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Open Access 01-12-2024 | Human Immunodeficiency Virus | Research

Examining changes in sexual lifestyles in Britain between 1990–2010: a latent class analysis approach

Authors: Luke Muschialli, Pantelis Samartsidis, Anne M. Presanis, Catherine H. Mercer

Published in: BMC Public Health | Issue 1/2024

Abstract

Background

Understanding sexual lifestyles and how they change over time is important for determining the likelihood of sexual health outcomes. Standard descriptive and regression methods are limited in their ability to capture multidimensional concepts such as sexual lifestyles. Latent Class Analysis (LCA) is a mixture modelling method that generates a categorical latent variable to derive homogenous groups from a heterogeneous population. Our study investigates (1) the potential of LCA to assess change over time in sexual lifestyles and (2) how quantifying this change using LCA compares to previous findings using standard approaches.

Methods

Probability-sampled data from three rounds of the National Survey of Sexual Attitudes and Lifestyle (Natsal) were used, restricted to sexually active participants (i.e., those reporting sexual partners in the past year) aged 16–44 years (N₁₉₉₀ = 11,738; N₂₀₀₀ = 9,690; N₂₀₁₀ = 8,397). An LCA model was built from four variables: number of sexual partners (past year), number of partners without a condom (past year), age at first sex and self-perceived HIV risk. Covariates included age, ethnicity, educational attainment, same-sex attraction, and marital status. Multinomial regression analyses and Chi-Squared tests were used to investigate change over time in the size of each class.

Results

We successfully used a LCA approach to examine change in sexual lifestyle over time. We observed a statistically significant increase between 1990 and 2010 in the proportion of men (χ² = 739.49, p < 0.01) and women (χ² = 1270.43, p < 0.01) in a latent class associated with reporting 2 or more partners in the last year, relatively high probabilities of reporting condomless sex partners, greater self-perceived HIV risk, and a high probability of first sex before age 16 years, increasing from 19.5% to 31.1% (men) and 9.9% to 22.1% (women).

Conclusion

Our results indicate the viability of LCA models to assess change over time for complex behavioural phenomena. They align with previous findings, namely changing sexual lifestyles in Britain in recent decades, partnership number driving class assignment, and significant sex differences in sexual lifestyles. This approach can be used to extend previous LCA models (e.g., to investigate the impact of COVID-19 on sexual lifestyles) and to support empirical evidence of change over time, facilitating more nuanced public health policy.

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Migchelsen S, et al. Sexually transmitted infections and screening for chlamydia in England, 2021. London: Health Security Agency; 2022.

Johnson AM, et al. Sexual behaviour in Britain: partnerships, practices, and HIV risk behaviours. Lancet. 2001;358(9296):1835–42. https://doi.org/10.1016/S0140-6736(01)06883-0.CrossRefPubMed

Vasilenko SA, Rice CE, Rosenberger JG. Patterns of Sexual Behavior and Sexually Transmitted Infections in Young Men Who Have Sex With Men. Sex Transm Dis. 2018;45(6):387–93. https://doi.org/10.1097/OLQ.0000000000000767.CrossRefPubMedPubMedCentral

Parkes A, Waltenberger M, Mercer C, Johnson A, Wellings K, Mitchell K. Latent class analysis of sexual health markers among men and women participating in a British probability sample survey. BMC Public Health. 2020;20(1):14. https://doi.org/10.1186/s12889-019-7959-7.CrossRefPubMedPubMedCentral

Stuart B, Hinde A. Identifying individuals engaging in risky sexual behaviour for chlamydia infection in the UK: a latent class approach. J Biosoc Sci. 2010;42(1):27–42. https://doi.org/10.1017/S0021932009990289.CrossRefPubMed

Johnson AM, Wadsworth J, Wellings K, Field J. Sexual Attitudes and Lifestyles. Oxford: Blackwell Scientific Publications; 1994.

Mercer CH, et al. Changes in sexual attitudes and lifestyles in Britain through the life course and over time: findings from the National Surveys of Sexual Attitudes and Lifestyles (Natsal). Lancet. 2013;382(9907):1781–94. https://doi.org/10.1016/S0140-6736(13)62035-8.CrossRefPubMedPubMedCentral

Lee CS, Faulkner KM, Thompson JH. Identifying subgroups: Part 2: Trajectories of change over time. Eur J Cardiovasc Nurs. 2020;19(5):444–50. https://doi.org/10.1177/1474515120911330.CrossRefPubMed

Department of Health, A Framework for Sexual Health Improvement in England. London: Department of Health; 2013.

10.

McCutcheon AL Latend Class Analysis. USA: SAGE Publications; 1987.

11.

Vasilenko SA, Lefkowitz ES, Welsh DP. Is Sexual Behavior Healthy for Adolescents? A Conceptual Framework for Research on Adolescent Sexual Behavior and Physical, Mental, and Social Health. New Dir Child Adolesc Dev. 2014;2014(144):3–19. https://doi.org/10.1002/cad.20057.CrossRefPubMed

12.

