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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.
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.
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).
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%,
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.
Sexual health is increasingly recognized as encompassing physical, mental, and emotional well-being in relation to sexuality and sexual relationships, and freedom from coercion [
Internet access is now nearly universal among people of reproductive age in the United Kingdom (98% aged 16-34 years, 93% aged 35-44 years in 2013) and more than one-third regularly uses the Internet to find information on health-related issues [
Specific objectives were (1) to estimate the prevalence of reporting recent (in the previous year) use of the Internet as a source of chlamydia testing, HIV testing, STI treatment, condoms/contraceptive supplies, and help/advice with one’s sex life from information/support websites among sexually experienced men and women; (2) to describe the population reporting this; and (3) to estimate the proportions reporting a preference for online sexual health care.
Britain’s third National Survey of Sexual Attitudes and Lifestyles (Natsal-3 [
The full survey is available online [
Several survey questions relevant to these analyses were not asked to participants aged 45 years and older. Therefore, the denominator for this study was limited to those aged 16 to 44 years, the age group in which most STI diagnoses occur [
Outcome variables for this study included reported use of Internet services for key sexual health reasons (
For timeframe, the question on sources of contraceptive supplies referred to the past year. Questions on HIV testing, chlamydia testing, and STI treatment referred to the last occurrence. For comparability, only participants who indicated that this last occurrence was in the previous year (determined from responses to other survey questions) were included as reporting these behaviors.
We had the following categories of explanatory variables: participants’ sociodemographics, Internet access, area-level measures, sexual behavior (in the past year and past 5 years), sexual health care use, and STI diagnosis. Variables for sexual behavior and service use were selected to match the timeframe of the primary outcome variable (the year before the survey interview). Some variables corresponding to the 5 years before the interview were included (having had same-sex partners, number of sexual partners, sexual health clinic attendance, and STI diagnosis) to reflect greater variability in certain behaviors in the population over this longer period [
Data were analyzed using the complex survey functions of Stata 12 to take account of clustering, stratification, and weighting of the Natsal-3 sample. Weights were applied to adjust for unequal probabilities of selection for participation in the survey. All analyses were conducted separately by sex. Participants with missing data for a given variable were excluded from analyses using this variable because item nonresponse in Natsal-3 was low (typically less than 0.5% in the CAPI and 1%-3% in the CASI) [
Logistic regression was used to obtain crude odds ratios to compare estimates of the odds of reporting use of information/support websites for advice/help with one’s sex life, by each explanatory variable. Multivariable logistic regression was used, adjusting only for age, as a potential confounder of associations with NS-SEC code, which contained a “full-time student” category; OAC 2011, which was based on population characteristics including age; recent STI diagnosis; and sexual behavior variables because young people report greater numbers of recent and new sexual partners than older adults [
The observed low prevalences of other outcome variables meant that it was not possible to explore their associated factors. Statistical significance was considered as
The Natsal-3 study was approved by the Oxfordshire Research Ethics Committee A (Ref: 10/H0604/27).
Among sexually experienced persons aged 16 to 44 years, Internet use for chlamydia testing, HIV testing, or STI treatment (combined) in the previous year was reported by 0.31% (12/3702) men and 0.16% (6/3716) women (
Details of the Natsal-3 survey questions used as outcome variables in these analyses of sexually experienced persons aged 16 to 44 years (unweighted N=8926, weighted N=7400).
