The Irish Study of Sexual Health and Relationships Sub-Report 1: Learning About Sex and First Sexual Experiences Kay Rundle Richard Layte Hannah McGee 2008 ISBN 1-905199-11-2 ii The Irish Study of Sexual Health and Relationships – Sub-Report 1: Learning About Sex and First Sexual Experiences Foreword by Minister for Health and Children, Mary Harney TD I WELCOME the publication of Learning About Sex and First Sexual Experiences, which is Sub-Report 1 of the Irish Study of Sexual Health and Relationships (ISSHR). On foot of a recommendation by the National AIDS Strategy Committee (NASC), my Department and the Crisis Pregnancy Agency commissioned in 2003 the Irish Study of Sexual Health and Relationships. We now have, for the first time, nationally representative data about the sexual knowledge, attitudes and behaviours of adults in Ireland. This data provides us with a benchmark for evaluating and shaping our policies and practices in relation to our overall sexual health. This sub-report investigates the complex interplay of factors that lead to early first intercourse being associated with high-risk sexual behaviour both at the time and later in life. It shows the strong relationships between early sexual initiation, disadvantaged backgrounds and poor sexual-health outcomes. It also shows the association between unsafe sex and the drinking of alcohol or taking of drugs. My Department’s National Health Strategy (2001) states that “the achievement of health and well-being is not the responsibility of the individual alone”. Not only individual factors but also external or structural factors – whether social, economic or environmental – determine aspects of health and behaviour. This sub-report provides policymakers and service providers with new understanding of the range of such factors. As a result, they will be able to plan and develop services and shape prevention activities that will help to improve the sexual health of Irish people and reduce the number of negative outcomes. In particular, they will be able to target programmes at people who are disadvantaged and most at risk. Given the dramatic changes in sexual practices revealed by ISSHR, it is clear that we need to focus, in particular, on the needs of young people, including adolescents. I congratulate all those involved in the survey and preparation of the report; the Economic and Social Research Institute (ESRI) and the Royal College of Surgeons in Ireland (RCSI), who conducted the report; the 7,441 participants who spoke candidly about this intimate, sensitive area of their lives, and the 27 interviewers. The data this report provides will inform in coming years the development of policies and services that help to improve the sexual health of our young people and, thus, of the adults of the future. Mary Harney TD Minister for Health & Children iii Introduction IT is a great pleasure for me to welcome the publication of Sub-Report 1 of the Irish Study of Sexual Health and Relationships (ISSHR): Learning About Sex and First Sexual Experiences. The ISSHR was commissioned by the Department of Health and Children and the Crisis Pregnancy Agency in response to a recommendation by the National AIDS Strategy Committee. It is the largest nationally representative study of sexual knowledge, attitudes and behaviour ever undertaken in Ireland. International evidence indicates that aspects of sexual health, such as contraception, crisis pregnancy and sexually transmitted infections, should be examined jointly. To this end, the Crisis Pregnancy Agency and the Department of Health and Children instigated the ISSHR project. The ISSHR findings have been outlined in a suite of reports – the Main Report, a Summary Report and three sub-reports; the latter provide detailed information in defined areas of interest. This, the first sub-report, focuses on the area of sexual learning and first sexual experiences. The Crisis Pregnancy Agency (CPA) and the sexual-health sector in general need robust evidence in order to develop sexual-health policies, to plan strategies and to inform the effective promotion of sexual-health messages. The ISSHR findings will be invaluable not only to the work of the CPA in preventing crisis pregnancy, but also to that of other organisations concerned with promoting sexual health, providing sexual-health services, preventing sexually transmitted infections, and providing sex education for young people. I would like to thank Ms Kay Rundle for her work on this report, as well as the entire ISSHR research team led by Professor Richard Layte of the Economic and Social Research Institute and Professor Hannah McGee of the Royal College of Surgeons in Ireland. Following their sterling work on the ISSHR Main Report and the Summary Report, producing this