Socioeconomic differences in self-rated health among women: a comparison of St. Petersburg to Estonia and Finland.

INTRODUCTION: Social determinants of health have not been intensively studied in Russia, even though the health divide has been clearly demonstrated by an increased mortality rate among those with low education. A comparative analysis of social health determinants in countries with different historical and economic backgrounds may provide useful evidence for addressing health inequalities. We aimed to assess socioeconomic determinants of self-rated health in St. Petersburg as compared to Estonia and Finland. METHODS: Data for women aged 18-44 were extracted from existing population-based surveys and analysed. In St. Petersburg the data were originally collected in 2003 (response rate 68%), in Estonia in 2004-2005 (54%), and in Finland in 2000-2001 (86%). The study samples comprised 865 women in St. Petersburg, 2141 in Estonia and 1897 in Finland. RESULTS: Self-rated health was much poorer in St. Petersburg than in Estonia or Finland. High education was negatively associated with poor self-rated health in all the studied populations; it was (partially) mediated via health behaviour and limiting long-term illness only in Estonia and Finland, but not in St. Petersburg. High personal income and employment did not associate with poor self-rated health among St. Petersburg women, as it did in Estonia and Finland. In St. Petersburg housewives rather than employed women had better self-rated health, unlike the two other areas. CONCLUSION: Women's self-rated health in St. Petersburg varied similarly by education but differently by income and employment as compared to Estonia and Finland. Education is likely the most meaningful dimension of women's socioeconomic position in St. Petersburg. More research is needed to further clarify the pathways between socioeconomic position and health in Russia.

Sociodemographic characteristics and attitudes of men buying sex in Finland.

AIM: To study the sociodemographic characteristics and attitudes associated with buying sex among Finnish men residing in different areas of Finland. METHODS: A population-based questionnaire survey among 18-74-year-old Finns in 1999 with a response rate among men of 38%. The data on 575 men were analysed with descriptive statistics and logistic regression. RESULTS: The overall proportion of men ever having bought sex was 14%. Men who at the time of the survey were in the age group 30-39, aged 50 or over, with 13-15 years of educational study, entrepreneurs, and with high income, were more likely to have ever bought sex. Being married and living with a partner at the time of the study lowered the odds of ever having bought sex. The differences between the groups were mostly the same in all residential areas, though the strength and statistical significance varied. The exception was the association with education, which occurred only in small towns. The effect of attitudes to buying sex was strong and did not differ by area of residence. CONCLUSIONS: Many men with different sociodemographic characteristics reported having bought sex. There was no noticeable variation in the sociodemographic characteristics and attitudes of men having bought sex by the area of residence. More current research is needed on the motives and health consciousness of men buying sex.

The determinants of sexually transmitted infections among reproductive age women in St. Petersburg, Estonia and Finland.

OBJECTIVES: Sexually transmitted infections' (STIs) rate vary in St. Petersburg, Estonia and Finland; the aim was to compare the determinants of self-reported sexually transmitted infections in these areas. METHODS: Data from four population-based questionnaire surveys were used (Finland in 1992 and 1999; St. Petersburg in 2003; Estonia in 2004). With the exception of the 1992 Finnish survey (interview) all were postal surveys, with 1,070 respondents in Finland (78 and 52% response rates), 1,147 (68%) in St. Petersburg, and 5,190 (54%) in Estonia. RESULTS: Risky sexual behaviours were equally common in the three areas and the determinants were the same. Women with an STIs history more often had had their first sexual intercourse when aged under 18, had not used condom during first intercourse, had a high number of lifetime or previous year sexual partners. However, marital status and education were not similar determinants. Cohabiting and well-educated women in Finland were more likely to have STIs while in other areas the associations found were not statistically significant. CONCLUSIONS: Risky behaviour predicts STIs, but does not explain the varying rates of STIs between areas.

The socio-demographic patterning of sexual risk behaviour: a survey of young men in Finland and Estonia.

BACKGROUND: Sexually transmitted infections (STIs) among the youth are an increasing challenge for public health in Europe. This study provided estimates of men's (18-25 years) sexual risk behaviour and self-reported STIs and their socio-demographic patterning in Finland and Estonia; two countries that are geographically close, but have very different STI epidemics. METHOD: Nationally representative cross-sectional population surveys with comparable survey questions were used. Data from self-administered questionnaires for 1765 men aged 18-25 years in Finland (85% of the age cohort was included in the sampling frame, 95% of the sample responded) and 748 in Estonia, with a response rate of 43% respectively, were analysed. Socio-demographic patterning of multiple partners, condom use and self-reported STIs are presented was studied using multiple logistic regression analysis. RESULTS: The main findings focus on associations found within each country. In Finland, higher age, low education and to a lesser extent relationship with a non-steady partner increased the likelihood of reporting multiple lifetime-partners, while in Estonia only higher age and low education revealed this effect. In relation to unprotected intercourse, in Finland, higher age, low education and relationship status with a steady partner increased the likelihood of reporting unprotected intercourse. In Estonia, the same was observed only for relationship status. In Finland the likelihood of self-reported STIs increased by older age and lower education and decreased by being with a non-steady partner, while in Estonia, a non-significant increase in self-reported STIs was observed only in the older age group. CONCLUSION: A clear socio-demographic patterning for sexual behaviour and self-reported STIs was revealed in Finland, but a less consistent trend was seen in Estonia. The findings of this study suggest that prevention strategies should focus in Finland on less educated singles and in Estonia on young men generally.