Question wording | Timeframe; number of responses permitted | Response options | Respondents eligible for each survey question | Number eligible for each question, unweighted (weighted) |
Have you sought help or advice regarding your sex life from any of the following sources in the last year? | During previous year; multiple responses | Information and support sites on the Internet;a family member/friend; self-help books/information leaflets; self-help groups; helpline; GP/family doctor; sexual health/GUM/STI clinic; psychiatrist or psychologist; relationship counsellor; other type of clinic or doctor; have not sought any help | Entire sample of the current study | 8926 (7400) |
Have you got contraception from any of these sources in the last year? | During previous year; multiple responses | Internet website;a a doctor or nurse at your GP’s surgery; sexual health clinic (GUM clinic); family planning clinic / contraceptive clinic / reproductive health clinic; NHS antenatal clinic / midwife; private doctor or clinic; youth advisory clinic (eg, Brook clinic); pharmacy/chemist; supplies from school/college/university services; over the counter at a petrol station/supermarket/other shop; vending machine; mail order; hospital accident and emergency (A&E) department; any other type of place (please say where); I have not got contraception in the last year | Those reporting use of any contraceptive methodb in the last year | 7182 (5862) |
When you were last tested for chlamydia, where were you offered the test? | Last occurrence; single response | Internet;a GP surgery; sexual health clinic (GUM clinic); NHS family planning clinic / contraceptive clinic / reproductive health clinic; antenatal clinic/midwife; private non-NHS clinics or doctor; youth advisory clinic (eg, Brook Clinic); School/college/university; termination of pregnancy (abortion) clinic; hospital accident and emergency (A&E) department; pharmacy/chemist; other non-health care place (eg, youth club, festival, bar); somewhere else | Those reporting chlamydia testing in the last year | 2387 (1545) |
Where were you tested? (the last HIV test if more than one) | Last occurrence; single response | Internet site offering postal kit;a GP surgery; sexual health clinic (GUM clinic); NHS family planning clinic / contraceptive clinic / reproductive health clinic; antenatal clinic / midwife; private non-NHS clinic or doctor; youth advisory clinic (eg, Brook clinic); termination of pregnancy (abortion) clinic; hospital accident and emergency (A&E) department; somewhere else | Those reporting HIV testing in the last year | 802 (562) |
Where were you last treated for [STIc]? | Last occurrence; single response | Internet site offering treatment;a GP surgery; sexual health clinic (GUM clinic); NHS family planning clinic / contraceptive clinic / reproductive health clinic; antenatal clinic / midwife; private non-NHS clinic or doctor; pharmacy/chemist; youth advisory clinic (eg, Brook clinic); termination of pregnancy (abortion) clinic; hospital accident and emergency (A&E) department; somewhere else | Those reporting having been told by a doctor / health professional that they had an STI in the last year | 178 (117) |
a Internet response options.
b Including condoms.
c Separate questions were asked about the following infections: chlamydia; gonorrhea; genital warts; syphilis;
Natsal-3 survey questions about preferred sources of sexual health care.
Question wordinga | Response options | Respondents eligible for each survey question | Number eligible for each question, unweighted (weighted) |
If you thought that you might have an infection that is transmitted by sex, where would you |
Internet site offering treatment;b GP surgery; sexual health clinic (GUM clinic); NHS Family planning clinic/contraceptive clinic/reproductive health clinic; NHS antenatal clinic/midwife; private non-NHS clinic or doctor; pharmacy/chemist; youth advisory clinic (eg, Brook clinic); hospital accident and emergency (A&E) department; somewhere else | Those reporting any lifetime sexual partners | 8858 (7338) |
If all of these different types of service were available in your area and easy to get to, which one would |
NHS or Department of Health website;b a doctor or Nurse at your GP’s surgery; sexual health clinic (GUM clinic); family planning clinic / contraceptive clinic / reproductive health clinic; youth advisory clinic (eg, Brook clinic); pharmacy/chemist; none of these; not needed | Those reporting use of any method in the last year | 6909 (5524) |
a Use of italics reflects emphasis given in the survey. One response could be selected at each question.
b Internet response options.
Percentage reporting seeking sexual health care and advice/help with one’s sex life in the previous year, and specifically using the Internet to do so, among sexually experienced persons aged 16-44 years by gender and age group.
