationship Violence

This research examined the relation between female adolescents' general alcohol use and their experience of relationship violence. This relation was examined both cross‐sectionally and longitudinally, controlling for the proximal (i.e., situational) effects of alcohol use. One hundred and six female high school students reported on their experiences of physical violence and sexual coercion by boyfriends, general patterns of alcohol use, victimization experiences while drinking, and hypothesized covariates including demographic and relationship variables and illicit drug use. Variables were assessed at 2 time points 4 months apart. Results indicated that general alcohol use was related to victimization both cross‐sectionally and longitudinally, but different findings emerged for different forms of victimization (physical‐only victimization vs. both physical and sexual victimization).     

Parenting Practices and Adolescent Sexual Behavior: A Longitudinal Study

The effects of parental attitudes, practices, and television mediation on adolescent sexual behaviors were investigated in a study of adolescent sexuality and media (N = 887). Confirmatory factor analyses supported an eight‐factor parenting model with television mediation factors as constructs distinct from general parenting practices. Logistic regressions indicated that adolescents reporting greater parental disapproval and limits on viewing at Wave 1 were less likely to initiate oral sex between Waves 1 and 2. Adolescents who reported more sexual communication with parents were more likely to initiate oral sex. Results for vaginal intercourse were similar to those for oral sex. Coviewing was a significant negative predictor of initiation of sexual behavior. Parental attitudes and television mediation can delay potentially risky adolescent sexual behaviors.     

Letters to the editor

Relatively little attention has been paid to the use and importance of labels used by men who have sex with men to describe insertive or receptive sexual behavior during intercourse. This study examines sexual self‐labels, sexual behavior, HIV transmission risk, and psychological functioning among 205 HIV‐seropositive men who have sex with men. The majority of participants (88%) identified as a “top, “ a “bottom, “ or “versatile. “ Tops were more likely to engage in insertive anal intercourse than bottoms, and bottoms were more likely to engage in receptive anal intercourse than tops, with versatiles reporting intermediate rates of both behaviors. Although the results suggest preliminary evidence regarding the predictive utility of self‐labels, sexual behaviors of self‐label groups were greatly overlapping. Differences were found among self‐label groups in gay self‐identification, internalized homophobia, sexual sensation seeking, and anxiety. Results suggest an added value in assessing self‐labels in addition to asking about sexual behavior.