Pflieger JC, Cook EC, Niccolai LM, Connell CM. Racial/Ethnic Differences in Patterns of Sexual Risk Behavior and Rates of Sexually Transmitted Infections Among Female Young Adults. Am J Public Health. 2013;103(5):903–9. https://doi.org/10.2105/AJPH.2012.301005.CrossRefPubMedPubMedCentral

13.

Lanza ST, Rhoades BL. Latent class analysis: an alternative perspective on subgroup analysis in prevention and treatment. Prev Sci. 2013;14(2):157–68. https://doi.org/10.1007/s11121-011-0201-1.CrossRefPubMedPubMedCentral

14.

Linzer DA, Lewis JB. poLCA: An R Packaged for Polytomous Variable Latent Class Analysis. J Stat Softw. 2011;42(10):1–29.CrossRef

15.

J. K. Vermunt and J. Magidson, ‘Latent Class Cluster Analysis’, in Applied Latent Class Analysis, A. L. McCutcheon and J. A. Hagenaars, Eds., Cambridge: Cambridge University Press, 2002, pp. 89–106. https://doi.org/10.1017/CBO9780511499531.004.

16.

Dangerfield DT, Harawa NT, Smith LR, Jeffries WL, Baezconde-Garbanati L, Bluthenthal R. Latent Classes of Sexual Risk Among Black Men Who Have Sex with Men and Women. Arch Sex Behav. 2018;47(7):2071–80. https://doi.org/10.1007/s10508-017-1142-y.CrossRefPubMedPubMedCentral

17.

Lanza ST, Bray BC, Collins LM. In: ‘An introduction to latent class and latent transition analysis’, in Handbook of psychology: Research methods in psychology, vol. 2. 2nd ed. Hoboken, NJ, US: John Wiley & Sons, Inc.; 2013. p. 691–716.

18.

2021, ‘The National Surveys of Sexual Attitudes and Lifestyles (Natsal): shaping sexual health policy and practice and enhancing public dialogue around sex.’, University College London, Impact Case Study, 2021. [Online]. Available: https://results2021.ref.ac.uk/impact/fddaa28f-0565-4229-86b7-f9b63205dd3e?page=1

19.

B. Erens, S. McManus, A. Prescott, and J. Field, ‘National Survey of Sexual Attitudes and Lifestyles II’, National Centre for Social Research, 2001, [Online]. Available: https://www.natsal.ac.uk/sites/default/files/2020-11/technical_report.pdf

20.

B. Erens et al., ‘National Survey of Sexual Attitudes and Lifestyles 3 Technical Report’, University College London, vol. 1: Methodology, 2013, [Online]. Available: www.natsal.ac.uk/sites/default/files/2020-11/natsal-3-technical-report.pdf

21.

R Core Team, ‘R: A language and environment for statistical computing’. in R Foundation for Statistical Computing. Vienna, Austria, 2022. [Online]. Available: https://www.R-project.org/

22.

Du P, Crook T, Whitener C, Albright P, Greenawalt D, Zurlo J. HIV transmission risk behaviors among people living with HIV/AIDS: the need to integrate HIV prevention interventions and public health strategies into HIV care. J Public Health Manag Pract. 2015;21(2):E1–10. https://doi.org/10.1097/PHH.0000000000000038.CrossRefPubMedPubMedCentral

23.

Conway DP, et al. Barriers to HIV testing and characteristics associated with never testing among gay and bisexual men attending sexual health clinics in Sydney. J Int AIDS Soc. 2015;18(1):20221. https://doi.org/10.7448/IAS.18.1.20221.CrossRefPubMedPubMedCentral

24.

Akaike H. Factor analysis and AIC. Psychometrika. 1987;52(3):317–32. https://doi.org/10.1007/BF02294359.MathSciNetCrossRef

25.

Schwarz G. Estimating the Dimension of a Model. Ann Stat. 1978;6(2):461–4. https://doi.org/10.1214/aos/1176344136.MathSciNetCrossRef

26.

Nylund KL, Asparouhov T, Muthén BO. Deciding on the Number of Classes in Latent Class Analysis and Growth Mixture Modeling: A Monte Carlo Simulation Study. Struct Equ Modeling. 2007;14(4):535–69. https://doi.org/10.1080/10705510701575396.MathSciNetCrossRef

27.

Magidson, Vermunt JK. Latent class models. In: Kaplan D, editor. In The Sage handbook of quantitative methodology for the social sciences. Thousands Oakes: Sage; 2004. p. 175–98.

28.

Yang C-C. Evaluating latent class analysis models in qualitative phenotype identification. Comput Stat Data Anal. 2006;50(4):1090–104. https://doi.org/10.1016/j.csda.2004.11.004.MathSciNetCrossRef

29.

Radcliffe K, Ahmad S, Gilleran G, Ross J. Demographic and behavioural profile of adults infected with chlamydia: a case-control study. Sexually Transmitted Infections. 2001;77(4):265. https://doi.org/10.1136/sti.77.4.265.CrossRefPubMedPubMedCentral

30.

R. Geary et al., ‘Sexual identity, attraction and behaviour in Britain: The implications of using different dimensions of sexual orientation to estimate the size of sexual minority population and inform public health interventions’, Plos One. 2018;13(1). https://doi.org/10.1371/journal.pone.0189607

31.