Mean age of men and women reporting use of Internet information/support websites for advice/help with their sex life (based on the first question described in
Variation in the prevalence and odds of reporting recent (past year) use of information/support websites for advice/help with one’s sex life (Internet information/support) among sexually experienced men aged 16 to 44 years.a
Variable | N, unweighted |
Prevalence (95% CI) | OR (95% CI) |
|
AOR (95% CI) |
|
||
|
||||||||
|
|
<.001 | — | |||||
|
|
16-24 | 1361 (994) | 7.7% (6.3-9.4) | 1 | — | ||
|
|
25-34 | 1451 (1299) | 4.93% (3.90-6.23) | 0.62 (0.45-0.86) | — | ||
|
|
35-44 | 784 (1383) | 1.84% (1.12-3.02) | 0.22 (0.13-0.39) | — | ||
|
|
.007 | .004 | |||||
|
|
White | 3134 (3118) | 4.01% (3.39-4.75) | 1 | 1 | ||
|
|
Asian/Asian British | 190 (270) | 6.9% (4.0-11.6) | 1.77 (0.98-3.21) | 2.11 (1.16-3.84) |
|
|
|
|
Black/black British | 126 (140) | 7.8% (3.7-15.4) | 2.01 (0.92-4.42) | 2.11 (0.93-4.81) |
|
|
|
|
Mixed/Chinese/other | 108 (110) | 9.4% (5.1-16.8) | 2.49 (1.26-4.93) | 2.2 (1.13-4.26) |
|
|
|
|
<.001 | <.001 | |||||
|
|
No academic qualifications | 252 (275) | 0.8% (0.3-2.5) | 0.60 (0.18-2.00) | 0.65 (0.20-2.18) | ||
|
|
Academic qualifications typically gained at age 16 | 880 (912) | 1.4% (0.8-2.3) | 1 | 1 |
|
|
|
|
Studying for/attained further academic qualifications | 2354 (2419) | 6.05% (5.13-7.13) | 4.57 (2.68-7.78) | 3.79 (2.20-6.51) |
|
|
|
|
<.001 | .001 | |||||
|
|
Managerial/professional | 1060 (1262) | 4.53% (3.42-5.98) | 1.46 (0.97-2.19) | 1.93 (1.27-2.93) |
|
|
|
|
Intermediate | 509 (554) | 3.0% (1.8-4.8) | 0.94 (0.53-1.66) | 1.16 (0.64-2.08) |
|
|
|
|
Semiroutine/routine | 1321 (1300) | 3.15% (2.40-4.11) | 1 | 1 |
|
|
|
|
No job | 122 (99) | 1.6% (0.4-6.4) | 0.48 (0.11-2.08) | 0.33 (0.08-1.42) |
|
|
|
|
Full-time student | 574 (452) | 11.1% (8.5-14.5) | 3.85 (2.53-5.86) | 1.95 (1.14-3.34) | ||
|
||||||||
|
|
|
.02 | .02 | ||||
|
|
Yes | 3327 (3442) | 4.73% (4.06-5.51) | 1 |
|
1 |
|
|
|
No | 267 (232) | 1.5% (0.6-3.9) | 0.30 (0.11-0.82) |
|
0.31 (0.11-0.84) | |
|
|
|||||||
|
|
.51 | .24 | |||||
|
|
1 (least deprived) | 642 (658) | 5.7% (4.2-7.7) | 1 | 1 |
|
|
|
|
2 | 653 (699) | 4.3% (3.1-6.0) | 0.74 (0.46-1.20) | 0.71 (0.44-1.14) |
|
|
|
|
3 | 690 (720) | 4.6% (3.3-6.5) | 0.81 (0.50-1.30) | 0.76 (0.47-1.23) |
|
|
|
|
4 | 774 (823) | 4.3% (2.9-6.4) | 0.75 (0.45-1.26) | 0.69 (0.41-1.15) |
|
|
|
|
5 (most deprived) | 837 (776) | 3.8% (2.7-5.3) | 0.66 (0.41-1.06) | 0.58 (0.36-0.93) |
|
|
|
|
<.001 | <.001 | |||||
|
|
1: “Rural residents” | 276 (294) | 3.2% (1.8-5.6) | 1 |
|
1 | |
|
|
2: “Cosmopolitans” | 302 (329) | 12.5% (9.0-17.2) | 4.33 (2.17-8.63) |
|
3.38 (1.68-6.77) |
|
|
|
3: “Ethnicity central” | 181 (225) | 5.4% (2.7-10.3) | 1.71 (0.69-4.27) |
|
1.58 (0.64-3.91) |
|
|
|
4: “Multicultural metropolitans” | 516 (595) | 3.7% (2.3-5.7) | 1.15 (0.54-2.43) |
|
1.04 (0.49-2.22) |
|
|
|
5: “Urbanites” | 665 (667) | 3.6% (2.4-5.3) | 1.13 (0.55-2.30) |
|
1.09 (0.53-2.24) |
|
|
|
6: “Suburbanites” | 587 (597) | 4.5% (3.2-6.3) | 1.44 (0.72-2.85) |
|
1.30 (0.65-2.59) |
|
|
|
