Accepted for/Published in: JMIR Public Health and Surveillance
Date Submitted: Jun 16, 2023
Date Accepted: Dec 14, 2023
Latent heterogeneity of online sexual experiences and associations with sexual risk behaviors and behavioral health outcomes in Chinese young adults: A cross-sectional study
ABSTRACT
Background:
Online sexual experiences (OSE) are increasingly common in young adults but existing papers reported only on specific types of OSE and did not show the heterogeneous nature of the repertoire of OSE. The use patterns of OSE remain unclear and the relationships between OSE and sexual risk behaviors and behavioral health outcomes have not been evaluated.
Objective:
The present study aimed to examine the latent heterogeneity of OSE in young adults and associations with sexual risk behaviors and behavioral health outcomes.
Methods:
The 2021 Youth Sexuality Study of Hong Kong Family Planning Association phone interviewed a random sample of 1,205 young adults in Hong Kong in 2022 (50.9% males, mean age = 23.0 years, SD = 2.86) on lifetime OSE, demographic and family characteristics, Patient Health Questionnaire-4 (PHQ-4), and sex-related factors (sexual orientation, sex knowledge, and sexual risk behaviors), and behavioral health outcomes (sexually transmitted infections (STI), drug use, and suicidal ideation) in the past year. Sample heterogeneity of OSE was analyzed via latent class analysis with substantive checking of the class profiles. Structural equation modeling was used to examine the direct and indirect associations between the OSE class and behavioral health outcomes via sexual risk behaviors and PHQ-4.
Results:
The data supported three latent classes of OSE with measurement invariance by sex. 33.1%, 56%, and 10.9% of the sample were in the Abstinent class (minimal OSE), Normative class (occasional OSE), and Active class (substantive OSE), respectively. Males showed a lower prevalence of the Abstinent class (21.4% versus 44.4%) and a higher prevalence of the Active class (17.0% versus 4.7%) than females. The Normative class showed significantly higher sex knowledge than the other two classes. The Active class was associated with males, non-heterosexuals, higher sex desire and PHQ-4, and more sexual risk behaviors than the other two classes. Compared to the non-Active (Abstinent and Normative) classes, the Active class was indirectly associated with higher rates of STI (absolute difference in % points Δ = 4.8%, p < 0.05) and drug use (Δ = 7.6%, p < 0.05) via sexual risk behaviors, and with higher rates of suicidal ideation (Δ = 2.5%, p < 0.05) via PHQ-4.
Conclusions:
The present study provided first results on the three (Abstinent, Normative, and Active) latent classes of OSE with distinct profiles in OSE, demographic and family characteristics, PHQ-4, sex-related factors, and behavioral health outcomes. The Active class showed indirect associations with higher rates of STI and drug use via sexual risk behaviors and higher rates of suicidal ideation via PHQ-4 than the other two classes. These results have implications for formulation and evaluation of targeted interventions to help young adults. Clinical Trial: Not applicable
Citation
Request queued. Please wait while the file is being generated. It may take some time.
Copyright
© The authors. All rights reserved. This is a privileged document currently under peer-review/community review (or an accepted/rejected manuscript). Authors have provided JMIR Publications with an exclusive license to publish this preprint on it's website for review and ahead-of-print citation purposes only. While the final peer-reviewed paper may be licensed under a cc-by license on publication, at this stage authors and publisher expressively prohibit redistribution of this draft paper other than for review purposes.