report entailed a great deal of extra effort for the authors; I am extremely grateful to them for undertaking the task. I would also like to thank the people who gave their time and expertise in steering and managing this project and in critiquing the reports. A special word of thanks is due to the staff of the Crisis Pregnancy Agency and the Department of Health and Children for their strong commitment to completing the project. Katharine Bulbulia Chair Crisis Pregnancy Agency iv The Irish Study of Sexual Health and Relationships – Sub-Report 1: Learning About Sex and First Sexual Experiences About the authors: Kay Rundle is a research psychologist and researcher at the Health Services Research Centre, RCSI. Her research focus is on sexual health and patient experiences of healthcare. Recent work includes a national study of contraception and crisis pregnancy and a review of renal patient services. Professor Richard Layte is a sociologist at the Economic and Social Research Institute. His work examines the way in which health and the use of health care services are influenced by socio- economic factors. Recent work includes papers on smoking and social class, contraceptive use and class, unemployment and mental health, and equity in health care utilisation in Ireland. He is the co-principal investigator on the ISSHR Study. Professor Hannah McGee is a health psychologist and director of the Health Services Research Centre, Royal College of Surgeons in Ireland (RCSI). Her research addresses the psychological and social factors associated with health, illness and healthcare in Ireland. Ongoing work includes national studies of ageing, stroke care and population health behaviour. She is the co-principal investigator on the ISSHR Study. v Acknowledgements THIS study was commissioned by the Department of Health and Children (DoHC) and the Crisis Pregnancy Agency (CPA). The authors would like to acknowledge the role played by a large number of people outside of the study team who contributed to the completion of the study. First, we wish to acknowledge the co-operation of the 7,441 individuals who gave their time to take part in the study and who discussed with us many extremely personal aspects of their lives. Without their generous assistance, this study could not have yielded the wealth of information that will be invaluable in developing locally informed policies and services in the coming years. The ESRI Survey Division, and James Williams, Amanda Quail, Ita Condron and Pauline Needham in particular, not only contributed hugely to the design of the survey and its protocols, but also showed fine judgement and professionalism in guiding the fieldwork to successful completion. The study team also wishes to acknowledge the hard work and commitment of the 27 interviewers who worked on the project: Miriam Ahern, Eimear Breheny, Delia Brownlee, Laura Callaghan, Claire Corcoran, Jessica Dempsey, Riona Donnelly, Frances Lyne, Phil Fitzsimons, Catherine Glennon, Kate Halligan, Kathleen Hyland, Hillary Heeney, Fiona Kane, Aoife Kearney, Ciara Lawless, Emer McDermott, Anne Marie McGirr, Charleen McGuane, Carmel McKenna, Katherine Norris, Marita O’Brien, Aideen O’Neill, Patricia O’Neill, Martine Taylor, Anne Toner and Eileen Vaughan. A large number of other people contributed to the development of the methodology, protocols and data analysis of the ISSHR study. The research team acknowledges their contribution. The following were members of either the Management and/or Steering Committee for part or all of the project: Bernie Hyland (HSE), Sharon Foley (CPA), Caroline Spillane (CPA), Dr Nazih Eldin (HSE), Dr Stephanie O’Keeffe (CPA), Olive McGovern (DoHC), Mary Smith (CPA), Frances Shearer (Department of Education & Science), Mick Quinlan (Gay Men’s Health Project), Deirdre Seery (Alliance SHC), Madeleine O’Carroll (CPA), Cíara O’Shea (DoHC), David Moloney (DoHC), Brian Mullen (DoHC), Deirdre Sullivan (CPA), Deirdre McGrath (CPA), Paul Walsh (CSO), Lucy Deegan Leirião (CPA), Prof. Linda Hogan (TCD), Paula Mullin (DoHC) and Chris Fitzgerald (DoHC). Other people generously participated in reading groups for the research reports: Dr Máirín O’Sullivan (DoES), Maeve Foreman (TCD), Dr Fenton Howell (HSE), Geraldine Luddy (NWC), Shay McGovern (DoHC), Karen Griffin (IFPA), Teresa McElhinney (HSE), Ann Nolan (AIDS Alliance), Ciaran McKinney (GHS), Biddy O’Neill (DoHC) and Tim McCarthy (DoHC). Others contributed at important points in the overall process: Collette Leigh and Rebecca Garavan (Royal College of Surgeons in Ireland). This study had a long gestation. Many groups and individuals encouraged and recommended the development of a robust evidence base on sexual health issues in Ireland. We thank all those who enabled this work.