7: “Constrained city dwellers” | 331 (271) | 4.1% (2.3-7.1) | 1.28 (0.56-2.94) |
|
1.06 (0.46-2.48) | |
|
|
8: “Hard-pressed living” | 738 (698) | 2.8% (2.0-4.0) | 0.87 (0.44-1.75) |
|
0.76 (0.38-1.52) | |
|
||||||||
|
|
.77 | .29 | |||||
|
|
0 | 191 (174) | 4.6% (2.4-8.6) | 1.06 (0.53-2.12) | 0.95 (0.48-1.89) |
|
|
|
|
1 | 2320 (2612) | 4.37% (3.63-5.26) | 1 | 1 |
|
|
|
|
2+ | 1051 (857) | 5.0% (3.7-6.6) | 1.14 (0.80-1.63) | 0.72 (0.48-1.08) | ||
|
≥ |
<.001 | .11 | |||||
|
|
No | 2129 (2503) | 3.34% (2.71-4.12) | 1 |
|
1 | |
|
|
Yes | 1428 (1134) | 7.14% (5.74-8.85) | 2.22 (1.61-3.07) |
|
1.39 (0.93-2.09) |
|
|
|
.12 | .30 | |||||
|
|
0 | 862 (780) | 5.9% (4.4-7.8) | 1 | 1 |
|
|
|
|
1 | 2139 (2412) | 4.15% (3.40-5.05) | 0.69 (0.48-0.98) | 0.96 (0.66-1.38) |
|
|
|
|
≥2 | 523 (419) | 4.5% (3.1-6.7) | 0.75 (0.46-1.25) | 0.69 (0.42-1.13) |
|
|
|
|
.004 | .009 | |||||
|
|
No | 3287 (3414) | 4.28% (3.64-5.03) | 1 |
|
1 | |
|
|
Yes | 306 (257) | 7.9% (5.4-11.6) | 1.92 (1.24-3.00) |
|
1.80 (1.16-2.79) |
|
|
||||||||
|
|
.04 | .96 | |||||
|
|
0-1 | 1441 (1805) | 3.63% (2.82-4.66) | 1 | 1 |
|
|
|
|
2-4 | 1106 (1012) | 5.17% (3.98-6.70) | 1.45 (0.99-2.13) | 0.94 (0.63-1.41) |
|
|
|
|
≥5 | 1024 (837) | 5.8% (4.4-7.6) | 1.64 (1.11-2.42) | 0.95 (0.60-1.49) |
|
|
|
≥ |
.002 | .008 | |||||
|
|
No | 3459 (3561) | 4.32% (3.68-5.06) | 1 | 1 | ||
|
|
Yes | 137 (116) | 10.9% (6.2-18.5) | 2.71 (1.43-5.14) | 2.44 (1.27-4.70) |
|
|
|
||||||||
|
|
|
.004 | .42 | ||||
|
|
Yes | 2391 (2223) | 5.46% (4.57-6.51) | 1 |
|
1 | |
|
|
Not reported | 1205 (1453) | 3.10% (2.24-4.28) | 0.55 (0.37-0.82) |
|
0.84 (0.55-1.29) |
|
|
|
|
.03 |
|
.89 | |||
|
|
Yes | 861 (712) | 5.9% (4.5-7.8) | 1 | 1 |
|
|
|
|
No | 2670 (2902) | 4.11% (3.41-4.95) | 0.68 (0.48-0.97) | 0.97 (0.67-1.41) |
|
|
|
|
.27 | .08 | |||||
|
|
Yes | 873 (703) | 5.3% (3.9-7.0) | 1 | 1 |
|
|
|
|
Not reported | 2723 (2974) | 4.35% (3.64-5.19) | 0.82 (0.57-1.17) | 1.40 (0.96-2.02) |
|
|
|
|
.68 | .97 | |||||
|
|
No | 3300 (3408) | 4.47% (3.81-5.24) | 1 | 1 |
|
|
|
|
Yes | 257 (225) | 5.0% (2.9-8.5) | 1.13 (0.63-2.04) | 0.99 (0.55-1.79) |
|
a Unweighted N=3614, weighted N=3697. Denominators vary due to item nonresponse.
b Denominator restricted to those aged 17 and older. No academic qualifications: left school at age 16 without passing any exams/gaining any qualifications (excludes qualifications gained at an older age); academic qualifications typically gained at age 16: left school at 16 having passed some exams/gained some qualifications (eg, English General Certificate of Secondary Education [GCSE] or equivalent); studying for or attained further academic qualifications: left school at age 17 or older.
c Based on National Statistics Socioeconomic Classification (NS-SEC) code. No job: no job of ≥10 hours per week in the last 10 years.
d Quintile of adjusted Index of Multiple Deprivation for Great Britain.
e Defined as reporting STI clinic attendance within the last year or responses other than “Internet” for questions listed in
f Defined as reporting any of: STI clinic attendance, chlamydia testing, or HIV testing within this last year.
g Natsal definition of STIs excludes thrush.