Risk factors for induced abortions in St Petersburg, Estonia and Finland. Results from surveys among women of reproductive age.

OBJECTIVES: To compare the risk factors of self-reported abortion in St Petersburg, Estonia and Finland, which are neighbouring areas having different abortion rates. METHODS: Data from four population-based questionnaire surveys (Finland 1992 and 1999; St Petersburg 2003; Estonia 2004) were used. With the exception of the 1992 Finnish survey (based on interviews) all were postal surveys. There were 1070 respondents in Finland (78% and 52% response rates), 1147 (68%) in St Petersburg, and 5190 (54%) in Estonia. RESULTS: The prevalence of self-reported abortions was highest among women in St Petersburg and among the two oldest age groups of Russian-speaking Estonians. In all areas women with a history of abortion were more likely to have low education, children, a history of multiple partners and to have had their first intercourse when younger than 18 years. Insufficient use of reliable contraception, both at first and last intercourse, was the only risk factor that was more common in St Petersburg and in Estonia than in Finland. In Estonia, more Estonian than Russian-speaking women used reliable contraceptives. CONCLUSION: The comparison of three areas suggests that high abortion rates are related to low contraceptive use and not to other risky sexual behaviour.

The impact of aging on human sexual activity and sexual desire.

This article empirically studies how much aging modifies human sexual activity and sexual desire, and what the most important determinants in this change are. The analyses are based on 2 representative national sex surveys conducted in Finland in the 1990s. As a result of female widowhood, aging men had a higher incidence of sexual intercourse compared with aging women; and in relationships, women were more likely than men to report lack of sexual desire. In regression analysis, age was a predictor of sexual activity but not of sexual desire, when controlling for the impact of other factors. Relationship duration did not play an important role in sexual activity or sexual desire when controlling for a number of other variables. Sexual desire, valuing sexuality, and a healthy partner were important to female sexual activity; and high sexual self-esteem, good health, and active sexual history were important to male sexual activity. To keep up their sexual desire, both men and women needed good health, good sexual functioning, positive sexual self-esteem, and a sexually skilful partner.

Sexual health among young adults in Finland: assessing risk and protective behaviour through a general health survey.

OBJECTIVE: To describe the extent of sexual risk and protective behaviours and reproductive health outcomes comparing men and women of 18-29 and assess the demographic correlates of these indicators within genders. DESIGN: A module of questions on sexual behaviour and reproductive health outcomes was integrated into a population-based general health survey in Finland. METHODS: A representative sample of people over 17, including 1,894 individuals between 18 and 29 years, was drawn from the population registry in 2001. Individual interviews and self-administered questionnaires were used with a response rate of 79% for the interview and 68% for the questionnaire. RESULTS: It was more common for younger men to stay single and have multiple partners while women of the same age were cohabiting or married and chose a regular sex partner. The mean number of sexual partner for men was 5.0 (SD 5.1) and for women 3.4 (SD 2.1). Besides higher prevalence of multiple partners, men reported also casual sex contacts more often than women, 33% vs. 20%. Both genders reported relatively high and concordant rates of contraception use. However, in casual sex contacts a condom was used consistently only by less than half of both sexes. Marital status was the strongest predictor for behaviour and health outcomes. CONCLUSIONS: Casual sex is common among young adults in Finland and often occurs without a condom. This study shows that it is feasible to incorporate sexual behaviour questions as part of a larger health survey offering an option for monitoring sexual behaviour when funding for large-scale HIV surveys is decreasing.

Single and double sexual standards in Finland, Estonia, and St. Petersburg.

The sexual revolution and fight for gender equality began in the West during the 1960s but did not reach the Soviet Union until the late 1980s. Using survey data from nationally representative samples from Finland in 1971, 1992, and 1999 and from two former Soviet areas, Estonia in 2000 and St. Petersburg in 1996, we investigated the following: (a) differences across decades and countries in acceptance of the sexual double standard (SDS) in attitudes toward marital infidelity and women's initiating sex; and (b) the relationship between the SDS and sexual satisfaction. Results show that Finland in the 1990s was more egalitarian than Finland in 1971, St. Petersburg in 1996, or Estonia in 2000. Egalitarian sexual attitudes were positively related to sexual satisfaction.