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      STI Risk Perception in the British Population and How It Relates to Sexual Behaviour and STI Healthcare Use: Findings From a Cross-sectional Survey (Natsal-3)

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          Abstract

          Background

          We investigated how STI risk perception relates to behavioural STI risk and STI healthcare (sexual health clinic attendance/chlamydia testing) in the British population.

          Methods

          Natsal-3, a national probability-sample survey undertaken 2010–12, included 8397 sexually-active 16–44 year-olds. Participants rated their risk of STIs (excluding HIV) given their current sexual lifestyle. Urine from a randomly-selected sub-sample of participants (n = 4550) was tested for prevalent STIs ( Chlamydia trachomatis, Neisseria gonorrhoeae, Mycoplasma genitalium, Trichomonas vaginalis).

          Findings

          Most men (64% (95% CI: 62–66)) and women (73% (72–74)) rated themselves as not at all at risk of STIs, 30% (29–32) men and 23% (22–25) women self-rated as not very much, and 5% (5–6) men and 3% (3–4) women as greatly/quite a lot at risk. Although those reporting STI risk behaviours were more likely to perceive themselves as at risk, > 70% men and > 85% women classified as having had unsafe sex in the past year, and similar proportions of those with a prevalent STI, perceived themselves as not at all or not very much at risk. Increased risk perception was associated with greater STI healthcare-use (past year), although not after adjusting for sexual behaviour, indicating in a mediation analysis that risk perception was neither necessary or sufficient for seeking care Furthermore, 58% (48–67) men and 31% (22–41) women who had unsafe sex (past year) and rated themselves as greatly/quite a lot at risk had neither attended nor tested.

          Interpretation

          Many people at risk of STIs in Britain underestimated their risk, and many who correctly perceived themselves to be at risk had not recently accessed STI healthcare. Health promotion needs to address this mismatch and ensure that people access healthcare appropriate to their needs.

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          Most cited references33

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          Mediation analysis.

          Mediating variables are prominent in psychological theory and research. A mediating variable transmits the effect of an independent variable on a dependent variable. Differences between mediating variables and confounders, moderators, and covariates are outlined. Statistical methods to assess mediation and modern comprehensive approaches are described. Future directions for mediation analysis are discussed.
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            Required sample size to detect the mediated effect.

            Mediation models are widely used, and there are many tests of the mediated effect. One of the most common questions that researchers have when planning mediation studies is, "How many subjects do I need to achieve adequate power when testing for mediation?" This article presents the necessary sample sizes for six of the most common and the most recommended tests of mediation for various combinations of parameters, to provide a guide for researchers when designing studies or applying for grants.
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              Unrealistic optimism about future life events.

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                Author and article information

                Contributors
                Journal
                EClinicalMedicine
                EClinicalMedicine
                Eclinicalmedicine
                The Lancet
                2589-5370
                1 August 2018
                Aug-Sep 2018
                : 2-3
                : 29-36
                Affiliations
                [a ]Institute for Global Health, University College London, Mortimer Market Centre, London WC1E 6JB, United Kingdom of Great Britain and Northern Ireland
                [b ]Department of Microbiology and Infection Control, University Hospital of Northern Norway, Sykehusvegen 38, 9019 Tromsø, Norway
                [c ]HIV and STI Department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, United Kingdom of Great Britain and Northern Ireland
                Author notes
                [* ]Corresponding author. c.mercer@ 123456ucl.ac.uk
                Article
                S2589-5370(18)30021-X
                10.1016/j.eclinm.2018.08.001
                6180228
                30320305
                1f1340dd-6ac6-4aad-8253-7e4aaf21af50
                © 2018 Published by Elsevier Ltd.

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 5 June 2018
                : 8 August 2018
                : 8 August 2018
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