A strong association was observed with education level; 1.4% of men and 2.0% of women who left school aged 16 years with General Certificates of Secondary Education (GCSEs), or equivalent qualifications, reported recent use of Internet information/support compared to 6.05% of men and 5.87% of women with, or studying for, further academic qualifications (both sexes:
Despite associations with these individual measures of social status (education, socioeconomic status), no overall association was observed between recent use of Internet information/support and area-level deprivation [
No overall association with ethnicity was observed among women after age adjustment, but Asian/Asian British men were more likely to report use of Internet information/support than white men (AOR 2.11, 95% CI 1.16-3.84,
Having home Internet access was reported by 93.5% (95% CI 92.9-94.0) of sexually experienced persons aged 16 to 44 years. The minority who did not have home Internet were less likely to report use of Internet information/support than those who had (men: OR 0.30, 95% CI 0.11-0.82,
Variation in the prevalence and odds of reporting recent (past year) use of Internet information/support among sexually experienced women aged 16 to 44 years.a
Variable | N, unweighted (weighted) | Prevalence (95% CI) | OR (95% CI) |
|
AOR (95% CI) |
|
||
|
||||||||
|
|
<.001 | — | |||||
|
|
16-24 | 1713 (956) | 7.8% (6.4-9.4) | 1 | — | ||
|
|
25-34 | 2386 (1317) | 5.28% (4.32-6.45) | 0.66 (0.49-0.89) | — | ||
|
|
35-44 | 1175 (1409) | 1.84% (1.16-2.90) | 0.22 (0.13-0.37) | — | ||
|
|
.02 |
|
.07 | ||||
|
|
White | 4619 (3179) | 4.39% (3.76-5.10) | 1 | 1 | ||
|
|
Asian/Asian British | 258 (220) | 3.8% (2.2-6.4) | 0.86 (0.49-1.52) | 0.96 (0.54-1.70) |
|
|
|
|
Black/black British | 174 (136) | 5.6% (3.0-10.2) | 1.30 (0.67-2.52) | 1.34 (0.70-2.59) |
|
|
|
|
Mixed/Chinese/other | 176 (117) | 11.1% (6.1-19.3) | 2.71 (1.39-5.28) | 2.32 (1.20-4.50) |
|
|
|
|
<.001 | <.001 | |||||
|
|
No academic qualifications | 372 (237) | 0.6% (0.2-1.9) | 0.29 (0.08-1.04) | 0.28 (0.08-0.98) | ||
|
|
Academic qualifications typically gained at age 16 | 1186 (863) | 2.0% (1.3-3.1) | 1 | 1 | ||
|
|
Studying for/attained further academic qualifications | 3607 (2528) | 5.87% (5.07-6.79) | 3.05 (1.88-4.97) | 2.49 (1.52-4.06) |
|
|
|
|
<.001 |
|
.06 | ||||
|
|
Managerial/professional | 1526 (1202) | 4.08% (3.16-5.26) | 1.21 (0.79-1.85) | 1.56 (1.02-2.40) | ||
|
|
Intermediate | 1006 (719) | 3.9% (2.5-5.9) | 1.14 (0.66-1.97) | 1.32 (0.76-2.29) |
|
|
|
|
Semiroutine/routine | 1582 (1028) | 3.39% (2.50-4.60) | 1 | 1 |
|
|
|
|
No job | 418 (285) | 4.6% (2.9-7.3) | 1.39 (0.78-2.46) | 1.39 (0.79-2.46) |
|
|
|
|
Full-time student | 717 (429) | 10.2% (7.9-13.1) | 3.23 (2.14-4.89) | 1.93 (1.24-3.00) | ||
|
||||||||
|
|
.001 |
|
<.001 | ||||
|
|
Yes | 4828 (3444) | 4.84% (4.21-5.56) | 1 | 1 | ||
|
|
No | 443 (236) | 1.3% (0.6-2.8) | 0.26 (0.11-0.58) | 0.23 (0.10-0.52) |
|
|
|
||||||||
|
|
.58 | .35 | |||||
|
|
1 (least deprived) | 847 (632) | 5.5% (4.0-7.4) | 1 | 1 | ||
|
|