Nicoll A, et al. Assessing the impact of national anti-HIV sexual health campaigns: trends in the transmission of HIV and other sexually transmitted infections in England. Sex Transm Infect. 2001;77(4):242–7. https://doi.org/10.1136/sti.77.4.242.CrossRefPubMedPubMedCentral

32.

Harris CR, Jenkins M, Glaser D. Gender differences in risk assessment: Why do women take fewer risks than men? Judgm Decis Mak. 2006;1:48–63.CrossRef

33.

Johnson AM, et al. Sexual behaviour in Britain: partnerships, practices, and HIV risk behaviours. The Lancet. 2001;358(9296):1835–42. https://doi.org/10.1016/S0140-6736(01)06883-0.CrossRef

34.

Laumann EO, Youm Y. Racial/ethnic group differences in the prevalence of sexually transmitted diseases in the United States: a network explanation. Sex Transm Dis. 1999;26(5):250–61. https://doi.org/10.1097/00007435-199905000-00003.CrossRefPubMed

35.

Ashenhurst JR, Wilhite ER, Harden KP, Fromme K. Number of Sexual Partners and Relationship Status Are Associated With Unprotected Sex Across Emerging Adulthood. Arch Sex Behav. 2017;46(2):419. https://doi.org/10.1007/s10508-016-0692-8.CrossRefPubMed

36.

Firman N, Palmer MJ, Timæus IM, Wellings K. ‘Contraceptive method use among women and its association with age, relationship status and duration: findings from the third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3). BMJ Sexual and Reproductive Health. 2018;44(3):165–74. https://doi.org/10.1136/bmjsrh-2017-200037.CrossRefPubMed

37.

Cope AB, Bernstein K, Matthias J, Rahman M, Diesel J, Pugsley DA, Schillinger JA, Ng RAC, Sachdev D, Shaw R, Nguyen TQ, Klingler EJ, Mobley VL, Samoff E, Petermanm TA. Unnamed Partners From Syphilis Partner Services Interviews, 7 Jurisdictions. Sex Transm Dis. 2020;47(12):811–8. https://doi.org/10.1097/OLQ.0000000000001269.CrossRefPubMedPubMedCentral

38.

Dema E, et al. Initial impacts of the COVID-19 pandemic on sexual and reproductive health service use and unmet need in Britain: findings from a quasi-representative survey (Natsal-COVID). The Lancet Public Health. 2022;7(1):e36–47. https://doi.org/10.1016/S2468-2667(21)00253-X.CrossRefPubMedPubMedCentral

39.

Natsal Surveys, ‘Natsal-4’, 2022. https://www.natsal.ac.uk/natsal-survey/natsal-4 (accessed Mar. 31, 2022).

40.

Agénor M, et al. Mapping the scientific literature on reproductive health among transgender and gender diverse people: a scoping review. Sex Reprod Health Matters. 2013;29(1):1886395. https://doi.org/10.1080/26410397.2021.1886395.CrossRef

41.

Field N, et al. Associations between health and sexual lifestyles in Britain: findings from the third National Survey of Sexual Attitudes and Lifestyles (Natsal-3). The Lancet. 2013;382(9907):1830–44. https://doi.org/10.1016/S0140-6736(13)62222-9.CrossRef

42.

Anderson RM, Garnett GP. Mathematical models of the transmission and control of sexually transmitted diseases. Sex Transm Dis. 2000;27(10):636–43. https://doi.org/10.1097/00007435-200011000-00012.CrossRefPubMed

43.

Mercer CH, et al. Impacts of COVID-19 on sexual behaviour in Britain: findings from a large, quasi-representative survey (Natsal-COVID). Sex Transm Infect. 2022;98(7):469–77. https://doi.org/10.1136/sextrans-2021-055210.CrossRefPubMed

44.

Sanchez TH, Zlotorzynska M, Rai M, Baral SD. Characterizing the Impact of COVID-19 on Men Who Have Sex with Men Across the United States in April, 2020. AIDS and Behaviour. 2020;24(7):2024–32. https://doi.org/10.1007/s10461-020-02894-2.CrossRef

45.

Mitchell KR, et al. Sexual and reproductive health in Britain during the first year of the COVID-19 pandemic: cross-sectional population survey (Natsal-COVID-Wave 2) and national surveillance data. Sexually Transmitted Infections. 2023;99(6):386–97. https://doi.org/10.1136/sextrans-2022-055680.CrossRefPubMed

Title: Examining changes in sexual lifestyles in Britain between 1990–2010: a latent class analysis approach
Authors: Luke Muschialli
Pantelis Samartsidis
Anne M. Presanis
Catherine H. Mercer
Publication date: 01-12-2024
Publisher: BioMed Central
Keyword: Human Immunodeficiency Virus
Published in: BMC Public Health / Issue 1/2024
Electronic ISSN: 1471-2458
DOI: https://doi.org/10.1186/s12889-024-17850-1

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Examining changes in sexual lifestyles in Britain between 1990–2010: a latent class analysis approach

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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