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Background Online sexual experiences (OSEs) are becoming increasingly common in young adults, but existing papers have reported only on specific types of OSEs and have not shown the heterogeneous nature of the repertoire of OSEs. The use patterns of OSEs remain unclear, and the relationships of OSEs with sexual risk behaviors and behavioral health outcomes have not been evaluated. Objective This study aimed to examine the latent heterogeneity of OSEs in young adults and the associations with sexual risk behaviors and behavioral health outcomes. Methods The 2021 Youth Sexuality Study of the Hong Kong Family Planning Association phone interviewed a random sample of 1205 young adults in Hong Kong in 2022 (male sex: 613/1205, 50.9%; mean age 23.0 years, SD 2.86 years) on lifetime OSEs, demographic and family characteristics, Patient Health Questionnaire-4 (PHQ-4) scores, sex-related factors (sexual orientation, sex knowledge, and sexual risk behaviors), and behavioral health outcomes (sexually transmitted infections [STIs], drug use, and suicidal ideation) in the past year. Sample heterogeneity of OSEs 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 scores. Results The data supported 3 latent classes of OSEs with measurement invariance by sex. In this study, 33.1% (398/1205), 56.0% (675/1205), and 10.9% (132/1205) of the sample were in the abstinent class (minimal OSEs), normative class (occasional OSEs), and active class (substantive OSEs), respectively. Male participants showed a lower prevalence of the abstinent class (131/613, 21.4% versus 263/592, 44.4%) and a higher prevalence of the active class (104/613, 17.0% versus 28/592, 4.7%) than female participants. The normative class showed significantly higher sex knowledge than the other 2 classes. The active class was associated with male sex, nonheterosexual status, higher sex desire and PHQ-4 scores, and more sexual risk behaviors than the other 2 classes. Compared with the nonactive (abstinent and normative) classes, the active class was indirectly associated with higher rates of STIs (absolute difference in percentage points [Δ]=4.8%; P=.03) and drug use (Δ=7.6%; P=.001) via sexual risk behaviors, and with higher rates of suicidal ideation (Δ=2.5%; P=.007) via PHQ-4 scores. Conclusions This study provided the first results on the 3 (abstinent, normative, and active) latent classes of OSEs with distinct profiles in OSEs, demographic and family characteristics, PHQ-4 scores, sex-related factors, and behavioral health outcomes. The active class showed indirect associations with higher rates of STIs and drug use via sexual risk behaviors and higher rates of suicidal ideation via PHQ-4 scores than the other 2 classes. These results have implications for the formulation and evaluation of targeted interventions to help young adults.
Background Online sexual experiences (OSEs) are becoming increasingly common in young adults, but existing papers have reported only on specific types of OSEs and have not shown the heterogeneous nature of the repertoire of OSEs. The use patterns of OSEs remain unclear, and the relationships of OSEs with sexual risk behaviors and behavioral health outcomes have not been evaluated. Objective This study aimed to examine the latent heterogeneity of OSEs in young adults and the associations with sexual risk behaviors and behavioral health outcomes. Methods The 2021 Youth Sexuality Study of the Hong Kong Family Planning Association phone interviewed a random sample of 1205 young adults in Hong Kong in 2022 (male sex: 613/1205, 50.9%; mean age 23.0 years, SD 2.86 years) on lifetime OSEs, demographic and family characteristics, Patient Health Questionnaire-4 (PHQ-4) scores, sex-related factors (sexual orientation, sex knowledge, and sexual risk behaviors), and behavioral health outcomes (sexually transmitted infections [STIs], drug use, and suicidal ideation) in the past year. Sample heterogeneity of OSEs 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 scores. Results The data supported 3 latent classes of OSEs with measurement invariance by sex. In this study, 33.1% (398/1205), 56.0% (675/1205), and 10.9% (132/1205) of the sample were in the abstinent class (minimal OSEs), normative class (occasional OSEs), and active class (substantive OSEs), respectively. Male participants showed a lower prevalence of the abstinent class (131/613, 21.4% versus 263/592, 44.4%) and a higher prevalence of the active class (104/613, 17.0% versus 28/592, 4.7%) than female participants. The normative class showed significantly higher sex knowledge than the other 2 classes. The active class was associated with male sex, nonheterosexual status, higher sex desire and PHQ-4 scores, and more sexual risk behaviors than the other 2 classes. Compared with the nonactive (abstinent and normative) classes, the active class was indirectly associated with higher rates of STIs (absolute difference in percentage points [Δ]=4.8%; P=.03) and drug use (Δ=7.6%; P=.001) via sexual risk behaviors, and with higher rates of suicidal ideation (Δ=2.5%; P=.007) via PHQ-4 scores. Conclusions This study provided the first results on the 3 (abstinent, normative, and active) latent classes of OSEs with distinct profiles in OSEs, demographic and family characteristics, PHQ-4 scores, sex-related factors, and behavioral health outcomes. The active class showed indirect associations with higher rates of STIs and drug use via sexual risk behaviors and higher rates of suicidal ideation via PHQ-4 scores than the other 2 classes. These results have implications for the formulation and evaluation of targeted interventions to help young adults.
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. CLINICALTRIAL Not applicable
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