2 | 952 (699) | 4.4% (3.1-6.1) | 0.79 (0.49-1.29) | 0.78 (0.48-1.26) |
|
|
|
|
3 | 1031 (739) | 4.8% (3.5-6.7) | 0.88 (0.55-1.41) | 0.83 (0.51-1.35) |
|
|
|
|
4 | 1183 (821) | 4.8% (3.5-6.5) | 0.87 (0.55-1.38) | 0.82 (0.51-1.29) |
|
|
|
|
5 (most deprived) | 1261 (792) | 3.7% (2.7-5.1) | 0.68 (0.42-1.08) | 0.61 (0.38-0.97) |
|
|
|
|
<.001 | <.001 | |||||
|
|
1: “Rural residents” | 414 (313) | 4.0% (2.5-6.4) | 1 | 1 | ||
|
|
2: “Cosmopolitans” | 349 (266) | 11.7% (8.3-16.3) | 3.20 (1.72-5.96) | 2.51 (1.34-4.70) |
|
|
|
|
3: “Ethnicity central” | 307 (257) | 5.7% (3.5-9.0) | 1.45 (0.72-2.91) | 1.32 (0.65-2.68) |
|
|
|
|
4: “Multicultural metropolitans” | 772 (557) | 5.5% (3.9-7.7) | 1.40 (0.76-2.57) | 1.27 (0.69-2.36) |
|
|
|
|
5: “Urbanites” | 961 (667) | 4.8% (3.4-6.6) | 1.20 (0.65-2.22) | 1.14 (0.61-2.14) |
|
|
|
|
6: “Suburbanites” | 799 (608) | 4.1% (2.8-5.8) | 1.02 (0.55-1.90) | 1.02 (0.55-1.92) |
|
|
|
|
7: “Constrained city dwellers” | 488 (277) | 3.3% (2.0-5.4) | 0.83 (0.41-1.69) | 0.70 (0.35-1.42) | ||
|
|
8: “Hard-pressed living” | 1184 (736) | 2.0% (1.3-3.1) | 0.50 (0.26-0.94) |
|
0.45 (0.24-0.86) |
|
|
||||||||
|
|
.008 |
|
.65 | ||||
|
|
0 | 284 (187) | 3.2% (1.7-6.0) | 0.75 (0.38-1.48) | 0.88 (0.45-1.73) |
|
|
|
|
1 | 3829 (2825) | 4.22% (3.58-4.96) | 1 | 1 |
|
|
|
|
≥2 | 1113 (631) | 6.9% (5.2-9.2) | 1.69 (1.19-2.40) | 1.18 (0.81-1.72) |
|
|
|
≥ |
<.001 | .11 | |||||
|
|
No | 3670 (2748) | 3.82% (3.19-4.56) | 1 | 1 | ||
|
|
Yes | 1553 (892) | 7.2% (5.7-8.9) | 1.95 (1.43-2.65) | 1.32 (0.94-1.85) |
|
|
|
|
<.001 | .03 | |||||
|
|
0 | 1007 (680) | 4.3% (3.1-5.8) | 1 | 1 | ||
|
|
1 | 3620 (2635) | 4.12% (3.47-4.89) | 0.97 (0.67-1.40) | 1.05 (0.73-1.50) |
|
|
|
|
≥2 | 575 (317) | 10.0% (7.1-13.9) | 2.51 (1.50-4.17) | 1.90 (1.11-3.26) |
|
|
|
|
<.001 | <.001 | |||||
|
|
No | 5079 (3559) | 4.38% (3.78-5.06) | 1 | 1 | ||
|
|
Yes | 189 (116) | 11.8% (7.5-18.1) | 2.93 (1.74-4.94) | 3.00 (1.76-5.13) |
|
|
|
||||||||
|
|
|
|
<.001 | .18 | |||
|
|
0-1 | 2649 (2116) | 3.77% (3.05-4.65) | 1 | 1 | ||
|
|
2-4 | 1630 (995) | 4.6% (3.6-5.8) | 1.23 (0.88-1.71) | 0.88 (0.63-1.23) |
|
|
|
|
≥5 | 958 (541) | 8.1% (6.1-10.7) | 2.25 (1.53-3.29) | 1.31 (0.85-2.01) |
|
|
|
≥ |
.09 |
|
.24 | ||||
|
|
No | 4972 (3493) | 4.47% (3.87-5.16) | 1 | 1 | ||
|
|
Yes | 302 (189) | 7.2% (4.3-11.9) | 1.65 (0.93-2.93) | 1.42 (0.80-2.52) |
|
|
|
||||||||
|
|
<.001 |
|
.11 | ||||
|
|
Yes | 4055 (2648) | 5.42% (4.66-6.30) | 1 | 1 | ||
|
|
Not reported | 1219 (1034) | 2.53% (1.70-3.75) | 0.45 (0.29-0.71) | 0.68 (0.42-1.10) |
|
|
|
|
|
<.001 |
|
.14 | |||
|
|
Yes | 1342 (779) | 7.4% (5.9-9.4) | 1 | 1 | ||
|
|
No | 3865 (2855) | 3.90% (3.27-4.63) | 0.51 (0.37-0.69) | 0.76 (0.53-1.09) |
|
|
|
|
.02 | .61 | |||||
|
|
Yes | 1908 (1130) | 5.80% (4.65-7.22) | 1 | 1 | ||
|
|
Not reported | 3366 (2552) | 4.08% (3.39-4.90) | 0.69 (0.51-0.94) | 1.10 (0.77-1.58) |
|
|
|
|
|
.75 |
|
.14 | |||
|
|
No | 4830 (3419) | 4.65% (4.03-5.36) | 1 | 1 | ||
|
|
Yes | 398 (225) | 4.2% (2.4-7.3) | 0.91 (0.50-1.64) | 0.63 (0.35-1.16) |
|
a Unweighted N=5312, weighted N=3703. Denominators vary due to item nonresponse.
b Denominator restricted to those aged 17 and older. No academic qualifications: left school at age 16 without passing any exams/gaining any qualifications (excludes qualifications gained at an older age); academic qualifications typically gained at age 16: left school at 16 having passed some exams/gained some qualifications (eg, English General Certificate of Secondary Education [GCSE] or equivalent); studying for or attained further academic qualifications: left school at age 17 or older.
c Based on National Statistics Socioeconomic Classification (NS-SEC) code. No job: no job of ≥10 hours per week in the last 10 years.
d Quintile of adjusted Index of Multiple Deprivation for Great Britain.
e Defined as reporting STI clinic attendance within the last year or responses other than “Internet” for questions listed in
f Defined as reporting any of: STI clinic attendance, chlamydia testing, or HIV testing within this last year.
g Natsal definition of STIs excludes thrush.
Use of Internet information/support was more commonly reported by women (but not men) reporting multiple sexual partners in the last year and among both men and women reporting new sexual partners in the last year, but these associations disappeared after age adjustment. Among women (but not men), use of Internet information/support was more commonly reported by those who reported multiple sexual partners in the previous year with whom they had not used condoms (AOR 1.90, 95% CI 1.11-3.26,
No association was observed between reporting use of Internet information/support and reporting STI diagnosis or diagnoses in the past 5 years. Use of Internet information/support was more common among those reporting recent non-Internet sources of sexual health care and advice/help, and having attended an STI clinic in the last 5 years, but not after adjusting for age. No association was observed with having used STI services in the previous year.
Less than 2% of sexually experienced participants aged 16 to 44 years reported that the first place they would look for diagnosis/treatment if they suspected that they had an STI would be an Internet site offering treatment. Among sexually experienced persons aged 16 to 44 years reporting use of any contraceptive method in the previous year, 5.45% men and 1.14% women indicated they would prefer to obtain supplies from an NHS or Department of Health website (
Preference for Internet sources of diagnosis/treatment of sexually transmitted infections and condoms/contraception.
Header | Men | Women | ||
N, unweighted (weighted) | % (95% CI) | N, unweighted (weighted) | % (95% CI) | |
Would first look on an Internet site offering treatment for diagnosis/treatment if STI suspecteda | 3589 (3668) | 1.77% (1.27-2.46) | 5269 (3670) | 0.81% (0.57-1.14) |
Preferred source of contraceptive supplies would be NHS/Dept of Health websitea | 2793 (2743) | 5.45% (4.52-6.56) | 4116 (2781) | 1.14% (0.82-1.58) |
a Question wording, response options, and eligible respondents are detailed in
Although Internet access is nearly universal in Britain, data from a recent national probability sample survey show that use of the Internet for key sexual health reasons is rare in the British population. Specifically, prevalence of reported use of Internet STI services is very low and reported use of the Internet for condoms/contraceptive supplies is also uncommon, particularly among women. Reporting recent use of Internet information and support websites for help/advice about one’s sex life was slightly higher, especially among younger people and among those who reported higher sexual risk behavior, including MSM and people who sought sexual partners online. However, those using information/support websites for advice/help with their sex lives may be from populations typically considered to have better access to sexual health care: the better-educated, residents of certain urban areas, and (among men) those of higher socioeconomic status. Despite this potential social inequality, those who reported recent use of information/support websites were as likely to report at least one previous STI diagnosis as those who did not report this.
We know of no other studies that have estimated the prevalence of use of the Internet for sexual health reasons or identified associated factors in a nationally representative sample. The association we found between use of information/support websites for advice/help with one’s sex life, and younger age, is unsurprising given young people’s greater Internet use [
Differences in men’s and women’s sexual behaviors [
Surveys of patients attending genitourinary medicine (GUM) clinics in England, conducted almost a decade before Natsal-3, found patients reporting Internet sex seeking were also more likely to report use of the Internet for sexual health information [
Echoing our study’s finding, little difference was found by IMD quintile in the proportion of NCSP Internet-ordered chlamydia home-sampling kits returned (2010) [
Use of Natsal-3 data has allowed our analyses to examine a wide range of sociodemographic, behavioral, and health service use variables, in a sample representative of the resident British population, in relation to use of information/support websites for advice/help with one’s sex life. Despite survey data being self-reported and, therefore, subject to recall and social desirability biases, they are of high quality; use of CASI was demonstrated to facilitate reliable reporting of sensitive information [
The very low prevalence of most outcome variables examined meant that their associations could not be explored. The exception was reported use of the Internet for advice/help with one’s sex life, but even this was reported by less than 5% of the study population; therefore, rare behaviors could not be included as explanatory variables in the analysis. We adjusted only for age in the multivariable analysis. Due to small numbers in some subgroups, we had to treat some variables crudely (eg, ethnicity), creating categories large enough to obtain sufficient subgroup sizes. This limits explanatory potential; for example, we cannot explore differences between black Caribbean and black African ethnicities. The subgroup mixed/Chinese/other is not particularly meaningful, although creation of this category gave sufficient subgroup sizes to explore associations with Britain’s major ethnic groups (Asian, black, white).
Natsal-3 survey questions (
An advantage of our study is that we were able to consider those who had used the Internet for a range of sexual health reasons and also those who would prefer to use it for sexual health care, although we lack data on which particular websites were used/preferred. However, the low proportions who reported a preference for using the Internet for STI diagnosis/treatment, or a preference for accessing contraception from an NHS website, probably underestimate the proportions that might choose Internet-based services if they were well-regulated and based in the NHS. This is because relevant survey questions (
We acknowledge that even an ideal survey question cannot give us a definitive answer about who will use online sexual health interventions and services in the future. However, we feel our main outcome variable, which addresses use of information/support websites (as distinct from lay advice/help sought online) for sexual health broadly defined, reflects those who may take up online sexual health services and interventions, fitting with their existing sexual health-seeking behavior.
Low levels of use of the Internet for contraception and STI services may reflect the limited availability and quality of currently available online services—particularly at the time the data were collected (2010-12) and in relation to STI testing and treatment [
Greater proportions reported use of information/support websites for advice/help with their sex lives, particularly among young people. This suggests scope for expansion of provision in the future, in this cohort and subsequent cohorts who have also grown up with the Internet, and as the range and quality of Internet sexual health care increase (as is likely given existing trends). An example of improved quality is the legalization and regulation of HIV home testing in the United Kingdom, available online [
age-adjusted odds ratio
computer-assisted personal interview
computer-assisted self-interview
General Certificate of Secondary Education
genitourinary medicine
human immunodeficiency virus
Index of Multiple Deprivation
men who have sex with men
National Health Service
National Statistics Socio-Economic Classification
Output Area Classification
sexually transmitted infection
The authors wish to thank Tariq Sadiq and Pippa Oakeshott for their helpful and constructive comments on a previous draft of the manuscript. Natsal-3 is a collaboration between University College London, London School of Hygiene and Tropical Medicine, National Centre for Social Research, Public Health England, and the University of Manchester. The study was supported by grants from the Medical Research Council (G0701757) and the Wellcome Trust (084840), with contributions from the Economic and Social Research Council and Department of Health.
We thank the study participants, the team of interviewers from NatCen Social Research, and operations and computing staff from NatCen Social Research.
The Electronic Self-Testing Instruments for Sexually Transmitted Infection Control (
This piece of work was undertaken as part of Catherine Aicken’s doctoral research, which is funded by the
None of the funders had any role in the analyses, interpretation, or decision to publish this paper.
None declared.